bluuebunny/crossref_metadata_2025 huggingface dataset:
A system dynamics approach for cost-benefit simulation in designing policies to enhance the cybersecurity resilience of small and medium-sized enterprises
Authors: Song Jihwon , Park Min Jae
Published: May 2024

The small and medium-sized enterprises (SMEs) with limited investment capacity are likely to be lax in enhancing their cybersecurity. Therefore, to strengthen cybersecurity at a national level, governments must intervene in the market by using support or regulatory policies to overcome market failures and address weaknesses. This study reviewed the efficiency of policy options to improve corporate cybersecurity resilience for SMEs that require government support, unlike large companies that can invest in security on their own. To achieve this, a causal loop diagram was created and analyzed from the perspective of system dynamics. The model incorporated government support variables and the decline in capabilities over time into the existing corporate security investment model reflecting the standard framework for cybersecurity from NIST. The simulation scenarios were constructed based on policy options considered by the Korean government. These include 1) pre-incident or post incident support services, and 2) management through tax credits and regulation. The results indicated that incentives, specifically tax credits, rather than regulation, were more effective in strengthening cyber resilience. This study describes the investment and internal capability development of a company affected by government policy, which is an external factor, and changes in profits can be observed by adding the company's profits and costs as variables. This profit variable allows for the comparison of a company's cyber resilience across scenarios. Additionally, if the government provides direct support immediately after a hacking incident, the company can recover more quickly. If these benefits are known and if the reporting of hacking damage is activated, cyber threat visibility will be secured by revealing hacking attacks that have been secretly conducted. Governments can use cyber threat visibility to strengthen national cybersecurity.
Cytomegalovirus infection and disease in systemic lupus erythematosus patients at a high-complexity hospital in southwestern Colombia
Authors: Contreras-Valero Juan Fernando , Ruíz-Ordóñez Ingrid , Pinilla-Monsalve Gabriel D. , Bautista-Vargas Mario , Ocampo-Piraquive Vanessa , Aguirre-Valencia David
Published: May 2024

Cytomegalovirus (CMV) infection and disease is a condition usually described in immunocompromised patients, but among them, those with connective tissue diseases are poorly represented. Here we present the clinical, laboratory characteristics, management and outcomes of systemic lupus erythematosus (SLE) patients who presented with a CMV infection/disease to a high complexity hospital in southwestern Colombia between 2011 and 2020. 16 SLE patients were found to have a CMV infection. SLE was predominantly characterized by renal involvement (10 patients; 62.50%), and 14 patients (87.5%) were receiving steroids previous to the CMV infection. The entire sample required hospital admission, mainly related to acute kidney injury, and nine patients were admitted to the intensive care unit (ICU). Gastrointestinal organ damage was the most common CMV disease manifestation. All patients received ganciclovir, five of them (31.25%) suffered from septic shock, and seven (43.75%) died. Age ≥38 years and the presence of septic shock at admission were correlated to the mortality outcome. To our knowledge, this is the first publication evaluating SLE patients with CMV infection/disease in a Colombian population.
Relationship of serum and dietary vitamin D with high cardiometabolic risk in Mexican systemic lupus erythematosus patients: A cross-sectional study
Authors: Ruiz-Ballesteros Adolfo I , Betancourt-Núñez Alejandra , Meza-Meza Mónica R , Rivera-Escoto Melissa , Mora-García Paulina E , Pesqueda-Cendejas Karen , Vizmanos Barbara , Parra-Rojas Isela , Campos-López Bertha , Montoya-Buelna Margarita , Cerpa-Cruz Sergio , De la Cruz-Mosso Ulises
Published: May 2024

Objetive: Serum and dietary vitamin D could influence clinical disease activity and cardiometabolic outcomes in systemic lupus erythematosus (SLE). This study aimed to assess the relationship of serum and dietary vitamin D with cardiometabolic risk in Mexican SLE patients and healthy subjects (HS).

Methods: 224 SLE patients and 201 HS were included in this cross-sectional study. Serum calcidiol was measured using a competitive enzyme-linked immunosorbent assay (ELISA). Vitamin D dietary intake was assessed by collecting three 24h food records. Dietary patterns (DPs) were identified using principal component analysis (PCA). Cardiometabolic status was analyzed through biochemical measurements and cardiometabolic indexes.

Results: Calcidiol deficiency (<20 ng/mL) was associated with 1.66-fold higher risk of excess weight by body mass index (BMI) (≥25 kg/m2) (p = .02), 2.25-fold higher risk to low high-density lipoprotein-cholesterol (HDL-C) (<40 mg/dL) (p < .001), and 1.74-fold higher risk to high triglycerides (TG) ≥150 mg/dL (p = .02). Inadequate vitamin D dietary intake was associated with 1.92-fold higher risk of presenting non-healthy waist circumference (WC) (>80 cm) (p < .01), 2.05-fold higher risk of android waist to hip ratio (WHR ≥85) (p < .01), and 1.72-fold higher risk to excess weight (p = .02). Non-adherence to a DP rich in vitamin D food sources was associated with higher WC, WHR, triglycerides, and lower high-density lipoprotein-cholesterol (HDL-C); furthermore, in HS, non-adherence to the DP rich in vitamin D food sources provided 2.11-fold higher risk to calcidiol deficiency.

In Cconclusion: A pattern of Calcidiol deficiency, inadequate vitamin D dietary intake, and non-adherence to a DP rich in vitamin D food sources was related to high cardiometabolic risk in SLE patients and HS.
Conscientiousness, Resilience, and Personality: What do Mature Female Students tell us About Being an Adult Learner on a Foundation Programme at a Business School?
Authors: Stoten David William
Published: May 2024

This paper reports on the coping strategies of mature female students whilst studying a Foundation Programme at a Business School. In recent years, research has focussed less on the problems that confront adult learners and more on how they exercise personal agency and cope with the multifarious challenges of combining study with part-time employment and a home life. In particular, interest has focussed on the personality and how specific traits are associated with performative success. This paper reports on two aspects of personality that appear in the literature: conscientiousness and resilience as these are associated with the exercise of personal agency. The research reports on interviews with five mature female students, three of whom are mothers with caring responsibilities. The findings were analysed using Interpretative Phenomenological Analysis and provide insight into the exercise of successful personal agency. This paper also offers a model of how to conceptualise the support for mature students with their complex and varied needs.
Diagnosis, management, and outcomes of immune checkpoint inhibitor induced acute interstitial nephritis: A single-center experience
Authors: Elghawy Omar , Patel Reema , Barsouk Adam , Puthumana Joe , Xu Jason , Sussman Jonathan , Horton Bethany , Kaur Varinder
Published: May 2024

Background

Immune checkpoint inhibitor (ICI)-associated acute interstitial nephritis (AIN) is a recognized complication of immunotherapy (IO), but literature on its management and outcomes is limited.

Methods

We retrospectively reviewed patients who received ICIs and developed biopsy-proven or clinically-suspected ICI-associated AIN at the University of Virginia Comprehensive Cancer Center from 2012–2023. We analyzed baseline characteristics and clinical outcomes, including treatment interruption and rechallenge rates. Acute kidney injury (AKI) was defined as a ≥ 1.5-fold increase in baseline creatinine under seven days, a two-fold increase above the upper limit of normal, or an increase by ≥0.3 mg/dL. Kidney function returning to within 0.3 mg/dL or less than twice baseline was considered complete (CRc) and partial (PRc) recovery, respectively.

Results

We identified 12 cases of ICI-AIN: four by biopsy (33%) and eight (67%) by clinical suspicion. Two patients received anti-CTLA-4 and anti-PD1, six received anti-PD1 alone, and four received chemo-immunotherapy. The majority (58%) of patients developed AIN within the first 5 cycles. Eight patients developed ≥ Grade 3 AKI, and six developed multiple irAEs. ICI was permanently discontinued in seven patients (58%) and temporarily interrupted in four (30%). The CRc and PRc rates were 67% and 8%, respectively. Upon AIN onset, the best disease response was stable disease in five patients, partial response in three, and progressive disease in three. Median overall survival was 4.87 years, and progression-free survival was 1.5 years.

Conclusions

Rechallenge with IO after kidney irAE may be possible in some patients but requires careful evaluation on an individual basis.
Efficacy and Safety of Direct Oral Anticoagulants for Acute Treatment of Venous Thromboembolism in Older Adults: A Network Meta-Analysis of Randomised Controlled Trials
Authors: Pessôa Renato Luís , Kessler Vitor Germano , Becker Gabriel Goerck , Garcia Gabriel Moretti , Duarte Araldi Pedro Victor , Aver Pedro Verza
Published: May 2024

Objective

This systematic review and network meta-analysis aimed to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in adults aged 75 and over undergoing acute venous thromboembolism (VTE) treatment.

Methods

PubMed, Embase and the CENTRAL were searched up to 25 December 2023. The incidence of VTE recurrence and bleeding events was assessed. Employing a frequentist network meta-analysis approach, interventions not directly compared could be indirectly assessed through the 95% confidence interval (CI), enhancing the interpretability of the search results. The surface under the cumulative ranking curves (SUCRA) was utilized to generate the relative ranking probabilities for each group.

Results

Our study, analysing 6 randomised controlled trials with 3665 patients, compares direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in adults aged 75 and over with acute venous thromboembolism. Edoxaban reduces VTE recurrence risk compared with VKAs (risk ratio [RR] .50, 95% CI 0.27 – .95), while apixaban significantly decreases bleeding risk compared with VKAs (RR .23, 95% CI 0.08 – .69), edoxaban (RR .28, 95% CI 0.09 – .86) and rivaroxaban (RR .28, 95% CI 0.09 – .86). Despite low overall evidence quality, apixaban consistently ranks highest for both efficacy and safety. Findings underscore the nuanced efficacy-safety balance in this population, emphasizing cautious interpretation due to evidence limitations.

Conclusion

Apixaban emerges as a favourable choice for acute VTE treatment in the elderly, displaying reduced bleeding risk compared to other treatments while maintaining comparable efficacy. Future studies should explore diverse anticoagulants efficacy and safety in older populations. Additionally, clinical prediction models tailored to geriatric cohorts are crucial for guiding treatment duration decisions.
Inclusion of Students with Disability in Qualitative Education Research – A Scoping Review
Authors: Young Kirsty , Clerke Teena
Published: May 2024

Children and adolescents are typically at the bottom of the hierarchy of knowledge production, and those with disabilities are further marginalised. Despite recent attempts to include them in the design and implementation of qualitative studies, it is unclear as to whether this is the case in education research. To explore this, we conducted a scoping review of qualitative research studies in K–12 education. We applied the conceptual framing of research with and by, which engages students with disability as research participants, rather than research on, which treats such students as the object of study. The aim was to generate a methodological map of studies conducted with or by students with disability, describe methodological approaches used, offer an interpretation of inclusive educational research, and identify areas for future research. We searched Proquest and Ebscohost databases, this journal and Google Scholar from 1 January 2012 to 31 December 2022 to identify studies using research with or by methodological approaches with school-aged students with disability. We included 96 studies from 29 countries, which focused predominantly on inclusion and participation, and student social and emotional wellbeing. We found that almost all studies took a research with approach by employing individual and focus group interviews, sometimes supplemented with arts- or play-based activities to guide student responses. Only two studies used a research by approach, involving students in decision-making from the outset of research, methods used and dissemination of outcomes. This suggests that the priorities and experiences of students with disability continue to be marginalised in research that guides educational decisions deemed best for them. We argue that educational research should move beyond ableist and exclusionary practices to include students with disability in knowledge generation that guides decisions about schooling to generate greater diversity in education research and practice.
Effects of tackle height and shoulder preference on head and trunk acceleration in rugby
Authors: Ogata Yuta , Soejima Takashi , Hara Kenji , Takahata Hiromi , Ando Yu , Yamashita Akihiro , Yamada Mutsuo , Murakami Hidetaka , Maeda Akira
Published: May 2024

Background

Most rugby injuries occur during tackles, therefore investigating safe tackling techniques is essential.

Objectives

To determine the effects of different tackle heights and shoulder preference on head and trunk acceleration.

Methods

Thirty-nine rugby players belonging to university leagues, adult leagues, and adult leagues, tackled a stationary tackle bag under three height conditions (high, middle, and low) with a dominant shoulder and a non-dominant shoulder. We calculated the peak head and trunk accelerations (PhA and PtA, respectively) during the tackles and evaluated the difference in accelerations by the tackle height and side.

Results

The PhA (26.1 g (17.1) g) during the tackles was significantly higher than the PtA (11.7(7.2) g, p < 0.01). The PhA was significantly larger in the high (27.4 (19.4) g) and middle (27.7 (17.0) g) tackles compared to the low (23.4 (14.6) g) tackle (high vs low: p < 0.01; middle vs low: p < 0.01). The PhA was significantly lower during the dominant shoulder side (23.0 (13.7) g) tackles than during the non-dominant shoulder side (30.4 (21.3) g) tackles ( p < 0.01).

Conclusion

The results suggest that coaching strategies and policies aimed at reducing tackler height and improving tackle technique on the non-dominant shoulder would help reduce head acceleration forces.
Chylothorax in Infants and Children After Congenital Heart Surgery: Approach and Review
Authors: Kumar Anil , Agarwal Sristy , Joshi Reena Khantwal , Gupta Arun , Rudrappa Siddhartha C. , Aggarwal Neeraj , Joshi Raja
Published: May 2024

Chylothorax in infants after surgery for congenital heart disease is associated with significant morbidity and mortality. Numerous management modalities applied alone or in various combinations have been utilized but definitive guidelines have not yet been established. We present two infants who developed refractory chylothorax after congenital heart surgery. We also reviewed evidence for the use of available treatment modalities. In our experience, the use of lymphangiography followed by pleurodesis by povidone-iodine was safe and our impression was that it may have played a decisive role in controlling the lymph leak.
Quality of early stroke care and long-term mortality in patients with acute stroke: A nationwide follow-up study
Authors: Eddelien Heidi Shil , Grøntved Simon , Hedegaard Jakob Nebeling , Thomsen Thordis , Kruuse Christina , Johnsen Søren Paaske
Published: May 2024

Introduction:

High quality of early stroke care is essential for optimizing the chance of a good patient outcome. The quality of care may be monitored by process performance measures (PPMs) and previous studies have found an association between fulfilment of PPMs and short-term mortality. However, the association with long-term mortality remains to be determined. We aimed to evaluate the association between fulfilment of PPMs and long-term mortality for patients with acute stroke in Denmark.

Patients and methods:

We used data from Danish health care registers between 2008 and 2020 to identify all patients admitted with incident stroke (haemorrhagic (ICH) or ischaemic stroke). The quality of early stroke care was assessed using 10 PPMs. Mortality was compared using Cox proportional hazard ratios, risk ratios computed using Poisson regression, and standardized relative survival.

Results:

We included 102,742 patients; 9804 cases of ICH, 88,591 cases of ischaemic stroke, and 4347 cases of unspecified strokes. The cumulative 10-year mortality risk was 56.8%. Fulfilment of the individual PPMs was associated with adjusted hazard rate ratios of death between 0.76 and 0.96. Patients with 100% fulfilment of all PPMs had a lower 10-year post-stroke mortality (adjusted risk ratio 0.90) compared to the patients with 0%–49% fulfilment and a standardized relative survival of 81.3%, compared to the general population.

Conclusion:

High quality of early stroke care was associated with lower long-term mortality following both ICH and ischaemic stroke, which emphasizes the importance of continued attention on the ability of stroke care providers to deliver high quality of early care.
The digitalization of discourse: Exploring key discussion points for the study of violence online
Authors: Recuero Raquel
Published: May 2024

This piece focuses on systematizing and exploring key issues for the study of how digitalization has impacted the concept, structure, and effects of discursive violence. By delving into the interplay between language, power struggles, and societal legitimization, the proposed discussion centers on the challenges posed by the digitalization of discourse, particularly within the context of inequalities. The examination of this specific issue is crucial for establishing a foundation for future research and interventions aimed at fostering healthier online communication.
Lift-Off Effect of Koch and Circular Differential Pickup Eddy Current Probes
Authors: Chen Guolong , Cao Zheng , Zhang Shuaishuai , Wei Ji , Gao Wei , Jin Wuyin
Published: May 2024

A flexible or planar eddy current probe with a differential structure can suppress the lift-off noise during the inspection of defects. However, the extent of the lift-off effect on differential probes, including different coil structures, varies. In this study, two planar eddy current probes with differential pickup structures and the same size, Koch and circular probes, were used to compare lift-off effects. The eddy current distributions of the probes perturbed by 0° and 90° cracks were obtained by finite element analysis. The analysis results show that the 90° crack can impede the eddy current induced by the Koch probe even further at relatively low lift-off distance. The peak-to-peak values of the signal output from the two probes were compared at different lift-off distances using finite element analysis and experimental methods. In addition, the effects of different frequencies on the lift-off were studied experimentally. The results show that the signal peak-to-peak value of the Koch probe for the inspection of cracks in 90° orientation is larger than that of the circular probe when the lift-off distance is smaller than 1.2 mm. In addition, the influence of the lift-off distance on the peak-to-peak signal value of the two probes was studied via normalization. This indicates that the influence becomes more evident with an increase in excitation frequency. This research discloses the lift-off effect of differential planar eddy current probes with different coil shapes and proves the detection merit of the Koch probe for 90° cracks at low lift-off distances.
Characterization of Neowestiellopsis persica A1387 (Hapalosiphonaceae) based on the cpcA, psbA, rpoC1, nifH and nifD gene sequences
Authors: Nowruzi Bahareh , Hutarova Lenka , Vešelenyiova Dominika , Metcalf James S.
Published: May 2024

Background

Complex descriptions of new strains of cyanobacteria appear very frequently. The main importance of these descriptions concerns potential new substances that they could synthesise, as well as their different properties as a result of their different ecological niches. The main gene used for these descriptions is 16 S with ITS or whole genome sequencing. Neowestiellopsis persica represents a unique example of the influence of ecology on morphological changes, with almost identical 16 S identity. Although our previously described Neowestiellopsis persica strain A1387 was characterized by 16 S analysis, we used different molecular markers to provide a way to separate strains of this genus that are closely related at the genetic level.

Materials and methods

In order to conduct an in-depth study, several molecular markers, namely psbA, rpoC1, nifD, nifH and cpcA were sequenced and studied in Neowestiellopsis persica strain A1387.

Results

The results of the phylogenetic analysis, based on cpcA, showed that the studied strain A 1387 falls into a separate clade than N. persica, indicating that this signature sequence could be a useful molecular marker for phylogenetic separation of similar strains isolated in the future.

Conclusions

Analysis of strain A1387 based on gene differences confirmed that it is a Neowestiellopsis strain. The morphological changes observed in the previous study could be due to different ecological and cultivation conditions compared to the type species. At the same time, the sequences obtained have increased our understanding of this species and will help in the future to better identify strains belonging to the genus Neowestiellopsis.
Identification and characterization of whole blood gene expression and splicing quantitative trait loci during early to mid-lactation of dairy cattle
Authors: Tang Yongjie , Zhang Jinning , Li Wenlong , Liu Xueqin , Chen Siqian , Mi Siyuan , Yang Jinyan , Teng Jinyan , Fang Lingzhao , Yu Ying
Published: May 2024

Background

Characterization of regulatory variants (e.g., gene expression quantitative trait loci, eQTL; gene splicing QTL, sQTL) is crucial for biologically interpreting molecular mechanisms underlying loci associated with complex traits. However, regulatory variants in dairy cattle, particularly in specific biological contexts (e.g., distinct lactation stages), remain largely unknown. In this study, we explored regulatory variants in whole blood samples collected during early to mid-lactation (22–150 days after calving) of 101 Holstein cows and analyzed them to decipher the regulatory mechanisms underlying complex traits in dairy cattle.

Results

We identified 14,303 genes and 227,705 intron clusters expressed in the white blood cells of 101 cattle. The average heritability of gene expression and intron excision ratio explained by cis-SNPs is 0.28 ± 0.13 and 0.25 ± 0.13, respectively. We identified 23,485 SNP-gene expression pairs and 18,166 SNP-intron cluster pairs in dairy cattle during early to mid-lactation. Compared with the 2,380,457 cis-eQTLs reported to be present in blood in the Cattle Genotype-Tissue Expression atlas (CattleGTEx), only 6,114 cis-eQTLs (P < 0.05) were detected in the present study. By conducting colocalization analysis between cis-e/sQTL and the results of genome-wide association studies (GWAS) from four traits, we identified a cis-e/sQTL (rs109421300) of the DGAT1 gene that might be a key marker in early to mid-lactation for milk yield, fat yield, protein yield, and somatic cell score (PP4 > 0.6). Finally, transcriptome-wide association studies (TWAS) revealed certain genes (e.g., FAM83H and TBC1D17) whose expression in white blood cells was significantly (P < 0.05) associated with complex traits.

Conclusions

This study investigated the genetic regulation of gene expression and alternative splicing in dairy cows during early to mid-lactation and provided new insights into the regulatory mechanisms underlying complex traits of economic importance.
A feasibility study on preoperative carbohydrate loading in older patients undergoing hip fracture surgery
Authors: Yap Kai Sing , Loh PS , Foong Yi Xian , Mok Chu Zhen , Ong Terence , Khor Hui Min
Published: May 2024

Background

Preoperative carbohydrate loading in Enhanced Recovery After Surgery is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming carbohydrate drink is safe up to 2 h preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. This study aimed to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects.

Methods

This was a randomized controlled, open labelled trial. Patients ≥ 65 years old without diabetes mellitus, has hip fracture were recruited in a tertiary hospital between November 2020 and May 2021. The intervention was carbohydrate loading versus standard preoperative fasting.

Results

Thirty-four ASA I-III patients (carbohydrate loading and control, n = 17 each), mean age 78 years (SEM ± 1.5), mean body mass index 23.7 (SEM ± 0.6 kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 17) demonstrated attrition rate of 29% (n = 5). Otherwise, all recruited patients were compliant (100% compliance) with no adverse events reported. There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level, muscle strength, postoperative infection and length of hospital stay assessed at 24–48 h postoperatively.

Conclusion

The implementation of preoperative carbohydrate loading was found to be feasible preoperatively in hip fracture surgeries but requires careful coordination among multidisciplinary teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients.

Trial registration

This study was registered in ClinicalTrial.gov (ClinicalTrials.gov identifier: NCT04614181, date of registration: 03/11/2020).
Psychometric properties of Persian version of advance care planning questionnaire among older adults in Iran
Authors: Golmohammadi Mobina , Barasteh Salman , Mollahadi Mohsen , Ali Shadi Baba , Ebadi Abbas
Published: May 2024

Introduction

Advanced age is associated with life-threatening conditions at the end of life. Many of these persons at the end of their lives cannot make decisions because of the variable consciousness. They are able to make decisions and identify their care priorities, in a process called advanced care planning. So, an instrument is required for investigating ACP of the elderly population. This study was performed to determine the psychometric properties of the Persian version of the advanced care planning questionnaire(ACPQ) in elderly population referring to Tehran.

Method

This methodological study was performed in five hospitals in 2021–2022. A total of 390 eligible elderlies were included. The psychometric assessment including translation, face validity, content validity were performed Alsothe exploratory factor analysis and confirmatory factor analysis were assessed. Reliability were done by internal consistency by assessing Cronbach alpha and stability was performed using test-retest.

Results

The face validity of the instrument was performed with minor changes. The content validity index for all of the items was above 0.79. In EFA four factors was extracted also CFA showed that the four-factor model has a good fit of the data (RMSEA: 0.04; NFI: 0.97 CFI: 0.99; IFI: 0.99; RFI: 0.96; AGFI: 0.87; GFI 0/90; standardized RMR: 0.02). Cronbach alpha and ICC were 0.72–0.94 and 0.85–0.96, respectively.

Conclusion

The Persian version of the advance care planning questionnaire has desirable psychometric properties for measuring the advanced care planning of the elderly population. In addition, healthcare providers in Iran can employ this questionnaire in their practice and research.
The predictive accuracy of machine learning for the risk of death in HIV patients: a systematic review and meta-analysis
Authors: Li Yuefei , Feng Ying , He Qian , Ni Zhen , Hu Xiaoyuan , Feng Xinhuan , Ni Mingjian
Published: May 2024

Background

Early prediction of mortality in individuals with HIV (PWH) has perpetually posed a formidable challenge. With the widespread integration of machine learning into clinical practice, some researchers endeavor to formulate models predicting the mortality risk for PWH. Nevertheless, the diverse timeframes of mortality among PWH and the potential multitude of modeling variables have cast doubt on the efficacy of the current predictive model for HIV-related deaths. To address this, we undertook a systematic review and meta-analysis, aiming to comprehensively assess the utilization of machine learning in the early prediction of HIV-related deaths and furnish evidence-based support for the advancement of artificial intelligence in this domain.

Methods

We systematically combed through the PubMed, Cochrane, Embase, and Web of Science databases on November 25, 2023. To evaluate the bias risk in the original studies included, we employed the Predictive Model Bias Risk Assessment Tool (PROBAST). During the meta-analysis, we conducted subgroup analysis based on survival and non-survival models. Additionally, we utilized meta-regression to explore the influence of death time on the predictive value of the model for HIV-related deaths.

Results

After our comprehensive review, we analyzed a total of 24 pieces of literature, encompassing data from 401,389 individuals diagnosed with HIV. Within this dataset, 23 articles specifically delved into deaths during long-term follow-ups outside hospital settings. The machine learning models applied for predicting these deaths comprised survival models (COX regression) and other non-survival models. The outcomes of the meta-analysis unveiled that within the training set, the c-index for predicting deaths among people with HIV (PWH) using predictive models stands at 0.83 (95% CI: 0.75–0.91). In the validation set, the c-index is slightly lower at 0.81 (95% CI: 0.78–0.85). Notably, the meta-regression analysis demonstrated that neither follow-up time nor the occurrence of death events significantly impacted the performance of the machine learning models.

Conclusions

The study suggests that machine learning is a viable approach for developing non-time-based predictions regarding HIV deaths. Nevertheless, the limited inclusion of original studies necessitates additional multicenter studies for thorough validation.
The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis
Authors: Li Hong , Hu Zhonghua , Fan Yuyan , Hao Yingying
Published: May 2024

Objective

The objective of the meta-analysis was to determine the influence of uterine fibroids on adverse outcomes, with specific emphasis on multiple or large (≥ 5 cm in diameter) fibroids.

Materials and methods

We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and SinoMed databases for eligible studies that investigated the influence of uterine fibroids on adverse outcomes in pregnancy. The pooled risk ratio (RR) of the variables was estimated with fixed effect or random effect models.

Results

Twenty-four studies with 237 509 participants were included. The pooled results showed that fibroids elevated the risk of adverse outcomes, including preterm birth, cesarean delivery, placenta previa, miscarriage, preterm premature rupture of membranes (PPROM), placental abruption, postpartum hemorrhage (PPH), fetal distress, malposition, intrauterine fetal death, low birth weight, breech presentation, and preeclampsia. However, after adjusting for the potential factors, negative effects were only seen for preterm birth, cesarean delivery, placenta previa, placental abruption, PPH, intrauterine fetal death, breech presentation, and preeclampsia. Subgroup analysis showed an association between larger fibroids and significantly elevated risks of breech presentation, PPH, and placenta previa in comparison with small fibroids. Multiple fibroids did not increase the risk of breech presentation, placental abruption, cesarean delivery, PPH, placenta previa, PPROM, preterm birth, and intrauterine growth restriction. Meta-regression analyses indicated that maternal age only affected the relationship between uterine fibroids and preterm birth, and BMI influenced the relationship between uterine fibroids and intrauterine fetal death. Other potential confounding factors had no impact on malposition, fetal distress, PPROM, miscarriage, placenta previa, placental abruption, and PPH.

Conclusion

The presence of uterine fibroids poses increased risks of adverse pregnancy and obstetric outcomes. Fibroid size influenced the risk of breech presentation, PPH, and placenta previa, while fibroid numbers had no impact on the risk of these outcomes.
Prevalence, associated factors and antimicrobial susceptibility patterns of Salmonella and Shigella species among diarrheic under five children in Sultan Sheik Hassan Yabere referral Hospital, Jigjiga, Eastern Ethiopia
Authors: Muse Kader , Urgessa Kedir , Shume Tadesse , Tahir Bawlah , Weldegebreal Fitsum
Published: May 2024

Background

Diarrhea caused by Salmonella and Shigella species are the leading cause of illness especially in developing countries. These infections are considered as the main public health problems in children, including Ethiopia. This study aimed to assess the prevalence, associated factors, and antimicrobial susceptibility patterns of Salmonella and Shigella species in Sheik Hassan Yabere Referral Hospital Jigjiga, Eastern Ethiopia from August 05 to November 15, 2022.

Method

A cross-sectional study was conducted among 239 under-five children with diarrhea selected through a convenient sampling technique. A structured questionnaire was used to collect associated factors. A stool sample was collected and processed for the identification of Salmonella and Shigella species using MacConkey adar, Xylose Lysine Deoxycholate agar (Oxoid Ltd) and Biochemical tests. The antimicrobial susceptibility pattern of isolates was performed using the Kirby-Bauer disc diffusion technique. The data was entered into Epi-data version 4.6 and exported to the statistical package of social science version 22 for analysis. The association between outcome and independent variables was assessed using bivariate, multivariable, and chi-square and P-value < 0.05 was considered as statistical significance.

Result

Overall prevalence of Salmonella and Shigella species was 6.3% (95% CI, 5.7–6.9%), of which 3.8% (95 CI, 3.2–4.4%) were Salmonella species and 2.5% (95% CI, 1.95-3%) were Shigella species. Unimproved water source (AOR = 5.08, 95% CI = 1.45, 17.25), open field (AOR = 2.3, 95% CI = 1.3, 5.03), rural residence (AOR = 1.8, 95% CI = 1.4, 7.5), Hand-washing practice (p = 0.001), and raw meat consumption (p = 0.002) were associated with occurrence of Salmonella and Shigella species. Salmonella and Shigella isolates were resistant to Ampicilin (100%). However, Salmonella isolates was sensitive to Norfloxacin (100%). About 22.2% and 16.7% of Salmonella and Shigella isolates were multi-drug resistant, respectively.

Conclusion

Prevalence of Salmonella and Shigella species were lower than most studies done in Ethiopia. Hand-washing habit, water source type, Open field waste disposal habit, raw meat consumption and rural residence were associated with Salmonellosis and shigellosis. All isolated Salmonella were sensitive to norfloxacin. The evidence from this study underscores the need for improved water, sanitation and hygiene (WASH) system and the imperative to implement drug susceptibility tests for the treatment of Salmonella and Shigella infection.
An adolescent case of ASXL3-related disorder with delayed onset of feeding difficulty
Authors: Arai Yuto , Okanishi Tohru , Okazaki Tetsuya , Awano Hiroyuki , Seyama Rie , Uchiyama Yuri , Matsumoto Naomichi , Tamasaki Akiko , Maegaki Yoshihiro
Published: May 2024

Background

ASXL3-related disorder, first described in 2013, is a genetic disorder with an autosomal dominant inheritance that is caused by a heterozygous loss-of-function variant in ASXL3. The most characteristic feature is neurodevelopmental delay with consistently limited speech. Feeding difficulty is a main symptom observed in infancy. However, no adolescent case has been reported.

Case presentation

A 14-year-old girl with ASXL3-related syndrome was referred to our hospital with subacute onset of emotional lability. Limbic encephalitis was ruled out by examination; however, the patient gradually showed a lack of interest in eating, with decreased diet volume. Consequently, she experienced significant weight loss. She experienced no symptoms of bulimia, or food allergy; therefore, avoidant/restrictive food intake disorder (ARFID) was clinically suspected.

Conclusions

We reported the first case of ASXL3-related disorder with adolescent onset of feeding difficulty. ARFID was considered a cause of the feeding difficulty.
Sleeping more than 8 h: a silent factor contributing to decreased muscle mass in Chinese community-dwelling older adults
Authors: Huang Qiongyu , Lin Hongsheng , Xiao Han , Zhang Liuwei , Chen Dafang , Dai Xiaotong
Published: May 2024

Background

Muscle mass loss is an age-related process that can be exacerbated by lifestyle, environmental and other factors, but can be mitigated by good sleep. The objective of this study was to investigate the correlation between varying time lags of sleep duration and the decline in muscle mass among individuals aged 60 years or older by using real-world health monitoring data obtained from wearable devices and smart home health monitoring devices.

Methods

This study included 86,037 observations from 2,869 participants in the Mobile Support System database. Missing data were supplemented by multiple imputation. The investigation utilized generalized estimating equations and restricted cubic spline curve to examine the relationship between sleep duration and low muscle mass. Various lag structures, including 0, 1, 2, 0–1, 0–2, and 1–2 months, were fitted, and the interaction effect of observation time with sleep duration was estimated for each lag structure. Additionally, subgroup analyses were conducted. The models were adjusted for various covariates, including gender, age, body mass index, footsteps, smoking status, drinking status, marital status, number of chronic diseases, number of medications, diabetes mellitus, hyperlipidemia, coronary artery disease, respiratory disease, and musculoskeletal disease and an interaction term between time and sleep duration.

Results

The results of the generalized estimating equation showed a significant correlation (p < 0.001) between sleep duration of 8 h or more and low muscle mass in older adults, using 6–7 h of sleep as a reference. This effect was seen over time and prolonged sleep accumulated over multiple months had a greater effect on muscle mass loss than a single month. The effect of long sleep duration on muscle mass loss was significantly greater in females than in males and greater in the over-75 than in the under-75 age group. Restricted cubic spline plots showed a non-linear relationship between sleep duration and low muscle mass (p < 0.001).

Conclusions

This study found an association between sustained nighttime sleep of more than eight hours and decreased muscle mass in older adults, especially older women.
Molecular interactions between metformin and D-limonene inhibit proliferation and promote apoptosis in breast and liver cancer cells
Authors: Salim Elsayed I. , Alabasy Mona M. , Nashar Eman M. El , Al-Zahrani Norah S. , Alzahrani Mohammed A. , Guo Zihu , Beltagy Doha M. , Shahen Mohamed
Published: May 2024

Background

Cancer is a fatal disease that severely affects humans. Designing new anticancer strategies and understanding the mechanism of action of anticancer agents is imperative.

Hypothesis/Purpose

In this study, we evaluated the utility of metformin and D-limonene, alone or in combination, as potential anticancer therapeutics using the human liver and breast cancer cell lines HepG2 and MCF-7.

Study design

An integrated systems pharmacology approach is presented for illustrating the molecular interactions between metformin and D-limonene.

Methods

We applied a systems-based analysis to introduce a drug–target–pathway network that clarifies different mechanisms of treatment. The combination treatment of metformin and D-limonene induced apoptosis in both cell lines compared with single drug treatments, as indicated by flow cytometric and gene expression analysis.

Results

The mRNA expression of Bax and P53 genes were significantly upregulated while Bcl-2, iNOS, and Cox-2 were significantly downregulated in all treatment groups compared with normal cells. The percentages of late apoptotic HepG2 and MCF-7 cells were higher in all treatment groups, particularly in the combination treatment group. Calculations for the combination index (CI) revealed a synergistic effect between both drugs for HepG2 cells (CI = 0.14) and MCF-7 cells (CI = 0.22).

Conclusion

Our data show that metformin, D-limonene, and their combinations exerted significant antitumor effects on the cancer cell lines by inducing apoptosis and modulating the expression of apoptotic genes.
Barriers to implementing problem-based learning at the school of medicine of Debre Berhan University, Ethiopia
Authors: Tefera Aklile Semu , Melaku Ermiyas Endewunet , Urgie Besufekad Mulugeta , Hassen Erzik Muhammed , Tamene Tilahun Deresse , Gebeyaw Enguday Demeke
Published: May 2024

Background

Implementing PBL in teaching and learning can be challenging due to a variety of complex barriers. Studies on barriers to the implementation of problem-based learning in Ethiopia are scarce. This study aimed to explore the barriers to the implementation of problem-based learning at the Debre Berhan University Medical School.

Methods

A qualitative study was conducted among faculty and medical students at the medical school. Purposive sampling was used to select participants. Semi-structured interviews were conducted with tutors and academic leaders, including the problem-based learning coordinator, the biomedical sciences coordinator, and the school dean. Data was also collected from students through focus group discussions. All interviews and discussions were recorded. The four steps of data analysis of Spradley, including domain analysis, taxonomic analysis, componential analysis, and theme analysis, were employed.

Results

The study identified student-related, tutor-related, case scenario-related, and assessment-related barriers as the most significant obstacles to implementing problem-based learning. These barriers included work overload for both students and tutors, lack of training and experience among tutors, student reluctance, absence of standardized case scenarios, subjectivity of assessment methods, and on-the-spot assessment of students.

Conclusions and recommendations

: Lack of both tutor and student commitment, lack of standardized cases, absence of a recognition of staff input, gap in communication skills, work overload, lack of continuous training, and at-spot evaluation of students were identified as the main barriers to the implementation of PBL.
A qualitative study of the value of simulation-based training for nursing students in primary care
Authors: Bray Lucy , Østergaard Doris
Published: May 2024

Background

Clinical placement is an essential component of nursing education, providing students with the opportunity to apply theoretical knowledge to practice. However, challenges such as lack of supervision and passive involvement in tasks can hinder the learning experience. Supplementing clinical placement with simulation-based training (SBT) has been explored as a potential solution, though this approach has been underexplored within primary care. This study aimed to explore the educational value of a supplemental SBT course for nursing students during primary care placement, as well as the adaption of this approach to a primary care setting.

Methods

A qualitative descriptive study was conducted at a medical education and simulation academy in Denmark. Sixth-semester nursing students on placement in primary care were invited to participate. The intervention consisted of a three-day simulation course covering core nursing competencies and common clinical conditions encountered within primary care. Simulation adopted a standardised patient approach. Data was collected using focus group interviews, which was analysed using inductive thematic analysis.

Results

Thirty-one nursing students participated in the study. Seven themes emerged from the analysis, including perceptions, educational value, simulation adjustments to primary care, educators’ competencies, learning needs within primary care, challenges of clinical placement and career guidance. Generally, participants perceived the intervention positively, appreciating its relevance to their clinical placement and its educational impact in this context. Participants also provided insights into the adaptation of SBT to a primary care setting, as well as nursing students’ learning needs within this context.

Conclusion

The findings indicate that the intervention had a positive impact on participant competencies within this context and enhanced their clinical practice within primary care. Furthermore, the results inform educators on how to effectively employ primary care-related SBT. Overall, this study supports the need for an increased application of SBT within primary care.

Trial registration

Not relevant.