bluuebunny/crossref_metadata_2025 huggingface dataset:
Thin Au/Ag/Cu-Water Nanoliquid Film Flow Over a Porous Unsteady Stretchable Cylinder
Authors: Gogoi Partha Pratim , Maity Susanta
Published: August 2024

Most of the previous works on the thin nanoliquid-film (NLF) flow on a stretchable horizontal cylinder are limited to the boundary-layer flow (BLF) of infinite depth liquid. In this article, we have removed the above restrictions to examine the unsteady thin NLF flow on a porous stretchable
cylinder by considering full momentum equations under the influence of thermal radiation and suction/injection. The implicit finite difference technique is utilized to obtain the numerical solutions to the problem. The present numerical solution is validated with the analytical solution obtained
by Maity et al.41 for the isothermal case. It is found that the film thickness for Au/water nanoliquid is higher in comparison with Ag/water and Cu/water nanoliquids, respectively. The film thickness of nanoliquid enhances for rising magnitude of nanoparticle volume fraction (φ),
porosity parameter (β), and Hartmann number (Mn). The film thickness of the nanoliquid increases or decreases as injection or suction (V) takes place through the surface of the cylinder. Furthermore, the sign of temperature gradient θR
changes inside the nanoliquid depending on the values of other parameters. The percentage of changes in the film height is presented with the different parameters of the flow problem.
Artificial Neural Network and Numerical Simulation for Magneto Hydrodynamics Hybrid Nanofluid Flow Towards a Stretching Cylinder
Authors: Ramasekhar Gunisetty
Published: August 2024

The present study focuses on influence of boundary layer flow of heat transfer analysis on hybrid nanofluid through a stretching cylinder. Moreover, the impressions of porous medium, heat generation/absorption are discussed. Further, the stimulus of non-linear thermal radiation and
MHD are part of this investigation. For motivation, the Artificial Neural Networks also deliberated. Arrogate similarity variables are employed to transform the governing modelled PDEs into a couple of highly nonlinear ODEs. A numerical approach based on the shooting approach with MATLAB bvp5c
built in function is employed for solution of the set of resulting ODEs and acquired outcomes are compared with existing literature, obtained results an exceptional agreement. Artificial nerve cells or node locations form a network of nerves, a contemporary name for a chain composed of human
brain cells. The impact of physical parameters like Magnetic Field, Eckert number, Porosity, Prandtl number, Heat generation, thermal radiation, parameters on dimensionless velocity and energy fields are discussed through graphs and tables. The velocity profile decreased by about 42% when
the magnetic field parameter values increases from 0.5 to 1.5. On the other hand increased by 78% on energy profile. The energy profile improved by about 97% when the Eckert number values increases from 1.0 < Ec < 3.0. The current model may be applicable in real life practical
implications of employing Water–Cu/Ag/Al2O3 nanofluids on cylinders encompass enhanced heat transfer efficiency, and extended component lifespan, energy savings, and environmental benefits. This kind of theoretical analysis may be used in daily life applications,
such as industrial and biomedical industries.
Do compulsory mental health patients have a right to receive a second opinion on their treatment under Australian mental health legislation?
Authors: Boyle Sam , Cockburn Emma , Mandeville Bianca
Published: August 2024

We reviewed Australian mental health legislation to determine what obligations it places on psychiatrists to facilitate second opinions for compulsory patients who request them. Only four jurisdictions—Australian Capital Territory, Queensland, Victoria, and Western Australia—have legislated for ‘patient-initiated’ second opinions. Within these four regimes, there is variation in important aspects of the second opinion process, and there is a general absence of direction given to the second opinion providers. Based on research showing the variability of second opinion provision under New Zealand mental health legislation, we argue that this absence is likely to result in significant variation in the quality and depth of second opinions provided in Australia. We argue that New South Wales, the Northern Territory, South Australia, and Tasmania should consider formal provision for patient-initiated second opinions in their mental health legislation. We believe that such legislation ought to be aware of the barriers patients may face in accessing second opinions, and avoid exacerbating these barriers as Queensland’s legislation appears to. Also, we argue that research on current practice in Australia should be conducted to better understand the effects of legislation on second opinions, and to help determine what amounts to best practice.
Toward Systematic Theology: Problems and Possibilities for Christian Theology in the Academy
Authors: DeHart Paul J.
Published: August 2024

This article comprises a set of reflections on the future of systematic theology in academic institutions. It identifies three long term trends that have been shaping the current institutional context of the field, and the ways theology has (partially) responded. The article next identifies developments in some of Christian theology’s more important academic conversation partners that are promising potential sources for its continued vitality. In the third part, theology’s future direction is generally indicated by asserting that successful theologians are going to be those who find ways to bridge the current cultural fault-line in the academic field. In the final parts, this general suggestion is made more specific by naming four developments in a future systematic theology (concerning the God–world relation, the interconnection of core doctrines, the anthropology of salvation, and the hermeneutic of scripture) that can meet the challenges and exploit the possibilities named in the first three parts.
Protective Factors Associated With the Loss of a Child due to Oncological Illness: Systematic Review
Authors: González-Biber Marina , Rueda-Extremera María , Gomez-Martínez Sandra , Cantero-García María
Published: August 2024

This systematic review explores factors influencing resilience and post-traumatic growth in parents who have lost a child under 25 to cancer. While such parents are vulnerable to complicated grief, not all experience it. Eight qualitative and mixed studies from ProQuest, Science Direct, PubMed, and Cochrane databases were included. They highlight the importance of support and communication with palliative care teams and other grieving families. Understanding the ambivalence experienced during the process is crucial. The review underscores the limited research in this area and offers direction for future studies. Psychological interventions could aid these parents in adapting to their new reality.
Self-Esteem and Anxiety as Mediators in the Relationship Between Emotional Intelligence and Eating Disorder Symptoms
Authors: Anić Petra , Mohorić Tamara , Pokrajac-Bulian Alessandra
Published: August 2024

This study investigated the relationship between emotional intelligence (EI) and eating disorder symptoms (EDS) by testing the serial mediation model, with self-esteem and anxiety as mediators. A total of 923 participants (61.9% female) aged 15–60 years completed questionnaires assessing their EI, self-esteem, anxiety, and EDS. Correlational analyses were conducted to assess the relationship between the study variables, and a serial mediation analysis was conducted to test the possible mediating role of self-esteem and anxiety in the relationship between EI and EDS. Correlation analyses revealed significant bivariate relationships between EI, self-esteem, and anxiety, but no significant correlation between EI and EDS. The relationship between EI and EDS was serially mediated by self-esteem and anxiety. High levels of EI were associated with higher self-esteem, which, in turn, was associated with lower anxiety and less EDS. The results offer potential mechanisms that could explain the relationship between EI and EDS and highlight the importance of EI in regulating eating behavior through self-esteem and anxiety.
Aetiology and management of persistent withdrawal occlusion in venous ports in oncology patients
Authors: Maňásek V , Zapletalová J , Olosová L , Filáková I , Kociánová I , Drdová K , Škarda J , Chovanec V , Vrána D
Published: August 2024

Introduction:

Persistent withdrawal occlusion (PWO) is a specific catheter malfunction characterized by the inability to withdraw blood through the device. The most common cause of PWO in ports is the presence of a fibroblastic sleeve (FS). If malfunction occurs, medication can be applied incorrectly with the increased risk of complications.

Methods:

One hundred seventy-seven cases of PWO in venous ports were managed. We focused on evaluating the cause of PWO, the frequency of occurrence of FS, and the options to address the malfunction. The patients underwent fluoroscopy with a contrast agent administration. Mechanical disruption (MD) with a syringe of saline using the flush method was used; in case of its failure, subsequent administration of a lock solution with taurolidine and urokinase, or low-dose thrombolysis with alteplase was indicated. Demographic data were compared with a control group.

Results:

A significantly higher proportion of female patients was found in the cohort of patients with PWO (80.3% vs 66.3%, p = 0.004), dominantly patients with ovarian cancer (12.8% vs 4.8%, p = 0.022). No effect of the cannulated vein or the type of treatment on the incidence of PWO was demonstrated. The presence of FS was verified in 70% of cases. MD with a syringe was successful in 53.5% of cases. A significantly shorter time to referral (3 weeks) was demonstrated with successful management. The overall success rate of achieving desobliteration by MD alone or in combination with a thrombolytic (urokinase or alteplase) administration was 97.4%.

Conclusion:

We created a method for resolving PWO using MD +/- application of thrombolytics with 97.4% success rate. Current evidence showed that FS is not likely to be affected by thrombolytic drugs; however, we have ascertained an effect of these drugs, proposing a hypothesis of microthrombotic events at the tip of the catheter if fibroblastic sleeve is present.
Modeling and simulation to improve patient admission process: a case study in an educational and treatment hospital
Authors: Rasoli Neda , Sheikhalishahi Mohammad
Published: August 2024

Increasing medical costs around the world and limited resources have led health decision-makers to focus on measuring and improving their performance to effectively deliver high-quality care. In such an environment, timeliness is one of the most significant attributes for service performance and patient satisfaction. As a result, decision-makers are continually looking for ways to reduce wait times, as this is the primary measure of care timeliness. In this article, the main contribution is to reduce patient waiting time during admission process and increase patient satisfaction incorporating combination of business process modeling (BPM) and discrete event simulation (DES). With the BPM notation (BPMN2.0) modeling language, the patient admission process is modeled. ARENA software has been used to simulate current (As-Is) and redesigned (To-Be) processes, and Process Analyzer is used to evaluate improvement scenarios. The process has been optimized by utilizing OptQuest to reduce waiting time. Based on the results, work in process (WIP) has been reduced by 29% and waiting time has been reduced by 6% in the optimal scenario. The root causes of long queues have been identified as redundancy in the patient admission process, a shortage of reception staff, non-value-added administrative activities, and suboptimal allocation of resources.
Border-Crossing Being: A Theological Reflection on the Imago Dei in an Age of Migration
Authors: Shin Wonchul
Published: August 2024

This article offers a theological reflection on the imago Dei in light of the lived experiences of migrants and then reconstructs theological anthropology in an age of migration. This article critically examines the groundbreaking works of Peter C. Phan and Daniel G. Goody in the intersection of migration and theology. Their theological understanding of God, specifically the imago Dei, centers on the incarnation as a gratuitous self-giving event that crosses over the ontological border between the divine and humanity. This article affirms the theological originality of perceiving the imago Dei as border-crossing. However, this article points out the inadequacy and even potential harmfulness of the theological understanding of the imago Dei grounded in divine self-giving love. This theological account fails to register the lived experiences of migrants, specifically forced migrants who move across borders in order to live a better life. Their ultimate motivation for border-crossing is not self-giving love, but deep hunger for freedom, dignity, and justice that have been absent in their daily lives. This article utilizes this epistemic value embedded in the lived experiences of migrants and reconceptualizes the imago Dei grounded in the divine desire for human flourishing. As a bearer of the imago Dei, humanity is also a border-crossing being, rooted in a desire for human flourishing, moving across the dividing walls of alienation and dehumanization in order to achieve human flourishing in securing basic conditions for human dignity, practicing social friendship, and building a culture of encounter.
Research in Psychiatry Medical Education through “MUST Enrich Grant”: A Scoping Review
Authors: Verma Nitisha , Gupta Snehil , Shatadal Pooja
Published: August 2024

Background:

The Indian Teachers of Psychiatry (IToP) forum introduced a unique research grant scheme- IToP-MUST (Minds United Scholarship for Teachers) Enrich Research Grant- for conducting research in psychiatry education. This scoping review’s objectives are to (a) assess the research areas and methodologies of MUST Enrich grant-supported research, (b) identify strengths and limitations of these research works, and (c) inform the researchers and funding agency concerning robust methodologies and study areas that can be considered in the future.

Methods:

We included all MUST-funded original educational research projects from their inception (2020) to the present, which were either published or, although unpublished, available in the public domain.

Results:

Eleven research projects were identified. Most awardees were junior academic faculty members (n = 9, 82%). Eight (73%) studies were related to Competency-Based Medical Education (CBME) and were based on teaching-learning (TL) or related methods under the CBME framework, focusing on newer TL methods. Seven of eight (88%) were based on undergraduate TL. Most (n = 8, 73%) of the studies had an observational cross-sectional design, whereas the rest were interventional studies. Almost all were quantitative studies (n = 10, 91%). The prime themes of the research were students’ and teachers’ perspectives on the study topic, innovations in psychiatry TL, and their educational impact.

Conclusion:

This review’s findings will inform funders and researchers about future research areas and help formulate robust methodologies. Other funders must earmark their funding for educational research to grow this field.
Cultural and gender differences in predicting flourishing through gratitude and life purpose: A moderated mediation analyses
Authors: Lasota Agnieszka , Shekhar Suraj Kushe
Published: August 2024

Background: This study investigated the relationship between gratitude, purpose in life and flourishing, as well as the mediating role of purpose in life in the relationship between gratitude and flourishing in two different cultures, Indian and Polish. We also examined the moderating role of gender in the relationship between gratitude and purpose in life. Methods: A sample of 328 Indian and 303 Polish participants aged 18–56 years completed the Gratitude, Resentment, and Appreciation Scale, the Purpose in Life Questionnaire, and the Flourishing Scale. Pearson’s correlations were used to assess the associations between the main study variables, and PROCESS software was used to calculate moderated mediation. Results: Findings showed that gratitude and purpose in life were positively related to flourishing. Life purpose mediated the relationship between gratitude and flourishing. In the Indian sample, gender was a statistically significant moderator between gratitude (and its three facets) and purpose in life. In the Polish sample, gender moderated the relationship between overall gratitude and only one dimension (a sense of abundance) and purpose in life. Conclusions: The results suggest that enhancing gratitude and a sense of purpose in life can significantly improve individuals’ flourishing, considering gender and cultural differences.
When is divorce more painful? The impact of social context in Türkiye
Authors: Uğur Zeynep B. , Karakaş Aydınbakar Ayşenur
Published: August 2024

This study investigates whether divorcees feel less worse-off when divorce is more prevalent around them. The 2013 Life Satisfaction Survey in Türkiye, which has approximately 196,000 observations and province-level representative data, is utilized. We used three province-level indicators about the prevalence of divorce to measure the impact of the social context on divorcees’ well-being. First, we replicate the previous findings that divorce is associated with lower happiness. Secondly, regardless of the measure used, living in a divorce-prevalent setting slightly mitigates the happiness disadvantage of divorcees. Thirdly, perceived social pressure plays a role in the lower happiness of divorcees regardless of the provincial divorce prevalence measures. Overall, the results show that the substantial psychological costs of divorce remain even after addressing the social dimensions of divorce with different measures.
Active perception network for non-myopic online exploration and visual surface coverage
Authors: Vutetakis David , Xiao Jing
Published: August 2024

This work addresses the problem of online exploration and visual sensor coverage of unknown environments. We introduce a novel perception roadmap we refer to as the Active Perception Network (APN) that serves as a hierarchical topological graph describing how to traverse and perceive an incrementally built spatial map of the environment. The APN state is incrementally updated to expand a connected configuration space that extends throughout as much of the known space as possible, using efficient difference-awareness techniques that track the discrete changes of the spatial map to inform the updates. A frontier-guided approach is presented for efficient evaluation of information gain and covisible information, which guides view sampling and refinement to ensure maximum coverage of the unmapped space is maintained within the APN. The updated roadmap is hierarchically decomposed into subgraph regions which we use to facilitate a non-myopic global view sequence planner. A comparative analysis to several state-of-the-art approaches was conducted, showing significant performance improvements in terms of total exploration time and surface coverage, and demonstrating high computational efficiency that is scalable to large and complex environments.
Beyond Dependency in Puerto Rico: Exploring Social and Solidarity Industrial Policy as an Alternative for the Global South
Authors: Fuentes-Ramírez Ricardo R.
Published: August 2024

This article challenges the mainstream economic argument that attributes Puerto Rico’s economic struggles to overly generous federal welfare programs or an excessively high minimum wage. It traces the root of the island’s structural economic issues to its mid-twentieth-century dependent growth strategy, pre-dating these commonly cited factors. Examining the role of Puerto Rican elites, the article argues that their vested interests in the current model could undermine a suitable industrial policy program. The article posits that the island’s vibrant worker cooperative movement and Social and Solidarity Economy (SSE) offer a more promising foundation for an effective industrial policy agenda. Finally, it introduces the concept of Social and Solidarity Industrial Policy as a framework for sustainable development in Puerto Rico and potentially other Global South economies, leveraging democratic state firms, worker cooperatives, and other SSE initiatives.

JEL Classification: B50, L52, O54
“I Have Moments Where I Am Down, But It Has Made Me Resilient”: Mental Health Strengths Among Youth At-Risk for and Living with HIV
Authors: Lewis Katherine Alyssa , Wong Curtis , Ma Alice , Valles Hailey , Polanco Dianna , Bhattacharya Gita , Arnold Elizabeth Mayfield , Fernández Maria Isabel , Rotheram-Borus Mary Jane , Swendeman Dallas Travis ,   Adolescent Medicine Trials Network (ATN) CARES Team
Published: August 2024

We analyzed mental health strengths among youth at-risk for or living with HIV ages 14 to 24 years. In total, 13% of participants were living with HIV, 88% identified as LGBQ+, and 14% identified as transgender, gender diverse, or non-binary. Most identified as either Hispanic/Latine (36%) or non-Hispanic Black (44%). Data from 257 youth in Los Angeles, California, and New Orleans, Louisiana, were collected within strengths-based coaching interventions for HIV prevention and treatment continuums through the Adolescent HIV Medicine Trials Network. Case notes from strengths assessment responses were analyzed to identify participants’ mental health strengths. Data were analyzed using content analysis and a theoretical lens integrating resilience theory and the minority stress model. In all, 96.9% of participants identified at least one strength. Participants described intrapersonal resilience assets (protective traits, stress management activities, feeling positive despite challenges, and no current mental health problems) and external resilience resources (peer and family social/emotional support and professional mental health care with sub-themes therapy/counseling and medication use). These results may inform the implementation of this coaching intervention and highlight youth’s ability to identify their strengths related to their mental health.
The Strategic Challenge of Decoupling from China: The Case of India’s ICT Sector
Authors: Shrivastava Megha
Published: August 2024

This article examines India’s challenges in a rather underexplored dimension—the information and communications technology (ICT) sector. This article deals with a key question: What impedes India’s prospects in the world’s ICT sector? The article identifies China’s strategic footprints in India’s ICT sector as the primary challenge and provides a deeper analysis of it. The article relies on quantitative data concerning the four key sub-sectors—e-commerce, consumer electronics, semiconductors and the telecom sector—to critically examine the strategic footprints of Chinese ICT in India’s ICT sector. The article further examines India’s evolving policy landscape in response to growing challenges. It concerns the recent debates in the tech policy circles and explores the scope of ‘technology decoupling’ from China. The article argues that India should see the concept of decoupling as distinct from US–China decoupling. Rather than decoupling, diversification away from China in a phased manner is found to be critical to secure India’s future in the evolving technological landscape.
NZYQ and constitutional culture
Authors: Naylor Samuel
Published: August 2024

The political and social reaction to the High Court's decision in NZYQ is evidence of a deficit of constitutional culture in Australia: there has been a race to the bottom in public debate. This is against the background of the failed Voice referendum. Possible ways forward are discussed, and France is mentioned as counterpoint on the issue of constitutional culture.
Long-Acting Injectable Pre-Exposure Prophylaxis Perceptions and Preferences Among Transgender and Nonbinary Young Adults in the United States
Authors: Gordon Allegra R. , Haiken Samantha , Murchison Gabriel R. , Agénor Madina , Hughto Jaclyn M. W. , Nelson Kimberly M.
Published: August 2024

Long-acting injectable pre-exposure prophylaxis for HIV prevention (LAI-PrEP) was approved for use in the United States in 2021, yet little is known about perceptions of LAI-PrEP among transgender and nonbinary young adults, a group that faces substantial barriers to HIV prevention. We investigated US transgender and nonbinary young adults’ perceptions of and attitudes toward LAI-PrEP and how perceived advantages and disadvantages of LAI-PrEP related to the PrEP continuum of care. We conducted semi-structured interviews with 31 transgender and nonbinary young adults who reported oral PrEP use or were PrEP-eligible. We analyzed responses using both a deductive RADaR approach, to identify LAI-PrEP perceptions relevant to the PrEP continuum of care, and an inductive thematic analysis to explore key themes. In this study, all PrEP-experienced and most PrEP-naïve participants indicated an interest in LAI-PrEP, citing advantages over daily oral medication (e.g., fewer adherence challenges). Three key themes emerged: (1) Some participants linked perceived advantages of LAI-PrEP to experiences with gender-affirming care (e.g., familiarity with needles via hormone use). (2) Participants weighed trade-offs and contextual factors that influenced their LAI-PrEP preferences (e.g., interest contingent on whether location for receiving injection was geographically accessible). (3) Participants envisaged alternative delivery methods that could enhance LAI-PrEP acceptability and uptake (e.g., home injection). HIV prevention programs should incorporate the insights of transgender and nonbinary young adults to ensure that emerging HIV prevention technologies are accessible and responsive to the needs and concerns of people of all gender modalities.
The Impact of Board Characteristics on the Financial Slack–CSR Relationship: Evidence From the Indian Hospitality and Tourism Industry
Authors: Tewari Shobha , Karthika S. , Bhattacharya Bibek , Singal Manisha
Published: August 2024

Extant research in the hospitality and tourism (H&T) industry has largely ignored the influence of contextual factors like institutional environment and board characteristics on the financial slack and CSR relationship. Our study combines the institutional differences hypothesis, slack resource theory, and agency theory to provide a nuanced understanding of this relationship in the context of the H&T industry in India. Using a panel of 464 firms from three H&T sectors between 2011 and 2019, our analyses indicate a U-shaped relationship between financial slack and CSR intensity, and a positive moderating effect of board gender diversity and board independence. We show how resource-constrained H&T firms in emerging markets with underdeveloped institutions deploy slack resources towards CSR and, rather than setting a minimum threshold, we posit that governmental policies should strengthen capital markets so that H&T firms can voluntarily invest in strategic CSR. Further, strengthening board diversity policies enables H&T firms to invest in CSR organically.
Mixed reality technology for older adults: Evaluating the impact of a novel virtual humanoid coach in a community-based physical exercise program in the Philippines
Authors: Dino Michael Joseph S. , Dion Kenneth W. , Abadir Peter M. , Budhathoki Chakra , Huang Chien-Ming , Ong Irvin , Vital Joseph Carlo , Cotter Valerie T. , Himmelfarb Cheryl R. Dennison , Davidson Patricia M.
Published: August 2024

Physical inactivity among older adults remains a global burden, leading to a variety of health challenges and even mortality. This study evaluated the impact of a novel virtual humanoid coach-driven physical exercise program among older adults. A non-randomized (quasi) experimental research was conducted in two community senior centers. The recruited participants ( n = 130) were primarily female older adults with a mean age of 66.40 and agreed to be purposively assigned either experimental or control groups. Trained healthcare providers performed health assessments in three time points using valid and reliable tools. Descriptive statistics, t-tests, and RM-ANOVA were used to quantitatively analyze the data using SPSS version 22. There are significant mean differences between the groups across all functional capacity assessments and Time 2-3 assessment of sleep quality. RM-ANOVA revealed significant differences in physical assessment over time between the two groups. The analyses of time and group interaction revealed significant improvement in health assessments among the members of the mixed reality group compared to the traditional groups. The impact of virtual coaches in community-based enhancing physical activity programs is comparable to the traditional mode and introduces a novel approach to promoting physical activity among older adults.
Pandemic Pathways: College Graduates Stalling, Regressing, and Pivoting during COVID-19
Authors: Loe Meika
Published: August 2024

This study focuses on young adults as they navigated work, relationships, and health disruptions during 21 months of “amplified uncertainty” in the United States. Using a longitudinal approach, I interviewed 20 diverse college graduates from seven selective four-year universities across the United States three times over the course of the pandemic to understand change over time in approaches to work, health, and relationships. Study participants were beginning a major life transition when COVID lockdowns began in March 2020. Although most anticipated uncertainty in this transition period, they were unprepared for disruptions precipitated by a massive global health scare. In the context of COVID, many of the graduates found themselves stalling, regressing, pivoting, reflecting, and ultimately, following new and revised pathways to adulthood. The end result is a rescripting of adulthood with new developmental milestones: self-reflection, openness to uncertainty, and intentionality regarding health and well-being.
The role of diet in cancer: the potential of shaping public policy and clinical outcomes in the UK
Authors: Britten Oliver , Tosi Sabrina
Published: August 2024

Cancer universally represents one of the largest public health concerns, substantially contributing to global disease burden and mortality. The multifaceted interplay of environmental and genetic factors in the disease aetiology and progression has required comprehensive research to elucidate modifiable elements which can reduce the risk of incidence and improve prognosis. Among these factors, diet and nutrition have emerged as the most fundamental with a significant potential for influence and effect. Nutrition is not only an essential part of human survival, but also a vital determinant of overall health. Certain dietary requirements are necessary to support normal physiology. This includes individualised levels of macronutrients (proteins, carbohydrates and fats) and specific micronutrients (vitamins and minerals). Extensive research has demonstrated that diet plays a role in cancer pathogenesis at the genetic, epigenetic and cellular level. Therefore, its potential as a modifiable determinant of cancer pathogenesis for the purpose of prevention and improving management of disease must be further explored and implemented. The ability to influence cancer incidence and outcomes through dietary changes is underutilised in clinical practice and insufficiently recognised among the general public, healthcare professionals and policy-makers. Dietary changes offer the opportunity for autonomy and control over individuals health outcomes. Research has revealed that particular dietary components, as well as cultural behaviours and epidemiological patterns may act as causative or protective factors in cancer development. This review aims to comprehensively synthesise this research to further explore how to best utilise this knowledge within the community and clinical environment for more effective cancer prevention and therapeutic strategies. The identified key areas for improvement include the development of more specific, widely accepted guidelines, promoting increased involvement of dieticians within cancer multidisciplinary teams, enhancing nutritional education for healthcare professionals and exploring the potential implementation of personalised nutrition tools. A greater understanding of the complex interactions between diet and cancer will facilitate informed clinical interventions and public health policies to reduce global cancer burden and improve care for cancer patients and survivors.
Continuing vocational training in times of economic uncertainty: an event-study analysis in real time
Authors: Dauth Christine , Lang Julia
Published: August 2024

Continuing vocational training (CVT) is a key channel for employees to adapt their skills to changing requirements in the labor market due to structural changes and digitization. The COVID-19 pandemic and the energy crisis as a consequence of the war in Ukraine may have accelerated these developments. Yet, it is unclear how the economic impact of these crises affects individuals’ occupational preferences. In this study, we want to investigate how interest in CVT changes in times of economic uncertainty. We use Google Trends data for Germany and apply an event study analysis to examine how interest in CVT developed with the onset of the COVID-19 pandemic and the Russian attack on Ukraine. We find that the interest in CVT strongly declined during the first wave of the pandemic regardless of how severely a region was affected. During the second lockdown, the decline in CVT interest was more pronounced in the eastern German states where we find a general decline in search intensity since March 2020. We also consider different channels that may have influenced the demand for CVT during the pandemic. Overall, we show that during the first 2.5 years of the pandemic, the search intensity for CVT decreased on average by 12 to 19 percent, while the search intensity for online CVT increased by 39 to 45 percent. We also see a decrease in the search intensity for CVT at the beginning of the energy crisis.
Interventions targeting patients with co-occuring severe mental illness and substance use (dual diagnosis) in general practice settings – a scoping review of the literature
Authors: Tranberg Katrine , Colnadar Bawan , Nielsen Maria Haahr , Hjorthøj Carsten , Møller Anne
Published: August 2024

Background

People with dual diagnosis die prematurely compared to the general population, and general practice might serve as a setting in the healthcare system to mend this gap in health inequity. However, little is known about which interventions that have been tested in this setting.

Aim

To scope the literature on interventions targeting patients with dual diagnosis in a general practice setting, the outcomes used, and the findings.

Design and setting

A scoping review of patients with dual diagnosis in general practice.

Methods

From a predeveloped search string, we used PubMed (Medline), PsychInfo, and Embase to identify scientific articles on interventions. Studies were excluded if they did not evaluate an intervention, if patients were under 18 years of age, and if not published in English. Duplicates were removed and all articles were initially screened by title and abstract and subsequent fulltext were read by two authors. Conflicts were discussed within the author group. A summative synthesis of the findings was performed to present the results.

Results

Seven articles were included in the analysis. Most studies investigated integrated care models between behavioural treatment and primary care, and a single study investigated the delivery of Cognitive Behavioral treatment (CBT). Outcomes were changes in mental illness scores and substance or alcohol use, treatment utilization, and implementation of the intervention in question. No studies revealed significant outcomes for patients with dual diagnosis.

Conclusion

Few intervention studies targeting patients with dual diagnosis exist in general practice. This calls for further investigation of the possibilities of implementing interventions targeting this patient group in general practice.
Clinical and surgical physician’s perception of nutrition knowledge
Authors: Ocampo-Ordóñez María Belén , Headley Ivonne , Arévalo-Alvear Emily Sofía , Wasser Heather , Román-Sánchez Andrea Carolina
Published: August 2024

Background

Due to the significant increase in the prevalence of food-related diseases, the value that physicians place on nutritional advice may have implications for patient treatment. The objective of this study was to evaluate the perception of the importance of nutritional intervention among physicians in the Universidad San Francisco de Quito’s (USFQ) healthcare system.

Methods

This cross-sectional study employed a telephone survey administered to a subset of all medical doctors (MDs) working in the healthcare system clinics of USFQ between 2021 and 2022. Study participants were recruited through voluntary response sample from a complete list of 253 MD. The single time questionnaire consisted of a 22-item validated survey in which attitudes, self-perceived capacity, and knowledge about nutrition ofmedical doctors were evaluated. Data was analyzed using descriptive statistics, two-sided t test, bivariate associations and linear and logistic regressions.

Results

136 MDs completed the survey yielding a response rate of 54%. Our analysis grouped participants into clinical (CE) and non-clinical specialties, hereafter referred to as surgical MDs. While a higher percentage of physicians in CE are confident in their ability to provide examples of recommended food portions based on national or international guidelines, 1 in 10 do not know how to use and interpret BMI or waist circumference, and around 1 in 3 do not know how many calories there are in one gram of fat, protein, or carbohydrates, and their basic metabolic functions. Almost all survey participants believe MDs can have an impact on the eating behavior of a patient if time is used to discuss the problem, however, almost half of survey participants believe nutrition counseling is not an effective use of time.

Conclusion

It is important to explore the perceptions and self-confidence of physicians around nutrition related issues. Our results demonstrated that nearly 1 in 4 surgical MDs do not feel capable of recognizing nutritional risk in patients, which highlights the essentiality of physicians having an updated understanding of basic nutrition principles. Future research should examine how commonly MDs refer patients to nutritionists/dietitians, as well as strategies for improving physician knowledge on basic nutrition concepts.
Machine learning characterization of a rare neurologic disease via electronic health records: a proof-of-principle study on stiff person syndrome
Authors: Park Soo Hwan , Song Seo Ho , Burton Frederick , Arsan Cybèle , Jobst Barbara , Feldman Mary
Published: August 2024

Background

Despite the frequent diagnostic delays of rare neurologic diseases (RND), it remains difficult to study RNDs and their comorbidities due to their rarity and hence the statistical underpowering. Affecting one to two in a million annually, stiff person syndrome (SPS) is an RND characterized by painful muscle spasms and rigidity. Leveraging underutilized electronic health records (EHR), this study showcased a machine-learning-based framework to identify clinical features that optimally characterize the diagnosis of SPS.

Methods

A machine-learning-based feature selection approach was employed on 319 items from the past medical histories of 48 individuals (23 with a diagnosis of SPS and 25 controls) with elevated serum autoantibodies against glutamic-acid-decarboxylase-65 (anti-GAD65) in Dartmouth Health’s EHR to determine features with the highest discriminatory power. Each iteration of the algorithm implemented a Support Vector Machine (SVM) model, generating importance scores—SHapley Additive exPlanation (SHAP) values—for each feature and removing one with the least salient. Evaluation metrics were calculated through repeated stratified cross-validation.

Results

Depression, hypothyroidism, GERD, and joint pain were the most characteristic features of SPS. Utilizing these features, the SVM model attained precision of 0.817 (95% CI 0.795–0.840), sensitivity of 0.766 (95% CI 0.743–0.790), F-score of 0.761 (95% CI 0.744–0.778), AUC of 0.808 (95% CI 0.791–0.825), and accuracy of 0.775 (95% CI 0.759–0.790).

Conclusions

This framework discerned features that, with further research, may help fully characterize the pathologic mechanism of SPS: depression, hypothyroidism, and GERD may respectively represent comorbidities through common inflammatory, genetic, and dysautonomic links. This methodology could address diagnostic challenges in neurology by uncovering latent associations and generating hypotheses for RNDs.
The PRIME-NL study: evaluating a complex healthcare intervention for people with Parkinson’s disease in a dynamic environment
Authors: Maas Bart R. , van den Bergh Robin , van den Berg Sanne W. , Hulstein Eveline , Stadhouders Niek , Jeurissen Patrick P.T. , de Vries Nienke M. , Bloem Bastiaan R. , Munneke Marten , Ben-Shlomo Yoav , Darweesh Sirwan K.L.
Published: August 2024

Background

An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Following publication of the original study protocol, the COVID-19 crisis delayed implementation of the full PRIME Parkinson care model by two years and hampered the recruitment of study participants.

Objective

To describe which methodological adjustments were made to the study protocol because of these developments.

Methods

We compare various outcomes between a region where PRIME Parkinson care was implemented (innovation region) versus the rest of the Netherlands (usual care region). We use healthcare claims data of virtually all people with Parkinson in the Netherlands and annual questionnaires in a representative subsample of 984 people with Parkinson, 566 caregivers and 192 healthcare professionals. Four major methodological adjustments had to be made since publication of the original protocol. First, we extended the evaluation period by two years. Second, we incorporated annual process measures of the stage of implementation of the new care model. Third, we introduced a real-time iterative feedback loop of interim results to relevant stakeholders. Fourth, we updated the statistical analysis plan.

Discussion

This manuscript provides transparency in how the design and analyses of the evaluation study had to be adapted to control for external influences in a dynamic environment, including eruption of the COVID-19 crisis. Our solutions could serve as a template for evaluating other complex healthcare interventions in a dynamic environment.
Early outcomes of experience warm surgery in children undergoing complete repair of tetralogy of Fallot in developing countries
Authors: Hussain Alaa Mohamad , Younes Mohammad Ali
Published: August 2024

Objectives

While significant evidence supports the benefits of normothermic cardiopulmonary bypass (NCPB) over hypothermic techniques, many institutions in developing countries, including ours, continue to employ hypothermic methods. This study aimed to assess the early postoperative outcomes of normothermic cardiopulmonary bypass (NCPB) for complete surgical repair via the Tetralogy of Fallot (TOF) within our national context.

Methods

We conducted this study in the Pediatric Cardiac Intensive Care Unit (PCICU) at the University Children’s Hospital. One hundred patients who underwent complete TOF repair were enrolled and categorized into two groups: the normothermic group (n = 50, temperature 35–37 °C) and the moderate hypothermic group (n = 50, temperature 28–32 °C). We evaluated mortality, morbidity, and postoperative complications in the PCICU as outcome measures.

Results

The demographic characteristics were similar between the two groups. However, the cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were notably longer in the hypothermic group. The study recorded seven deaths, yielding an overall mortality rate of 7%. No significant differences were observed between the two groups concerning mortality, morbidity, or postoperative complications in the PCICU.

Conclusions

Our findings suggest that normothermic procedures, while not demonstrably effective, are safe for pediatric cardiac surgery. Further research is warranted to substantiate and endorse the adoption of this technique.
The effects of mineral trioxide aggregate and second-generation autologous growth factor on pulpotomy via TNF-α and NF-kβ/p65 pathways
Authors: Kurt Ayça , Çıkman Ahter Şanal , Balaban Emre , Gümrükçü Zeynep , Mercantepe Tolga , Tümkaya Levent , Karabağ Mert
Published: August 2024

This study aims to investigate the effect of Mineral Trioxide Aggregate (MTA), a bioactive endodontic cement, and Concentrated Growth Factor (CGF), a second-generation autologous growth factor, on pulpotomy-induced pulp inflammation. The study utilized the maxillary anterior central teeth of thirty-six young male Sprague Dawley rats. Forty-eight teeth were randomly assigned to two groups (12 rats/group; 24 teeth/group) based on the capping material (MTA or CGF). Subsequently, two subgroups (MTAG and CGFG) were formed per group (12 teeth/group) based on the time following pulpotomy (2-weeks and 4-weeks). The central teeth of the 12 animals assigned to the control group (CG) were not manipulated in any way, both in the 2-week group and in the 4-week group. Tissue samples extracted from rats at the end of the experiment were stained with H&E for histopathological analysis. For immunohistochemical analysis, primary antibodies for TNF-α and NF-kβ/65 were incubated. Data obtained from semi-quantitative analysis were assessed for normal distribution using Skewness-Kurtosis values, Q-Q plot, Levene’s test, and the Shapiro-Wilk test on statistical software. A P value < 0.05 was considered significant. When compared with the control group, both MTAG and CGFG showed increased edematous and inflammatory areas. In MTAG, edematous and inflammatory areas decreased significantly from the 2nd week (2(2–2), 2(1–2)) to the 4th week (1(1–1), 1(0–1)), while in CGFG, edematous areas decreased (2(2–3), 1.5(1–2)), and inflammatory areas increased significantly (2(2–3), 3(2-2.5)). When compared with the control group, TNF-α and NF-kβ/p65 positivity were higher in both MTAG and CGFG. In MTAG, TNF-α [2(1.5-2)] and NF-kβ/p65 [1.5(1–2)] positivity decreased significantly from the 2nd week to the 4th week [TNF-α: 1(1–1), NF-kβ/p65: 1(1–2)], while no significant change was observed in CGFG. In conclusion, this study revealed a reduction in cells showing TNF-α and NF-kβ/p65 positivity in the MTA treatment group compared to the CGF group. Although MTA demonstrated more favorable results than CGF in mitigating pulpal inflammation within the scope of this study, further experimental and clinical investigations are warranted to obtain comprehensive data regarding CGF.