bluuebunny/crossref_metadata_2025 huggingface dataset:
Logical coupling and paradigm shift of regional cultures in terms of “the belt and road initiative” —— A case study of lingnan culture
Authors: Xinhong Wang , Dingju Zhu , Yingxi Mo
Published: November 2023

Regional culture plays an important role in the dissemination of culture along “the Belt and Road Initiative”, and through the efficient application, layout and flow of cultural resources, it can achieve industrial and economic efficiency. Cultural exchanges and interflow are raised and recommended by “the Belt and Road Initiative”. From the three dimensions of history, reality and development, the paradigm shift of regional culture in the context of “the Belt and Road Initiative”cultural development must be based on a historical and developmental perspective, with heritage and innovation as the body, and contemporary values to reflect on the problems in cultural development, so as to achieve the integration of unity and pluralism, and to provide a strong impetus for the cultural development of “the Belt and Road Initiative”.
Leadership in Canadian and French high security prisons expectations and perceptions
Authors: Herzog-Evans Martine , Ricciardelli Rosemary , Thomas Jérôme
Published: November 2023

The literature has yet to study the ideal type of prison leadership in the eyes of frontline staff. Methodologically, most studies draw upon written questionnaires distributed to governors, not to their staff and analyse their data without using management or human needs theories. This study contrasts with the extant literature inasmuch as it is comparative (France/Canada) and draws upon Appreciative Inquiry interviews. It also draws upon three strands of literature and their variables: the general theory of management, self-determination theory and legitimacy of justice-procedural justice theories. The study finds that French and Canadian prison officers have needs in areas uncovered in this literature: competence, relatedness, autonomy, general fairness, respect/dignity and care. Our samples have mixed feelings about their local hierarchy; they are very critical regarding their national hierarchies. Prison officers describe their managers as being essentially either laissez-faire or as transactional. Limitations and institutional policy implications are explored.
Predictors of 10-year Mortality After Hip Fracture Surgery in a Pre-Pandemic Cohort
Authors: Loh Bryan , Jiang Lei , Timing Liu , Kong Naomi , Ganesan Ganga , Tan Kelvin Bryan , Bee Suang , Koh Joyce Suang Bee , Howe Tet Sen , Huei Ng Yeong
Published: November 2023

Introduction

Though hip fractures are associated with significant mortality and morbidity, increasing life expectancy in developed countries necessitates an analysis of mortality trends and factors predicting long term survival. The aim of this study is to identify the predictors of 10-year mortality as well as assess the correlation of Age-adjusted Charlson comorbidity index (ACCI) with 10-year mortality in a surgically treated Asian geriatric hip fracture population.

Materials and Methods

From January 1, 2007 to December 31, 2009, 766 patients who underwent surgery for hip fracture with a minimum follow up of 10-years were recruited to the study (92% follow-up rate). A review of the patient’s electronic hospital records was performed to glean the following data: patient demographics, pre-existing comorbidities, operation duration, length of stay, fracture configuration, as well as mortality data up to 10 years. CCI scores and individual co-morbidities were correlated with inpatient, 30-day, 1-year, 5-year and beyond 10-year mortality.

Results

Of the 766 patients, the mortality rate for 30-day, 1-year, 5-year and 10-years was 2.9%, 12.0%, 38.9% and 61.6% respectively. The average ACCI was 5.31. The 10-year mortality for patients with ACCI ≤ 3, ACCI 4-5 and ACCI ≥ 6 are 29.4%, 57.4% and 77.5% respectively. End-Stage-Renal Failure (ESRF), liver failure and COPD were dominant predictors of mortality at 10 years, whereas cancer was the predominant predictor at 1 year.

Discussion

ACCI significantly correlates with the 10-year mortality after surgically treated hip fractures with a shift of the dominant predictors from cancer to ESRF and COPD. This could inform future health policy and resource planning. This data also represents recently available pre-pandemic survival trends after hip fracture surgery and serves as a baseline for post-pandemic outcome surveillance of interventions for fragility fractures.

Conclusion

This study demonstrates that ACCI correlated with 10-year mortality after surgical treatment of hip fractures.
Does Private Information Always Hurt Retail Investors? The Impact of Private Information on Cost of Equity: Moderating Role of Investment Adjustment
Authors: Saleem Sana , Usman Muhammad , Akhtar Muhammad Naveed
Published: November 2023

Private information puts naïve traders at a significant trading disadvantage and at the same it provide crucial signals managers for investment adjustment. These two forces have opposing effects on the cost of equity, and the overall effect is determined by which force dominates. For clinching this effect, this study finds out how investment adjustment plays the moderating role between private information and COE. The study employs data of non-financial firms listed on PSX from 2008 to 2019. Further, the study employs a two-step system GMM dynamic panel estimator to analyze the data. The findings of the study show that companies with a low investment adjustment flexibility known as “value firms” do not gain as much from information incorporated in market prices compared to firms having high flexibility in adjusting investment “growth firms.” This study adds to the literature by revealing unique insight on the effect of investment adjustment in reducing the influence of private information on COE and corporate investment as well.

JEL classification: D82, G14, G410.
Online Retailers’ Perceived Ethics and Consumer Repetitive Purchases Under the Moderating Role of Reputation: A Commitment-Trust Theory Perspective
Authors: Ghali-Zinoubi Zohra
Published: November 2023

In a highly competitive market, online stores are requested to identify key factors to implement customers’ trust and commitment, which are vital determinants of high-quality relationships. As online transactions are witnessing increasing risks of cybercrimes and abuse incidents, offering ethical online services has become crucial in building robust and sustainable relationships with customers. The current study has been conducted in this context and its objective is twofold: on the one hand, it aims at understanding the effects of online retailers’ perceived ethics on e-trust and e-commitment, which in turn predict repetitive purchases, and on the other hand, it seeks to test the moderator role of reputation in the relationship between e-trust, e-commitment, and repetitive purchases. The Structural Equation Modeling (SEM) method was employed to analyze the data collected from a web survey conducted in Saudi Arabia involving 328 online shoppers. The results showed that all ethical dimensions influence e-trust and e-commitment in a significant way, hence predicting repetitive purchases from the same e-service platforms. The reputation of online retailers also plays a significant moderator role in the relationships between e-trust and repetitive purchases, as well as between e-commitment and repetitive purchases. This study is interesting for three main reasons. First, it is the earliest of its kind to assess online retailers’ ethical practices through seven dimensions in the context of the business-to-consumer (B2C) market. Second, it constitutes a further extension of the trust-commitment theory by testing the moderating role of online retailer reputation. Third, the findings provide relevant managerial implications for online retailers to enhance the loyalty of their consumers based on their ethical practices.
Nurses’ Psychological Trauma and Cognitive Control in the COVID-19 Pandemic
Authors: Yu-Chin Chiu , Forster Anna K. , Zhang Lingsong , Foli Karen J.
Published: November 2023

Introduction

During the COVID-19 pandemic, nurses have faced various nurse-specific traumas in their workplaces, but there is limited understanding of the resulting outcomes and factors that contribute to them.

Objective

To address this gap, the study employed the middle-range theory of nurses’ psychological trauma (NPT) to examine these relationships among frontline nurses working in critical care areas.

Methods

In a quantitative cross-sectional study, the study compared nurses identified as probable cases of posttraumatic stress disorder (PTSD) with those identified as not probable cases. The study investigated the nurse-specific traumas they experienced, their individual personality traits, and the buffers they possessed. The study also sought to identify specific types of nurse-specific traumas that could be associated with negative outcomes, such as alcohol and drug use.

Results

It was found that PTSD-probable nurses reported higher levels of trauma from disasters and system/medically induced trauma compared to not-probable nurses. They also experienced more nonwork-related humankind traumas and displayed lower resilience. Furthermore, PTSD-probable nurses identified with trait urgency and trait avoidance motivation. Additionally, trauma from disasters was associated with alcohol use.

Conclusion

The study highlights the elevated levels of trauma, lower resilience, and specific psychological traits associated with PTSD-probable nurses, emphasizing the need for targeted interventions and support to mitigate the negative outcomes experienced by frontline nurses.
From Private Practice to Academia: The Experience of a General Academic Pediatrician
Authors: Kum-Nji Philip
Published: November 2023

After pediatric residency, the author worked in a rural community where he was able to immediately practice skills acquired during training such as intubations, bag-mask ventilation, IV placement, ear irrigation, foreign body removal from eyes and ears, abscess incision and drainage, intraosseous placement for rapid hydration of a severely dehydrated infant, EKG, X-ray readings, and ear-irrigations to cite but a few examples. Furthermore, the writer acquired other high-valued procedural skills such as neonatal male circumcision, frenotomy, ligation of supernumerary digits, and manual separation of labial adhesions. The author feels that he could only have acquired and maintained these skills by working in a busy rural pediatric practice. When the writer later became a faculty member, he was able to effectively train medical students and pediatric residents to acquire these same skills. Even though there is a paucity of research information on procedural skills acquisition among general pediatric residents, the writer proposes that the recruitment of full-time general academic pediatricians with real-world experience may be potentially beneficial for the training of medical students and pediatric residents.
Ibrutinib and venetoclax as primary therapy in symptomatic, treatment-naïve Waldenström macroglobulinemia
Authors: Castillo Jorge J. , Branagan Andrew R. , Sermer David , Flynn Catherine A. , Meid Kirsten , Little Megan , Stockman Katherine , White Timothy , Canning Alexa , Guerrera Maria L. , Kofides Amanda , Liu Shirong , Liu Xia , Richardson Kris , Tsakmaklis Nicholas , Patterson Christopher J. , Hunter Zachary R. , Treon Steven P. , Sarosiek Shayna
Published: November 2023

Concurrent Bruton tyrosine kinase and BCL2 inhibition has not yet been investigated in Waldenström macroglobulinemia (WM). We performed an investigator-initiated trial of ibrutinib and venetoclax in symptomatic treatment-naïve patients with MYD88-mutated WM. Patients received ibrutinib 420 mg once daily (cycle 1), followed by a ramp-up of venetoclax to 400 mg daily (cycle 2). The combination was then administered for 22 additional 4-week cycles. The attainment of very good partial response (VGPR) was the primary end point. Forty-five patients were enrolled in this study. The median baseline characteristics were as follows: age 67 years, serum IgM 43 g/L, and hemoglobin 102 g/L. Seventeen patients (38%) carried CXCR4 mutations. Nineteen patients (42%) achieved VGPR. Grade 3 or higher adverse events included neutropenia (38%), mucositis (9%), and tumor lysis syndrome (7%). Atrial fibrillation occurred in 3 (9%), and ventricular arrhythmia in 4 (9%) patients that included 2 grade 5 events. With a median follow-up of 24.4 months, the 24-month progression-free survival (PFS) and overall survival (OS) rates were 76% and 96%, respectively, and were not impacted by CXCR4 mutations. The median time on therapy was 10.2 months, and the median time after the end of therapy (EOT) was 13.3 months. Eleven of the 12 progression events occurred after EOT, and the 12-month PFS rates after EOT were 79%; 93% if VGPR was attained, and 69% for other patients (P = .12). Ibrutinib and venetoclax induced high VGPR rates and durable responses after EOT, although they were associated with a higher-than-expected rate of ventricular arrhythmia in patients with WM, leading to early study treatment termination. This trial was registered at www.clinicaltrials.gov as #NCT04273139.
Bronchodilator responsiveness in children with primary ciliary dyskinesia
Authors: Seidl Elias , Gatt Dvir , Wee Wallace B. , Wilson David , Ratjen Felix , Grasemann Hartmut
Published: November 2023

Background

Reversible airway obstruction is common in children with primary ciliary dyskinesia. However, the diagnostic value of adding bronchodilator (BD) response testing to routine spirometry is unclear.

Methods

This is a retrospective analysis of pulmonary function test results obtained from children with primary ciliary dyskinesia seen as outpatients at the Hospital for Sick Children, Toronto. Spirometry results were collected for every appointment with BD response testing (“Visit”, with pre-BD and post-BD measurements) as well as for the previous (“Baseline”) and following (“Follow-up”) encounters.

Results

A positive BD response was seen in 86 out of 474 (18.1%) of the pulmonary function tests from 82 children with primary ciliary dyskinesia. BD responsiveness was associated with a significant absolute change (±sd) in % predicted forced expiratory volume in 1 s (FEV1) from Baseline to Visit pre-BD (−6.5±10.3%, p<0.001), but not from Baseline to Follow-up (0.4±10.8, p=0.757). Antimicrobial therapy was initiated more commonly following a Visit with a positive BD response (OR 3.8, 95% CI 2.2–6.6) compared to no BD response. Children with a positive BD response had a greater annual decline in FEV1% predicted compared to those with no BD response (−0.9% per yearversus−0.5% per year, p<0.001). The annual decline in FEV1% predicted was greater in children with multiple compared to one measured positive BD responses (−1.3% per yearversus−0.6% per year, p<0.001) and in those not treated with antibiotic therapy following a positive BD response compared to those treated with antibiotics (−1.1%versus−0.6%, p<0.001).

Conclusion

A positive BD response in children with primary ciliary dyskinesia may help identify those at risk for accelerated lung disease progression.
Consensus goals and standards for specialist cough clinics: the NEUROCOUGH international Delphi study
Authors: Song Woo-Jung , Dupont Lieven , Birring Surinder S. , Chung Kian Fan , Dąbrowska Marta , Dicpinigaitis Peter , Ribas Christian Domingo , Fontana Giovanni , Gibson Peter G. , Guilleminault Laurent , Hull James H. , Idzko Marco , Kardos Peter , Kim Hyun Jung , Lai Kefang , Lavorini Federico , Millqvist Eva , Morice Alyn H. , Niimi Akio , Parker Sean M. , Satia Imran , Smith Jaclyn A. , van den Berg Jan Willem , McGarvey Lorcan P.
Published: November 2023

Background

Current guidelines on the management of chronic cough do not provide recommendations for the operation of specialist cough clinics. The objective of the present study was to develop expert consensus on goals and standard procedures for specialist cough clinics.

Methods

We undertook a modified Delphi process, whereby initial statements proposed by experts were categorised and presented back to panellists over two ranking rounds using an 11-point Likert scale to identify consensus.

Results

An international panel of 57 experts from 19 countries participated, with consensus reached on 15 out of 16 statements, covering the aims, roles and standard procedures of specialist cough clinics. Panellists agreed that specialist cough clinics offer optimal care for patients with chronic cough. They also agreed that history taking should enquire as to cough triggers, cough severity rating scales should be routinely used, and a minimum of chest radiography, spirometry and measurements of type 2 inflammatory markers should be undertaken in newly referred patients. The importance of specialist cough clinics in promoting clinical research and cough specialty training was acknowledged. Variability in healthcare resources and clinical needs between geographical regions was noted.

Conclusions

The Delphi exercise provides a platform and guidance for both established cough clinics and those in planning stages.
Unlocking gut microbiota potential of dairy cows in varied environmental conditions using shotgun metagenomic approach
Authors: Khan Faheem Ahmed , Pandupuspitasari Nuruliarizki Shinta , Huang Chunjie , Negara Windu , Ahmed Bilal , Putri Ezi Masdia , Lestari Puji , Priyatno Tri Puji , Prima Ari , Restitrisnani Vita , Surachman Maman , Akhadiarto Sindu , Darmawan I Wayan Angga , Wahyuni Dimar Sari , Herdis Herdis
Published: November 2023

Food security and environmental pollution are major concerns for the expanding world population, where farm animals are the largest source of dietary proteins and are responsible for producing anthropogenic gases, including methane, especially by cows. We sampled the fecal microbiomes of cows from varying environmental regions of Pakistan to determine the better-performing microbiomes for higher yields and lower methane emissions by applying the shotgun metagenomic approach. We selected managed dairy farms in the Chakwal, Salt Range, and Patoki regions of Pakistan, and also incorporated animals from local farmers. Milk yield and milk fat, and protein contents were measured and correlated with microbiome diversity and function. The average milk protein content from the Salt Range farms was 2.68%, with an average peak milk yield of 45 litters/head/day, compared to 3.68% in Patoki farms with an average peak milk yield of 18 litters/head/day. Salt-range dairy cows prefer S-adenosyl-L-methionine (SAMe) to S-adenosyl-L-homocysteine (SAH) conversion reactions and are responsible for low milk protein content. It is linked to Bacteroides fragilles which account for 10% of the total Bacteroides, compared to 3% in the Patoki region. The solid Non-Fat in the salt range was 8.29%, whereas that in patoki was 6.34%. Moreover, Lactobacillus plantarum high abundance in Salt Range provided propionate as alternate sink to [H], and overcoming a Methanobrevibacter ruminantium high methane emissions in the Salt Range. Furthermore, our results identified ruminant fecal microbiomes that can be used as fecal microbiota transplants (FMT) to high-methane emitters and low-performing herds to increase farm output and reduce the environmental damage caused by anthropogenic gases emitted by dairy cows.
Whole genome analysis of echinocandin non-susceptible Candida Glabrata clinical isolates: a multi-center study in China
Authors: Li Yi , Hou Xin , Li Ruoyu , Liao Kang , Ma Ling , Wang Xiaoming , Ji Ping , Kong Haishen , Xia Yun , Ding Hui , Kang Wei , Zhang Ge , Li Jin , Xiao Meng , Li Yingxing , Xu Yingchun
Published: November 2023

Background

Candida glabrata is an important cause of invasive candidiasis. Echinocandins are the first-line treatment of invasive candidiasis caused by C. glabrata. The epidemiological echinocandin sensitivity requires long-term surveillance and the understanding about whole genome characteristics of echinocandin non-susceptible isolates was limited.

Results

The present study investigated the echinocandin susceptibility of 1650 C. glabrata clinical isolates in China from August 2014 to July 2019. The in vitro activity of micafungin was significantly better than those of caspofungin and anidulafungin (P < 0.001), assessed by MIC50/90 values. Whole genome sequencing was conducted on non-susceptible isolates and geography-matched susceptible isolates. Thirteen isolates (0.79%) were resistant to at least one echinocandin. Six isolates (0.36%) were solely intermediate to caspofungin. Common evolutionary analysis of echinocandin-resistant and echinocandin-intermediate isolates revealed genes related with reduced caspofungin sensitivity, including previously identified sphinganine hydroxylase encoding gene SUR2. Genome-wide association study identified SNPs at subtelometric regions that were associated with echinocandin non-susceptibility. In-host evolution of echinocandin resistance of serial isolates revealed an enrichment for non-synonymous mutations in adhesins genes and loss of subtelometric regions containing adhesin genes.

Conclusions

The echinocandins are highly active against C. glabrata in China with a resistant rate of 0.79%. Echinocandin non-susceptible isolates carried common evolved genes which are related with reduced caspofungin sensitivity. In-host evolution of C. glabrata accompanied intensive changing of adhesins profile.
Assembly, annotation and analysis of the chloroplast genome of the Algarrobo tree Neltuma pallida (subfamily: Caesalpinioideae)
Authors: Caycho Esteban , La Torre Renato , Orjeda Gisella
Published: November 2023

Background

Neltuma pallida is a tree that grows in arid soils in northwestern Peru. As a predominant species of the Equatorial Dry Forest ecoregion, it holds significant economic and ecological value for both people and environment. Despite this, the species is severely threatened and there is a lack of genetic and genomic research, hindering the proposal of evidence-based conservation strategies.

Results

In this work, we conducted the assembly, annotation, analysis and comparison of the chloroplast genome of a N. pallida specimen with those of related species. The assembled chloroplast genome has a length of 162,381 bp with a typical quadripartite structure (LSC-IRA-SSC-IRB). The calculated GC content was 35.97%. However, this is variable between regions, with a higher GC content observed in the IRs. A total of 132 genes were annotated, of which 19 were duplicates and 22 contained at least one intron in their sequence. A substantial number of repetitive sequences of different types were identified in the assembled genome, predominantly tandem repeats (> 300). In particular, 142 microsatellites (SSR) markers were identified. The phylogenetic reconstruction showed that N. pallida grouped with the other Neltuma species and with Prosopis cineraria. The analysis of sequence divergence between the chloroplast genome sequences of N. pallida, N. juliflora, P. farcta and Strombocarpa tamarugo revealed a high degree of similarity.

Conclusions

The N. pallida chloroplast genome was found to be similar to those of closely related species. With a size of 162,831 bp, it had the classical chloroplast quadripartite structure and GC content of 35.97%. Most of the 132 identified genes were protein-coding genes. Additionally, over 800 repetitive sequences were identified, including 142 SSR markers. In the phylogenetic analysis, N. pallida grouped with other Neltuma spp. and P. cineraria. Furthermore, N. pallida chloroplast was highly conserved when compared with genomes of closely related species. These findings can be of great potential for further diversity studies and genetic improvement of N. pallida.
Prognostic value of platelet distribution width to lymphocyte ratio in patients with hepatocellular carcinoma following hepatectomy
Authors: Zhong Zhi-Han , Liang Lei , Fu Tian-Wei , Dai Mu-Gen , Cheng Jian , Liu Si-Yu , Ye Tai-Wei , Shen Guo-Liang , Zhang Cheng-Wu , Huang Dong-Sheng , Liu Jun-Wei
Published: November 2023

Background

Platelet distribution width (PDW), but not platelet count, was found to more comprehensively reflect platelet activity. The present study, thus, aimed to evaluate the prognostic value of PDW to lymphocyte ratio (PDWLR) in patients with hepatocellular carcinoma (HCC) following hepatectomy.

Methods

Patients following hepatectomy were analyzed retrospectively. The Kaplan-Meier survival curves and Cox regression model were used to determine the prognostic value of PDWLR.

Results

241 patients were analyzed eventually, and stratified into low and high PDWLR groups (≤ 9.66 vs. > 9.66). Results of comparing the baseline characteristics showed that high PDWLR was significantly associated with cirrhosis, and intraoperative blood loss (all P < 0.05). In multivariate COX regression analysis, PDWLR was demonstrated as an independent risk factor for OS (HR: 1.549, P = 0.041) and RFS (HR: 1.655, P = 0.005). Moreover, PDWLR demonstrated a superior capacity for predicting prognosis compared to other indicators.

Conclusion

Preoperative PDWLR has a potential value in predicting the prognosis of HCC patients following hepatectomy, which may help in clinical decision-making for individual treatment.
Study protocol for Ketamine as an adjunctive therapy for major depression (2): a randomised controlled trial (KARMA-Dep [2])
Authors: Jelovac Ana , McCaffrey Cathal , Terao Masashi , Shanahan Enda , Mohamed Enas , Whooley Emma , McDonagh Kelly , McDonogh Sarah , Igoe Anna , Loughran Orlaith , Shackleton Ellie , O’Neill Ciaran , McLoughlin Declan M.
Published: November 2023

Background

Depression is a common psychiatric disorder and a leading cause of disability worldwide. Conventional monoaminergic antidepressants have limited efficacy and take weeks to exert a therapeutic effect. Single infusions of subanaesthetic doses of ketamine exhibit rapid antidepressant action but effects are transient and relapse is common. One potential strategy for increasing ketamine’s antidepressant efficacy and/or prolonging its therapeutic benefit may be serial infusions. There is limited evidence on the efficacy and safety of repeated ketamine infusions against an active comparator.

Methods

This protocol describes an ongoing pragmatic, randomised, controlled, parallel-group, patient- and rater-blind, superiority trial. Eligible adult inpatients with a confirmed DSM-5 diagnosis of a major depressive episode (unipolar or bipolar) are randomly allocated in a 1:1 ratio to a course of up to eight infusions of ketamine or midazolam twice-weekly over four weeks. The primary objective is to assess the efficacy of serial adjunctive ketamine infusions versus active comparator midazolam by measuring Montgomery-Åsberg Depression Rating Scale score difference between arms from before the first infusion to 24 h after the final infusion, supplemented by a 95% confidence interval. To facilitate generalisability of results, the trial takes place under “real world” conditions with both groups continuing to receive regular inpatient care including treatment-as-usual pharmacotherapy, nursing care, and psychological and other therapies during the randomised treatment phase and regular outpatient care thereafter. Participants are monitored for relapse during a 24-week follow-up after the end of the randomised phase. Secondary objectives of the trial are to assess: response and remission rates at the end of randomised phase; relapse status during the 24-week follow-up after the end of the randomised phase; the safety and tolerability of repeated ketamine infusions regarding psychotomimetic and other psychiatric side effects, cognitive side effects, as well as withdrawal symptoms, haemodynamic stability, neurological, urological, and other physical side effects; and quality of life and cost-effectiveness.

Discussion

There is an unmet clinical need for rapidly-acting novel antidepressants. This trial will provide efficacy, safety and health economic data on serial ketamine infusions and thus help inform clinical practice on the potential role of this treatment in the management of depression.

Trial registration

EudraCT 2019-003109-92. Registered 2 October 2019. ClinicalTrials.gov NCT04939649. Registered 25 June 2021.
Use of a digital contact tracing system in Singapore to mitigate COVID-19 spread
Authors: Chow Bryan W. K. , Lim Yi Ding , Poh Richard C. H. , Ko Amy , Hong Guo Hao , Zou Steffen W. L. , Cheah Joshua , Ho Shaowei , Lee Vernon J. M. , Ho Marc Z. J.
Published: November 2023

Background

Contact tracing has been essential to reducing spread of COVID-19. Singapore leveraged technology to assist with contact tracing efforts using a Bluetooth-based app and token platform called ‘TraceTogether’.

Methods

We reviewed the impact of this system during the country’s Delta and Omicron waves (24 August 2021 to 17 February 2022) to identify differences in number of close contacts and time savings between full automation using TraceTogether alone as compared to manual contact tracing supplemented by TraceTogether. Characteristics of digital contact tracing app or token users were reviewed. Thereafter, the number of close contacts identified by manual and digital contact tracing methods, and the number of confirmed COVID-19 cases among contacts were analysed. The difference in time taken for identification of close contacts was also determined.

Findings

Adoption rate for TraceTogether was high, with 93.3% of cases having a registered device. There was a 9.8 h (34.9%) reduction in time savings for close contacts to be informed using TraceTogether alone compared to manual contact tracing supplemented by TraceTogether. The proportion of close contacts automatically identified through TraceTogether alone and turned positive was 3.6%. For those identified through manual contact tracing supplemented by TraceTogether, this proportion was 12.5% and 6.2% for those served quarantine orders and health risk warnings respectively.

Interpretation

The high adoption rate of ‘TraceTogether’ suggest that digital solutions remain a promising option to improve contact tracing in future epidemics. This may have been through its concurrent use with vaccine differentiated public health measures and policies which engender public trust. There is future potential for utilising such technology in managing communicable diseases to achieve good public health outcomes.
How is nicotine vaping product (e-cigarette) use monitored in primary care electronic health records in the United Kingdom? An exploratory analysis of Clinical Practice Research Datalink (CPRD)
Authors: Tildy Bernadett E. , McNeill Ann , Robins John , Dregan Alexandru , Richardson Sol , Brose Leonie S.
Published: November 2023

Background

Electronic health records (EHRs) could identify long-term health effects of nicotine vaping. We characterised the extent to which vaping is recorded in primary care EHRs in the UK, on a population level.

Methods

We performed descriptive analysis of Clinical Practice Research Datalink (CPRD), primary care electronic health records of 25% of the UK population (~ 16 million patients). Patients aged ≥ 18 years whose vaping status was recorded using medical codes between 2006 and 2022 were identified. We reported the frequency of vaping codes; their distribution by patient age, gender, and ethnicity; trends in vaping recording over time (including interrupted time series analyses); and transitions in patient smoking status.

Results

Seven medical codes indicated current or former vaping, from 150,114 patients. When their vaping status was first recorded, mean patient age was 50.2 years (standard deviation: 15.0), 52.4% were female, and 82.1% were White. Of those recorded as currently vaping, almost all (98.9%) had records of their prior smoking status: 55.0% had been smoking, 38.3% had stopped smoking, 5.6% had never smoked. Of those who were smoking prior to being recorded as vaping, more than a year after the vaping record, over a third (34.2%) were still smoking, under a quarter (23.7%) quit smoking, 1.7% received a ‘never smoked’ status, and there was no smoking status for 40.4%. The ‘e-cigarette or vaping product use-associated lung injury’ (EVALI) outbreak was significantly associated with a declining trend in new records of current vaping between September 2019 and March 2020; and an immediate significant increase in new records of former vaping, followed by a declining trend.

Conclusions

Few patients are being asked about vaping. Most who vape had smoked, and many quit smoking after starting vaping. To enable electronic health records to provide stronger evidence on health effects, we recommend improved completeness, accuracy and consistency.
Comparative effectiveness of hybrid and laparoscopic techniques for repairing complex incisional ventral hernias: a systematic review and meta-analysis
Authors: Wu Quan , Ma Weijie , Wang Qianqian , Liu Yaqi , Xu Yaokai
Published: November 2023

Background

The recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH.

Methods

An exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.

Results

The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.

Conclusions

The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.
From emissions to incisions and beyond: the repercussions of climate change on surgical disease in low- and-middle-income countries
Authors: Martins Russell Seth , Poulikidis Kostantinos , Razi Syed Shahzad , Latif M. Jawad , Tafuri Kyle , Bhora Faiz Y.
Published: November 2023

Climate change has far-reaching repercussions for surgical healthcare in low- and middle-income countries. Natural disasters cause injuries and infrastructural damage, while air pollution and global warming may increase surgical disease and predispose to worse outcomes. Socioeconomic ramifications further strain healthcare systems, highlighting the need for integrated climate and healthcare policies.
Chronic pain in female breast cancer survivors - prevalence, characteristics and contributing factors: a cross-sectional pilot study
Authors: Shabangu Nelisiwe , Thebe Tselane , Casey Michelle , Wesselmann Ursula , Parker Romy
Published: November 2023

Background

While the global incidence of breast cancer is increasing, there is also an increase in the numbers of breast cancer survivors and in survival duration, as early detection programs are implemented, and treatments are optimized. Breast cancer survivors in several countries commonly struggle with a range of symptoms (fatigue, insomnia, depression) with 25–80% of survivors suffering from chronic pain. There is a paucity of literature reporting on breast cancer survivors in South Africa. In this pilot study we aimed to determine the prevalence of chronic pain in female breast cancer survivors attending the breast oncology clinic.

Methods

A cross-sectional survey was conducted of all breast cancer survivors attending the Groote Schuur Hospital Breast Unit during one month in 2019. 44 female breast cancer survivors (median age 60.5y) completed a sociodemographic questionnaire, the Brief Pain Inventory, Pain Catastrophizing Scale and measures for neuropathic pain (DN4), health related quality of life (HRQoL; EQ-5d-3 L), physical activity (IPAQ), depression and anxiety (PHQ4), and screening questions to evaluate sleep, happiness and perceived discrimination in the language of their choice.

Results

The prevalence of chronic pain (pain on most days for more than three months) was 59% (95%CI 44–72), a significantly higher number than the 18,3% prevalence of chronic pain reported by South African adults. 39% of the women were classified as having neuropathic pain. The median pain severity score was 3.75 (IQR = 2.75-5) and the median pain interference with function score was 4 (IQR = 2.9–5.4). The women were experiencing pain in a median of 2 different body sites (IQR = 1–3). The women with pain were more likely to be unemployed or receiving a disability grant, had significantly worse HRQoL, and significantly worse scores for risk of depression and anxiety.

Conclusion

The results of this pilot study suggest that chronic pain may be a significant burden for South African breast cancer survivors. Routine screening for chronic pain in breast cancer survivors is recommended with a larger study indicated to explore this issue further.
Training in retinoscopy: learning curves using a standardized method
Authors: Estay Antonio M. , Plaza-Rosales Iván , Torres Hernán R. , Cerfogli Fabiola I.
Published: November 2023

Background

Retinoscopy is one of the most effective objective techniques for evaluating refractive status, especially in non-cooperative patients. However, it presents a slow learning curve that often leads to student frustration. With the current Covid-19 pandemic and the need for social isolation, clinical education based on simulation has become more relevant. Therefore, we implemented retinoscopy laboratories and learning protocols to reduce student stress and learning time.

Methods

We conducted a study to evaluate the retinoscopy learning curve using a new training protocol proposal. One hundred trainees were assessed in four stages, corresponding to 08, 12, 16, and 20 hours of training. Six different refractive defects were used trying to reproduce frequent conditions of care. The time spent on the assessment was not considered as additional training time. To analyze the data, we used non-parametric statistics and linear regression to assess the variables associated with training time and performance rate.

Results

The mean performance score at 08 hrs was 32.49% (±16.69 SD); at 12 hrs was 59.75% (±18.80 SD); at 16 hrs was 70.83% (±18.53 SD) and at 20 hrs was 84.26% (±13.18 SD). Performance at 12 hrs was significative higher than 08 hrs of training, but did not show significant differences with the performance rate at 16 and 20 hrs. We found a strong positive correlation between performance and training time in retinoscopy (R = 0.9773, CI: 0.2678 - 0.9995 p = 0.0227).

Conclusion

This study showed that an increasing number of hours of practice positively correlates with performance in retinoscopy. The elaboration of a protocol and standardization of performance per hour also allowed us to estimate that a minimum of 13.4 hrs of practice is required to achieve 60% performance. Using the resulting formula, it is possible to determine the number of hours of retinoscopy practice are necessary to reach a certain level of performance.
The attitudes of postgraduate medical students towards the curriculum by degree type: a large-scale questionnaire survey
Authors: Jia Xue , Zhu Yuyi , Zhong Xuelian , Wen Qiao , Wang Deren , Xu Mangmang
Published: November 2023

Background

Chinese medical schools have offered both professional and academic degrees for postgraduate students. However, there is limited information about the attitudes of professional-degree and academic-degree students. We aimed to examine the attitudes of full-time postgraduate students towards the curriculum, stratified by degree type.

Methods

A 29-item online questionnaire was distributed to postgraduate students in West China School of Medicine of Sichuan University in 2020. The questionnaire was designed to collect students’ demographic characteristics, attitudes towards curricular provision and content, and classroom organization. A comparison was made between groups based on degree type (academic degree versus professional degree).

Results

Overall, 645 out of 908 students at West China School of Medicine completed the questionnaire. Comparing with students pursuing academic degrees, professional-degree students were more interested if the curriculum included specialized knowledge and clinical skills, and expressed concerns over the excessive compulsory courses and inadequate optional courses (p < 0.001), particularly prominent among first-year postgraduate students. Besides, a greater proportion of professional-degree students thought the curriculum was conflict with clinical work to some extent, and they also rated taking attendance in class as less reasonable (p < 0.01). Conversely, students pursuing academic degrees expressed that the courses were inadequate in interdisciplinary curriculum and had some crossover or repetition, and they assigned a higher importance rating for the curriculum when comparing professional-degree students (all p < 0.05).

Conclusions

Different attitudes toward the curriculum are observed between students pursuing professional degrees and those pursuing academic degrees. This study provides benchmark data for future postgraduate course reforms in China.
Objections to assisted dying within institutions: systemic solutions for rapprochement
Authors: Peisah Carmelle , Sheppard Adrianna , Leung Kelvin CY
Published: November 2023

In this Matters Arising article, we outline how the recent article “The impact on patients of objections by institutions to assisted dying: a qualitative study of family caregivers’ perceptions” (White et al., 2023 Mar 13;24(1):22) informed Voluntary Assisted Dying (VAD) implementation in our large Australian public health setting, where objections do not emanate from, but within, the institution. In reporting the harms to patients and caregivers created by institutional objection, White et al. provide an evidenced-based road map for potential potholes or risks associated with VAD implementation. We discuss the complexities emerging from the diverse views of health professionals and the ethical tensions arising from such, especially within certain specialties, and how we developed systemic strategies that support patients, caregivers and staff alike. We highlighted the need to shift from “Do you support VAD?“ to “How can we support you as healthcare professionals to integrate VAD into your practice, in a way that complies with the legislation, meets the needs of patients and caregivers, and feels safe and does not compromise your moral stance?“
Australian general practitioners’ perspectives on integrating specialist diabetes care with primary care: qualitative study
Authors: Taylor Rachael , Acharya Shamasunder , Parsons Martha , Ranasinghe Ushank , Fleming Kerry , Harris Melissa L. , Kuzulugil Deniz , Byles Julie , Philcox Annalise , Tavener Meredith , Attia John , Kuehn Johanna , Hure Alexis
Published: November 2023

Background

Improving the coordination and integration of health services is recognised nationally and internationally as a key strategy for improving the quality of diabetes care. The Australian Diabetes Alliance Program (DAP) is an integrated care model implemented in the Hunter New England Local Health District (HNELHD), New South Wales (NSW), in which endocrinologists and diabetes educators collaborate with primary care teams via case-conferencing, practice performance review, and education sessions. The objective of this study was to report on general practitioners’ (GPs) perspectives on DAP and whether the program impacts on their skills, knowledge, and approach in delivering care to adult patients with type 2 diabetes.

Methods

Four primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (< 80% of patients annually) from HNELHD, NSW provided the sampling frame. A total of nine GPs were interviewed. The transcripts from the interviews were reviewed and analysed to identify emergent patterns and themes.

Results

Overall, GPs were supportive of DAP. They considered that DAP resulted in significant changes in their knowledge, skills, and approach and improved the quality of diabetes care. Taking a more holistic approach to care, including assessing patients with diabetes for co-morbidities and risk factors that may impact on their future health was also noted. DAP was noted to increase the confidence levels of GPs, which enabled active involvement in the provision of diabetes care rather than referring patients for tertiary specialist care. However, some indicated the program could be time consuming and greater flexibility was needed.

Conclusions

GPs reported DAP to benefit their knowledge, skills and approach for managing diabetes. Future research will need to investigate how to improve the intensity and flexibility of the program based on the workload of GPs to ensure long-term acceptability of the program.
Managed care updates of subscriber jail release to prompt community suicide prevention: clinical trial protocol
Authors: Arias Sarah A. , Sperber Kimberly , Jones Richard , Taxman Faye S. , Miller Ted R. , Zylberfuden Sarah , Weinstock Lauren M. , Brown Gregory K. , Ahmedani Brian , Johnson Jennifer E.
Published: November 2023

Background

Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide prevention practices triggered by advances in informatics that alert CareSource, a large managed care organization (MCO), when a subscriber is released from jail.

Methods

This randomized controlled trial investigates two evidence-based suicide prevention practices triggered by CareSource’s jail detention/release notifications, in a partial factorial design. The first phase randomizes ~ 43,000 CareSource subscribers who pass through any Ohio jail to receive Caring Contact letters sent by CareSource or to Usual Care after jail release. The second phase (running simultaneously) involves a subset of ~ 6,000 of the 43,000 subscribers passing through jail who have been seen in one of 12 contracted behavioral health agencies in the 6 months prior to incarceration in a stepped-wedge design. Agencies will receive: (a) notifications of the client’s jail detention/release, (b) instructions for re-engaging these clients, and (c) training in suicide risk assessment and the Safety Planning Intervention for use at re-engagement. We will track suicide-related and service linkage outcomes 6 months following jail release using claims data.

Conclusions

This design allows us to rigorously test two intervention main effects and their interaction. It also provides valuable information on the effects of system-level change and the scalability of interventions using big data from a MCO to flag jail release and suicide risk.

Trial registration

The trial is registered at clinicaltrials.gov (NCT05579600). Registered 27 June, 2023.