bluuebunny/crossref_metadata_2025 huggingface dataset:
Influential factors of small and medium-sized enterprises growth across developed and developing countries: A systematic literature review
Authors: Fajarika Dian , Trapsilawati Fitri , Sopha Bertha Maya
Published: August 2024

Small and medium-sized enterprises (SMEs) are contributors to economic growth. Many studies have mentioned a broad range of factors that influence the development of SMEs. However, studies examining SME growth between developed and developing countries have not been comprehensively investigated. The growth of SMEs relies on the entrepreneurial skills of the entrepreneur, who has the ability to manage business effectively, achieve profit, identify market opportunities, and enhance innovation by optimizing all available resources. The objective of this article was to synthesize the factors that influence the growth of small and medium-sized enterprises (SMEs) across developed and developing countries. This study particularly synthesized interrelationship factors depicted in a framework addressing resources and capabilities for SME growth. A systematic literature review (SLR) was employed to examine the research activities on this topic, referring to 108 articles from the Scopus and Web of Sciences databases. The articles synthesized individual studies to analyze the trend of SME growth research in developed and developing countries. Next, the factors of SME growth were identified into 6 (six) categories, including human capital resources, entrepreneurial perspectives on marketing, innovation, SMEs partnership, technology, and entrepreneur personality. The result represents that the factor extensively studied concerning SME growth is innovation capability, both in developed and developing countries. Differences exist in both critical factors and interrelationships among factors in developed and developing countries, particularly in the innovation capability, SME partnership and marketing capabilities.
Encapsulation of Pomelo Peel Essential oil (Citrus maxima) Using the Alginate/Chitosan complex
Authors: Nguyen Cam Ngan Thi , Nguyen Thuong Nhan Phu , Van Chi Khang , Mai Huynh Cang
Published: August 2024

Objective: This study aimed to determine appropriate parameters for encapsulating pomelo peel essential oil (Citrus maxima) using the alginate/chitosan complex. Methods: The investigated parameters included the concentration of sodium alginate solution (2 ‒ 3.5% w/v based on the volume of mixture), the concentration of pomelo essential oil (20 ‒ 40% w/w based on dry matter of wall marerials), the concentration of Tween 80 (0 ‒ 20% w/w based on dry matter of wall marerials), the concentration of CaCl2 solution (0.5 ‒ 3.5% w/v based on the volume of mixture), time (10 min – 20 min) and speed of emulsion homogenization (489-4402 × g), the concentration of chitosan solution (0.5 ‒ 2% w/v based on the volume of mixture), and pH of chitosan solution (4 ‒ 6). Results: The results showed encapsulation yield (EY%) and encapsulation efficiency (EE%) of 91.64% and 85.18%, respectively, when using the concentration of sodium alginate solution as 3% (w/v based on the volume of mixture), the concentration of essential oil as 30% (w/w based on dry matter of wall marerials), the concentration of Tween 80 as 15% (w/w based on dry matter of wall marerials), the concentration of CaCl2 solution as 1.5% (w/v based on the volume of mixture), homogenization time as 10 min and homogenization speed as 4402 × g, the concentration of chitosan as 2% (w/v based on the volume of mixture) and pH of Chitosan solution as 5. Conclusion: The alginate/chitosan complex was proven effective in encapsulating pomelo essential oil (Citrus maxima) on a laboratory scale. The resulting encapsulated particles had a relatively uniform size and a high ability to retain essential oils in the core of the particles. Further studies should be conducted to elucidate the mechanism of the encapsulation process and to additionally evaluate the physical and chemical properties of the encapsulated particles.
Enhancing concrete’s ballistic impact resistance using Alfa fiber
Authors: Tahenti Baya , Trabelsi Abderraouf , Kammoun Zied
Published: August 2024

Natural fibers are gaining interest in recent years due to the increasing calls for eco-friendly materials production. Concrete reinforcement with Alfa fiber is attracting attention to take benefit of natural fiber advantages in the construction sector. The mechanical and physical characteristics of concrete reinforced with Alfa fibers have been primarily investigated. The current study seeks to analyse the ballistic protection performance of Alfa-reinforced concrete in response to the emerging need to withstand bullet impacts and protect occupants in light of the increasing armed hostilities. Eight formulations were selected for the concrete preparation by varying the Alfa fiber content from 0 to 100 kg/m³. After determining the mechanical characteristics of the concrete such as compressive, flexural and tensile strength, ballistic resistance to bullet impacts is determined by measuring the penetration depth, the crater area and the lost mass after impact in concrete slab 10 and 15 cm thick. The formulations of Alfa-reinforced concrete exhibited lower penetration depth, crater area, and lost mass compared to the reference concrete. Optimal values were achieved with 15 kg/m³ of fibers. A dependency between the ballistic response on the fibrous concrete and flexural strength of concrete is also remarked. In conclusion, the study demonstrates that incorporating Alfa fibers into concrete significantly enhances its ballistic resistance, with optimum performance observed at 15 kg/m³ of fiber inclusion. These findings underscore the potential of Alfa-reinforced concrete for use in military constructions and structures vulnerable to impact risks, paving the way for further research and practical applications in enhancing structural and occupant safety.
Do sexual minorities participate more in politics?
Authors: Daoust Jean-François , Çakır Semih , Dassonneville Ruth , Guévremont Mélyann
Published: August 2024

Individuals who participate more in politics tend to be better represented politically. As a result, it is important to examine which groups are more and which groups are less likely to participate. In this paper, we study the institutional and non-institutional political participation of an important group that has only received scant attention in the literature: sexual minorities. To do so, we leverage recent datasets and conduct the first comprehensive study on the relationship between sexual orientation and non-electoral political participation in Canada. Consistent with our theoretical expectations, the analyses reveal that sexual minorities ( n = 2061) participate to a greater extent in politics compared to heterosexuals ( n = 23,652), even after controlling for numerous socioeconomic factors. We also find that the sexuality gap is similar across gender identities. We conclude by discussing the implications of our findings for the comparative literature on sexuality and politics.
Contracts rethought and redesigned: A new era with AI
Authors: Autto Hilja , Haapio Helena , Nuottila Jouko
Published: August 2024

This article discusses the potential of generative artificial intelligence (AI) to revolutionize contract thinking and design. Experience and research tell us that most contracts focus on the wrong things—failure rather than success—and are presented in a way that is inaccessible to many people. Using the principles of proactive contracting and contract design, AI-powered writing assistants such as ChatGPT can help change the contracting paradigm by facilitating the transition from drafting to design and from reaction to proactive action. They can help transform the content, language, structure, and presentation of contracts, simplifying the tedious parts and increasing stakeholder empowerment and choice. This exploratory article presents examples of using AI tools to generate ideas and clauses for commercial contracts and to support contract redesign. This facilitates the creation of easy-to-read explanations, headings, and layered layouts that make contracts more effective, transparent, and sustainable, leading to better business and societal outcomes.
Serial Assessment of Factors Associated With Patient-Reported Outcomes up to 2 Years After ACL Reconstruction Using Autologous Hamstring Tendon: Results From the TMDU MAKS Study
Authors: Katagiri Hiroki , Nakagawa Yusuke , Ohara Toshiyuki , Nakamura Tomomasa , Yoshihara Aritoshi , Hayashi Masaya , Yoshimura Hideya , Nagase Tsuyoshi , Sekiya Ichiro , Koga Hideyuki
Published: August 2024

Background:

Understanding the factors related to patient-reported outcomes (PROs) after anterior cruciate ligament reconstruction (ACLR) can lead to more effective interventions.

Purpose/Hypothesis:

The purpose of this study was to identify factors associated with PRO scores after ACLR. It was hypothesized that concomitant meniscal treatment and postoperative range of motion (ROM) would be associated with early postoperative PRO scores and that postoperative physical findings would be associated with 2-year postoperative PRO scores.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

We examined the data from the Tokyo Medical and Dental University Multicenter Arthroscopic Knee Surgery (TMDU MAKS) Study for patients who underwent primary ACLR with autologous hamstring tendon grafts; 1252 patients in the TMDU MAKS Study were eligible for inclusion. The International Knee Documentation Committee (IKDC) subjective score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score of the patients at 3 months (n = 675), 1 year (n = 660), and 2 years (n = 375) postoperatively were assessed using multiple regression to evaluate the strength of the relationship between PRO scores and the following predictor variables: patient-specific factors, treatment-specific factors, and physical findings.

Results:

Improvement in all PROs significantly exceeded the minimal important change at 1 and 2 years postoperatively. Older age and female sex were predictive of lower PRO scores up to 2 years postoperatively. Concurrent meniscal treatment and limited range of knee motion were predictive of lower PRO scores at 3 months and 1 year postoperatively. A tighter knee (ie, less anterior translation) on the injured side compared with the contralateral knee was predictive of lower KOOS–Quality of Life and IKDC scores at 2 years postoperatively. At all 3 postoperative time points, greater side-to-side difference in knee ROM was predictive of lower PRO scores.

Conclusion:

Inferior PRO scores were associated with concomitant meniscal treatment and limited postoperative ROM until 1 year postoperatively and with older age and female sex up to 2 years postoperatively. PRO scores were associated with knee stability at all assessed time points.
Are we being equitable enough? Lessons learned from sites lost in an implementation trial
Authors: Austin Elizabeth J. , Chen Jessica , Ferro Lori , Saxon Andrew J. , Fortney John C. , Curran Geoffrey M. , Ratzliff Anna D. , Williams Emily C.
Published: August 2024

Background

There is a growing interest in practice-based implementation research, yet too often research prioritizes and is most successful in academic settings. During a national implementation trial to evaluate the effectiveness of Collaborative Care for co-occurring opioid use and mental health disorders, we lost three of our 11 participating implementation sites, all representing community sites.

Method

To better understand needed supports for implementation trial participation, we conducted exit interviews ( n = 5) with key staff at these community sites. Interview transcripts were double-coded and analyzed using Rapid Assessment Process. Qualitative themes were iteratively reviewed by the study team.

Results

Three themes emerged characterizing challenges for community sites, including that: (1) research threatens sites’ most precious resource—staff; (2) staff lack comfort with and skills for research; and (3) research participation in its current form does not offer a clear return on investment.

Conclusions

Learnings from this work illuminate some of the barriers community sites face when trying to participate in multisite implementation research. An undercurrent of participant perspectives was the belief that community sites like theirs are just not set up to successfully participate in clinical trial research, including population-based implementation trials. Future implementation trials should consider strategies that disrupt traditional approaches, increasing the equitable inclusion of diverse practice settings in implementation research.
The digitalization imperative
Authors: Ricaurte Paola
Published: August 2024

The relentless push for universal digitization driven by market forces mirrors historical patterns of spiritual and linguistic colonization. It is imperative to safeguard the right to exist beyond the dictates of top-down digitization efforts. Embracing diverse approaches to digitization, shaped by communities rather than imposed by nation-states or corporations, is essential for addressing the planetary crisis. This commentary argues that communities in the majority world should have the autonomy to determine their political, economic, technological, and cultural pathways, ensuring their right to self-determination. The argument is structured by first reflecting on the widespread processes of universal digitization and their historical context. It then addresses the imperative of community-led digitization, exploring various technological alternatives that are more inclusive and representative of local needs and values. Finally, it discusses the potential negative implications of not adopting these alternative technological models, including the perpetuation of inequalities, loss of cultural identity, and further environmental degradation. By advocating for a decentralized and community-focused approach to digitization, this commentary highlights the importance of preserving diversity and promoting sustainable development in the digital age.
Recent advancements and prospects in noble and non-noble electrocatalysts for materials methanol oxidation reactions
Authors: Singh Monika , Sharma Hari Mohan , Gupta Ram K. , Kumar Anuj
Published: August 2024

The direct methanol fuel cell (DMFC) represents a highly promising alternative power source for small electronics and automobiles due to its low operating temperatures, high efficiency, and energy density. The methanol oxidation process (MOR) constitutes a fundamental chemical reaction occurring at the positive electrode of a DMFC. Pt-based materials serve as widely utilized MOR electrocatalysts in DMFCs. Nevertheless, various challenges, such as sluggish reaction rates, high production costs primarily attributed to the expensive Pt-based catalyst, and the adverse effects of CO poisoning on the Pt catalysts, hinder the commercialization of DMFCs. Consequently, endeavors to identify an alternative catalyst to Pt-based catalysts that mitigate these drawbacks represent a critical focal point of DMFC research. In pursuit of this objective, researchers have developed diverse classes of MOR electrocatalysts, encompassing those derived from noble and non-noble metals. This review paper delves into the fundamental concept of MOR and its operational mechanisms, as well as the latest advancements in electrocatalysts derived from noble and non-noble metals, such as single-atom and molecule catalysts. Moreover, a comprehensive analysis of the constraints and prospects of MOR electrocatalysts, encompassing those based on noble metals and those based on non-noble metals, has been undertaken.
Role of paranasal abnormalities and systemic inflammation on primary acquired nasolacrimal duct obstruction
Authors: Sevimli Neslihan , Aydın Kurna Sevda , Çakır Muhammet , Akkaya Sezen
Published: August 2024

Background

To determine the paranasal changes and inflammatory markers that may cause primary acquired nasolacrimal duct obstruction (PANDO) and to determine their relationship with success rates on different types of surgeries.

Main body

We retrospectively reviewed the blood sample and computed tomography (CT) results on 92 patients who underwent dacryocystorhinostomy (DCR) surgery for PANDO and 82 healthy controls. Age, gender, paranasal abnormalities, hemogram values, International Normalized Ratio (INR) values, type of surgery, and recurrence rate were recorded; systemic Immune-inflammation Index (SII), neutrophil-to-lymphocyte ratio (NLR), monocytes-to- lymphocyte ratio (MLR) and platelet-to-lymphocyte ratio (PLR) were calculated in both groups. In the case group, total white blood cells, monocytes, and INR values were significantly lower (p < 0.05). Platelet, lymphocyte, neutrophil, PLR, MLR, NLR, and SII values did not differ significantly between the control and case groups (p > 0.05). There was no significant difference in the CT results between the groups (p > 0.05). No correlation was found between CT findings and inflammatory markers. Dacryocystitis (DC) was seen in 20% of patients and they were all in the case group. No correlation was found between recurrence rate and age, gender, type of surgery, CT findings, and blood results (p > 0.05). The recurrence rate was significantly higher in patients with bilateral PANDO and with DC (p < 0.05).

Short conclusion

The incidence of PANDO may not be directly related to paranasal abnormalities and systemic inflammation. Low INR values may cause obstruction in the nasolacrimal duct. Age, gender, type of surgery, CT findings, and inflammation level do not affect the success of the surgery.
Airway management of a patient with coffin-lowry syndrome: a case report
Authors: Ghose Shaarav , Nisar Faria , Aleem Bushra Abdul
Published: August 2024

Coffin-Lowry Syndrome (CLS) is a rare X-linked genetic disorder characterized by growth delays, facial dysmorphisms, and intellectual disabilities. Currently, there are limited published case reports regarding the anesthetic management of patients with CLS. Managing anesthesia for CLS patients can be complex due to difficult airway management. In this case report, we present a patient with CLS who underwent surgical intervention, highlighting the anesthetic considerations encountered throughout the perioperative period. We aim to summarize the difficulties involved in anesthetic management of rare conditions like CLS to improve clinical outcomes for affected individuals.
Associations between specialized dementia care, COVID-19 and central nervous system medication use in assisted living: a population-based repeated cross-sectional study
Authors: Maxwell Colleen J. , Dampf Hana , Squires Jillian P. , Hogan David B. , Cotton Cecilia A. , MMath Erik Youngson , Hsu Zoe , Hoben Matthias
Published: August 2024

Background

Assisted living (AL) is an increasingly common residential setting for persons with dementia; yet concerns exist about sub-optimal care of this population in AL given its lower levels of staffing and services. Our objectives were to (i) examine associations between AL setting (dementia care vs. other), COVID-19 pandemic waves, and prevalent antipsychotic, antidepressant, anti-dementia, benzodiazepine, and anticonvulsant drug use among residents with dementia/cognitive impairment, and (ii) explore associations between resident and home characteristics and prevalent medication use.

Methods

We conducted a population-based, repeated cross-sectional study using linked clinical and health administrative databases for all publicly funded AL homes in Alberta, Canada, examined between January 2018 - December 2021. The quarterly proportion of residents dispensed a study medication was examined for each setting and period (pandemic vs. comparable historical [2018/2019 combined]) focusing on four pandemic waves (March-May 2020, September 2020-February 2021, March-May 2021, September-December 2021). Log-binomial GEE models estimated prevalence ratios (PR) for period (pandemic vs. historical periods), setting (dementia care vs. other) and period-setting interactions, adjusting for resident (age, sex) and home (COVID-19 cases, health region, ownership) characteristics.

Results

On March 1, 2020, there were 2,779 dementia care and 3,013 other AL residents (mean age 83, 69% female) with dementia/cognitive impairment. Antipsychotic use increased during waves 2–4 in both settings, but this was more pronounced in dementia care than other AL during waves 3 and 4 (e.g., adjusted [adj]PR 1.20, 95% CI 1.14–1.27 vs. adjPR 1.09, 95% CI 1.02–1.17, interaction p = 0.023, wave 3). Both settings showed a statistically significant but modest increase in antidepressant use and decrease in benzodiazepine use. For dementia care AL residents only, there was a statistically significant increase in gabapentinoid use during several waves (e.g., adjPR 1.32, 95% CI 1.10–1.59, wave 3). Other than a modest decrease in prevalent anti-dementia drug use for both settings in wave 2, no other significant pandemic effects were observed.

Conclusions

The persistence of the pandemic-associated increase in antipsychotic and antidepressant use in AL residents coupled with a greater increase in antipsychotic and gabapentinoid use for dementia care settings raises concerns about the attendant risks for residents with cognitive impairment.
Barriers and facilitators when implementing midwifery continuity of carer: a narrative analysis of the international literature
Authors: Middlemiss Aimee Louise , Channon Susan , Sanders Julia , Kenyon Sara , Milton Rebecca , Prendeville Tina , Barry Susan , Strange Heather , Jones Aled
Published: August 2024

Background

Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.

Methods

In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.

Results

Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.

Conclusions

By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.
Engagement in rapid public health research among young people from underserved communities: maximising opportunities and overcoming barriers
Authors: Denford Sarah , Holt Lydia , Essery Rosie , Kesten Joanna , Cabral Christie , Weston Dale , Horwood Jeremy , Hickman Matthew , Amlôt Richard , Yardley Lucy
Published: August 2024

Background

Inclusion in public health research of young people from low-income households and those from minority ethnic groups remains low. It is recognised that there is a need to change the way in which research is conducted so that it becomes more inclusive. The aim of this work was to identify novel and innovative ways to maximise recruitment and inclusion of diverse participants when doing co-production within very short time frames for emergency responses.

Method

We conducted interviews with young people from low-income and minority ethnic backgrounds, and members or leaders of groups or organisations supporting or representing young people from underserved communities.

Results

A total of 42 participants took part in an interview. This included 30 young people from low income or minority ethnic backgrounds and 12 community leaders/service providers. Of the 30 young people, 26 participants identified as female and 12 participants identified as being from a minority ethnic background. Participants discussed a number of interrelated barriers to research involvement and identified ways in which barriers may be reduced. Prejudice and discrimination experienced by young people from underserved communities has led to substantial mistrust of educational and governmental establishments. Rigid and unfamiliar research practices further limit the involvement of young people. Four themes were identified as ways of supporting involvement, including: making opportunities available for young people, adaptations to research governance, understanding and acknowledging challenges faced by young people, and ensuring reciprocal benefits.

Conclusion

This research explored barriers to engagement in rapid public health co-production. Working with communities to co-produce rapid recruitment and research procedures to suit the needs and the context in which young people live is necessary.
How fragile the positive results of Chinese herbal medicine randomized controlled trials on irritable bowel syndrome are?
Authors: Luo Minjing , Huang Jinghan , Wang Yingqiao , Li Yilin , Liu Zhihan , Liu Meijun , Tao Yunci , Cao Rui , Chai Qianyun , Liu Jianping , Fei Yutong
Published: August 2024

Objective

The fragility index (FI), which is the minimum number of changes in status from “event” to “non-event” resulting in a loss of statistical significance, serves as a significant supplementary indicator for clinical physicians in interpreting clinical trial results and aids in understanding the outcomes of randomized controlled trials (RCTs). In this systematic literature survey, we evaluated the FI for RCTs evaluating Chinese herbal medicine (CHM) for irritable bowel syndrome (IBS), and explored potential associations between study characteristics and the robustness of RCTs.

Methods

A comprehensive search was conducted in four databases in Chinese and four databases in English from their inception to January 1, 2023. RCTs encompassed 1:1 ratio into two parallel arms and reported at least one binary outcome that demonstrated statistical significance were included. FI was calculated by the iterative reduction of a target outcome event in the treatment group and concomitant subtraction of a non-target event from that group, until positive significance (defined as P < 0.05 by Fisher’s exact test) is lost. The lower the FI (minimum 1) of a trial outcome, the more fragile the positive result of the outcome was. Linear regression models were adopted to explore influence factors of the value of FI.

Results

A total of 30 trials from 2 4118 potentially relevant citations were finally included. The median FI of total trials included was 1.5 (interquartile range [IQR], 1–5), and half of the trials (n = 15) had a FI equal to 1. In 12 trials (40%), the total number of participants lost to follow-up surpassed the respective FI. The study also identified that increased FI was significantly associated with no TCM syndrome differentiation for inclusion criteria of the patients, larger total sample size, low risk of bias, and larger numbers of events.

Conclusions

The majority of CHM IBS RCTs with positive results were found to be fragile. Ensuring adequate sample size, scientifically rigorous study design, proper control of confounding factors, and a quality control calibration for consistency of TCM diagnostic results among clinicians should be addressed to increase the robustness of the RCTs. We recommend reporting the FI as one of the components of sensitivity analysis in future RCTs to facilitate the assessment of the fragility of trials.
The prevalence of herbal medicine among Sudanese adults: a cross-sectional study 2021
Authors: Mohamed Raheeg , Mohamed Reham , Dafalla Rana , Ahmed Aya , Abdeldaim Abdulrahman
Published: August 2024

Background

The use of herbal medicine has a long history in Sudan and is widely practiced among the general population. However, there is a lack of studies examining the prevalence, patterns, and predictors of herbal medicine usage in Sudan. Thus, this study was conducted to bridge this gap.

Methods

This descriptive cross-sectional study was conducted between January and February 2021. It included Sudanese adults residing in Omdurman, Sudan, using systematic and simple random sampling methods. Data were collected using a structured, adapted questionnaire comprising: the socio-demographic characteristics and the knowledge of herbal medicine and its usage. Moreover, it investigated the commonly used herbal remedies and the participants’ sources of information and procurement of such products. Additionally, we examined the correlation between socio-demographic factors, cultural beliefs, and the use of herbal medicine. Data were analyzed using SPSS, and categorical data were presented as frequencies and percentages. Associations were assessed using chi-square, Fisher’s exact tests, and binary logistic regression (p < 0.05).

Results

This study included 381 participants, of which 48.1% were females and 31.4% were aged 20-30. The majority of participants were aware of the practice of herbal medicine and the prevalence of its usage was 85.9%. Peppermint, acacia, hibiscus, ginger, and fenugreek were the most commonly used remedies. Chi-square and Fisher’s exact testing revealed that the participants’ gender and beliefs in the safety and effectiveness of herbal medicines were significantly associated with herbal medicine usage (p < 0.05). Binary logistic regression analysis showed that only the perception of herbal medicine’s safety was an independent predictor of its usage (p-value 0.038).

Conclusion

This study reported a very high prevalence of herbal medicine usage, highlighting the acceptability of Sudanese adults towards herbal medicine usage. This prompts further studies to explore their safety, efficacy, and the possibility of their integration into mainstream healthcare practices and policies.
Knowledge, attitude, and practice of Egyptian medical students towards healthcare workers’ recommended vaccines: a nationwide cross-sectional survey
Authors: Mohamed Shawqi Mohamed , El-Said Yara Mohamed , Behery Mostafa B. , Abdelaziz Ali , Ibrahem Esraa Shawky , ElBoraie Aly , Khattab Mohamed Ayman , Ghattas Ahmad S. , Naeem Ahmed , Madany Maysa , Elboraay Toka , Naguib Mostafa Mahmoud , Allam Abdallah R. , Allam Ahmed Hafez , Bahbah Ammar Ayman , Ewis Marwa Ibrahim , Elsayed Mostafa Ahmed , Sherief Leenah , KhallafAllah Mahmoud Tawfik , Gouda Mohamed Alaa , Aboshady Omar Ali
Published: August 2024

Background

Vaccination of healthcare workers (HCWs) is pivotal in decreasing the incidence of contagious infections in hospital settings. In this study, we assessed the knowledge, attitude, and practice regarding HCWs’ recommended vaccines among medical students and interns in Egypt.

Methods

A multicenter, cross-sectional study was conducted using a structured, pilot-tested, and self-administered questionnaire among Egyptian medical students and interns. We invited 1332 participants to our survey using a systematic random sampling that included participants across nine medical schools in Egypt during the 2021–2022 academic year.

Results

Out of 1332 participants, 1141 completed our questionnaire with a response rate of 85.7%. Overall, 43% of the participants had intermediate knowledge (knew 2–3 HCWs’ recommended vaccines). Furthermore, 36.7% had received a booster dose of at least one of the HCWs’ recommended vaccines over the last 10 years, with only 6.1% having received all recommended vaccines. Hepatitis B vaccine was the most widely known (71%) and received (66.7%). Interns were more likely to know, receive, and recommend HCWs’ recommended vaccines. The majority (> 90%) agreed that vaccination is beneficial and safe, with a median score of eight (interquartile range [IQR: Q25-Q75]: 7–9) out of ten for vaccine efficacy and eight (IQR: 7–8) for safety. However, the median score for hesitancy was five (IQR: 2–7). The most common influential and limiting factors for vaccination were scientific facts (60.1%) and fear of vaccine side effects (44.9%).

Conclusion

Although medical students in Egypt have good knowledge of and attitudes towards vaccination, there is a gap in their practices. Interventions are needed to improve vaccination uptake among medical students in Egypt.
Qualitative studies involving users of clinical neurotechnology: a scoping review
Authors: Starke Georg , Akmazoglu Tugba Basaran , Colucci Annalisa , Vermehren Mareike , van Beinum Amanda , Buthut Maria , Soekadar Surjo R. , Bublitz Christoph , Chandler Jennifer A. , Ienca Marcello
Published: August 2024

Background

The rise of a new generation of intelligent neuroprostheses, brain-computer interfaces (BCI) and adaptive closed-loop brain stimulation devices hastens the clinical deployment of neurotechnologies to treat neurological and neuropsychiatric disorders. However, it remains unclear how these nascent technologies may impact the subjective experience of their users. To inform this debate, it is crucial to have a solid understanding how more established current technologies already affect their users. In recent years, researchers have used qualitative research methods to explore the subjective experience of individuals who become users of clinical neurotechnology. Yet, a synthesis of these more recent findings focusing on qualitative methods is still lacking.

Methods

To address this gap in the literature, we systematically searched five databases for original research articles that investigated subjective experiences of persons using or receiving neuroprosthetics, BCIs or neuromodulation with qualitative interviews and raised normative questions.

Results

36 research articles were included and analysed using qualitative content analysis. Our findings synthesise the current scientific literature and reveal a pronounced focus on usability and other technical aspects of user experience. In parallel, they highlight a relative neglect of considerations regarding agency, self-perception, personal identity and subjective experience.

Conclusions

Our synthesis of the existing qualitative literature on clinical neurotechnology highlights the need to expand the current methodological focus as to investigate also non-technical aspects of user experience. Given the critical role considerations of agency, self-perception and personal identity play in assessing the ethical and legal significance of these technologies, our findings reveal a critical gap in the existing literature. This review provides a comprehensive synthesis of the current qualitative research landscape on neurotechnology and the limitations thereof. These findings can inform researchers on how to study the subjective experience of neurotechnology users more holistically and build patient-centred neurotechnology.
A new model to understand the complexity of inequalities in dementia
Authors: Giebel Clarissa
Published: August 2024

Many people living with dementia and unpaid carers experience inequalities in care related to challenges in receiving a correct diagnosis, care and support. Whilst complexities of the evidence are well recognised including barriers in receiving a diagnosis or post-diagnostic care, no coherent model has captured the far-reaching types and levels of inequalities to date. Building on the established Dahlgren & Whitehead Rainbow model of health determinants, this paper introduces the new Dementia Inequalities model. The Dementia Inequalities model, similar to the original general rainbow model, categorises determinants of health and well-being in dementia into three layers: (1) Individual; (2) Social and community networks; and (3) Society and infrastructure. Each layer comprises of general determinants, which have been identified in the original model but also may be different in dementia, such as age (specifically referring to young- versus late-onset dementia) and ethnicity, as well as new dementia-specific determinants, such as rare dementia subtype, having an unpaid carer, and knowledge about dementia in the health and social care workforce. Each layer and its individual determinants are discussed referring to existing research and evidence syntheses in the field, arguing for the need of this new model. A total of 48 people with lived, caring, and professional experiences of dementia have been consulted in the process of the development of this model. The Dementia Inequalities model provides a coherent, evidence-based overview of inequalities in dementia diagnosis and care and can be used in health and social care, as well as in commissioning of care services, to support people living with dementia and their unpaid carers better and try and create more equity in diagnosis and care.
The CD47/TSP-1 axis: a promising avenue for ovarian cancer treatment and biomarker research
Authors: Moniot Aurélie , Schneider Christophe , Chardin Laure , Yaniz-Galende Elisa , Genestie Catherine , Etiennot Marion , Henry Aubéri , Drelon Coralie , Le Formal Audrey , Langlois Benoit , Venat Laurence , Louvet Christophe , Favier Laure , Lortholary Alain , Berton-Rigaud Dominique , Dohollou Nadine , Desauw Christophe , Fabbro Michel , Malaurie Emmanuelle , Dubot Coraline , Kurtz Jean Emmanuel , Bonichon Lamichhane Nathalie , Pujade-Lauraine Éric , Jeanne Albin , Leary Alexandra , Dedieu Stéphane
Published: August 2024

Background

Ovarian cancer (OC) remains one of the most challenging and deadly malignancies facing women today. While PARP inhibitors (PARPis) have transformed the treatment landscape for women with advanced OC, many patients will relapse and the PARPi-resistant setting is an area of unmet medical need. Traditional immunotherapies targeting PD-1/PD-L1 have failed to show any benefit in OC. The CD47/TSP-1 axis may be relevant in OC. We aimed to describe changes in CD47 expression with platinum therapy and their relationship with immune features and prognosis.

Methods

Tumor and blood samples collected from OC patients in the CHIVA trial were assessed for CD47 and TSP-1 before and after neoadjuvant chemotherapy (NACT) and multiplex analysis was used to investigate immune markers. Considering the therapeutic relevance of targeting the CD47/TSP-1 axis, we used the CD47-derived TAX2 peptide to selectively antagonize it in a preclinical model of aggressive ovarian carcinoma.

Results

Significant reductions in CD47 expression were observed post NACT. Tumor patients having the highest CD47 expression profile at baseline showed the greatest CD4+ and CD8+ T-cell influx post NACT and displayed a better prognosis. In addition, TSP-1 plasma levels decreased significantly under NACT, and high TSP-1 was associated with a worse prognosis. We demonstrated that TAX2 exhibited a selective and favorable biodistribution profile in mice, localizing at the tumor sites. Using a relevant peritoneal carcinomatosis model displaying PARPi resistance, we demonstrated that post-olaparib (post-PARPi) administration of TAX2 significantly reduced tumor burden and prolonged survival. Remarkably, TAX2 used sequentially was also able to increase animal survival even under treatment conditions allowing olaparib efficacy.

Conclusions

Our study thus (1) proposes a CD47-based stratification of patients who may be most likely to benefit from postoperative immunotherapy, and (2) suggests that TAX2 is a potential alternative therapy for patients relapsing on PARP inhibitors.
The analysis of the medical tourism expansion policy in Taiwan: a policy analysis using Kingdon’s multiple streams
Authors: Yu Ying-Ju , Huang Nicole , Kuo Hsu-Sung
Published: August 2024

Background

Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan.

Methods

A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon's multiple streams.

Results

In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties.

Conclusion

Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.
Fairy: fast approximate coverage for multi-sample metagenomic binning
Authors: Shaw Jim , Yu Yun William
Published: August 2024

Background

Metagenomic binning, the clustering of assembled contigs that belong to the same genome, is a crucial step for recovering metagenome-assembled genomes (MAGs). Contigs are linked by exploiting consistent signatures along a genome, such as read coverage patterns. Using coverage from multiple samples leads to higher-quality MAGs; however, standard pipelines require all-to-all read alignments for multiple samples to compute coverage, becoming a key computational bottleneck.

Results

We present fairy (https://github.com/bluenote-1577/fairy), an approximate coverage calculation method for metagenomic binning. Fairy is a fast k-mer-based alignment-free method. For multi-sample binning, fairy can be $$> 250 \times$$

>
250
×

faster than read alignment and accurate enough for binning. Fairy is compatible with several existing binners on host and non-host-associated datasets. Using MetaBAT2, fairy recovers $$98.5\%$$

98.5
%

of MAGs with $$> 50\%$$

>
50
%

completeness and $$< 5\%$$

<
5
%

contamination relative to alignment with BWA. Notably, multi-sample binning with fairy is always better than single-sample binning using BWA ($$> 1.5\times$$

>
1.5
×

more $$>50\%$$

>
50
%

complete MAGs on average) while still being faster. For a public sediment metagenome project, we demonstrate that multi-sample binning recovers higher quality Asgard archaea MAGs than single-sample binning and that fairy’s results are indistinguishable from read alignment.

Conclusions

Fairy is a new tool for approximately and quickly calculating multi-sample coverage for binning, resolving a computational bottleneck for metagenomics.
Smartphone-sensor-based human activities classification for forensics: a machine learning approach
Authors: Moubarak Nchouwat Ndumgouo Ibrahim , Omar Njutapmvoui Mbah Mohamed , Youssef Vepouyoum Njouokouo
Published: August 2024

The accurate classification of human activities in crime scenes during forensics (criminalistics) is of utmost importance in classifying suspicious and unlawful activities, easing their acceptability and interpretability by judges during legal procedures in courts or by other non-experts in the field of forensics. This paper implements machine learning (ML) algorithms: support vector machine (SVM) and decision tree (DT), to demonstrate with a high accuracy, how data emanating from smartphones’ sensors reveal and isolate relevant information about static and dynamic human activities in criminalistics. Smartphones’ data from five different sensors (accelerometer, gravity, orientation, Gyroscope and light), related to ten recurrent crime scenes activities, grouped into three classes of events (normal, felony and none-felony events) are classified by the proposed algorithms, with novelty being the classification decisions based on the entire period of the events and not instantaneous decision makings. Three independent data-subsets were made, with permutations done between them and at each time, two sets used for training and the third set used for testing. Time- and frequency-domain features were initially used separately and then combined for the model training and testing. The best average training accuracies of 100% and 97.8% were obtained for the DT and SVM, respectively, and the testing accuracies of 89.1% were obtained for both algorithms. We therefore believe that these results will serve as a solid persuasive and convincing argument to judges and non-experts of the field of forensics to accept and easily interpret computer-aided classification of suspicious activities emanating from criminalistic studies.