bluuebunny/crossref_metadata_2025 huggingface dataset:
Progress and scenario-based projections of health service availability and coverage towards UHC in the post-conflict and post-pandemic Iraq: a Bayesian hierarchical regression approach
Authors: Taniguchi Hiroko , Rahman Md Mizanur , Hussain Ashraf , Nomura Shuhei , Devanathan Ganan , Hashizume Masahiro
Published: October 2024

Background

Two decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The coronavirus disease (COVID-19) pandemic brought additional disruption to health service provision.

Objectives

At the midpoint towards universal health coverage (UHC) in 2030, this study aims to gain a better understanding of the trends of UHC progress in Iraq in the context of the conflicts and the COVID-19 pandemic and to indicate possible pragmatic options.

Design

This study employed Bayesian hierarchical regression models to estimate trends and projections of health service availability and coverage indicators up to 2030. Furthermore, for health service coverage, four scenarios were defined based on the availability of health services, and projections were made for each scenario up to 2030.

Setting

Our approach used the yearly data from the Ministry of Health and four nationally representative household surveys between 2000 and 2020. We evaluated the subnational-level progress in three health service availability indicators and 13 health service coverage indicators in 18 governorates in Iraq from 2000 to 2030.

Results

The findings from 2000 to 2020 revealed a lack of progress in the indicators of health facility and inpatient bed, and pronounced detrimental effects from major conflicts and the pandemic on all measured health service coverage indicators. Despite these setbacks, several health service coverage indicators demonstrated resilience and elasticity in their recovery. The projected trends for 2021 to 2030 indicated limited alternations in the health service availability. By 2030, five health service coverage indicators will achieve the designated 80% targets. A scenario-based analysis predicts improved coverage of antenatal care, and child immunisation and treatment if health service availability is bolstered to globally recommended standards. Under this scenario, several governorates—Anbar, Baghdad, Nainawa, Qadissiyah, Salahaddin, Thiqar and Wasit—presented improved health service coverage in more indicators.

Conclusion

Strengthened health service availability has the potential to significantly improve fragile health service coverage indicators and in more vulnerable governorates.
Qualitative study investigating the health needs of school-aged children and adolescents in Dubai
Authors: Alrahma Ali Muneer , Belal Sana Easa , Koko Fatima Hassan Mohamed , Alabady Kadhim
Published: September 2024

Background

Children’s health has been linked with morbidities such as cardiovascular events, type 2 diabetes and obesity in adulthood. Further efforts are needed to understand the current and emerging challenges due to the potential changes in the social context among school-aged children and adolescents at schools.

Objective

The study aims to investigate the health needs of school-aged children and adolescents in Dubai, United Arab Emirates (UAE).

Design

9 semistructured focus groups and 1 in-depth interview among 10 entities and 5 schools were used to investigate current health needs for schools. The participants were selected using purposive sampling. Data were analysed using a content analysis approach.

Setting

The focus groups and the in-depth interviews were conducted face to face in Dubai, UAE, from February to May 2023.

Participants

52 participants representing different specialties and roles in school health, such as senior employees, managers, teachers, healthcare professionals, principals, social workers/counsellors and parents, participated in this study. Most participants were females, 41 (78.8%) compared with 11 males (21.2%).

Results

The study identified six health themes that address the health needs in schools. The themes highlighted the importance of creating new school health services, programmes, health education sessions, policies, data quality measures and innovative technologies. The participants deemed developing and improving health services, programmes, health education sessions, policies in nutrition, social and mental health, physical activity, and health promotion necessary in schools. Training school staff to manage and handle data was also essential to improve data quality. Using innovative technologies such as applications and electronic student files linked to electronic medical systems may further support school health professionals in schools.

Conclusion

The health needs assessment identified the gaps and challenges that must be addressed to improve students’ health. Policy-makers could use the key results from the six themes to develop effective school health strategies.
Trends in incidence and mortality for gynaecological cancers in Southeastern China during 2011–2020: a retrospective analysis of registry data
Authors: Liu Linying , Zhou Yan , Lin Jie , Xie Ning , Yu Haijuan , Deng Sufang , Sun Yang
Published: September 2024

Objectives

This study aimed to investigate the changes in the incidence and mortality trends of ovarian cancer (OC), cervical cancer (CC) and uterine cancer (UC) in the Fujian Province, southeastern China.

Design

Provincial, population-based, retrospective observational study.

Setting

Fujian province, southeastern China between 2011-2020.

Participants

From 2011 to 2020, 6178 new cases and 2037 deaths caused by 3 gynaecological cancers were eligible for analysis.

Primary and secondary outcome measures

The primary outcome measures were the incidence and mortality rates, including the age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), of three gynaecological cancers. The secondary outcome measure was the prevalence (average annual per cent changes (AAPC)).

Results

The incidence of all three gynaecological cancers increased from 2011 to 2020. CC had the slowest upward trend, with an AAPC of 2.54% over the period. However, it had the highest ASIR among the 3 cancers in 2020 (10.41/100 000). UC showed a rapid increase, with an AAPC of 15.15% from 2016 to 2020. While the mortality rate of UC remained stable, both CC and OC also exhibited rising trends, with the CC having the highest ASMR (3.05/100 000) in 2020. The ASMR for CC increased rapidly, with the highest AAPC of 5.51%. Conversely, changes in the ASMR for UC were not statistically significant (p=0.601). Moreover, high incidence rates were more common among perimenopausal women and older participants in the respective cancer groups where the increased mortality was observed.

Conclusions

Gynaecological cancer burden remains a public health issue in Fujian Province, with an increasing incidence. Improving the healthcare system and promoting a healthy lifestyle should be highlighted to reduce the cancer burden.
Prospective cohort for early detection of liver cancer (Pearl): a study protocol
Authors: Khanna Kartikeya , Barnes Eleanor , Benselin Jennifer , Culver Emma , Irving William , Innes Hamish , Pavlides Michael , Consortium DeLIVER
Published: October 2024

Introduction

Hepatocellular carcinoma (HCC) is the fastest-rising and fourth most common cause of cancer death worldwide. Liver cirrhosis is the largest underlying risk factor for HCC. Therefore, patients with cirrhosis should have regular ultrasound and biochemical screening to pick up early HCC. Early HCC can be cured; more advanced HCCs have limited treatment options and poor prognosis. Current screening methods are suboptimal with poor sensitivity in picking up early disease. In this study, the investigators aim to recruit people with liver cirrhosis into a Prospective cohort for early detection of liver cancer—the Pearl cohort. The investigators believe that by using state-of-the-art tests we can improve the detection of early HCC.

Methods and analysis

This is a UK-based prospective, longitudinal, diagnostic, prognostic, multicentre, non-CTIMP study. Aiming to recruit 3000 patients with liver cirrhosis without a HCC diagnosis, the Pearl cohort will be followed actively for 3 years from recruitment and then passively via registry data for ten years thereafter. Blood and urine samples will be taken and information from routine care will be gathered. These will be used to assess novel diagnostic approaches for the detection early HCC and to develop models to identify those most at risk for developing HCC.

Participants will be linked to national UK health registries to ensure long-term capture of HCC incidence and other relevant endpoints. Approximately 75 patients are predicted to develop de novo HCC within the 3-year follow up period. After this period, the study teams will obtain data on participants for at least 10 years after the last contact. This cohort will help develop an understanding of the incidence of HCC in a UK population stratified by underlying cirrhosis aetiology.

Ethics and dissemination

Ethical approval has been granted by REC and the trial is registered on ClinicalTrials.gov. The results will be published in peer-reviewed journals and presented at relevant meetings.

Trial registration number

NCT05541601.
Have interventions aimed at assisting general practitioners in facilitating earlier diagnosis of type 1 diabetes in children been successful in preventing acute complications? A systematic review
Authors: Beccia Chiara , McMorrow Rita , Donald Andrew , de Mendonça Lucas , White Mary , Hunter Barbara , Manski-Nankervis Jo-Anne
Published: October 2024

Background

Diabetic ketoacidosis (DKA) is a life-threatening emergency that can result from delayed diagnosis of type 1 diabetes mellitus (T1DM). Three-quarters of Australian children with a new diagnosis of T1DM visit their general practitioner (GP) the week prior to developing DKA, with similar trends observed internationally.

Objective

To summarise interventions in general practice to reduce diagnostic delay in paediatric T1DM and to evaluate their effectiveness.

Methods

Six databases (Ovid, Web of Science, CINAHL, Evidence-Based Medicine Reviews, Google Scholar and EMBASE) were searched. Any English language, less than 20 years study involving interventions targeting GPs specifically in the prevention of paediatric DKA, was included. Primary outcomes were (a) the number of children presenting to the hospital in DKA following diagnostic delay after a GP visit and (b) DKA rate. The secondary outcome was changes in GPs’ behaviour regarding timeliness of referrals. Two reviewers completed title, abstract and full-text review, with conflicts resolved by a third reviewer. ROBINS-I risk of bias was used for appraisal. High heterogeneity among studies rendered meta-analysis unsuitable. Structured tabulation of results was completed for analysis. The date of last search was 2 July 2023.

Results

Eight studies were included (three conference abstracts and five peer-reviewed publications.) We identified six intervention types attempting to facilitate timely diagnosis of type 1 diabetes in the general practice setting: direct communication, indirect communication, education sessions, electronic clinical decision support tools, updated referral pathways and provision of glucose and/or ketone monitors. Due to the limited number of peer-reviewed studies identified by this review, we were not able to identify the extent to which these interventions were successful.

Conclusion

Paucity of information regarding study methodology and high heterogeneity among study design and outcome measures limited our conclusions regarding acceptability, effectiveness and reach. Future studies should include GPs in their design and consider the sustainability of interventions in the long term.

PROSPERO registration number

CRD42023412504.
Building capacity and capability for quality improvement: insights from a nascent regional health system
Authors: Ng Yan Jun , Lew Kelvin Sin Min , Yap Adrian Ujin , Quek Lit Sin , Hwang Chi Hong
Published: September 2024

Objectives

Quality improvement (QI) is critical in facilitating advancements in patient outcomes, system efficiency and professional growth. This paper aimed to elucidate the underlying rationale and framework guiding JurongHealth Campus (JHC), a nascent Regional Health System, in developing its QI capacity and capability at all levels of the organisation.

Methods

An exhaustive analysis of high-performance management systems and effective improvement frameworks was conducted, and the principles were customised to suit the local context.

A three-phased approach was applied: (1) developing the JHC QI framework; (2) building capacity through a dosing approach and (3) building capability through QI projects and initiatives using the model for improvement (MFI). Three components of the RE-AIM implementation strategy were assessed: (1) Reach—overall percentage of staff trained; (2) Effectiveness—outcomes from organisation-wide improvement projects and (3) Adoption—number of QI projects collated and presented.

Results

The percentage of staff trained in QI increased from 11.3% to 22.0% between January 2020 and March 2024, with over 350 projects documented in the central repository. The effectiveness of the MFI was demonstrated by improving inpatient discharges before 12pm performance from 21.52% to 25.84% and reducing the 30-day inpatient readmission rate from 13.92% to 12.96%.

Conclusion

Four critical factors for an effective QI framework were identified: (1) establishing a common language for improvement; (2) defining distinct roles and skills for improvement at different levels of the organisation; (3) adopting a dosing approach to QI training according to the defined roles and skills and (4) building a critical mass of committed staff trained in QI practice. The pragmatic approach to developing QI capability is both scalable and applicable to emerging healthcare institutions.
Burden of the COVID-19 pandemic on adolescent mental health in the Lombardy Region, Italy: a retrospective database review
Authors: Clavenna Antonio , Cartabia Massimo , Fortino Ida , Bonati Maurizio
Published: September 2024

Background

Previous research has assessed the impact of the COVID-19 pandemic on adolescent mental health (MH). How the pandemic changed healthcare resource utilisation for MH conditions was investigated less, however, in particular in Italy.

Methods

Data concerning outpatient visits in child and adolescent mental health services (CAMHSs), access to emergency departments (EDs), hospital admissions and drug prescriptions collected in administrative databases of the Lombardy Region, Italy, concerning adolescents 12–17 years old and occurring in the 2016–2021 period were analysed.

Annual and monthly prevalence of healthcare (CAHMS/ED visits/hospital admissions) use for MH conditions and of psychotropic drug prescriptions were estimated. A negative binomial regression model was used to model the pre-pandemic monthly number of prevalent cases by gender. The total number of pandemic (1 March 2020 to 31 December 2021) cases predicted from the model was compared with the number of observed cases.

Results

The overall annual rate of healthcare service utilisation slightly increased in the 2016–2019 period (from 63.8‰ to 67.8‰), decreased in 2020 (57.1‰) and returned to values similar to 2016 (64.9‰) the following year. A 2% relative increase was observed in girls, and a 10% decrease in boys, when comparing the prevalence in 2021 with that in 2019. Differences between genders were particularly evident for ED attendance, with an observed/predicted cases ratio in 2021 of 0.81 (95% CI 0.79 to 0.83) in boys, and 1.18 (95% CI 1.16 to 1.20) in girls, and for psychotropic drug prescriptions (0.83 (95% CI 0.82 to 0.84) and 1.24 (95% CI 1.23 to 1.25), respectively).

Conclusions

The current study confirms that the use of health services for MH conditions during the COVID-19 pandemic increased among adolescent girls but decreased among boys, and that gender differences emerged in the MH impact of the pandemic.
Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border
Authors: Bancone Germana , Gilder Mary Ellen , Win Elsie , Gornsawun Gornpan , Moo Paw Khu , Archasuksan Laypaw , Wai Nan San , Win Sylverine , Hanboonkunupakarn Borimas , Nosten Francois , Carrara Verena Ilona , McGready Rose
Published: September 2024

Background

Neonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.

Methods

A study was carried out at Shoklo Malaria Research Unit (SMRU) clinics along the Thailand–Myanmar border to evaluate a non-invasive test for diagnosis of NH in a low-resource setting. Performance of a transcutaneous bilirubinometer Dräger Jaundice Meter JM-105 was assessed against routine capillary serum bilirubin testing (with BR-501 microbilirubinometer) before phototherapy during neonatal care in the first week of life. Results were analysed by direct agreement and by various bilirubin thresholds used in clinical practice. Total serum bilirubin was also measured in cord blood at birth and tested for prediction of hyperbilirubinaemia requiring phototherapy in the first week of life.

Results

Between April 2020 and May 2023, 742 neonates born at SMRU facilities were included in the study. A total of 695 neonates provided one to nine capillary blood samples for analysis of serum bilirubin (total 1244 tests) during the first week of life. Performance of transcutaneous bilirubinometer was assessed in 307 neonates who provided 687 paired transcutaneous capillary blood tests. Bilirubin levels were also measured in 738 cord blood samples. Adjusted values of transcutaneous bilirubinometer showed excellent agreement with capillary serum bilirubin concentration (intraclass correlation coefficient=0.923) and high sensitivity (>98%) at all clinical thresholds analysed across 3 years of sampling and multiple users. Concentrations of bilirubin detected in cord blood were not useful in identifying neonates at risk of hyperbilirubinaemia requiring treatment.

Conclusions

The transcutaneous bilirubinometer is a reliable tool to screen neonates and identify those needing confirmatory blood testing. Bilirubin concentrations in cord blood are not predictive of hyperbilirubinaemia in neonates.
Prevalence, symptomatology and factors associated with asthma in adolescents aged 13–14 years from rural Sri Lanka: an analytical cross-sectional study
Authors: Siriwardhana Tharusha Chamanthi , Sumanapala Vimansha , Subhanee Thiweda , Sulakkhana Savithri , Sridharan Periyasami Sivabalan , Thennakoon Sajeewa , Rajapakse Shashanka
Published: September 2024

Background

Asthma is the most common chronic disease affecting children. However, the epidemiology of asthma in adolescents from rural geographies is lacking.

Methods

An analytical cross-sectional study was conducted in secondary schools located in the municipal council area of the rural district of Anuradhapura, Sri Lanka. Random sampling was used to select 32 grade 8 classes from 6 out of 9 schools. The prevalence and symptomatology of asthma were determined using the validated International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire and asthma symptom control using the asthma control test (ACT) translated into Sinhalese.

Results

The study sample consisted of 1029 participants aged 13–14 years, including 528 (51.3%) boys and 501 (48.7%) girls. The prevalence of wheeze ever, current wheeze and wheeze while playing was 32.6% (n=335), 23.7% (n=244) and 25.2% (n=259), respectively. The prevalence of parent-reported physician-diagnosed asthma was 19.0% (n=196; 95% CI 16.7 to 21.6). Severe asthma was reported by 157 (15.3%; 95% CI 13.1 to 17.6) adolescents. The independent factors associated with severe asthma were sleeping on a cloth laid on the floor instead of a bed (p<0.02, adjusted-OR 9.72; 95% CI 1.56 to 60.78), cooking using sawdust (p=0.04, adjusted-OR 8.71; 95% CI 1.10 to 68.69) eczema (p<0.01; adjusted-OR 7.39; 95% CI 3.34 to 16.39) and allergic rhinitis (p<0.01; adjusted-OR 5.50; 95% CI 3.80 to 7.98). While having a cemented floor in the house (p<0.04; adjusted-OR 0.68; 95% CI 0.47 to 0.99) was a protective factor. Poor control of asthma symptoms was detected in 29 (29.9%) adolescents which was associated with comorbid allergic rhinitis (p<0.01; unadjusted-OR 5.40; 95% CI 1.84 to 15.82).

Conclusion

Almost one in four adolescents had current wheeze, and 15.3% had severe asthma. Severe asthma was independently associated with allergic rhinitis, eczema, cooking using sawdust as fuel and sleeping on a cloth on the floor instead of a bed. Poor symptom control was found in 29.9% of severe asthmatics which was associated with comorbid allergic rhinitis.
Local area crime and alcohol consumption: longitudinal evidence from Australia
Authors: Churchill Rejoice E A , Koomson Isaac , Awaworyi Churchill Sefa
Published: October 2024

Background

Alcohol misuse is a major public health issue. Understanding factors that contribute to alcohol misuse or risky drinking behaviour is important for policy. This study examined if crime rates in the neighbourhood (postcode) where a person lives influences their likelihood of engaging in risky drinking behaviour. We further explored social capital and mental health as channels through which neighbourhood crime influences risky drinking behaviour.

Methods

Using 18 waves of household longitudinal data from the Household, Income and Labour Dynamics in Australia Survey for the period 2002 to 2019 merged with official police statistics on neighbourhood crime rates, we adopted fixed-effect regression models that allow us to address concerns relating to endogenous sorting of participants as well as omitted variable bias.

Results

We find that an increase in neighbourhood crime is associated with an increase in the likelihood of risky drinking (OR=1.107, 95% CI 1.073 to 1.120), alcohol expenditure (b=0.063, 95% CI 0.041 to 0.076), alcohol consumption frequency (b=0.071, 95% CI 0.055 to 0.083) and quantity (b=0.046, 95% CI 0.032 to 0.052). We present exploratory evidence that social capital and mental health mediate the relationship between neighbourhood crime and alcohol use. Specifically, our results suggest that by eroding the level of trust and decreasing mental health, neighbourhood crime tends to increase the probability that people engage in risky alcohol behaviour.

Conclusion

Our findings suggest that targeting crime and in particular the channels through which crime influences risky alcohol behaviour (ie, trust and mental health) can be instrumental in addressing alcohol misuse.
Phase II basket trial of dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors (DART) SWOG S1609: the desmoid tumors
Authors: Chae Young Kwang , Othus Megan , Patel Sandip , Powers Benjamin , Hsueh Chung-Tsen , Govindarajan Rangaswamy , Bucur Silvana , Kim Hye Sung , Chung Liam IL-Young , McLeod Christine , Chen Helen X , Sharon Elad , Streicher Howard , Ryan Christopher W , Blanke Charles , Kurzrock Razelle
Published: September 2024

Background

Dual inhibition using anti-programmed death-1 (PD-1) and anti-cytotoxic T-lymphocyte antigen-4 (CTLA-4) checkpoint inhibitors has proven effective in many cancers. However, its efficacy in rare solid cancers remains unclear. Desmoid tumors are ultrarare soft-tissue tumors, traditionally treated with surgery. This study reviews the first results of using ipilimumab and nivolumab in the desmoid tumor cohort of the SWOG S1609 Dual Anti-CTLA-4 & Anti-PD-1 blockade in Rare Tumors (DART) trial.

Methods

DART is a prospective/open-label/multicenter (1,016 US sites)/multicohort phase II trial of ipilimumab (1 mg/kg intravenously every 6 weeks) plus nivolumab (240 mg intravenously every 2 weeks) that opened at 1,016 US sites. The primary endpoint included overall response rate (ORR) defined as confirmed complete (CR) and partial responses (PR) based on Response Evaluation Criteria in Solid Tumors (RECIST) v.1.1. Secondary endpoints include progression-free survival (PFS), overall survival (OS), clinical benefit rate (CBR; stable disease (SD) ≥6 months plus CR and PR) and toxicity.

Results

Sixteen evaluable patients (median age: 37) with desmoid tumors and a median of 1.5 prior therapies (with no prior exposure to immunotherapy) were analyzed. The tumors varied in location (eight abdomen, three lower limb, two upper limb, two pelvis, and one neck). ORR was 18.8% (3/16; 3 confirmed PR): 40% regression (PFS 30+ months), 83% regression (PFS 16 months) and 71% regression (PFS 8.4 months). Seven additional patients (43.8%) had prolonged SD over 6 months (PFS: 16.5, 22.4+, 22.6, 30.1, 38.2+, 48.3+ and 60.7+ months). Overall CBR was 62.5% (10/16). Median PFS was 19.4 months, with 6-month PFS of 73% and 1-year PFS of 67%. All patients were alive at 1 year; median OS was not assessable, as 13 patients were alive at analysis. Common adverse events included fatigue, nausea and hypothyroidism, with 50% experiencing grade 3–4 events. There were no grade 5 events.

Conclusion

Treatment with ipilimumab and nivolumab in desmoid tumors yielded an ORR of 18.8% and a CBR of 62.5% with durable responses seen. This is the first prospective study exploring the efficacy of this combination in this rare disease. Ongoing studies aim to identify markers for response and resistance. Expanded trials are necessary.

Trial registration number

NCT02834013.
A multicenter, randomized, non-comparative, phase II study of nivolumab ± ipilimumab for patients with metastatic sarcoma (Alliance A091401): expansion cohorts and correlative analyses
Authors: Seligson Nathan D , Chen James L , Goodrich Austin C , Van Tine Brian A , Campbell Jordan D , Richards Allison L , Antonescu Cristina R , Liebner David A , Milhem Mohammed M , Streicher Howard , Tap William D , Schwartz Gary K , George Suzanne , D'Angelo Sandra P
Published: September 2024

Background

In this open-label, randomized, non-comparative, multicenter phase II study (Alliance A091401) we report on three expansion cohorts treated with nivolumab (N) with and without ipilimumab (N+I) and provide a multi-omic correlative analysis of actionable biomarkers.

Methods

Patients were randomized (non-comparative) to receive either N or N+I. The primary endpoint was a 6-month confirmed response rate (CRR) defined by Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included treatment-related adverse events (TRAEs), progression-free survival, and overall survival. Multi-omic correlative analyses were conducted using samples from both the primary and expansion cohorts.

Results

A total of 66 patients were evaluated for the primary endpoint with disease including gastrointestinal stromal tumor (GIST, n=18), undifferentiated pleomorphic sarcoma (UPS, n=24), and dedifferentiated liposarcoma (DDLPS, n=24). Neither N nor N+I achieved a complete or partial response in the GIST expansion cohort. In DDLPS and UPS, the primary response endpoint of CRR was met with N+I (both 16.6%, 2/12) but not with N alone (both 8.3%, 1/12). In the GIST cohort, TRAE was higher with N+I treatment, halting enrollment as required per protocol. In a correlative analysis of patients for the expansion cohort and the original cohort (n=86), traditional biomarkers of immunotherapy response were not correlated with response in any histological subtype. Markers of genomic instability including the presence of gene fusions and increased subclonal mutations correlated with improved clinical outcomes.

Conclusions

This expansion cohort reaffirms the outcomes of A091401. There remains a pressing need to determine the role of and predictive biomarkers for immunotherapy in sarcoma.

Trial registration number

NCT02500797.
On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis
Authors: Vittecoq Olivier , Brevet Pauline , Gerard Baptiste , Lequerre Thierry
Published: September 2024

In rheumatoid arthritis (RA), the identification of prognostic factors (PF) capable of predicting disease outcome, response to treatment or success of dose reduction is an important issue, as these factors are intended to serve as a basis for decision-making. The task is complex from the outset, as the definition of disease prognosis or therapeutic prognosis is not uniquevocal. The heterogeneity of the definitions used partly explains the failure to identify PF that can be applied at an individual level. But other factors also contribute. First, the scope of the disease studied is too broad, including nosologically different entities. Second, potential PF are only measured at a single point of time, whereas changes over a period of time should be taken into account to a greater extent, not forgetting the potential impact of the treatment received during this period. Beyond these limiting factors, one of the main obstacles to the identification of PF is probably the fact that the phase of the disease is not sufficiently taken into account. Predicting the disease outcome when it is well established is a more complex challenge than when it is just beginning, as many factors are likely to interfere. The same applies to therapeutic PF, which should be determined according to disease duration. Difficulties also arise from the approaches used, which are often restricted to a single field of interest whereas they should be much more integrative and call on new large-scale data analysis tools with a view to precision medicine.

In RA, prognosis can be defined at two levels: disease outcome, including joint damage and risk of extra-articular manifestations and/or complications, and treatment outcome, including response to therapy, risk of adverse effects and drug-free remission.
Central post-stroke pain: advances in clinical and preclinical research
Authors: Yuan Xiqian , Hu Siyuan , Fan Xiaochong , Jiang Chao , Xu Yan , Hao Ruochen , Xu Zili , Yu Yiyang , Rastegar-Kashkooli Yousef , Huang Leo , Wang Tom J , Wang Qiao , Su Songxue , Wang Limin , Wang Junyang , Wang Menglu , Kim Yun Tai , Bhawal Ujjal K , Wang Fushun , Zhao Ting , Wang Junmin , Chen Xuemei , Wang Jian
Published: September 2024

Central poststroke pain (CPSP) is a medical complication that arises poststroke and significantly impacts the quality of life and social functioning of affected individuals. Despite ongoing research, the exact pathomechanisms of CPSP remain unclear, and practical treatments are still unavailable. Our review aims to systematically analyse current clinical and preclinical studies on CPSP, which is critical for identifying gaps in knowledge and guiding the development of effective therapies. The review will clarify the clinical characteristics, evaluation scales and contemporary therapeutic approaches for CPSP based on clinical investigations. It will particularly emphasise the CPSP model initiated by stroke, shedding light on its underlying mechanisms and evaluating treatments validated in preclinical studies. Furthermore, the review will not only highlight methodological limitations in animal trials but also offer specific recommendations to researchers to improve the quality of future investigations and guide the development of effective therapies. This review is expected to provide valuable insights into the current knowledge regarding CPSP and can serve as a guide for future research and clinical practice. The review will contribute to the scientific understanding of CPSP and help develop effective clinical interventions.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) for non-trauma patients in an urban hospital: a series of two cases
Authors: van de Voort Jan C , Vrancken Suzanne M , Manusama Eric R , Borger van der Burg Boudewijn L S , Klinkert Pieter , Hoencamp Rigo
Published: September 2024

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly being used for temporary bleeding control in patients with trauma with non-compressible truncal hemorrhage (NCTH). In recent years, the technique is gaining popularity in postpartum hemorrhage and non-traumatic cardiac arrest, although still underutilized. In other surgical fields, however, there is not yet much awareness for the possible advantages of this technique. Consequently, for non-trauma indications, limited data are available.

Methods

Description of the use of REBOA in two patients with hemorrhagic shock due to exsanguinating non-traumatic NCTH.

Results

In the first case, REBOA was deployed at the emergency department in a patient in their 80s presenting with hemorrhagic shock due to a ruptured abdominal aortic aneurysm. Hemodynamic stability was obtained and a CT scan was subsequently performed for planning of endovascular aneurysm repair. After successful placement of the endograft, the REBOA catheter was deflated and removed. In the second case, REBOA was performed in a patient with shock due to iatrogenic epigastric artery bleeding after an umbilical hernia repair to prevent hemodynamic collapse and facilitate induction of anesthesia for definitive surgery. During laparotomy, blood pressure-guided intermittent aortic balloon occlusion was used to preserve perfusion of the abdominal organs. Patient made a full recovery.

Conclusion

REBOA deployment was successful in achieving temporary hemorrhage control and hemodynamic stability in patients with non-traumatic NCTH. REBOA facilitated diagnostic work-up, transportation to the operating room and prevented hemodynamic collapse during definitive surgical repair. In the right patient and skilled hands, this relatively simple endovascular procedure could buy precious time and prove lifesaving in a variety of non-compressible hemorrhage.
Implementation of a novel daily performance improvement checklist (PIC) improves alcohol screening and intervention compliance in trauma
Authors: Jeffery Michelle , Toussaint Ashley , Choron Rachel L , Englert Zachary P , Piplani Charoo , Murphy Timothy , Falcon Lisa A , Narayan Mayur , Teichman Amanda L
Published: September 2024

Introduction

Screening, brief intervention, and referral to treatment (SBIRT) has demonstrated up to 50% reduction in alcohol-related traumatic injury and is mandated by the American College of Surgeons for trauma center accreditation. While SBIRT effectiveness has been previously investigated, optimal implementation in the trauma setting has not. We sought to improve SBIRT compliance through integration of screening into a performance improvement checklist (PIC) deployed during morning report. We hypothesized that PIC would establish a self-sustaining model for improved alcohol screening/intervention.

Methods

This was a retrospective study comparing trauma patients pre-PIC (January–May 2022) to post-PIC (January–May 2023) after PIC implementation in January 2023. The primary outcome was SBIRT performance. The PIC prompted alcohol intervention specialist consultation if blood alcohol content >80 mg/dL, <21 years old, or Alcohol Use Disorders Identification Test ≥8. Significance was determined if p<0.05.

Results

There were 705 pre-PIC and 840 post-PIC patients. Pre-PIC unscreened patients were more often uninsured (13% vs. 25%, p<0.01) and black (8% vs. 14%, p=0.02) compared with screened pre-PIC patients. There were no significant differences among screened versus unscreened patients after PIC with respect to age, sex, race, or ethnicity (p>0.05). Overall, screening improved pre-PIC to post-PIC (52% vs. 88%, p<0.01) and the percentage of patients who screened positively also increased after PIC (8% vs. 23%, p<0.01). Brief intervention was unchanged (83% vs. 81%, p=1).

Conclusion

The PIC is a novel tool that demonstrated improved alcohol screening and referral. It improved compliance with SBIRT and reduced implicit bias in the population screened. Utilization of a PIC is easily translatable to other centers and could become a national standard to advance performance improvement.

Level of evidence

IV.
Use of an Integrated Pulmonary Index pathway decreased unplanned ICU admissions in elderly patients with rib fractures
Authors: Davis Nicholas , Lindbloom Peter , Hromatka Kathleen , Gipson Jonathan , West Michaela A
Published: September 2024

Unplanned intensive care unit (ICU) admission (UIA) is a Trauma Quality Improvement Program benchmark that is associated with increased morbidity, mortality, and length of stay (LOS). Elderly patients with multiple rib fractures are at increased risk of respiratory failure. The Integrated Pulmonary Index (IPI) assesses respiratory compromise by incorporating SpO2, respiratory rate, pulse, and end-tidal CO2to yield an integer between 1 and 10 (worst and best). We hypothesized that IPI monitoring would decrease UIA for respiratory failure in elderly trauma patients with rib fractures.

Methods

Elderly (≥65 years old) trauma inpatients admitted to a level 1 trauma center from February 2020 to February 2023 were retrospectively studied during the introduction of IPI monitoring on the trauma floor. Patients with ≥4 rib fractures (or ≥2 with history of chronic obstructive pulmonary disease) were eligible for IPI monitoring and were compared with a group of chest Abbreviated Injury Scale score of 3 (≥3 rib fractures) patients who received usual care. Nurses contacted the surgeon for IPI ≤7. Patient intervention was left to the discretion of the provider. The primary endpoint was UIA for respiratory failure. Secondary endpoints were overall UIA, mortality, and LOS. Statistical analysis was performed using χ2test and Student’s t-test, with p<0.05 considered significant.

Results

A total of 110 patients received IPI monitoring and were compared with 207 patients who did not. The IPI cohort was comparable to the non-IPI cohort in terms of gender, Injury Severity Score, Abbreviated Injury Scale, mortality, and LOS. There were 16 UIAs in the non-IPI cohort and two in the IPI cohort (p=0.039). There were no UIAs for respiratory failure in the IPI group compared with nine in the non-IPI group (p=0.03).

Conclusion

IPI monitoring is an easy-to-set up tool with minimal risk and was associated with a significant decrease in UIA in elderly patients with rib fracture.

Level of evidence

Level III, therapeutic/care management.
Optimal Operation Framework of the Hydrogen-Electric Integrated Energy System by Considering the Power-to-Hydrogen Efficiency Factor
Authors: Dong Yannan , Gao Liu , Wang Haixin , Marquez Fausto Pedro Garcia , Yuan Jiahui , Ma Shaohua , Yang Junyou , Dong Henan , Chen Zhe
Published: October 2024

To enhance the power-to-hydrogen (P2H) efficiency and multiple energy utilization efficiency of the hydrogen-electric integrated energy system (HE-IES), an optimal operation framework considering the P2H factor is proposed. First, the proton exchange membrane electrolytic cells model which considers mass transfer characteristics is established. Efficient hydrogen production operating parameters are obtained through simulation to maximize the P2H efficiency. Second, the HE-IES is established, including the hydrogen flow system, wind power (WP), energy storage systems, gas boiler, combined heat and power and methanation unit. Based on the characteristics of the devices and efficient hydrogen operating parameters, the optimal operation framework considering the P2H efficiency factor is proposed. To realize the low economic operating costs and maximize the utilization of WP, a multi-objective function based on fuzzy membership function solving is applied. Finally, the case studies show that the proposed operation framework reduces the economic operation cost by 28.29% and improves the WP utilization rate by 31.9%.
Secure SRAM Memory Design for Secret Data Protection Against Data Imprinting and Power Attack
Authors: Gupta Aastha , Sindal Ravi , Neema Vaibhav
Published: October 2024

SRAM is crucial in cryptographic devices for temporarily storing secret keys used in encryption and decryption. However, conventional 6T SRAM cells are vulnerable to side-channel attacks (SCA) via power consumption analysis, as writing the same and opposite data consumes unequal power. Additionally, the Negative Bias Temperature Instability (NBTI) effect in PMOS transistors introduces a data imprinting attack, where attackers exploit differences in the relative strength of pull-up transistors, affecting the threshold voltage ([Formula: see text], noise margin (SNM), and delay of the SRAM cell, to retrieve stored data. To address these vulnerabilities, a new SRAM cell design is proposed, incorporating a loop cutting technique to prevent SCA and data toggling behavior to mitigate the data imprinting attack. Monte Carlo simulations of power dissipation during various write operations show that the proposed cell achieves a secure write operation with a maximum overlap of 96.87%. The loop cutting technique reduces power dissipation by 1.54 times and write operation time by 1.44 times compared to the conventional 6T SRAM cell. The stress factor (SF) is also calculated to measure the stress on storage nodes over time. The SF for the 6T SRAM cell is 2.34 after 180 min, while the data toggling approach in the proposed SRAM cell achieves an SF of 0.72, effectively preventing the data imprinting effect. The introduction of transmission gates increases the area overhead of the proposed cell by 1.88[Formula: see text]. All simulations are conducted using the gpdk 90-nm technology file in Cadence Virtuoso.
Efficacy and Safety of Finerenone Across the Ejection Fraction Spectrum in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of the FINEARTS-HF Trial
Authors: Docherty Kieran F. , Henderson Alasdair D. , Jhund Pardeep S. , Claggett Brian L. , Desai Akshay S. , Mueller Katharina , Viswanathan Prabhakar , Scalise Andrea , Lam Carolyn S.P. , Senni Michele , Shah Sanjiv J. , Voors Adriaan A. , Zannad Faiez , Pitt Bertram , Vaduganathan Muthiah , Solomon Scott D. , McMurray John J.V.
Published: September 2024

BACKGROUND:

The effects of treatments for heart failure (HF) may vary among patients according to left ventricular ejection fraction (LVEF). In FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure), the nonsteroidal mineralocorticoid receptor antagonist finerenone reduced the risk of cardiovascular death and total worsening HF events in patients with HF with mildly reduced or preserved ejection fraction. We examined the effect of finerenone according to LVEF in FINEARTS-HF.

METHODS:

FINEARTS-HF was a randomized, placebo-controlled trial examining the efficacy and safety of finerenone in patients with HF and LVEF ≥40%. The treatment effect of finerenone was examined in prespecified analyses according to LVEF categories (<50%, ≥50% to <60%, and ≥60%) and with LVEF as a continuous variable. The primary outcome was a composite of total (first and recurrent) worsening HF events and cardiovascular death.

RESULTS:

Baseline LVEF data were available for 5993 of the 6001 participants in FINEARTS-HF. Mean and median LVEF were 53±8% and 53% (interquartile range, 46%–58%), respectively. LVEF was <50% in 2172 (36%), between 50% and <60% in 2674 (45%), and ≥60% in 1147 (19%). Patients with higher LVEF were older, were more commonly female, were less likely to have a history of coronary artery disease, and more frequently had a history of hypertension and chronic kidney disease compared with those with a lower LVEF. Finerenone reduced the risk of cardiovascular death and total HF events consistently across LVEF categories (LVEF <50% rate ratio, 0.84 [95% CI, 0.68–1.03]; LVEF ≥50% to <60% rate ratio, 0.80 [0.66–0.97]; and LVEF ≥60% rate ratio, 0.94 [0.70–1.25];
P
interaction
=0.70). There was no modification of the benefit of finerenone across the range of LVEF when analyzed as a continuous variable (
P
interaction
=0.28). There was a similar consistent effect of finerenone on reducing the total number of worsening HF events (continuous
P
interaction
=0.26).

CONCLUSIONS:

In patients with HF with mildly reduced or preserved ejection fraction, finerenone reduced the risk of cardiovascular death and worsening HF events, irrespective of LVEF.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04435626. URL:
https://eudract.ema.europa.eu
; Unique identifier: 2020-000306-29.
Tail Bounds on the Runtime of Categorical Compact Genetic Algorithm
Authors: Hamano Ryoki , Uchida Kento , Shirakawa Shinichi , Morinaga Daiki , Akimoto Youhei
Published: October 2024

The majority of theoretical analyses of evolutionary algorithms in the discrete domain focus on binary optimization algorithms, even though black-box optimization on the categorical domain has many practical applications. In this paper, we consider a probabilistic model-based algorithm using the family of categorical distributions as its underlying distribution and set the sample size as two. We term this specific algorithm the categorical compact genetic algorithm (ccGA). The ccGA can be considered as an extension of the compact genetic algorithm (cGA), which is an efficient binary optimization algorithm. We theoretically analyze the dependency of the number of possible categories K, the number of dimensions D, and the learning rate η on the runtime. We investigate the tail bound of the runtime on two typical linear functions on the categorical domain: categorical OneMax (COM) and KVal. We derive that the runtimes on COM and KVal are O(Dln(DK)/η) and Θ(DlnK/η) with high probability, respectively. Our analysis is a generalization for that of the cGA on the binary domain.
Two new species of mites in the family Pachylaelapidae from Türkiye (Acari: Mesostigmata)
Authors: ÖZBEK HASAN HÜSEYİN , HALLIDAY BRUCE
Published: September 2024

This study reviews some species of mites in the family Pachylaelapidae from Türkiye. Onchodellus marginatus sp. nov. and Pachylaelaps (Longipachylaelaps) vermiger sp. nov. are described as new species. Olopachys (Olopachys) caucasicus Koroleva, 1976, and Pachylaelaps (Pachylaelaps) imitans Berlese, 1920 are re-described on the basis of newly-collected specimens.
A new species of planthopper in the genus Eumyndus (Hemiptera: Cixiidae) from palms in eastern Madagascar and molecular evidence for the synonymy of Eumyndus kraussi and Eumyndus metcalfi
Authors: BAHDER BRIAN W. , RANDRETSIFERANA SAFIDINIRINA ARMANDE , RANDRETSIFERANA ANDRIANATENAINA , STROIŃSKI ADAM , ŁUKASIK PIOTR , BARTLETT CHARLES R. , PILET FABIAN , HASINJAKA RASOLONDALAO HARIN’HALA
Published: September 2024

A new species of Eumyndus Synave, 1956, a genus endemic to Madagascar, is here described as Eumyndus jeanjacquei sp. nov. The new species was collected from the palm Vonitra fibrosa (C.H.Wright) Becc., 1911. Molecular data are provided for the new species from the barcoding region (5’ half) of the cytochrome c oxidase subunit I (COI) gene, 18S rRNA gene and D9-D10 expansion region of the 28S rRNA gene and support placement of the new species in Eumyndus. A new synonymy is proposed based on examination of type material: E. metcalfi Synave, 1956 equals E. kraussi Synave, 1956, new synonym.
New species and genus of Columbellidae (Gastropoda: Buccinoidea) from the Western Pacific
Authors: MONSECOUR KEVIN , RAINES BRET K.
Published: September 2024

Ten new species and one new genus of Columbellidae from several Pacific Islands are introduced as new to science. The following species originating from Saipan, Northern Marianas are described: Ascalista saipanensis sp. nov., Mitrella harryleei sp. nov., Mitropsis noduliferus sp. nov., Retizafra praefulgida sp. nov. and Zafra spadicea sp. nov. Euspiralta okinawaensis sp. nov. originates from Okinawa, Japan. Zafra fijiensis sp. nov. originates from Fiji. From Wake Atoll the species Mokumea gracilicostata sp. nov., Speirazafra wakensis gen. nov. et sp. nov. and Zafra thaanumi sp. nov..