bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of the Demographic Dividend Effort Index, a novel tool to measure existing efforts to create a favourable environment to harness a demographic dividend: results from an experts’ survey from six sub-Saharan African countries
Authors: Rusatira Jean Christophe , Cardona Carolina , Martinez-Baack Michelle , Rimon Jose G , Ahmed Saifuddin
Published: March 2023

Objective

This study aimed to develop a tool to measure the extent of national efforts in policies, services, research and programmes implemented to cultivate and harness the benefits of a potential demographic dividend in six sub-Saharan African countries.

Design

The survey was self-administered online using the SurveyMonkey platform. The survey questionnaire covered six key sectors: family planning, maternal and child health, education, women's empowerment, labour market, and governance and economic institution. Each sector-specific questionnaire was structured around five practice domains: policymaking, services and programmes, advocacy, research and civil society. Each item was scored from 1 to 10. Factor analysis was used to select the items to be retained for final score estimation. Simple averages were computed to estimate sectoral and domain scores and overall country scores were estimated using weighted country mean scores. Internal consistency, construct validity and reliability were examined using factor analysis and Cronbach’s alpha.

Setting

Sub-Saharan Africa.

Participants

A total of 440 knowledgeable informants from six countries; namely, Ethiopia (73), Kenya (69), Nigeria (67), Rwanda (54), Senegal (81) and Tanzania (96).

Results

Based on the results from factor analysis, 38 items were dropped from the analysis and Cronbach’s alpha results ranged from 0.84 to 0.98 across domains. The overall demographic dividend effort index (DDEI) scores ranged between 5.4 (95% CI 5.1 to 5.8) in Ethiopia to 7.7 (95% CI 7.5 to 8.0) in Rwanda. In most countries, the disaggregated scores by sector revealed low scores in the labour market and women’s empowerment.

Conclusion

The DDEI scores highlight important gaps in key health and development sectors. The DDEI proved to be a reliable and internally consistent tool for effort measurement in key demographic dividend sectors. The DDEI can serve as a self-evaluation tool for local actors and may complement existing quantitative tools such as the Global Gender Gap and the Human Capital Index.
The Pyruvate Kinase Deficiency Global Longitudinal (Peak) Registry: rationale and study design
Authors: Grace Rachael F , van Beers Eduard J , Vives Corrons Joan-Lluis , Glader Bertil , Glenthøj Andreas , Kanno Hitoshi , Kuo Kevin H M , Lander Carl , Layton D Mark , Pospíŝilová Dagmar , Viprakasit Vip , Li Junlong , Yan Yan , Boscoe Audra N , Bowden Chris , Bianchi Paola
Published: March 2023

Introduction

Pyruvate kinase (PK) deficiency is a rare, under-recognised, hereditary condition that leads to chronic haemolytic anaemia and potentially serious secondary complications, such as iron overload, cholecystitis, pulmonary hypertension and extramedullary haematopoiesis. It is an autosomal recessive disease caused by homozygous or compound heterozygous mutations in thePKLRgene. Due to its rarity and clinical heterogeneity, information on the natural history and long-term clinical course of PK deficiency is limited, presenting major challenges to patient management, the development of new therapies and establishing disease-specific treatment recommendations. The Pyruvate Kinase Deficiency Global Longitudinal (Peak) Registry is an initiative to address the gaps in the knowledge of PK deficiency. This manuscript describes the objectives, study design and methodology for the Peak Registry.

Methods and analysis

The Peak Registry is an observational, longitudinal, global registry of adult and paediatric patients with a genetically confirmed diagnosis of PK deficiency. The Peak Steering Committee is composed of 11 clinicians and researchers with experience in the diagnosis and management of PK deficiency from 10 countries, a patient representative and representatives from the sponsor (Agios Pharmaceuticals). The registry objective is to foster an understanding of the longitudinal clinical implications of PK deficiency, including its natural history, treatments and outcomes, and variability in clinical care. The aim is to enrol up to 500 participants from approximately 60 study centres across 20 countries over 7 years, with between 2 and 9 years of follow-up. Data will include demographics, diagnosis history, genotyping, transfusion history, relevant clinical events, medications, emergency room visits and hospitalisations.

Ethics and dissemination

Registry protocol and informed consent forms are approved by institutional review boards/independent ethics committees at each study site. The study is being conducted in accordance with the Declaration of Helsinki. Registry data will be published in peer-reviewed journal articles and conference publications.

Trial registration number

NCT03481738.
Older patient participation in discharge medication communication: an observational study
Authors: Tobiano Georgia , Manias Elizabeth , Thalib Lukman , Dornan Gemma , Teasdale Trudy , Wellwood Jeremy , Chaboyer Wendy
Published: March 2023

Objective

To describe the extent to which older patients participate in discharge medication communication, and identify factors that predict patient participation in discharge medication communication.

Design

Observational study.

Setting

An Australian metropolitan tertiary hospital.

Participants

173 older patients were observed undertaking one medication communication encounter prior to hospital discharge.

Outcome

Patient participation measured with MEDICODE, a valid and reliable coding framework used to analyse medication communication. MEDICODE provides two measures for patient participation: (1) Preponderance of Initiative and (2) Dialogue Ratio.

Results

The median for Preponderance of Initiative was 0.7 (IQR=0.5–1.0) and Dialogue Ratio was 0.3 (IQR=0.2–0.4), indicating healthcare professionals took more initiative and medication encounters were mostly monologue rather than a dialogue or dyad. Logistic regression revealed that patients had 30% less chance of having dialogue or dyads with every increase in one medication discussed (OR 0.7, 95% CI 0.5 to 0.9, p=0.01). Additionally, the higher the patient’s risk of a medication-related problem, the more initiative the healthcare professionals took in the conversation (OR 1.5, 95% CI 1.0 to 2.1, p=0.04).

Conclusion

Older patients are passive during hospital discharge medication conversations. Discussing less medications over several medication conversations spread throughout patient hospitalisation and targeting patients at high risk of medication-related problems may promote more active patient participation, and in turn medication safety outcomes.
Potentiality of algorithms and artificial intelligence adoption to improve medication management in primary care: a systematic review
Authors: Damiani Gianfranco , Altamura Gerardo , Zedda Massimo , Nurchis Mario Cesare , Aulino Giovanni , Heidar Alizadeh Aurora , Cazzato Francesca , Della Morte Gabriele , Caputo Matteo , Grassi Simone , Oliva Antonio
Published: March 2023

Objectives

The aim of this study is to investigate the effect of artificial intelligence (AI) and/or algorithms on drug management in primary care settings comparing AI and/or algorithms with standard clinical practice. Second, we evaluated what is the most frequently reported type of medication error and the most used AI machine type.

Methods

A systematic review of literature was conducted querying PubMed, Cochrane and ISI Web of Science until November 2021. The search strategy and the study selection were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Population, Intervention, Comparator, Outcome framework. Specifically, the Population chosen was general population of all ages (ie, including paediatric patients) in primary care settings (ie, home setting, ambulatory and nursery homes); the Intervention considered was the analysis AI and/or algorithms (ie, intelligent programs or software) application in primary care for reducing medications errors, the Comparator was the general practice and, lastly, the Outcome was the reduction of preventable medication errors (eg, overprescribing, inappropriate medication, drug interaction, risk of injury, dosing errors or in an increase in adherence to therapy). The methodological quality of included studies was appraised adopting the Quality Assessment of Controlled Intervention Studies of the National Institute of Health for randomised controlled trials.

Results

Studies reported in different ways the effective reduction of medication error. Ten out of 14 included studies, corresponding to 71% of articles, reported a reduction of medication errors, supporting the hypothesis that AI is an important tool for patient safety.

Conclusion

This study highlights how a proper application of AI in primary care is possible, since it provides an important tool to support the physician with drug management in non-hospital environments.
Meaning of Family Reported Outcome Measure (FROM-16) severity score bands: a cross-sectional online study in the UK
Authors: Shah Rubina , Finlay Andrew Y , Salek Sam M , Nixon Stuart J , Otwombe Kennedy , Ali Faraz M , Ingram John R
Published: March 2023

Objective

To assign clinical meanings to the Family Reported Outcome Measure (FROM-16) scores through the development of score bands using the anchor-based approach.

Design and setting

A cross-sectional online study recruited participants through UK-based patient support groups, research support platforms (HealthWise Wales, Autism Research Centre-Cambridge University database, Join Dementia Research) and through social service departments in Wales.

Participants

Family members/partners (aged ≥18 years) of patients with different health conditions.

Intervention

Family members/partners of patients completed the FROM-16 questionnaire and a Global Question (GQ).

Main outcome measure

Various FROM-16 band sets were devised as a result of mapping of mean, median and mode of the GQ scores to FROM-16 total score, and receiver operating characteristic-area under the curve cut-off values. The band set with the best agreement with GQ based on weighted kappa was selected.

Results

A total of 4413 family members/partners (male=1533, 34.7%; female=2858, 64.8%; Prefer not to say=16, 0.4%; other=6, 0.14%) of people with a health condition (male=1994, 45.2%; female=2400, 54.4%; Prefer not to say=12, 0.3%; other=7, 0.16%) completed the online survey: mean FROM-16 score=15.02 (range 0–32, SD=8.08), mean GQ score=2.32 (range 0–4, SD=1.08). The proposed FROM-16 score bandings are: 0–1=no effect on the quality of life of family member; 2–8=small effect on family member; 9–16=moderate effect on family member; 17–25=very large effect on family member; 26–32=extremely large effect on family member (weighted kappa=0.60).

Conclusion

The FROM-16 score descriptor bands provide new information to clinicians about interpreting scores and score changes, allowing better-informed treatment decisions for patients and their families. The score banding of FROM-16, along with a short administration time, demonstrates its potential to support holistic clinical practice.
Are there inequalities in the attendance and effectiveness of behavioural weight management interventions for adults in the UK? Protocol for an individual participant data (IPD) meta-analysis
Authors: Birch Jack M , Mueller Julia , Sharp Stephen , Logue Jennifer , Kelly Michael P , Griffin Simon J , Ahern Amy
Published: March 2023

Introduction

It is important to identify whether behavioural weight management interventions work well across different groups in the population so health inequalities in obesity are not widened. Previous systematic reviews of inequalities in the attendance and effectiveness of behavioural weight management interventions have been limited because few trials report relevant analyses and heterogeneity in the categorisation of inequality characteristics prevents meta-analysis. An individual participant data meta-analysis (IPD-MA) allows us to reanalyse all trials with available data in a uniform way. We aim to conduct an IPD meta-analysis of UK randomised controlled trials to examine whether there are inequalities in the attendance and effectiveness of behavioural weight interventions.

Methods and analysis

In a recently published systematic review, we identified 17 UK-based randomised controlled trials of primary care-relevant behavioural interventions, conducted in adults living with overweight or obesity and reporting weight outcomes at baseline and 1-year follow-up. The corresponding author of each trial will be invited to contribute data to the IPD-MA. The outcomes of interest are weight at 12-months and intervention attendance (number of sessions offered vs number of sessions attended). We will primarily consider whether there is an interaction between intervention group and characteristics where inequalities occur, such as by gender/sex, socioeconomic status or age. The IPD-MA will be conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses of IPD guidelines.

Ethics and dissemination

No further ethical approval was required as ethical approval for each individual study was obtained by the original trial investigators from appropriate ethics committees. The completed IPD-MA will be disseminated at conferences, in a peer-reviewed journal and contribute to the lead author’s PhD thesis. Investigators of each individual study included in the final IPD-MA will be invited to collaborate on any publications that arise from the project.
Inequity and vulnerability in Latin American Indigenous and non-Indigenous populations with rheumatic diseases: a syndemic approach
Authors: Granados Ysabel , Gastelum Strozzi Alfonso , Alvarez-Nemegyei Jose , Quintana Rosana , Julian-Santiago Flor , Santos Ana M , Guevara-Pacheco Sergio , Loyola-Sanchez Adalberto , Goycochea-Robles Maria Victoria , Juarez Vicente , Garza-Elizondo Mario Alberto , Rueda Juan Camilo , Burgos-Vargas Ruben , Londoño John , Pons-Estel Bernardo A , Pelaez-Ballestas Ingris
Published: March 2023

Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions.

Objective

To estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach.

Design

This is a secondary analysis of a previously published large-scale study on the prevalence of RMD.

Setting

Studies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis.

Participants

A total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population.

Results

The variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence.

Conclusions

A syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.
iPAPP: study protocol for a multicentre randomised controlled trial comparing safety and efficacy of intravenous paracetamol and indomethacin for the treatment of patent ductus arteriosus in preterm infants
Authors: Namba Fumihiko , Honda Masakazu , Sakatani Shun , Motojima Yukiko , Kikuchi Kayoko , Sako Mayumi , Ogawa Kunio , Mikami Masashi , Kawada Kou , Fukuoka Noriyasu , Ueda Keiko
Published: March 2023

Introduction

Patent ductus arteriosus (PDA) causes severe morbidity in premature infants. Although the use of indomethacin is the standard therapy for PDA, it is sometimes not applicable because of its adverse effects, such as renal and platelet dysfunctions. Paracetamol has emerged as an alternative to indomethacin owing to its excellent safety profile in infants. Of the recently reported case series and clinical trials on the use of paracetamol for PDA, there are few reports in Japan on paracetamol use in preterm infants. Furthermore, indications for the use of paracetamol for PDA have not been approved for use in PDA. While the safety of intravenous paracetamol therapy in case series of preterm infants treated for haemodynamically significant PDA (hsPDA) has been reported, studies which were conducted to compare paracetamol to indomethacin are limited. We, therefore, intend to investigate the hypothesis that intravenous administration of paracetamol has superior safety over indomethacin.

Methods and analysis

Multicentre open-label randomised controlled trial for intravenous administration of paracetamol for PDA in preterm infants. The inclusion criteria are (1) hsPDA, (2) gestational age from 24 to 34 weeks and birth weight (BW) from 500 to 2000 g, (3) enrolment between 24 hours and 7 days from birth and (4) obtaining parental consent. The primary outcome is renal dysfunction within 48 hours from the last dose of the study drug. Enrolled patients fulfilling all the inclusion criteria are randomly allocated to either intravenous paracetamol or intravenous indomethacin. This trial requires 110 patients.

Ethics and dissemination

The clinical trial would follow Japan’s Clinical Trials Act. The trial protocol was approved by the Clinical Research Review Board of Saitama Medical University (approval number: 222001). A written informed consent would be obtained from one of the parents. The results are expected to be published in a scientific journal.

Trial registration number

jRCTs031220386.

Protocol version

31 March 2022, version 1.0.
Neostigmine for the treatment of acute pancreatitis: a protocol for a systematic review and meta-analysis
Authors: He Kun , Yan Xiaxiao , Yang Zihan , Zhang Yuelun , Shu Huijun , Wu Dong
Published: March 2023

Introduction

Acute pancreatitis (AP) is a common disease with substantial mortality. Gut dysfunction may result in abdominal compartment syndrome (ACS) and delay enteral nutrition, worsening AP condition. Neostigmine is used as a prokinetic drug for the treatment of AP. But there are no recommendations from guidelines due to the lack of evidence. Therefore, we plan to conduct a systematic review and meta-analysis to explore the efficacy and safety of neostigmine for AP, aiming to provide current evidence for clinical practice.

Methods and analysis

We prepared this protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. We will search the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang, conference proceedings and ongoing trials registers for eligible studies comparing neostigmine plus conventional therapy with conventional therapy. Primary outcomes include new-onset ACS and serious adverse events caused by neostigmine. Evaluation of the risk of bias, heterogeneity and quality of evidence will follow recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Trial sequential analysis will be used to control the risk of random errors and assess conclusions in the meta-analysis.

Ethics and dissemination

Ethics approval is unnecessary as the systematic review is based on published studies. Study findings will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42022369536.
Skin-to-skin contact in the delivery room for very preterm infants: a randomised clinical trial
Authors: Kristoffersen Laila , Bergseng Håkon , Engesland Helene , Bagstevold Anne , Aker Karoline , Støen Ragnhild
Published: March 2023

Objective

Evaluating safety, feasibility and effects on physiological parameters of skin-to-skin contact (SSC) from birth between mothers and very preterm infants in a high-income setting.

Design

Open-label randomised controlled trial.

Setting

Three Norwegian neonatal units.

Patients

Preterm infants at gestational age (GA) 280–316weeks and birth weight >1000g delivered vaginally or by caesarean section (C-section).

Intervention

Two hours of early SSC between the mother and the infant compared to standard care (SC) where the infant is separated from the mother and transferred to the neonatal unit in an incubator.

Results

108 infants (63% male, 57% C-section, mean (SD) GA 30.3 weeks (1.3) and birth weight 1437 g (260)) were included. Median (IQR) age at randomisation was 23 min (17–30). During the first 2 hours after randomisation, 4% (2 of 51) and 7% (4 of 57) were hypothermic (<36.0°C) in the SSC and SC group, respectively (p=0.68, OR 0.5, 95% CI 0.1 to 3.1). Significantly fewer infants in the SSC group had hyperthermia (>37.5°C) (26% (13 of 57) vs 47% (27 of 51), respectively, p=0.02, OR 0.4, 95% CI 0.2 to 0.9). No infant needed mechanical ventilation within the first 2 hours. Median (IQR) duration of SSC was 120 (80–120) min in the intervention group. There was no difference in heart rate, respiratory rate and oxygen saturation between groups during the first 24 hours.

Conclusion

This study from a high-income setting confirmed that SSC from birth for very preterm infants was safe and feasible. Physiological parameters were not affected by the intervention. The long-term effects on neurodevelopment, maternal–infant bonding and maternal mental health will be collected.

Trial registration number

NCT02024854.
Contraceptive use and pregnancy planning in Britain during the first year of the COVID-19 pandemic: findings from a large, quasi-representative survey (Natsal-COVID)
Authors: Baxter Andrew J , Geary Rebecca S , Dema Emily , Bosó Pérez Raquel , Riddell Julie , Willis Malachi , Conolly Anne , Oakley Laura L , Copas Andrew J , Gibbs Jo , Bonell Christopher , Sonnenberg Pam , Mercer Catherine H , Clifton Soazig , Field Nigel , Mitchell Kirsten
Published: March 2023

Background

Contraceptive services were significantly disrupted during the COVID-19 pandemic in Britain. We investigated contraception-related health inequalities in the first year of the pandemic.

Methods

Natsal-COVID Wave 2 surveyed 6658 adults aged 18–59 years between March and April 2021, using quotas and weighting to achieve quasi-representativeness. Our analysis included sexually active participants aged 18–44 years, described as female at birth. We analysed contraception use, contraceptive switching due to the pandemic, contraceptive service access, and pregnancy plannedness.

Results

Of 1488 participants, 1619 were at risk of unplanned pregnancy, of whom 54.1% (51.0%–57.1%) reported routinely using effective contraception in the past year. Among all participants, 14.3% (12.5%–16.3%) reported switching or stopping contraception due to the pandemic. 3.2% (2.0%–5.1%) of those using effective methods pre-pandemic switched to less effective methods, while 3.8% (2.5%–5.9%) stopped. 29.3% (26.9%–31.8%) of at-risk participants reported seeking contraceptive services, of whom 16.4% (13.0%–20.4%) reported difficulty accessing services. Clinic closures and cancelled appointments were commonly reported pandemic-related reasons for difficulty accessing services. This unmet need was associated with younger age, diverse sexual identities and anxiety symptoms. Of 199 pregnancies, 6.6% (3.9%–11.1%) scored as ‘unplanned’; less planning was associated with younger age, lower social grade and unemployment.

Conclusions

Just under a third of participants sought contraceptive services during the pandemic and most were successful, indicating resilience and adaptability of service delivery. However, one in six reported an unmet need due to the pandemic. COVID-induced inequalities in service access potentially exacerbated existing reproductive health inequalities. These should be addressed in the post-pandemic period and beyond.
Blood pressure self-monitoring practice and associated factors among adult hypertensive patients on follow-up at South Wollo Zone Public Hospitals, Northeast Ethiopia
Authors: Edmealem Afework , Geleta Esmael , Mengesha Zemen , Tegegne Belachew , Ademe Sewunet , Liknaw Tiliksew
Published: March 2023

Background

Hypertension is a silent killer that causes serious health issues in all parts of the world. It is risk factor for cardiovascular disease, stroke and kidney disease. Self-monitoring practice has been identified as an important component of hypertension management. Hence, this study aimed to assess blood pressure (BP) self-monitoring practice and associated factors among adult hypertensive patients on follow-up in South Wollo Zone public hospitals, Northeast Ethiopia.

Methods

Hospital-based cross-sectional study was conducted from 1 June 2022 to 30 June 2022, among 336 adult hypertensive patients on follow-up at selected South Wollo Zone public hospitals. Data were collected by using self-administered pretested structured questionnaires; the collected data were entered into Epi-data V.4.6 and then exported to SPSS V.25 software for analysis. Descriptive statistics such as frequency and percentage were used to describe the study participants. Tables and texts were used for data presentation. Binary logistic regression was conducted to test the association between the independent and dependent variables. Adjusted OR (AOR) with 95% CI was estimated to identify the factors associated with BP self-monitoring and the level of significance was declared at p<0.05.

Results

The proportion (95% CI) of BP self-monitoring practice among hypertensive patients in South Wollo Zone Public Hospitals was 8.93% (95% CI 6.3% to 12.5%). In the multivariable analysis, urban residence (AOR 3.97, 95% CI (1.11 to 14.20)), comorbidity (AOR 4.80, 95% CI (1.23 to 18.69)), regular healthcare professional visit (AOR 4.64, 95% CI (1.02 to 21.14)), advice on the type of devices used for BP self-monitoring (AOR 5.26, 95% CI (1.49 to 18.58)) and knowledge on hypertension self-care (AOR 13.13, 95% CI (4.21 to 40.99)) were positively associated with BP self-monitoring practice.

Conclusion

The proportion of BP self-monitoring practice was low. Living in urban areas, comorbidity, regular healthcare professional visits, advice on the type of devices used for BP self-monitoring, and knowledge of hypertension self-care were positively associated with BP self-monitoring practice.
Sex differences in the efficacy, safety and persistence of patients with psoriatic arthritis treated with tofacitinib: a post-hoc analysis of phase 3 trials and long-term extension
Authors: Eder Lihi , Gladman Dafna D , Mease Philip , Pollock Remy A , Luna Rayana , Aydin Sibel Z , Ogdie Alexis , Polachek Ari , Gruben David , Cadatal Mary Jane , Kinch Cassandra , Strand Vibeke
Published: March 2023

Background

Evaluate the impact of sex on tofacitinib efficacy, safety and persistence (time to discontinuation) in patients with psoriatic arthritis (PsA).

Methods

Data were pooled from two phase 3 randomised controlled trials. Patients were randomised to tofacitinib 5 mg or 10 mg two times per day, adalimumab 40 mg every 2 weeks or placebo. Efficacy outcomes to month 12 included American College of Rheumatology (ACR)20/50/70, minimal disease activity (MDA), Psoriasis Area Severity Index (PASI)75, change from baseline (∆) in Health Assessment Questionnaire-Disability Index (HAQ-DI) and ∆Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Safety was assessed to month 12 and persistence was assessed to month 42 of a long-term extension study.

Results

Overall, 816 patients were included (54.3% females). At baseline, higher tender joint counts, enthesitis scores and worse HAQ-DI and FACIT-F were reported in females versus males; presence of dactylitis and PASI were greater in males versus females. At month 3, tofacitinib efficacy generally exceeded placebo in both sexes. Overall, similar ACR20/50/70, PASI75, ∆HAQ-DI and ∆FACIT-F were observed for tofacitinib between sexes; females were less likely to achieve MDA. Similar proportions of males/females receiving tofacitinib (both doses) experienced treatment-emergent adverse events (AEs). Serious AEs occurred in 3.4%/6.6% and 4.0%/5.9% males/females with tofacitinib 5 mg and 10 mg two times per day. Persistence was generally similar between sexes.

Conclusion

Tofacitinib efficacy exceeded placebo in both sexes and was comparable between sexes. Consistent with previous studies of PsA treatments, females were less likely to achieve MDA, likely due to baseline differences. Safety and time to discontinuation were generally similar between sexes.

Trial registration number

NCT01877668;NCT01882439;NCT01976364.
Risk of cancer in Korean patients with psoriatic arthritis: a nationwide population-based cohort study
Authors: Eun Yeonghee , Hwang Jiwon , Seo Gi Hyeon , Ahn Joong Kyong
Published: March 2023

Objective

While many studies on the increased risk of cancer in patients with psoriasis are available, data on the risk of cancer in patients with psoriatic arthritis (PsA) are still scarce. We assessed the risk of cancer in patients with PsA in a nationwide population-based cohort in Korea.

Methods

From 2010 to June 2021, patients newly diagnosed with PsA and 1:10 age-matched and sex-matched controls were included in this study. The outcome was the incidence of overall and specific cancers.

Results

Total 162 cancers occurred in 4688 PsA patients (incidence rate 83.2 (95% CI 70.8 to 97.0) per 10 000 person-years) and 1307 cancers occurred in 46 880 controls (incidence rate 66.9 (95% CI 63.3 to 70.6) per 10 000 person-years). The adjusted HR (aHR) of overall cancer in PsA patients was 1.20 (95% CI 1.02 to 1.41). However, this significance disappeared when non-melanoma skin cancer (NMSC) was excluded (aHR 1.16, 95% CI 0.98 to 1.37). Among specific cancers, the risk of NMSC (aHR 3.64 (95% CI 1.61 to 8.23)), lymphoma (aHR 2.63 (95% CI 1.30 to 5.30)) and thyroid cancer (aHR 1.83 (95% CI 1.18 to 2.85)) was higher in patients with PsA than in controls.

Conclusion

The risk of overall cancer was higher in patients with PsA than in the general population. Patients with PsA had increased risks of NMSC, lymphoma and thyroid cancer compared with the general population. Our findings suggest a need to conduct cancer screening by a detailed history and comprehensive clinical examination in patients with PsA.
Perception of exercise-induced dyspnea after experimentally induced breathing discomfort
Authors: Chang Jou-Chung , Angus Sarah A. , Doherty Connor J. , Thompson Benjamin P. , Mann Leah M. , Molgat-Seon Yannick , Dominelli Paolo B.
Published: March 2023

The perception of dyspnea is influenced by both physiological and psychological factors. We sought to determine whether exertional dyspnea perception could be experimentally manipulated through prior exposure to heightened dyspnea while exercising. We hypothesized that dyspnea perception during exercise would be lower following an induced dyspnea task (IDT). Sixteen healthy participants (eight females, eight males) completed two days of exercise testing. Day 1 involved an incremental cycle exercise test starting at 40 W for females and 60 W for males, increasing by 20 W each minute until volitional exhaustion. Following the maximal exercise test on Day 1, participants completed IDT, involving 5 min of exercise at 70% of peak work rate with 500 mL dead space and external resistance (i.e., 6.8 ± 2.3 cm·H2O·s−1·L−1 inspiration, 3.8 ± 0.7 cm·H2O·s−1·L−1 expiration). Day 2 consisted of an incremental exercise test identical to Day 1. At maximal exercise, there were no differences in oxygen uptake (V̇O2; 44.7 ± 7.7 vs. 46.5 ± 6.3 mL·kg−1·min−1), minute ventilation (120 ± 35 vs. 127 ± 38 L·min−1), dyspnea (6.5 [4, 8.5] vs. 6 [4.25, 8.75]), or leg discomfort (6 [5, 8.75] vs. 7 [5, 9]) between days (all p > 0.05). At 60%–80% of peak V̇O2 (V̇O2peak), dyspnea was significantly lower on Day 2 (−0.75 [−1.375, 0] for 60% and −0.5 [0, −2] for 80%, p < 0.05) despite no differences in relevant physiological variables. The onset of perceived dyspnea occurred at a significantly higher exercise intensity on Day 2 than on Day 1 (42% ± 19% vs. 51% ± 17% V̇O2peak, respectively; p < 0.05). Except for 40% V̇O2peak ( p = 0.05), RPE-L was not different at any intensities nor was the onset of perceived leg discomfort different between days (38% ± 14% vs. 43% ± 10% V̇O2peak, respectively; p = 0.10). Exposure to heightened dyspnea alters exercise-induced dyspnea perception during subsequent submaximal exercise bouts.
Mismatches in salmon social–ecological systems: Challenges and opportunities for (re)alignment in the Skeena River watershed
Authors: Connors Katrina
Published: March 2023

Mismatches between institutions and social–ecological systems (SESs) are one of the foremost challenges in natural resource management. However, while mismatches are often cited in the literature as a major challenge, empirical evidence of mismatches and their consequences is limited. This is particularly true for complex SESs, such as on the Pacific Coast of North America, where salmon drive interactions across multiple environments, jurisdictions, and scales. Here, I use the theoretical concept of fit to examine institutional alignment in a large-scale Pacific salmon SES, the Skeena River watershed in British Columbia, Canada. Utilizing Canadian federal environmental assessments as a proxy for colonial environmental governance institutions, I describe the common causes and consequences of mismatches between institutions and salmon SESs. This case study suggests that mismatches are threatening salmon sustainability and negatively affecting Indigenous People’s rights, livelihoods, and approaches to resource management and stewardship. I argue that improving social–ecological fit in salmon SESs will require new or revitalized forms of environmental governance that consciously fit the underlying social–ecological dynamics. While these findings are based on the Skeena River watershed, they may be generalizable to other salmon SESs in which mismatches between social and ecological processes and institutions exist.
Gravitational matter creation, multi-fluid cosmology and kinetic theory
Authors: Trevisani S. R. G. , Lima J. A. S.
Published: March 2023

A macroscopic and kinetic relativistic description for a decoupled multi-fluid cosmology endowed with gravitationally induced particle production of all components is proposed. The temperature law for each decoupled particle species is also kinetically derived. The present approach points to the possibility of an exact (semi-classical) quantum-gravitational kinetic treatment by incorporating back reaction effects for an arbitrary set of dominant decoupled components. As an illustration we show that a cosmology driven by creation of cold dark matter and baryons (without dark energy) evolves like $$\Lambda $$
Λ
CDM. However, the complete physical emulation is broken when photon creation is added to the mixture thereby pointing to a crucial test in the future. The present analysis also open up a new window to investigate the Supernova-CMB tension on the values of $$H_0$$

H
0

, as well as the $$S_8$$

S
8

tension since creation of all components changes slightly the CMB results and the expansion history both at early and late times. Finally, it is also argued that cross-correlations between CMB temperature maps and the Sunyaev–Zeldovich effect may provide a crucial and accurate test confronting extended CCDM and $$\Lambda $$
Λ
CDM models.
Investigations concerning the effects of thermal radiation, induced magnetic field, and chemical reaction on MHD flow through a permeable medium
Authors: Mishra Manasi , Panda J. P. , Sahoo Sudhansu S.
Published: March 2023

This paper focuses on the effects of heat radiation and chemical reactions on naturally occurring convective MHD flow that conducts electricity when there is an induced magnetic field present between two vertical walls having a porous medium between them. An analytical method is adopted to investigate the impacts of all pertinent parameters concerning the presented multi-physics problem. With the aid of relevant conversions, the nonlinear PDEs are remodeled into nonlinear ODEs.The effects of radiation parameters, Hartmann number, Hall current, chemical reaction and porosity parameters are scrutinized on velocity components, induced magnetic field, and current density. The results predict that the temperature profile decreases as the radiation factor rises, whereas the induced magnetic field would exhibit the opposite pattern. The profiles of component velocity get more intense for high rates of the porosity parameter. Additionally, profiles of induced magnetic field surges with elevated chemical reaction parameter values have been noted. The presented approach is very promising for multi-physics phenomena like chemical reactors and solar thermal devices.
Locally Active Memristor with Variable Parameters and Its Oscillation Circuit
Authors: Li Haodong , Li Chunlai , He Shaobo
Published: March 2023

This paper designs a locally active memristor with two variable parameters based on Chua’s unfolding theorem. The dynamical behavior of the memristor is analyzed by employing pinched hysteresis loop, power-off plot (POP), DC V–I curve, small-signal analysis, and edge-of-chaos theory. It is found that the proposed memristor exhibits nonvolatile and bistable behaviors because of coexisting pinched hysteresis loops. And the variable parameters can realize the rotation of the coexisting pinched hysteresis loops, regulate the range of the locally active region and even transform the shape of the DC V–I curve into S-type or N-type. Furthermore, a simple oscillation circuit is constructed by connecting this locally active memristor with an inductor, a capacitor, a resistance, and a bias voltage. It is shown by analysis that the memristive circuit can generate complex nonlinear dynamics such as multiscroll attractor, initial condition-based dynamics switching, transient phenomenon with the same dynamical state but different offsets and amplitudes, and symmetric coexisting attractors. The measurement observed from the implementation circuit further verifies the numerical results of the oscillation circuit.
Additional Food Causes Predators to Explode — Unless the Predators Compete
Authors: Parshad Rana D. , Wickramasooriya Sureni , Antwi-Fordjour Kwadwo , Banerjee Aniket
Published: March 2023

The literature posits that an introduced predator population is able to drive its target pest population to extinction, if supplemented with high quality additional food of sufficient quantity. We show this approach actually leads to infinite time blow-up of the predator population, so is unpragmatic as a pest management strategy. We propose an alternate model in which the additional food induces predator competition. Analysis of this model indicates that depending on the competition parameter [Formula: see text], one can have global stability of the pest-free state, bistability dynamics, or up to three interior equilibria. As [Formula: see text] and the additional food quantity [Formula: see text] are varied standard codimension one and codimension two bifurcations are observed. We also use structural symmetries to construct several nonstandard bifurcations such as saddle-node-transcritical bifurcation (SNTC) in codimension two and a cusp-transcritical bifurcation (CPTC), also in codimension two. We further use symmetry to construct a novel pitchfork-transcritical bifurcation (PTC) in codimension two, thus explicitly characterizing a new organizing center of the model. Our findings indicate that increasing additional food in predator–pest models can hinder bio-control, contrarily to some of the literature. However, additional food that also induces predator competition, leads to rich dynamics and enhances bio-control.
MOTION CAPTURE ANALYSIS OF EX VIVO KNEE KINEMATIC SIMULATOR: A COMPREHENSIVE EXPERIMENTAL PROTOCOL
Authors: BORI EDOARDO , INNOCENTI BERNARDO
Published: March 2023

Preface: Understanding knee kinematics is a fundamental prerequisite to address restoration in pathological joints; these performances represent the goal to achieve after the treatment. Experimental activities addressing knee kinematics often involve Motion Capture systems to acquire information, both for in vivo and ex vivo studies. This technique allows a complete analysis of the joint kinematics and is able to provide useful results for the comparison mentioned above. Objectives: The definition of a reproducible and straightforward protocol represents a beneficial factor to improve both reliability and the time required: in this study a new protocol for kinematics experimental activities on ex vivo knee specimens was developed, validated and tested. Methods: Synthetic bones were chosen for the analysis and different Total Knee Arthroplasties models were selected (a Cruciate Retaining, a Posterior Stabilized, a Constrained Condylar Knee and a Rotating Hinge). A dedicated frame was used to support and secure the knee specimens and pair the extensor mechanism to a motor. The Motion Capture System was assembled and paired with dedicated marker-sets to be fixed to the specimens. A post-processing tool was developed to analyze the outputs and was validated with a goniometer. A series of force-driven tasks were defined, implemented and run in the motor system for all the different prosthesis configurations and kinematics output were analyzed, comparing the outputs with the expected results. Results: The validation of the system returned satisfying results in terms of correspondence between the angles imposed and the ones measured, with an average error below [Formula: see text] and a standard deviation below [Formula: see text] for each kind of rotation. The results from the different testing were coherent with the type of specimens and prostheses tested. Conclusions: This study proved that the protocol and testing set-up developed for knee kinematics in vitro analysis are able to provide reliable and coherent data, as proven by the post-processing validation and by the testing campaign on synthetic specimens.
Modified Boundary Knot Method for Multi-Dimensional Harmonic-Type Equations
Authors: Liu Le , Lei Min , Yue Jun Hong , Niu Rui Ping
Published: March 2023

This paper presents the modified boundary knot method (MBKM) for solving the homogeneous harmonic type boundary value problems (BVPs). Since no non-singular general solutions are applicable for harmonic-type equations, the general solutions of Helmholtz-type operator with a free parameter [Formula: see text] can be used to approximate the solutions of these problems by adjusting the [Formula: see text]. Compared with the classical boundary knot method (BKM) where the source nodes are the same as the boundary collocation nodes, the MBKM employs the ghost points method, which resets the source points to a disk-like region covering the primary problem area. This modification results in better accuracy without any increase in the computational cost. On the other hand, as the accuracy of the MBKM depends heavily on the parameter [Formula: see text], the effective condition number (ECN) is first employed to find a proper [Formula: see text] in MBKM. Several 2D and 3D numerical examples are listed to illustrate the superior performance of the MBKM in solving harmonic-type BVPs. The accuracy of MBKM is improved by one to two orders of magnitude compared to the classical BKM. Meanwhile, the validity of the ECN for obtaining a suitable [Formula: see text] for problems under complex geometric regions is also demonstrated.
Noncommutative Dirac and Schrödinger equations in the background of the new generalized Morse potential and a class of Yukawa potential with the improved Coulomb-like tensor potential as a tensor in 3D-ERQM and 3D-ENRQM symmetries
Authors: Maireche Abdelmadjid
Published: March 2023

Relativistic and nonrelativistic quantum mechanics formulated in a noncommutative space–space have recently become the object of renewed interest. In the context of three-dimensional extended relativistic quantum mechanics (3D-ERQM) symmetries with arbitrary spin-orbit coupling quantum number [Formula: see text], we approximate to solve the deformed Dirac equation for a new suggested new generalized Morse potential and a class of Yukawa potential including improved Coulomb-like tensor interaction (N(GMP-CYP) plus ICLTI). In the framework of the spin and pseudospin (p-spin) symmetry, we obtain the global new energy eigenvalue which equals the energy eigenvalue in the usual relativistic QM as the main part plus three corrected parts produced from the effect of the spin-orbit interaction, the new modified Zeeman, and the rotational Fermi term, by using the parametric of the well-known Bopp’s shift method and standard perturbation theory using Greene–Aldrich approximation to nonlinear and exponential terms in the effective potential. The new values that we got appeared sensitive to the quantum numbers ([Formula: see text]), the mixed potential depths ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]), the range of the potential [Formula: see text] and noncommutativity parameters ([Formula: see text],[Formula: see text],[Formula: see text]). We have studied the nonrelativistic limit of new spin symmetry under the N(GMP-ICYP) model, we will also treat some important special cases such as the new generalized Morse potential, the new class of Yukawa potential, the new Hellmann potential, the new inversely quadratic Yukawa potential, the new Hulthén potential and new Coulomb potential. Finally, we studied a case of composite systems.