bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Outcomes of Posterior Circulation Involvement in Moyamoya Disease
Authors: Tigchelaar Seth S. , Wang Allan R. , Vaca Silvia D. , Li Yiping , Steinberg Gary K.
Published: April 2024

BACKGROUND:

Moyamoya disease (MMD) is a progressive, occlusive disease of the internal carotid arteries and their proximal branches, with the subsequent development of an abnormal vascular network that is rupture-prone. Steno-occlusive changes in the posterior cerebral arteries (PCAs) may contribute to worsened outcomes in patients with MMD; however, there is little information on the incidence and natural history of posterior circulation MMD (PCMMD). We describe clinical PCMMD characteristics in a large cohort of patients with MMD.

METHODS:

We retrospectively reviewed patients with MMD treated between 1991 and 2019 at a large academic medical center. Demographics, perioperative outcomes, and radiological phenotypes were recorded for 770 patients. PCA disease was graded as either 0 (no disease), 1 (mild), 2 (moderate), or 3 (severe or occluded) based on cerebral angiography. Patients with angiographically confirmed MMD diagnosis with at least 6 months follow-up and completion of revascularization surgery were included; patients with intracranial atherosclerosis, intracranial dissection, vasculitis, and undefined inflammatory processes were excluded. The presence of stenosis/occlusion was graded radiographically to assess for disease progression and the prevalence of risk factors related to reduced progression-free survival.

RESULTS:

In all, 686 patients met the inclusion criteria, with PCA disease identified in 282 (41.1%) patients. Of those 282 patients with PCMMD, disease severity ranged from 99 (35.1%) with mild, 72 (25.5%) with moderate, and 111 (39.4%) with severe. The total number of postoperative complications was significantly associated with PCMMD severity (
P
=0.0067). Additionally, PCMMD severity correlated with worse postoperative modified Rankin Scale scores (
P
<0.0001). At a mean follow-up of 6.0±3.9 (range, 0.1–25.0) years, a total of 60 (12.6%) patients showed new/worsening PCMMD. The overall postoperative, progression-free survival in patients with PCMMD was 95.4% at 1 year, 82.4% at 3 years, 68.8% at 5 years, and 28.3% at 10 years, with prognostic factors for progression including preoperative PCMMD status, history of tobacco use, and hypertension (
P
<0.0001,
P
<0.001, and
P
<0.0001, respectively).

CONCLUSIONS:

PCA disease involvement in MMD is associated with higher rates of ischemic perioperative complications and worsened functional outcomes, likely due to reduced collateral flow. Ten-year progression of PCA disease is highly likely and should be monitored throughout follow-up; future studies will assess the impact of PCA disease progression on long-term outcomes.
Reciting Buddhist Texts: Long Suttas of the Dīghanikāya in Performance
Authors: Shaw Sarah
Published: April 2024

Recital was, and is, an essential part of Buddhist textual transmission. Recently, the role of repetition as a literary feature has been discussed as a key element in the construction and final composition of the texts. This article contributes to the discussion through a literary analysis of the role of repetition and recital in two suttas of the Dīghanikāya. With examination of two key repeat passages and the way each is presented, it demonstrates that repetition in each sutta discussed forms a key function, crucially dependent on what one might term a literary, or an experiential, effect. The suttas were intended to be heard; long suttas were, and often still are, performative, listened to over sometimes several hours, embedded in rituals designed to highlight their efficacy. This article shows that the recital of key repeat passages within the long suttas is linked to specific and often distinctive literary and meditative effects, particularly adapted for oral performance. It suggests that such passages should not be marginalized but rather seen as central indicators of meaning.
Aristotle on the Cause of Unity: the Argument of Metaphysics H.3–6
Authors: Pfeiffer Christian
Published: April 2024

I argue that Metaphysics H.6 is not an isolated chapter but the conclusion of an argument begun in H.3. This view will provide further and better arguments for the following view about long-standing interpretative debates: first, Aristotle provides a substantive account of the unity of the composite substance (although he also briefly addresses the unity of the form); second, neither Aristotle’s conception of matter nor his account of form changes between H.1–5 and H.6; and third, H does not rely on and is not completed by book Θ in any significant way.
Exploring Attempts at Judicial Resolution of the Nkonya-Alavanyo Communal Conflict in Ghana
Authors: Agyei Prince Duah , Odartey-Wellington Felix
Published: April 2024

While the literature on the Nkonya-Alavanyo conflict references litigation and its apparent ineffectiveness in resolving the conflict, there is a paucity of detail about this litigation. This paper contributes to a more holistic comprehension of the discourses structuring resolution attempts in this conflict, with lessons for the resolution of communal conflicts generally. Drawing on archival data, media reports, and field interviews, we examine the trajectory of the Nkonya-Alavanyo conflict in the Ghanaian judicial system as an example of an intractable communal conflict that has defied legal attempts at resolution. We argue that judicial attempts at resolving the conflict have been ineffective because the resultant juridical discourse is polysemic and – to the extent that the non-negotiable value of justice is a factor in the conflict – is subject to divergent articulations. Second, we submit that the juridical discourse competes with State, civil society, and partisan articulations that do not privilege judicial decisions, with State discourse increasingly being one of militarisation.
South Sudan’s Transitional Constitution: the Making, Failure and Lessons
Authors: Deng Mark A. W.
Published: April 2024

The period 2005 to 2011 has a special significance for the people of Sudan. It not only saw the emergence of South Sudan as an independent country, but it also marked the beginning of formal constitution-making in South Sudan’s tumultuous political history. Two important documents – the Interim Constitution 2005 and the Transitional Constitution 2011 – were enacted during this period. I discuss both documents in this paper. I find that the Transitional Constitution unnecessarily concentrates power in the president. I argue that in failing to constrain the president, the Transitional Constitution has failed the task of a modern constitution.
A subspecies of marbled newt (Triturus marmoratus) in the Iberian Peninsula newly resolved from congruent nuclear and mitochondrial dna data
Authors: Arntzen Jan W.
Published: April 2024

The herpetofauna of the Iberian Peninsula is relatively well-researched, yet detailed studies, at least in part relying on molecular genetic data, continue to reveal taxa new to science, mostly species and subspecies. Newts of the genus Triturus are one such group with undiscovered yet taxonomically relevant variation, as shown by the recent description of new (sub)species of pygmy newts (T. pygmaeus, T. rudolfi). The marbled newt, Triturus marmoratus, shows an equally deep and geographically coherent spatial-genetic diversification. It is here shown that a northern and a southern group are characterized by different mitochondrial dna profiles and are also differentiated in morphometry and colouration pattern. With no firm evidence for selection against intermediate genotypes, the southern group is described at the subspecies level, as T. marmoratus harmannis ssp. nov. The subspecies’ contact zone is situated at ca. 41.5 northern latitude and stretches from the Atlantic coast near Porto, Portugal to the northeast of Madrid, Spain.
Effectiveness of multigene analysis for associating dimorphic partners in flat wasps (Hymenoptera, Bethylidae, Dissomphalus)
Authors: FAGUNDES VALÉRIA , MONJARDIM MARINA , MARTINELLI ARTURO B. , MUGRABI DANIELE F. , AZEVEDO CELSO O.
Published: April 2024

DNA sequences have proved valuable for associating males and females of the same dimorphic species in Hymenoptera. These molecular associations, however, depend on the used DNA sequences and the analysis methods. In the present study, we evaluated the molecular associations on 23 species of Dissomphalus (Hymenoptera, Bethylidae) using the three most common DNA sequences in molecular studies of Hymenoptera (28S rRNA, COI and ITS2). Our results indicated the male-female association with these three markers. COI, however, showed to be more suitable than the other markers because there was no overlap of genetic variation among species. In contrast, the 28S rRNA showed overlapping of genetic distance limits, indicating that the distance matrix is not enough to assign a sexual conspecificity. We were able to perform female association to the described species D. verus Mugrabi & Azevedo, demonstrating that phylogenetic analysis is a valuable tool for associating the sexes of dimorphic species.
Synoptic Conditions and Lake-to-Lake Connections for Days with Lake Effect on All of the Great Lakes
Authors: Laird Neil F. , Crossett Caitlin C. , Britt Catherine J. , Metz Nicholas D. , Carmer Kelly , McBroom Braedyn D.
Published: April 2024

An investigation of lake effect (LE) and the associated synoptic environment is presented for days when all five lakes in the Great Lakes (GL) region had LE bands [five-lake days (5LDs)]. The study utilized an expanded database of observed LE clouds over the GL during 25 cold seasons (October–March) from 1997/98 to 2021/22. LE bands occurred on 2870 days (64% of all cold-season days). Nearly a third of all LE bands occurred during 5LDs, although 5LDs consisted of just 17.1% of LE days. A majority of 5LDs (56.5%) had lake-to-lake (L2L) bands, and these days comprised 43.5% of all L2L occurrences. 5LDs occurred with a mean of 26.1 (SD = 6.2) days per cold season until 2008/09 and then decreased to a mean of 13.8 (SD = 5.5) days during subsequent cold seasons. January and February had the largest number of consecutive LE days in the GL with a mean of 5.7 and 5.4 days, respectively. As the number of consecutive LE days increases, both the number of 5LDs and the occurrence of consecutive 5LD increase. This translates to an increased potential of heavy snowfall impacts in multiple, localized areas of the GL for extended time periods. The mean composite synoptic pattern of 5LDs exhibited characteristics consistent with lake-aggregate disturbances and showed similarity to synoptic patterns favorable for LE over one or two of the GL found by previous studies. The results demonstrate that several additional areas of the GL are often experiencing LE bands when a localized area has active LE bands occurring.
Large Mediastinal Mass as a Rare Presentation of Schistosomiasis
Authors: Bushrow Luke , Kneuertz Peter , Maher William , Shilo Konstantin
Published: April 2024

A 39-year-old woman originally from Northeast Africa sought medical attention for positional dyspnea. Computed tomography of the chest revealed an 8.5 cm hypodense anterior mediastinal mass with peripheral calcifications that raised a wide differential diagnosis including infectious and neoplastic lesions. Following surgical resection, a large cavitary necrotizing and calcified granuloma involving the thymus was identified on histopathological examination. The changes were associated with parasitic eggs that based on their morphology suggested infection due to trematode species. The diagnosis was further corroborated by identification of the increased IgG titers for Schistosoma species (ELISA Kit, NovaTec). The patient's symptoms improved following surgery and praziquantel therapy. This unique presentation emphasizes an unusual manifestation of schistosomiasis that can pose a diagnostic challenge, especially in non-endemic regions. It suggests that mediastinal involvement by schistosomiasis is likely due to an ectopic deposition of the parasitic eggs within a definitive host. Suspicion for schistosomiasis should be heightened based on patient demographics and travel to endemic areas.
The integration of the cancer experience into identity: Perspectives from young adults
Authors: Marín-Chollom Amanda M , Beaucant Paige , King Cameron , Pervil Ian , Rubin Lisa R , Revenson Tracey A
Published: April 2024

The study explored how young adults with cancer create a cancer identity across the illness trajectory. Young adults with hematological cancers ( n = 53, ages 20–39) completed a semi-structured interview and brief questionnaire. Deductive thematic analysis was used to code interviews. Four identity categories (Acceptance, Enrichment, Engulfment, and Rejection) were coded and linked to the cancer stage (pre-treatment, active treatment, post-treatment). Pre-treatment, there was minimal expression about identity. Acceptance during active treatment involved identity work around disclosure and the integration of pre-cancer identity with the treatment experience. Post-treatment, acceptance involved actively making sense of the cancer experience and its long-term impact; Enrichment was more frequent post-treatment. Engulfment was expressed most during treatment. Individuals who remained engulfed post-treatment expressed difficulties moving beyond the patient’s identity. Rejection of a cancer identity was rarely expressed. Understanding how young adults integrate the cancer experience into their identity may suggest intervention strategies.
Urban heat island patterns in garden cities: Putrajaya as a case study
Authors: Harun Zambri , Akkurt Nevzat , Khor Yu King , Abbas Ashraf A , Lotfy Eslam Reda
Published: April 2024

The garden-city model, characterised by sprawling urban expansion and extensive open spaces, features green and water surfaces alongside substantial road networks, large parking lots and unshaded lands. This diverse landscape contributes to uneven air temperature distribution within the city. Our study investigated urban heat island (UHI) patterns in various urban environments within Putrajaya, focusing on rural, business, residential and near-water areas. Atmospheric data were collected over a year. Putrajaya exhibits two distinct UHI patterns: cool-day-hot-night in residential zones and hot-noon-temperate-elsewhere in impermeable areas. Business areas display alternating patterns based on seasonal climatic conditions and anthropogenic factors. The efficacy of artificial water bodies as a UHI countermeasure in garden cities depends on the size of the water body and the nature of the surrounding land cover. Shaded and green areas exhibit UHI intensities limited to 3°C, while impermeable areas, regardless of proximity to water surfaces, experience UHI up to 6°C. Overall, the garden-city model tends to restrict UHI variations within −1 to 3°C compared to −2 to 4°C in nearby Kuala Lumpur.
Auricular Hematomas in a High-Volume Trauma Population: A Retrospective Review
Authors: Phillips Alisa L. , Luttrell Jordan B. , Berry Joseph M. , Dedhia Raj D. , Eid Anas
Published: April 2024

Study Design

Retrospective review.

Objective

Auricular hematomas are generally associated with sports-related injuries, with studies predominantly in white populations and high neighborhood socioeconomic status (NSES) compared to our county. A previous population-based study of trauma patients in our county, Shelby County, Tennessee, shows that those who live in high vs low NSES experienced socioeconomic variation in injury. We aim to determine if differences exist in clinical management and outcomes in this population.

Methods

Patients from two hospital systems diagnosed with auricular hematomas from 2008–2023 were reviewed retrospectively. Inclusion criteria included adequate follow-up, clinical description of the hematoma, and comment on any complications or recurrence.

Results

48 patients, with a median age of 28 (range: 0–83), with the most common etiology being assault/non-accidental trauma (NAT) at 41.7%, equally distributed across all NSES ( P = .30), with one sports-related injury. Facial trauma consults were associated with lower recurrence rates, 25% vs 62.5% ( P = .003) and were less likely to be placed for self-pay patients ( P = .019). Bolster placement resulted in lower recurrence rates, 23.3% compared to 58.3% ( P = .030).

Conclusions

Higher rates of assault/NAT etiologies existed in our population, independent of NSES. Our study reiterates the importance of facial trauma consultation and bolster usage to reduce recurrence.
Ecological risk assessment and source tracing of heavy metals in surface sediments of a hilly riverine reservoir in Chongqing, China
Authors: Ao Liang , Chang Ruiting , Tang Yanqiu , Zhang Sheng
Published: April 2024

Background

This work conducted quantitative and qualitative analyses on the heavy metals in 32 surface sediment samples collected from eight sampling sites across four seasons in the Yutan reservoir, a typical mountainous hilly riverine reservoir in Southwest China.

Results

Nine heavy metals were identified: (Cr, Cd, Pb, Cu, Zn, Hg, As, Ni, and Co). The concentrations varied within the ranges of 23.16 ~ 34.62, 0.53 ~ 1.09, 31.88 ~ 59.04, 51.94 ~ 85.84, 106.76 ~ 227.69, 0.08 ~ 0.15, 12.57 ~ 25.60, 12.06 ~ 27.64 and 11.04 ~ 14.56 mg/kg, respectively, following a decreased concentration order of Zn > Cu > Pb > Cr > Ni > As > Co > Cd > Hg. Except for Cd, which accumulated in winter, and Hg, which reduced in spring. The concentration of heavy metals showed no significant seasonal variation and generally had higher contents at the river mouth and lower concentrations in open water areas and branches. The geoaccumulation index (Igeo) assessment also indicated that the reservoir was uncontaminated by Cr and Ni (Igeo < 0), slightly polluted by Pb, Cu, Zn, and Co (0 < Igeo < 1), moderately polluted by Hg and As (1 < Igeo < 2), and heavily polluted by Cd (1.44 < Igeo < 2.48). Notably, the most polluted sites were at the river mouth, followed by the sediments in branches with slight pollution. Source tracing analysis revealed that Cr, Ni, Cd, Pb, Hg, As, organic matter, total nitrogen, and total phosphorus were primarily attributed to non-point sources. In contrast, Fe was linked to the hardware industry. Moreover, Al originated from sewage and drinking water treatment processes. Cu and Zn were discharged from three components, indicating complex sources.

Conclusions

The findings underscored that non-point sources were the primary contributors to the increased risk of heavy metal contamination in the reservior’s sediment. In addition, to effectively manage the risk and enhance the aquatic environment, greater focus should be placed on the inner load of heavy metals in the sediment of the mountainous hilly riverine reservoirs, particularly after controlling external pollution sources.
Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya
Authors: Kassam Nadeem , Ngunga Mzee , Varwani Mohamed , Msunza Miriam , Jeilan Mohamed
Published: April 2024

Introduction

Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) –related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group’s phenotypic characteristics; risk factors and clinical outcomes are not well described. contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the demographic and clinical characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes.

Methodology

This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of all young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young individuals as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with Pearson chi- square or Fisher’s exact tests. Continuous variables were reported as means or medians and compared with independent t-tests or Mann-Whitney U tests. P- value < 0.05 was considered statistically significant.

Results

Among 506 patients hospitalized with ACS, (n = 138,27.2%) were aged 50 years and below. The study population was male (n = 107, 79.9%) and African(n = 82,61.2%) predominant with a median age of 46.5 years (IQR 41.0–50.0). Hypertension (n = 101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n = 69,51.5%) having a family history of premature ASCVD(n = 70,52.2%) and were on lipid-lowering therapy(n = 68,50.7%) prior to presentation. ST-segment–elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n = 77, 57.5%). Of the significant coronary artery disease (n = 75,56.0%), the majority of the individuals had single vessel disease (n = 60, 80%) with a predilection of left anterior deciding artery(n = 47,62.6%). The Main cause of ACS was atherosclerosis (n = 41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The in-hospital mortality was (n = 2, 1.5%).

Conclusion

This study highlights that young individuals contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. The principal cause was atherosclerosis. The findings of this study highlight the importance of developing systems of care that enable the early detection of CAD. Traditional cardiovascular risk factors were prevalent and modifiable, thus targets of intervention.
Influential factors on disease activity in Crohn’s disease and their Roc curve evaluation: a cross-sectional study
Authors: Wang Jing , Tong Shuping , Lu Bingqing
Published: April 2024

Objective

This study aims to investigate the factors influencing disease activity in patients with Crohn’s disease (CD) and provide insights and references for the management and prevention of CD.

Methods

We recruited CD patients who met the inclusion and exclusion criteria and were treated at the First Affiliated Hospital of Soochow University from November 2022 to June 2023. Generalized linear mixed models were used to analyze the factors affecting disease activity in CD patients. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of these factors for disease activity.

Results

A total of 268 CD participants aged 18 to 65 were included in the study, with over 68% of them in remission or experiencing mild disease activity, indicating relatively good disease control. The results of the generalized linear mixed models showed that older age, absence of diabetes, high levels of physical activity, and a low dietary inflammatory index (DII) were protective factors for lower disease activity in CD patients (p < 0.05). ROC curve analysis demonstrated that physical activity level, age, and DII all had ROC areas greater than 0.6 in predicting disease activity in CD patients (p < 0.05).

Conclusion

The factors influencing the disease activity of CD patients are numerous and should be given attention. CD patients who are younger, have low levels of physical activity, high DII, and have diabetes are at a higher risk of increased disease activity. By reducing or avoiding the mentioned risk factors and leveraging protective factors, it is possible to mitigate the disease activity of CD to some extent.
Profiling chronic diseases and hospitalizations in older home care recipients: a nationwide cohort study in Sweden
Authors: Schmidt-Mende Katharina , Arvinge Cecilia , Cioffi Giovanni , Gustafsson Lars Lennart , Modig Karin , Meyer Anna Carina
Published: April 2024

Background

Older adults with home care (HC) often have complex disease patterns and use healthcare extensively. Increased understanding is necessary to tailor their care. To our knowledge, this is the first study to describe patterns of morbidity and hospitalizations among community-dwelling older HC recipients nationwide and in subgroups defined by age, sex, and amount of HC, and to compare patterns to community-dwelling older adults without HC.

Methods

Nationwide register-based cohort study in community-dwelling adults aged 70 and older receiving publicly funded HC in Sweden on January 1st 2019 and an age-and-sex matched comparison group (“non-HC recipients”). Using register data from inpatient and specialized outpatient care, we assessed the prevalence of sixty chronic diseases, frailty, multimorbidity and hospitalizations, calculated incidence rates and explored reasons for hospitalizations during two years of follow-up.

Results

We identified 138,113 HC recipients (mean age 85, 66% women, 57% ≥5 chronic diseases). The most prevalent diseases were hypertension (55%) and eye conditions (48%). Compared to non-HC recipients, HC recipients had a higher prevalence of almost all diseases, with an overrepresentation of neurological (26.1 vs. 9.5%) disease and dementia (9.3 vs. 1.5%). 61% of HC recipients were hospitalized at least once during two years, which was 1.6 times as often as non-HC recipients. One third of HC recipients´ hospitalizations (37.4%) were due to injuries, infections, and heart failure. Hospitalizations for chronic obstructive pulmonary disease, confusion, infections, and breathing difficulties were 3–5 times higher among HC recipients compared to non-HC recipients.

Conclusion

Compared to non-HC recipients, HC recipients more often live alone, have higher degrees of frailty, suffer from more chronic diseases, especially neurological disease, and are hospitalized almost twice as often. The results provide a thorough description of HC recipients, which might be useful for targeted healthcare interventions including closer collaboration between primary care, neurologists, and rehabilitation.
Determinants of household decision making autonomy among rural married women based on Ethiopian demography health survey: a multilevel analysis
Authors: Bitew Desalegn Anmut , Getahun Amare Belete , Gedef Getachew Muluye , Andualem Fantahun , Getnet Mihret
Published: April 2024

Introduction

Decisions made at the household level have great impact on the welfare of the individual, the local community, as well as the welfare of the nation. Women’s independent decision on reproductive health increases women’s access to health information and utilization of reproductive services. This has great impact on maternal and child health outcomes. However, women in developing or low-income countries often have limited autonomy and control over their household decisions. Therefore the main purpose of this research project is to investigate the potential determinants of rural women’s household decision making autonomy.

Methods

A multi level analysis was performed using the fourth Ethiopian Demographic and Health Survey (EDHS) 2016 data set. A weighted sample of 8,565 married rural women was included in the final analysis. Women were considered to be autonomous if they made decisions alone or jointly with their husband in all three household decision components. It was dichotomized as yes = 1 and no = 0. Multico linearity and chi-square tests were checked and variables which did not fulfill the assumptions were excluded from the analysis. Four models were fitted. Variables with p-value ≤ 0.25 in the bi-variable multilevel logistic regression were included in the multivariable multilevel logistic regression. The Adjusted Odds Ratio (AOR) with a 95% confidence interval (95% CI) was computed. Variables with a P-value of less than 0.05 in the multi-variable multilevel logistic regression were declared as statistically significant predictors.

Result

A total of 8,565 weighted participants involved. From the total respondents, 68.55%(CI: 67.5%, 69.5%) of women had decision making autonomy. wealth index (poor: AOR: 0.84; 95% CI: 0.72, 0.97 and middle: AOR: 0.85; 95% CI 0.73, 0.98), literacy (illiterate: AOR: 0.75; 95% CI: 0.66, 0.86), respondents working status (Not working; AOR 0.68; 95% CI; 0.60, 0.76) ,who decides on marriage (parents: AOR 0.76; 95% CI; 0.67, 0.87), and proportion of early marriage in the community (high proportion of early marriage AOR: 1.35; 95% CI; 1.10, 1.72).

Conclusion

Women decision making autonomy was significantly determined by women economic participation (their wealth and their working status), women’s literacy, proportion of early marriage in the community and women’s involvement in decision of their marriage. Improving women’s economic participation and enhancing women’s participation to decide on their marriage will enhance women’s decision making autonomy.
A cross-sectional study on turnover intention of nurses in eastern China
Authors: Huang Haolian , Wang Liping , Qian Ruilian , Zhang Yanhong
Published: April 2024

Background

This study aimed to investigate the turnover intention among nurses in eastern China and explore the association between turnover intention and personal characteristics, family factors, and work-related factors.

Methods

A total of 2504 nurses participated in a cross-sectional survey administered in 26 hospitals in Eastern China from October to November 2017. In December 2021, a survey was conducted on nurses who resigned between December 2017 and November 2021.

Results

The turnover intention score of in-service nurses was 15 (12–17), and 43% of nurses had a high turnover intention, which was mainly due to the following reasons: age < 40 years, raising two or more children, monthly income of USD786.10-1572.20 or < USD786.10, occupation was assigned or selected according to parental wishes, ≤ 1 or ≥ 2-night shifts per week, contractual or third-party personnel agents, full-time nurses with part-time jobs, and high job stress. Among 102 retired nurses, 80.4% reported family reasons for leaving, 39.2% for work reasons, and 21.6% for other personal reasons.

Conclusion

Nurses’ intention to leave their occupation is high in Eastern China. Age < 40 years old, > 1 child, low income, involuntary career selection, frequent night shifts, informal employment, part-time, and high job stress are significant factors associated with nurses’ willingness to leave. Government and hospital administrators should consider ways to address these factors to retain nurses in hospitals in eastern China and improve the quality of nursing services.
Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon)
Authors: Takougang Innocent , Lekeumo Cheuyem Fabrice Zobel , Ze Billy Ralph Sanding , Tsamoh Forlemu Fabiola , Moneboulou Hortense Mengong
Published: April 2024

Background

Healthcare workers (HCW) are exposed to infectious agents within biological materials including blood, tissues, other body fluids and on medical supplies, contaminated surfaces within the care delivery environment. Trends in occupational injuries are influenced by the level of awareness and observance of standard precautions (SP) among HCWs. This study aimed to assess the level of awareness of SP, exposure to body fluids, reporting pattern and management among HCWs in a Referral Hospital.

Methods

The present hospital-based cross-sectional study was carried out from 1st November 2020 to 31st May 2021. The exhaustive sampling method was used and a total of 120 consenting HCWs were invited to participate. A self-administered questionnaire addressed questions related to knowledge, experience, circumstances of exposure, reporting, management of occupational exposure to body fluids, hepatitis B vaccination status. Data were analyzed using R Statistic version 4.3.1. Ap-value < 0.05 was considered significant.

Results

Out of the 120 participating HCWs, 104 (86.7%) reported at least one accidental exposure to body fluids over the last year. Men (aOR = 4.19;p = 0.277) and HCWs aged 35 and over (aOR = 4.11;p = 0.114) were more at risk for AEB even though the difference was not statistically significant. Nurses/midwives (aOR = 65.9;p-value = 0.0005) and cleaners (aOR = 14.7;p-value = 0.0438) faced the highest risk of exposure. Lack of knowledge (79%) and patient agitation (49%) were the most reported reasons for exposure. Half of the participants (53%) reported that they used a personal protective equipment during care. Face mask (59.2%) and gowns (30.8%) were the most commonly used PPE. Most HCWs (62%) did not report AEB. Half of the affected HCWs (50.8%) received a course of post-exposure antiretroviral therapy. Few HCWs (4.2%) were fully immunized against Hepatitis B.

Conclusions

Most HCWs reported an accidental exposure to body fluids over the last year. Midwives and nurses were disproportionally affected socio-professional groups. Two-thirds of the AEB were undeclared. Only half of the participants reported using PPE systematically. Hepatitis B vaccination coverage was low. There is need to strengthen the observance of standard precautions, including preventive vaccination and the systematic reporting and management of AEB.
Updated reference values for static lung volumes from a healthy population in Austria
Authors: Mraz Tobias , Asgari Shervin , Karimi Ahmad , Breyer Marie-Kathrin , Hartl Sylvia , Sunanta Owat , Ofenheimer Alina , Burghuber Otto C. , Zacharasiewicz Angela , Lamprecht Bernd , Schiffers Caspar , Wouters Emiel F. M. , Breyer-Kohansal Robab
Published: April 2024

Background

Reference values for lung volumes are necessary to identify and diagnose restrictive lung diseases and hyperinflation, but the values have to be validated in the relevant population. Our aim was to investigate the Global Lung Function Initiative (GLI) reference equations in a representative healthy Austrian population and create population-derived reference equations if poor fit was observed.

Methods

We analysed spirometry and body plethysmography data from 5371 respiratory healthy subjects (6–80 years) from the Austrian LEAD Study. Fit with the GLI equations was examined using z-scores and distributions within the limits of normality. LEAD reference equations were then created using the LMS method and the generalized additive model of location shape and scale package according to GLI models.

Results

Good fit, defined as mean z-scores between + 0.5 and -0.5,was not observed for the GLI static lung volume equations, with mean z-scores > 0.5 for residual volume (RV), RV/TLC (total lung capacity) and TLC in both sexes, and for expiratory reserve volume (ERV) and inspiratory capacity in females. Distribution within the limits of normality were shifted to the upper limit except for ERV. Population-derived reference equations from the LEAD cohort showed superior fit for lung volumes and provided reproducible results.

Conclusion

GLI lung volume reference equations demonstrated a poor fit for our cohort, especially in females. Therefore a new set of Austrian reference equations for static lung volumes was developed, that can be applied to both children and adults (6–80 years of age).
Tea polyphenol-derived nanomedicine for targeted photothermal thrombolysis and inflammation suppression
Authors: Wang Hui , Tang Cui , Xiang Yuxia , Zou Chan , Hu Jianming , Yang Guoping , Zhou Wenhu
Published: April 2024

Thrombotic diseases impose a significant global health burden, and conventional drug-based thrombolytic therapies are encumbered by the risk of bleeding complications. In this study, we introduce a novel drug-free nanomedicine founded on tea polyphenols nanoparticles (TPNs), which exhibits multifaceted capabilities for localized photothermal thrombolysis. TPNs were synthesized through a one-pot process under mild conditions, deriving from the monomeric epigallocatechin-3-gallate (EGCG). Within this process, indocyanine green (ICG) was effectively encapsulated, exploiting multiple intermolecular interactions between EGCG and ICG. While both TPNs and ICG inherently possessed photothermal potential, their synergy significantly enhanced photothermal conversion and stability. Furthermore, the nanomedicine was functionalized with cRGD for targeted delivery to activated platelets within thrombus sites, eliciting robust thrombolysis upon laser irradiation across diverse thrombus types. Importantly, the nanomedicine’s potent free radical scavenging abilities concurrently mitigated vascular inflammation, thus diminishing the risk of disease recurrence. In summary, this highly biocompatible multifunctional nanomaterial holds promise as a comprehensive approach that combines thrombolysis with anti-inflammatory actions, offering precision in thrombosis treatment.
Gut microbiota-derived butyrate restores impaired regulatory T cells in patients with AChR myasthenia gravis via mTOR-mediated autophagy
Authors: He Long , Zhong Zhuotai , Wen Shuting , Li Peiwu , Jiang Qilong , Liu Fengbin
Published: April 2024

More than 80% of patients with myasthenia gravis (MG) are positive for anti-acetylcholine receptor (AChR) antibodies. Regulatory T cells (Tregs) suppress overproduction of these antibodies, and patients with AChR antibody-positive MG (AChR MG) exhibit impaired Treg function and reduced Treg numbers. The gut microbiota and their metabolites play a crucial role in maintaining Treg differentiation and function. However, whether impaired Tregs correlate with gut microbiota activity in patients with AChR MG remains unknown. Here, we demonstrate that butyric acid-producing gut bacteria and serum butyric acid level are reduced in patients with AChR MG. Butyrate supplementation effectively enhanced Treg differentiation and their suppressive function of AChR MG. Mechanistically, butyrate activates autophagy of Treg cells by inhibiting the mammalian target of rapamycin. Activation of autophagy increased oxidative phosphorylation and surface expression of cytotoxic T-lymphocyte-associated protein 4 on Treg cells, thereby promoting Treg differentiation and their suppressive function in AChR MG. This observed effect of butyrate was blocked using chloroquine, an autophagy inhibitor, suggesting the vital role of butyrate-activated autophagy in Tregs of patients with AChR MG. We propose that gut bacteria derived butyrate has potential therapeutic efficacy against AChR MG by restoring impaired Tregs.
The protein phosphatase-2A subunit PR130 is involved in the formation of cytotoxic protein aggregates in pancreatic ductal adenocarcinoma cells
Authors: Nguyen Alexandra , Mustafa Al-Hassan M. , Leydecker Alessa K. , Halilovic Melisa , Murr Janine , Butter Falk , Krämer Oliver H.
Published: April 2024

As a major source of cellular serine and threonine phosphatase activity, protein phosphatase-2A (PP2A) modulates signaling pathways in health and disease. PP2A complexes consist of catalytic, scaffolding, and B-type subunits. Seventeen PP2A B-type subunits direct PP2A complexes to selected substrates. It is ill-defined how PP2A B-type subunits determine the growth and drug responsiveness of tumor cells. Pancreatic ductal adenocarcinoma (PDAC) is a disease with poor prognosis. We analyzed the responses of murine and human mesenchymal and epithelial PDAC cells to the specific PP2A inhibitor phendione. We assessed protein levels by immunoblot and proteomics and cell fate by flow cytometry, confocal microscopy, and genetic manipulation. We show that murine mesenchymal PDAC cells express significantly higher levels of the PP2A B-type subunit PR130 than epithelial PDAC cells. This overexpression of PR130 is associated with a dependency of such metastasis-prone cells on the catalytic activity of PP2A. Phendione induces apoptosis and an accumulation of cytotoxic protein aggregates in murine mesenchymal and human PDAC cells. These processes occur independently of the frequently mutated tumor suppressor p53. Proteomic analyses reveal that phendione upregulates the chaperone HSP70 in mesenchymal PDAC cells. Inhibition of HSP70 promotes phendione-induced apoptosis and phendione promotes a proteasomal degradation of PR130. Genetic elimination of PR130 sensitizes murine and human PDAC cells to phendione-induced apoptosis and protein aggregate formation. These data suggest that the PP2A-PR130 complex dephosphorylates and thereby prevents the aggregation of proteins in tumor cells.

Graphical Abstract
Addition of inflammation-related biomarkers to the CAIDE model for risk prediction of all-cause dementia, Alzheimer’s disease and vascular dementia in a prospective study
Authors: Trares Kira , Wiesenfarth Manuel , Stocker Hannah , Perna Laura , Petrera Agnese , Hauck Stefanie M. , Beyreuther Konrad , Brenner Hermann , Schöttker Ben
Published: April 2024

Background

It is of interest whether inflammatory biomarkers can improve dementia prediction models, such as the widely used Cardiovascular Risk Factors, Aging and Dementia (CAIDE) model.

Methods

The Olink Target 96 Inflammation panel was assessed in a nested case-cohort design within a large, population-based German cohort study (n = 9940; age-range: 50–75 years). All study participants who developed dementia over 20 years of follow-up and had complete CAIDE variable data (n = 562, including 173 Alzheimer’s disease (AD) and 199 vascular dementia (VD) cases) as well asn = 1,356 controls were selected for measurements. 69 inflammation-related biomarkers were eligible for use. LASSO logistic regression and bootstrapping were utilized to select relevant biomarkers and determine areas under the curve (AUCs).

Results

The CAIDE model 2 (including Apolipoprotein E (APOE) ε4 carrier status) predicted all-cause dementia, AD, and VD better than CAIDE model 1 (withoutAPOEε4) with AUCs of 0.725, 0.752 and 0.707, respectively. Although 20, 7, and 4 inflammation-related biomarkers were selected by LASSO regression to improve CAIDE model 2, the AUCs did not increase markedly. CAIDE models 1 and 2 generally performed better in mid-life (50–64 years) than in late-life (65–75 years) sub-samples of our cohort, but again, inflammation-related biomarkers did not improve their predictive abilities.

Conclusions

Despite a lack of improvement in dementia risk prediction, the selected inflammation-related biomarkers were significantly associated with dementia outcomes and may serve as a starting point to further elucidate the pathogenesis of dementia.
NSF DARE—Transforming modeling in neurorehabilitation: Four threads for catalyzing progress
Authors: Valero-Cuevas Francisco J. , Finley James , Orsborn Amy , Fung Natalie , Hicks Jennifer L. , Huang He , Reinkensmeyer David , Schweighofer Nicolas , Weber Douglas , Steele Katherine M.
Published: April 2024

We present an overview of the Conference on Transformative Opportunities for Modeling in Neurorehabilitation held in March 2023. It was supported by the Disability and Rehabilitation Engineering (DARE) program from the National Science Foundation’s Engineering Biology and Health Cluster. The conference brought together experts and trainees from around the world to discuss critical questions, challenges, and opportunities at the intersection of computational modeling and neurorehabilitation to understand, optimize, and improve clinical translation of neurorehabilitation. We organized the conference around four key, relevant, and promising Focus Areas for modeling: Adaptation & Plasticity, Personalization, Human-Device Interactions, and Modeling ‘In-the-Wild’. We identified four common threads across the Focus Areas that, if addressed, can catalyze progress in the short, medium, and long terms. These were: (i) the need to capture and curate appropriate and useful data necessary to develop, validate, and deploy useful computational models (ii) the need to create multi-scale models that span the personalization spectrum from individuals to populations, and from cellular to behavioral levels (iii) the need for algorithms that extract as much information from available data, while requiring as little data as possible from each client (iv) the insistence on leveraging readily available sensors and data systems to push model-driven treatments from the lab, and into the clinic, home, workplace, and community. The conference archive can be found at (dare2023.usc.edu). These topics are also extended by three perspective papers prepared by trainees and junior faculty, clinician researchers, and federal funding agency representatives who attended the conference.
Hepatitis B relapse after entecavir or tenofovir alafenamide cessation under anti-viral prophylaxis for cancer chemotherapy
Authors: Fang Hsin-Wei , Tseng Po-Lin , Hu Tsung-Hui , Wang Jing-Houng , Hung Chao-Hung , Lu Sheng-Nan , Chen Chien-Hung
Published: April 2024

Background

No study has comparing hepatitis B virus (HBV) relapse rates among patients with both cancer and hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) who completed anti-viral prophylaxis for chemotherapy and then stopped taking entecavir or tenofovir alafenamide (TAF).

Methods

A total of 227 HBeAg-negative cancer patients without cirrhosis who previously took entecavir (n = 144) or TAF (n = 83) for antiviral prophylaxis were enrolled.

Results

The cumulative incidence of virological and clinical relapse at 2 years was 37% and 10.4%, respectively, in the entecavir group, and 46.7% and 19.5%, respectively, in the TAF group. The multivariate analysis revealed that the use of hematologic malignancy, TAF use, and high-viremia group at baseline were independent risk factors for virological relapse, and use of rituximab, TAF use, higher FIB-4 index and high-viremia group at baseline were independent risk factors for clinical relapse. After propensity score-matching, the patients who discontinued TAF therapy still exhibited higher virological (P = 0.031) and clinical relapse rates (P = 0.012) than did those who discontinued entecavir therapy. The patients were allocated to high- (> 2000 IU/mL), moderate- (between 20 and 2000 IU/mL) and low- (< 20 IU/mL) viremia groups. In the high-viremia group, those who had taken TAF for antiviral prophylaxis had higher rates of virological and clinical relapse than did those who had taken entecavir; in the moderate- and low-viremia groups, no significant difference in virological and clinical relapse rates was detected between the entecavir and TAF groups. Three patients experienced hepatic decompensation upon clinical relapse. All three patients were lymphoma and underwent rituximab therapy. One patient developed acute on chronic liver failure and died even though timely retreatment.

Conclusions

In patients with both cancer and CHB who underwent antiviral prophylaxis, TAF use was associated with a higher chance of HBV relapse than entecavir use after nucleos(t)ide analogue cessation, particularly in the high-viremia group. Patients who are hematologic malignancy and undergo a rituximab-containing cytotoxic therapy should be monitored closely after withdrawal from prophylactic NA treatment.