bluuebunny/crossref_metadata_2025 huggingface dataset:
U.S. Ninth Graders’ Math Course Placement at the Intersection of Learning Disability Status, Race, and Socioeconomic Status
Authors: Shifrer Dara
Published: July 2023

This study integrates an intersectional framework with data on 15,000 U.S. ninth graders from the High School Longitudinal Study of 2009 to investigate differences in ninth-grade math course placement at the intersection of adolescents’ learning disability status, race, and socioeconomic status (SES). Descriptive results support an increased liability perspective, with the negative relationship between a learning disability and math course placement larger for adolescents more privileged in terms of their race and/or SES. Adjusted results suggest that the lower math course placements of youth with learning disabilities are due to cumulative disadvantage rather than disability-related inequities in the transition to high school for youth of diverse racial and socioeconomic backgrounds. In addition to demonstrating the importance of intersectional perspectives, this study provides a roadmap for future studies by introducing the new perspective of increased liability to be used in conjunction with the widely employed perspective of multiple marginalization.
Pediatric Oncology, Palliative Care and Low- or Middle- Income Countries: A Call for Action
Authors: Siddiqui Mohd Faizan , Nohra Lea , Saleh Mustafa , Thakkar Keval , Trivedi Rishika , Moujally Sophie Nicolas , Deeb Hadeel , Nicolas Gregory , Emmanuel Nancy
Published: July 2023

Pediatric oncology, which includes cancer screening and therapy in children, poses significant challenges in low- and middle-income countries (LMICs). Palliative care improves children’s and their families’ quality of life. In LMICs, palliative care resources are scarce, resulting in poor symptom management, psychological support, and spiritual care. All relevant English-language articles on pediatric palliative oncology were searched in PubMed, Google Scholar, Scopus, and Medline databases using the following keywords: “Pediatric Oncology,” “Pediatric Palliative Oncology,” “Pediatric Palliative Care,” “Palliative Care,” “Child Cancer,” and “Lower- and Middle-Income Countries.” This study highlights the significance of incorporating palliative care early in therapy and the recommendations may improve the competence of information provided by medical professionals to patients and families. LMICs have the potential to improve overall treatment and outcomes for child cancer patients and their families by prioritizing the integration of palliative care, guaranteeing a compassionate and dignified attitude toward the disease.
Enhancing Students’ Skills in Applying Theory Through Collaborative and Active Learning: A Pre-Post Evaluation of an Innovative Theory Course for Graduate Public Health Students
Authors: McGee Robin E. , Walker Elizabeth Reisinger , McBride Colleen M. , Nehl Eric J. , Rice Whitney S. , Wise Nicolette E. , Jones-Harrell Carla , Lang Delia L.
Published: July 2023

Modern public health practice includes planning, implementation, and evaluation of programs targeting the structural and social determinants of health. To prepare graduate students to engage with theory in complex, practical, and innovative ways, a new model of course delivery was created to focus on developing and applying theorizing skills to the social ecological model. Throughout the semester, students engage in collaborative learning to apply theory to real-world public health interventions focused on high-profile public health issues. Data were gleaned from three course sections ( N = 80) using a pre-post study design to evaluate students’ ability to apply theory at various levels of the social ecological model and confidence to meet course objectives. The post-course survey also included questions about the helpfulness of specific course elements and asked for recommendations for improvement. Descriptive statistics were calculated and differences between pre- and post-ratings were tested with paired samples t-tests and Wilcoxon signed rank tests. Students improved in their ability to apply theory by the end of the semester ( p < .001) and in their confidence in meeting all learning objectives ( p < .001). Most students found that this new format of engaging with theory in complex, applied, and innovative ways by working in teams, completing in-class activities, and open poster presentations beneficial. Engaging students in a new course format led to critical reflection about various levels of influence on health and enhanced students’ ability to apply theory at multiple levels of influence. Further refinement and course development will continue to facilitate developing theorizing skills.
Virtual Follow up After Distal Radius Fracture Surgery—Patient Experiences During the COVID-19 Pandemic
Authors: Arvidsson Linnea , Hägglund Benjamin , Petersson Lena , Arvidsson Eva , Tägil Magnus
Published: July 2023

The majority of patients with a distal radius fracture (DRF) are elderly, a group known to experience difficulties with new technology, partly due to a low level of digital literacy. At the beginning of the coronavirus disease 2019 pandemic, during the spring 2020, patients that underwent DRF surgery had regular follow-ups replaced by video calls from their surgeon and physiotherapist. Afterward, patients answered questionnaires regarding health and digital literacy and took part in semistructured interviews regarding the experience of the virtual follow-up. By systemic text condensation, 2 major categories were identified: (1) The video call—new, but surprisingly simple: All but 1 found it easier than expected, and (2) Video calls—the patient's choice: All but 1 patient preferred video calls to physical visits for follow-up. This is the first mixed methods study to assess patients’ experiences of digital follow-up after DRF surgery. This study indicates that digital follow-up was highly appreciated, even among patients with low levels of digital literacy. Digital technologies must be made suitable even for patients with inadequate levels of digital literacy.
What would other emergency stroke teams do? Using explainable machine learning to understand variation in thrombolysis practice
Authors: Pearn Kerry , Allen Michael , Laws Anna , Monks Thomas , Everson Richard , James Martin
Published: July 2023

Introduction:

The aim of this work was to understand between-hospital variation in thrombolysis use among emergency stroke admissions in England and Wales.

Patients:

A total of 88,928 patients who arrived at all 132 emergency stroke hospitals in England Wales within 4 h of stroke onset, from 2016 to 2018.

Methods:

Machine learning was applied to the Sentinel Stroke National Audit Programme (SSNAP) data set, to learn which patients in each hospital would likely receive thrombolysis. We used XGBoost machine learning models, coupled with a SHAP model for explainability; Shapley (SHAP) values, providing estimates of how patient features, and hospital identity, influence the odds of receiving thrombolysis.

Results:

Thrombolysis use in patients arriving within 4 h of known or estimated stroke onset ranged 7% -49% between hospitals. The odds of receiving thrombolysis reduced 9-fold over the first 120 min of arrival-to-scan time, varied 30-fold with stroke severity, reduced 3-fold with estimated rather than precise stroke onset time, fell 6-fold with increasing pre-stroke disability, fell 4-fold with onset during sleep, fell 5-fold with use of anticoagulants, fell 2-fold between 80 and 110 years of age, reduced 3-fold between 120 and 240 min of onset-to-arrival time and varied 13-fold between hospitals. The majority of between-hospital variance was explained by the hospital, rather than the differences in local patient populations.

Conclusions:

Using explainable machine learning, we identified that the majority of the between-hospital variation in thrombolysis use in England and Wales may be explained by differences in in-hospital processes and differences in attitudes to judging suitability for thrombolysis.
Republication of “Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes”
Authors: Chan K. B. , Yeung Raymond
Published: July 2023

Background:

Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients’ clinical outcomes could be achieved with this technique.

Methods:

We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively.

Results:

The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively ( P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees ( P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) ( P < .05).

Conclusions:

Satisfactory hallux valgus deformity correction and patients’ outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy.

Level of Evidence:

Level IV, case series study.
The lived experiences of metal hypersensitivity
Authors: Dordunoo Dzifa , Doane Gweneth , Carey Jett , Lagura Jell Adrienne , Mallidou Anastasia , van der Merwe Jans , Schroeder Scott
Published: July 2023

Background

Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients’ experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions.

Methods

This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis.

Results

The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed.

Conclusion

Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and additional strategies are needed to mitigate this issue in the health system.
The effect of clinical risk management training on patient safety competency and related aspects in nursing students
Authors: Padash Mahnaz , Miri Sakineh , Azizzadeh Forouzi Mansooreh , Jouparinejad Somayeh , Farokhzadian Jamileh
Published: July 2023

Background

Students’ exposure to clinical risk management during their studentships can improve their safety competency, comfort speaking up about patient safety, and attitudes toward patient safety education. This study aimed to determine the effect of clinical risk management training on nursing students’ patient safety competency, attitudes toward broader aspects of patient safety in professional education, and comfort in speaking up about patient safety.

Methods

This experimental study used stratified sampling to assign 56 nursing students to intervention and control groups (28 students in each group). The intervention group received clinical risk management training in three three-hour sessions. The Health Professional Education in Patient Safety Survey was used to collect data from both groups before and one month after the intervention.

Results

The study found no statistically significant difference in patient safety competency and its subscales between the intervention and control groups in the pretest stage, but these competencies increased significantly in the intervention group in the post-test stage compared to the control group. The mean scores of attitudes toward broader aspects of patient safety in professional education and comfort speaking up about patient safety did not differ significantly between the intervention and control groups in the pre-test stage, but they increased significantly in the intervention group in the post-test stage compared with the control group.

Conclusion

It is recommended that clinical risk management and patient safety training be applied to the nursing curriculum so that nursing students become competent to provide safe care in clinical settings.
Multimodal methods for managing deontic rights in interdisciplinary trials
Authors: Nicolaisen Emilie Munch , Rasmussen Gitte
Published: July 2023

This paper focuses on interdisciplinary trials as a multiparty and multiactivity setting in which different professions are needed for students with mobility disabilities to try out robot-assisted gait training. Through an ethnomethodological and conversation analytic approach to multimodal interaction analysis, we investigate how a research team collaborates with the employees at a sports high school to get students who are wheelchair users to walk. The paper provides an analysis of the professionals’ employment of multimodal resources for managing deontic rights when organizing interdisciplinary trials. It examines how the professionals initiate and negotiate their own and others’ actions necessary for preparing the student for walking. Based on video recordings, the paper focuses on the professionals’ deontic claims concerning co-participants’ actions and analyzes their temporal and spatial contingencies. Building on prior research on deontics, this paper contributes to our understanding of the interactive accomplishment of deontic authority and its sensitivity to contextual features.
Speech Analysis of Patients with Cleft Palate Using Artificial Intelligence Techniques: A Systematic Review
Authors: Zhang Andi , Pyon Rachel E. , Chen Kevin , Lin Alexander Y.
Published: July 2023

Introduction:

This systematic review examines the use of machine learning (ML) algorithms to detect hypernasal speech in patients with cleft palate (CP), which can persist after primary repair surgery, and require revision. Due to a shortage of speech language pathologists (SLPs), automated detection tools could help improve access to care in underserved areas. The study compares the characteristics and accuracy of different types of machine learning algorithms.

Methods:

On August 18, 2021, searches were conducted across 8 databases: PubMed, SCOPUS, Cochrane, IEEE, ACM, L&LB, PsychInfo, and CINAHL. Search terms used were: (Artificial Intelligence OR Machine Learning OR Neural networks AND Cleft lip OR Cleft palate OR Hypernasality OR Velopharyngeal Insufficiency). To be included, papers needed to describe ML algorithms for CP speech detection and report concordance to human professional speech clinicians.

Results:

Database searches yielded 135 unique articles. Five articles met full inclusion criteria and 3 additional articles were identified by hand searching references of articles that passed initial screening. These algorithms were categorized as either Feature Dependent non-Deep learning (n = 5) or Feature Dependent deep learning (n = 2) algorithms or Feature Independent deep learning (n = 3) algorithms. Their pooled average concordance were 0.85, 0.93, and 0.91 respectively. Their average training database sizes were 3587, 3921, and 6306 speech samples respectively.

Conclusion:

Machine learning algorithms have been shown to be an effective tool for the evaluation of hypernasal speech. This systematic review has shown that ML algorithms are able to detect hypernasality with high concordance, consistent with professional speech language clinicians in a rapid, and autonomous manner. ML algorithms can extend the reach of speech language pathologists and complement their gold standard, this long-term outcome monitoring has great potential to improve treatment outcomes.
Mobile X-ray services in nursing homes as an enabler to healthcare-in-place for residents: informal carers’ views
Authors: Dollard Joanne , Edwards Jane , Yadav Lalit , Gaget Virginie , Tivey David , Maddern Guy J. , Visvanathan Renuka
Published: July 2023

Background

Informal carers (ICs) of residents living in nursing homes (NH) have a key role in the care of residents, including making decisions about and providing care. As radiology has a role in decision making about care, it is important to understand IC’s perspectives about resident’s use of mobile X-ray services (MXS). The aim was to explore the perspectives of ICs of residents living in nursing homes about the use of MXS.

Methods

From November 2020 to February 2021, twenty ICs of residents living in four nursing homes in different areas of one Australian city participated. Their perspectives of MXS, including benefits and barriers, were explored in semi-structured interviews. Data were analysed using thematic analysis.

Results

ICs were resident’s children (80%) and spouses (20%). One resident had received a MXS. Four themes were developed: (1) a priority for resident well-being, where ICs were positive about using MXS, because residents could receive healthcare without transfer; (2) MXS could reduce carer burden; (3) economic considerations, where MXS could reduce health system burden but the MXS call-out fee could result in health inequities; and (4) pathways to translation, including the need to improve consumer awareness of MXS, ensure effective processes to using MXS,, consider nursing home staff levels to manage MXS and ICs expectations about quality and availability of MXS.

Conclusions

ICs consider MXS can benefit resident well-being by potentially reducing transfers to hospital or radiology facilities and advocated equitable access. ICs cautioned that the quality and safety of healthcare delivered in nursing homes should equal what they would receive in hospitals.
Affirming educational and workplace settings are associated with positive mental health and happiness outcomes for LGBTQA + youth in Australia
Authors: Amos Natalie , Hill Adam O. , Jones Jami , Melendez-Torres G. J. , Carman Marina , Lyons Anthony , Bourne Adam
Published: July 2023

Background

Affirming socio-cultural settings are essential for protecting the mental health and wellbeing of lesbian, bisexual or pansexual, trans and gender diverse, asexual and queer (LGBTQA +) youth. However, limited research has explored the role of affirming educational and workplace settings, as reported by LGBTQA + youth themselves, with respect to their mental health and wellbeing. Moreover, existing research maintains a focus on mitigating poor mental health outcomes, with little attention to positive wellbeing outcomes among LGBTQA + youth.

Methods

Using data from the largest national survey of LGBTQA + youth aged 14–21 in Australia, multivariable regression analyses were conducted to explore associations between affirming educational and workplace settings and psychological distress and subjective wellbeing among 4,331 cisgender and 1,537 trans and gender diverse youth. Additionally, a series of multivariable regression analyses were conducted to explore individual sociodemographic traits that are associated with reporting affirming educational or workplace settings.

Results

Both cisgender and trans or gender diverse participants who reported that their education institution or workplace were affirming of their LGBTQA + identity reported lower levels of psychological distress as well as higher levels of subjective happiness. Additionally, affirming environments were not experienced equally across all subsections of LGBTQA + youth, with reporting of an affirming educational or workplace setting differing most noticeably across gender, type of educational institution and residential location.

Conclusion

The findings demonstrate that affirming educational and workplace settings can result not only in better mental health, but also greater levels of subjective happiness among LGBTQA + youth. The outcomes illustrate the importance of ensuring all LGBTQA + youth are afforded the opportunity to thrive in environments where they feel validated and confident to express their identities. The findings further highlight a need to target education institutions and workplaces to ensure the implementation of policies and practices that promote not just inclusion of LGBTQA + youth but affirmation of their identities.
Gallic acid and metformin co-administration reduce oxidative stress, apoptosis and inflammation via Fas/caspase-3 and NF-κB signaling pathways in thioacetamide-induced acute hepatic encephalopathy in rats
Authors: Mohamed Ehsan Khedre , Hafez Dawlat Mohamed
Published: July 2023

Background

Hepatic encephalopathy (HE) is a consequence of chronic or acute liver diseases. This study evaluates the combined effect of gallic acid (GA), and metformin (Met) on the liver and brain damage associated with HE.

Methods

Acute HE was induced by a single dose of thioacetamide (TAA) (300 mg/kg) as an I.P. injection. Treated groups received GA group (100 mg/kg/day,p.o), Met (200 mg/kg/day,p.o), or their combination for 25 consecutive days before TAA injection.

Results

The administration of TAA induced various biochemical and histopathological alterations. In contrast, treatment with GA either alone or combined with Met resulted in improved liver functions by the significant reduction in serum ALT, AST, and ALP activities, and ammonia levels. Inflammatory mediators; TNF-α, IL-6, and NFkβ levels were decreased by these treatments as well as apoptotic cascade via down-regulation of FAS and caspase-3 (CASP-3) expression in hepatic tissues. Furthermore, GA and Met either alone or combined protected the liver and brain tissues from damage by increased glutathione concentration while decreasing malondialdehyde. In addition, it was accompanied by the improvement of the brain neurotransmitter profile via the restoration of norepinephrine, dopamine, and serotonin levels. Based on our data, this is the first study to report a novel combined hepatoprotective and cognitive enhancing effect of GA and Met against TAA-induced acute liver and brain injury.

Conclusion

GA and Met combination resulted in a prominent improvement in HE complications, relative to monotherapy. Both agents potentiated the antioxidant, anti-inflammatory, and anti-apoptotic effects of each other.
Optimizing expression of Nanobody® molecules in Pichia pastoris through co-expression of auxiliary proteins under methanol and methanol-free conditions
Authors: De Groeve Manu , Laukens Bram , Schotte Peter
Published: July 2023

Background

Ablynx NV, a subsidiary of Sanofi, has a long-standing focus on the development of Nanobody® molecules as biopharmaceuticals (Nanobody® is a registered trademark of Ablynx NV). Nanobody molecules are single variable domains, and they have been met with great success part due to their favorable expression properties in several microbial systems. Nevertheless, the search for the host of the future is an ongoing and challenging process. Komagataella phaffi (Pichia pastoris) is one of the most suitable organisms to produce Nanobody molecules. In addition, genetic engineering of Pichia is easy and an effective approach to improve titers.

Results

Here we report that P. pastoris engineered to co-express genes encoding four auxiliary proteins (HAC1, KAR2, PDI and RPP0), leads to a marked improvement in the expression of Nanobody molecules using the AOX1 methanol induction system. Titer improvement is mainly attributed to HAC1, and its beneficial effect was also observed in a methanol-free expression system.

Conclusion

Our findings are based on over a thousand fed-batch fermentations and offer a valuable guide to produce Nanobody molecules in P. pastoris. The presented differences in expressability between types of Nanobody molecules will be helpful for researchers to select both the type of Nanobody molecule and Pichia strain and may stimulate further the development of a more ecological methanol-free expression platform.
Association between dietary inflammatory index and infertility of women; Results from RaNCD Cohort Study
Authors: Moludi Jalal , Kamari Negin , Darbandi Mitra , Mostafaei Shayan , Moradi Shima , Pasdar Yahya , Najafi Farid , Navabi Jafar , Saber Amir
Published: July 2023

Background

In recent decades, more and more attention has been paid to the influence of nutrition on reproductive health. Nevertheless, the imminent association between diet-related inflammation and the risk of infertility has not yet been established. The aim of the current study was to investigate the ability of the Dietary Inflammatory Index (DII) to estimate infertility incidence in women.

Methods

This cross-sectional study was conducted using data from Ravansar non-communicable diseases (RaNCD) cohort study on 4437 participants. The DII was calculated based on the reported consumption of up to 31 food parameters measured via a validated and reproducible 118-item food-frequency questionnaire (FFQ). Multiple logistic regression analysis was applied to estimate the multivariable odds ratio (OR) adjusted for potential confounding variables.

Results

Out of all participants, 411 women (9.26%) were infertile. The mean ± SD age and weight of infertile women were 43.67 ± 7.47 years and 72.86 ± 13.02 kg, respectively. Statistical analyses showed the odds ratio of infertility in the fourth quartile (pro-inflammatory diet) was 1.76 times higher than in the first quartile (anti-inflammatory diet) of DII (95% CI: 1.57–2.02).

Conclusions

The findings of this study provide compelling evidence about the association between infertility and the quality of diet in women. Therefore, interventions and programs aimed at promoting a healthy lifestyle and using healthy diets can be considered as one of the effective approaches in the prevention and treatment of infertility in women.
Vulnerability of migrant women during disasters: a scoping review of the literature
Authors: Trentin Monica , Rubini Elena , Bahattab Awsan , Loddo Mariarosa , Della Corte Francesco , Ragazzoni Luca , Valente Martina
Published: July 2023

Background

Disasters have an unequal impact on the population because of differences in conditions of vulnerability, exposure, and capacity. Migrants and women are among the groups that are at greater risk for and disproportionately affected by disasters. However, despite the large body of evidence that analyzes their vulnerability separately, disaster research that targets migrant women is scant. The aim of this scoping review was to analyze the published scientific literature concerning the vulnerability of migrant women and the consequent negative impact they experience during disasters.

Methods

A literature search was conducted on December 15th, 2021 on Pubmed, Scopus, and Web of Science databases. No time filter was applied to the search. Information regarding the article’s main characteristics and design, migrant women and their migration experience, as well as about the type of disaster was collected. The factors responsible for the vulnerability of migrant women and the negative outcomes experienced during a disaster were extracted and inductively clustered in main themes reflecting several vulnerability pathways. The review followed the Joanna Briggs Institute methodology for scoping reviews and relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Results

After full text review, 14 articles met the inclusion criteria. All of them adopted a qualitative methodology and focused on COVID-19. The pandemic negatively affected migrant women, by triggering numerous drivers that increased their level of exposure and vulnerability. Overall, six vulnerability factors have been identified: legal status, poverty conditions, pre-existing health conditions, limited agency, gender inequality and language and cultural barriers. These resulted in nine impacts: worsening of mental health status, poor access to care, worsening of physical health conditions, fraud, exacerbation of poverty, gender-based violence, jeopardization of educational path, and unfulfillment of their religious needs.

Conclusions

This review provided an analysis of the vulnerability factors of migrant women and the pathways leading to negative outcomes during a disaster. Overall, the COVID-19 pandemic demonstrated that health equity is a goal that is still far to reach. The post-pandemic era should constitute the momentum for thoroughly addressing the social determinants of health that systematically marginalize the most vulnerable groups.
Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study
Authors: Kota Komlan , Chomienne Marie-Hélène , Geneau Robert , Yaya Sanni
Published: July 2023

Background

Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15–49 years.

Methods

This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15–49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16.

Results

Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services.

Conclusions

Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women’s economic empowerment and education to reduce the barriers.
Circ-NFKB1 sponges miR-203a-5p to regulate ERBB4 expression and promotes IL-1β induced chondrocytes apoptosis
Authors: Wang Zhao , Bao Hongwei , Hou Jingzhao , Ju Bin , Ji Yong
Published: July 2023

Background

Osteoarthritis (OA) is a chronic disease of the bones and joints that commonly affects middle-aged and elderly individuals, characterized by the degeneration of articular cartilage and inflammation of the joints. The molecular mechanisms of OA urgently need to be further examined. Our study intended to uncover circ-NFKB1/miR-203a-5p/ERBB4 axis in regulating interleukin-1β (IL-1β) induced chondrocytes apoptosis.

Methods

GSE178724, GSE79258 and GSE169077 were downloaded from Gene Expression Omibus (GEO) database and differentially expressed circRNAs, miRNAs and mRNAs were obtained by R software. Annexin V assay was used to determine cell apoptosis rate. ELISA was further performed to identify the inflammation response. Dual-luciferase reporter gene assay was conducted to examine the combination among circ-NFKB1, miR-203a-5p and ERBB4.

Results

Our research demonstrated that circ-NFKB1 and ERBB4 were significantly upregulated through bioinformatic analysis. MiR-203a-5p was significantly downregulated through bioinformatic analysis. Silencing of circ-NFKB1 notably inhibited the IL-1β induced chondrocytes apoptosis and upregulated ERBB4 expression. Through prediction on bioinformatics analysis, miR-203a-5p was the target binding circ-NFKB1, and ERBB4 was the potential target of miR-203a-5p. Subsequently, these changes induced by the silencing of circ-NFKB1 were reversed upon addition of pcDNA/ERBB4.

Conclusions

Silencing circ-NFKB1 could sponge miR-203a-5p to regulate ERBB4 expression and alleviate OA progression.
Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia
Authors: Gossip Kate , Pagliaro Claudia , Comben Charlotte , Fjeldsoe Kevin , Whiteford Harvey , Diminic Sandra
Published: July 2023

Background

The aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State.

Methods

The activity and capacity of Tasmania’s 2018–19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development.

Results

Bed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services.

Conclusions

This study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.
Metabolism, metabolites, and macrophages in cancer
Authors: Li Mengyuan , Yang Yuhan , Xiong Liting , Jiang Ping , Wang Junjie , Li Chunxiao
Published: July 2023

Tumour-associated macrophages (TAMs) are crucial components of the tumour microenvironment and play a significant role in tumour development and drug resistance by creating an immunosuppressive microenvironment. Macrophages are essential components of both the innate and adaptive immune systems and contribute to pathogen resistance and the regulation of organism homeostasis. Macrophage function and polarization are closely linked to altered metabolism. Generally, M1 macrophages rely primarily on aerobic glycolysis, whereas M2 macrophages depend on oxidative metabolism. Metabolic studies have revealed that the metabolic signature of TAMs and metabolites in the tumour microenvironment regulate the function and polarization of TAMs. However, the precise effects of metabolic reprogramming on tumours and TAMs remain incompletely understood. In this review, we discuss the impact of metabolic pathways on macrophage function and polarization as well as potential strategies for reprogramming macrophage metabolism in cancer treatment.
Liver metastasis from colorectal cancer: pathogenetic development, immune landscape of the tumour microenvironment and therapeutic approaches
Authors: Wang Yaxian , Zhong Xinyang , He Xuefeng , Hu Zijuan , Huang Huixia , Chen Jiayu , Chen Keji , Zhao Senlin , Wei Ping , Li Dawei
Published: July 2023

Colorectal cancer liver metastasis (CRLM) is one of the leading causes of death among patients with colorectal cancer (CRC). Although immunotherapy has demonstrated encouraging outcomes in CRC, its benefits are minimal in CRLM. The complex immune landscape of the hepatic tumour microenvironment is essential for the development of a premetastatic niche and for the colonisation and metastasis of CRC cells; thus, an in-depth understanding of these mechanisms can provide effective immunotherapeutic targets for CRLM. This review summarises recent studies on the immune landscape of the tumour microenvironment of CRLM and highlights therapeutic prospects for targeting the suppressive immune microenvironment of CRLM.
Kinetic coupling in distal foot joints during walking
Authors: Williams Lauren R. , Arch Elisa S. , Bruening Dustin A.
Published: July 2023

Background

Kinematic coupling between the first metatarsophalangeal (MTP) and midtarsal joints is evident during gait and other movement tasks, however kinetic foot coupling during walking has not been examined. Furthermore, contributing factors to foot coupling are still unclear. Therefore, the purpose of this study was to investigate kinematic and kinetic coupling within the foot by restricting MTP motion during overground walking. We hypothesized that when the MTP joint was prevented from fully extending, the midtarsal joint would achieve less peak motion and generate less positive work compared to walking with normal MTP motion.

Methods

Twenty‐six individuals participated in this randomized cross‐over study. Using motion capture to track motion, participants walked at 1.3 m/s while wearing a brace that restricted MTP motion in a neutral (BR_NT) or extended (BR_EX) position. Additionally, participants walked while wearing the brace in a freely moveable setting (BR_UN) and with no brace (CON). A pressure/shear sensing device was used to capture forces under each foot segment. During stance, peak joint motion and work were calculated for the MTP and midtarsal joints using inverse dynamics. A series of ANOVAs and Holm post hoc tests were performed for all metrics (alpha = 0.05).

Results

The brace successfully decreased peak MTP motion by 19% compared to BR_UN and CON. This was coupled with 9.8% less midtarsal motion. Kinetically, the work absorbed by the MTP joint (26–51%) and generated by the midtarsal joint (30–38%) were both less in BR_EX and BR_NT compared to BR_UN.

Conclusion

Implications and sources of coupling between the MTP and midtarsal joints are discussed within the context of center of pressure shifts and changes to segmental foot forces. Our results suggest that interventions aimed at modulating MTP negative work (such as footwear or assistive device design) should not ignore the midtarsal joint.
Statistical analysis plan for a cluster randomised trial in Madhya Pradesh, India: support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)
Authors: Keddie Suzanne , Fazzio Ila , Shivalli Siddharudha , Magill Nicholas , Elbourne Diana , Sharma Dropti , Shekhawat Sajjan Singh , Banerji Rukmini , Karnati Sridevi , Reddy Harshavardhan , Eble Alex , Boone Peter , Frost Chris
Published: July 2023

Background

India has made steady progress in improving rates of primary school enrolment but levels of learning achievement remain low. The Support To Rural India’s Public Education System (STRIPES) trial provided evidence that an after-school para-teacher intervention improved numeracy and literacy levels in Telangana, India. The STRIPES2 trial investigates whether such an intervention will have a similar effect on the literacy and numeracy of primary school age children in the Satna District of Madhya Pradesh, India.

Methods/design

The STRIPES2 trial forms one part of a cluster-randomised controlled trial with villages (clusters) randomised to receive either a health (CHAMPION2) or education (STRIPES2) intervention. Building on the design of the earlier CHAMPION/STRIPES trial, villages receiving the health intervention are controls for the education intervention and vice versa. The primary outcome is a combined literacy and numeracy score. Secondary outcomes include separate scores for literacy and numeracy; caregivers’ engagement with child’s learning; expenditure on education; enrolment in school; caregiver’s report of school attendance and the cost effectiveness of the intervention. Over 7000 primary school age children have been recruited and randomised in STRIPES2.

Discussion

This update to the published trial protocol gives a detailed plan for the statistical analysis of the STRIPES 2 trial.

Trial registration

Registry of India: CTRI/2019/05/019296. Registered on 23 May 2019. http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=31198&EncHid=&modid=&compid=%27,%2731198det%27
Anal fistulotomy with one-stage shaped skin grafting for intersphincter anal fistulas: study protocol on a multicentre randomised controlled trial
Authors: Zhao Yongchang , Xie Wei , Wu Xiaoshuo , Li Xiaolan , Guo Jinyan , Cao Qiurui , Liang Jiadi , Chen Xin-lin , Zhao Wentao , Sun Feng , Li Hongjie , Luo Weimin , Li Yuying
Published: July 2023

Background

Anal fistulas are mainly treated via surgery. They can be difficult to treat without surgical intervention. Numerous procedures, such as fistulectomy and fistulotomy, are performed to treat anal fistulas and achieve good effects. However, the wounds created through fistulectomy and fistulotomy take a long time to heal. Therefore, a multicentre randomised controlled trial (RCT) is proposed to study the efficacy of one-stage shaped skin grafting at the surgical wound to heal low simple intersphincter anal fistulas.

Methods

This study is a multicentre, hospital-based RCT. It will be performed at three hospitals. A total of 104 patients with low simple intersphincter anal fistulas who meet the inclusion criteria will be included in this trial and will be allocated randomly to two groups (test and control groups). The patients in the test group will receive one-stage anal fistulotomy surgery combined with shaped skin grafting, and those in the control group will undergo anal fistulotomy only. All the operations will be performed by attending colorectal surgeons or surgeons of a higher level. Effectiveness and safety indicators will be observed, recorded and analysed.

Discussion

Anal fistulotomy can heal low simple intersphincter anal fistulas effectively and safely with a low recurrence rate. Skin grafts promote wound epithelisation significantly. We believe that skin grafting can treat low simple intersphincter fistulas with a short healing time.

Trial registration

Chinese Clinical Trial Register, ChiCTR2000039174. Registered on 28 October 2020.
Quantification of identifying cognitive impairment using olfactory-stimulated functional near-infrared spectroscopy with machine learning: a post hoc analysis of a diagnostic trial and validation of an external additional trial
Authors: Kim Jaewon , Lee Hayeon , Lee Jinseok , Rhee Sang Youl , Shin Jae Il , Lee Seung Won , Cho Wonyoung , Min Chanyang , Kwon Rosie , Kim Jae Gwan , Yon Dong Keon
Published: July 2023

Background

We aimed to quantify the identification of mild cognitive impairment and/or Alzheimer’s disease using olfactory-stimulated functional near-infrared spectroscopy using machine learning through a post hoc analysis of a previous diagnostic trial and an external additional trial.

Methods

We conducted two independent, patient-level, single-group, diagnostic interventional trials (original and additional trials) involving elderly volunteers (aged > 60 years) with suspected declining cognitive function. All volunteers were assessed by measuring the oxygenation difference in the orbitofrontal cortex using an open-label olfactory-stimulated functional near-infrared spectroscopy approach, medical interview, amyloid positron emission tomography, brain magnetic resonance imaging, Mini-Mental State Examination, and Seoul Neuropsychological Screening Battery.

Results

In total, 97 (original trial) and 36 (additional trial) elderly volunteers with suspected decline in cognitive function met the eligibility criteria. The statistical model reported classification accuracies of 87.3% in patients with mild cognitive impairment and Alzheimer’s disease in internal validation (original trial) but 63.9% in external validation (additional trial). The machine learning algorithm achieved 92.5% accuracy with the internal validation data and 82.5% accuracy with the external validation data. For the diagnosis of mild cognitive impairment, machine learning performed better than statistical methods with internal (86.0% versus 85.2%) and external validation data (85.4% versus 68.8%).

Interpretation

In two independent trials, machine learning models using olfactory-stimulated oxygenation differences in the orbitofrontal cortex were superior in diagnosing mild cognitive impairment and Alzheimer’s disease compared to classic statistical models. Our results suggest that the machine learning algorithm is stable across different patient groups and increases generalization and reproducibility.

Trial registration

Clinical Research Information Service (CRiS) of Republic of Korea; CRIS numbers, KCT0006197 and KCT0007589.

Graphical Abstract
Explaining compound activity predictions with a substructure-aware loss for graph neural networks
Authors: Amara Kenza , Rodríguez-Pérez Raquel , Jiménez-Luna José
Published: July 2023

Explainable machine learning is increasingly used in drug discovery to help rationalize compound property predictions. Feature attribution techniques are popular choices to identify which molecular substructures are responsible for a predicted property change. However, established molecular feature attribution methods have so far displayed low performance for popular deep learning algorithms such as graph neural networks (GNNs), especially when compared with simpler modeling alternatives such as random forests coupled with atom masking. To mitigate this problem, a modification of the regression objective for GNNs is proposed to specifically account for common core structures between pairs of molecules. The presented approach shows higher accuracy on a recently-proposed explainability benchmark. This methodology has the potential to assist with model explainability in drug discovery pipelines, particularly in lead optimization efforts where specific chemical series are investigated.