bluuebunny/crossref_metadata_2025 huggingface dataset:
Visualizing Multiple Sexual Identity Responses Using a Network Approach
Authors: Julian Christopher A. , Newmyer Lauren , Manning Wendy D. , Dush Claire M. Kamp
Published: September 2024

Measurement strategies for gauging sexual identity within the United States’s population-based data infrastructure are evolving. Despite notable advancements, most measurement techniques still do not accurately reflect the nuanced ways in which sexually diverse adults conceptualize their identities. One measurement limitation involves asking participants to choose a single “best” identity. In this visualization, drawing on data from the National Couples’ Health and Time Study, the authors illustrate the complexity of sexual identity responses by constructing a network that aggregates the patterns of multiple identities chosen by respondents. The findings underscore that relying on a single-item response risks undercounting the range of sexually diverse identities. As national surveys progress in incorporating sexual identity measures, a “select all that apply” option is crucial if the identities of sexually diverse adults are to be accurately represented.
Multiple Sclerosis and COVID-19: An Overview on Risk, Severity, and Association With Disease Modifying Therapies
Authors: Hollist Mary , Hollist Abraham , Au Katherine , Betts Colton , Kirmani Maha , Kirmani Maaida , Armour Benjamin , Udeh Mercy C , Kirmani Batool F
Published: September 2024

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, emerged in December 2019, sparking a global health crisis. While initially recognized as a respiratory illness, it has become evident that Coronavirus disease 2019 (COVID-19) also affects the central nervous system. This comprehensive review focuses on the neurological manifestations of COVID-19 and its impact on patients with preexisting neurological disorders, particularly those with multiple sclerosis (MS) receiving disease-modifying therapies. Advancements in management, including vaccinations, antiviral therapy, and targeted prophylaxis, have led to a decline in the incidence and severity of COVID-19. Nevertheless, significant complications persist, particularly in patients with advanced MS, who are highly vulnerable to infectious agents like SARS-CoV-2. This review explores the evolving understanding of MS and its association with SARS-CoV-2, encompassing neuroinvasiveness, pathogenesis, disease severity, and outcomes. Research findings reveal substantial neurological implications for some MS patients with COVID-19, with a potential risk of disease relapse and severity. A notable proportion of MS patients experiencing COVID-19 may manifest new symptoms, experience exacerbation of existing symptoms, or encounter both simultaneously, underscoring the diverse neurological effects of the virus. While vaccination and therapeutics have mitigated the overall impact, specific subgroups, especially those on anti-CD20 therapy and with existing disability, remain at higher risk, necessitating ongoing vigilance and tailored care.
Guidelines or mindlines? – implementing a new CKD guideline in German primary care
Authors: Laker Konrad , Bothe Tim , Ebert Natalie , Heintze Christoph , Schaeffner Elke , Krüger Karen
Published: September 2024

Background

The development of clinical guidelines aimed at GPs is a key strategy to improving the management of chronic kidney disease (CKD). In 2019, the first CKD guideline aimed specifically at GPs practicing in Germany was published by the German College of General Practitioners and Family Physicians (DEGAM.)

Aims

The aim of this study is to identify the barriers and enablers for the implementation of this guideline. The results of this project, together with quantitative evaluation against quality indicators for CKD in primary care will inform an update to the guideline.

Methods

We performed 17 semi-structured interviews with GPs practicing in Berlin and Brandenburg. Transcripts were analysed using qualitative content analysis as described by Mayring.

Results

We found that the perception of low clinical priority of CKD compared to other chronic diseases, opportunity cost of using guidelines, as well as poor patient understanding were significant barriers. GPs expressed that improved graphic design or integration of guideline recommendations in clinical decision support systems were enabling factors. Clinical problems concerning CKD were mostly solved by recourse to informal communication with specialists. GPs reported that they rarely consulted CKD guidelines as an aide to clinical decision making.

Conclusion

The most significant barrier to use was that guidelines were not used as step-by-step decision aide in consultations with patients. Our analysis suggests that informal contact between primary and secondary care is significant conduit for evidence-based information on CKD in German primary care. Implementation projects should support the development of these relationships.
Detection of hepatocellular carcinoma feeding vessels: MDCT angiography with 3D reconstruction versus digital subtraction angiography
Authors: Ahmed Ramy M. , Ali Wageeh A. , AbdelHakam Ahmed M. , Ahmed Sayed H.
Published: September 2024

Background

Accurate detection of Hepatocellular carcinoma (HCC) feeding vessels during transcatheter arterial chemoembolization (TACE) is important for an effective treatment, while limiting non-target embolization. This study aimed to investigate the feasibility and accuracy of pre-TACE three dimensional (3D) CT angiography for tumor-feeding vessels detection compared to DSA.

Methods

Sixty-nine consecutive patients referred for TACE from May 2022 to May 2023 were included. (3D) CT images were reconstructed from the pre-TACE diagnostic multiphasic contrast enhanced CT images and compared with non-selective digital subtraction angiography (DSA) images obtained during TACE for detection of HCC feeding vessels. A “Ground truth” made by consensus between observers after reviewing all available pre-TACE CT images, and DSA and CBCT images during TACE to detect the true feeding vessels was the gold standard. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy and ROC curve with AUC were calculated for each modality and compared.

Results

A total of 136 active HCCs were detected in the 69 consecutive patients included in the study. 185 feeding arteries were detected by 3D CT and DSA and included in the analysis. 3D CT detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV and accuracy of 91%, 71%, 98%, 36%, and 90%, respectively, with mean AUC = 0.81. DSA detection of feeding arteries revealed mean sensitivity, specificity, PPV, NPV, and accuracy of 80%, 58%, 96.5%, 16.5% and 78%, respectively, with mean AUC = 0.69.

Conclusions

Pre-TACE 3D CT angiography has shown promise in improving the detection of HCC feeding vessels compared to DSA. However, further studies are required to confirm these findings across different clinical settings and patient populations.

Trial registration

This study was prospectively registered at Clinicaltrials.gov with ID NCT05304572; Date of registration: 2-4-2022.
Paediatric mass casualty response through the lens of Functional Resonance Analytical Methodology- lessons learned
Authors: MacKinnon R. J. , Slater D. , Jenner R. , Stenfors T. , Kennedy C. , Härenstam K. P.
Published: September 2024

Background

Mass Casualty Incidents are rare but can significantly stress healthcare systems. Functional Resonance Analytical Methodology (FRAM) is a systematic approach to model and explore how complex systems adapt to variations and to understand resilient properties in the face of perturbations. The aim of this study was to use FRAM to create a model of a paediatric trauma system during the initial response to the Manchester Arena Attack to provide resilience-based insights for the management of future Mass Casualty Incidents (MCI).

Methods

Qualitative interviews in the immediate aftermath of a terrorist bombing, were followed up with further in-depth probing of subject matter experts to create a validated and verified FRAM model. This model was compared with real incident data, then simplified for future studies.

Results

A Work As Imagined (WAI) model of how a paediatric emergency department provided resilient healthcare for MCI patients from reception and resuscitation to definitive care is presented. A focused model exploring the pathway for the most severely injured patients that will facilitate the simulation of a myriad of potential emergency preparedness resilience response scenarios is also presented.

Conclusions

The systematic approach undertaken in this study has produced a model of a paediatric trauma system during the initial response to the Manchester Arena Attack, providing key insights on how a resilient performance was sustained. This modelling may provide an important step forward in the preparedness and planning for future MCIs.
On-treatment biopsies to predict response to neoadjuvant chemotherapy for breast cancer
Authors: Sinn Bruno Valentin , Sychra Katharina , Untch Michael , Karn Thomas , van Mackelenbergh Marion , Huober Jens , Schmitt Wolfgang , Marmé Frederik , Schem Christian , Solbach Christine , Stickeler Elmar , Tesch Hans , Fasching Peter A. , Schneeweiss Andreas , Müller Volkmar , Holtschmidt Johannes , Nekljudova Valentina , Loibl Sibylle , Denkert Carsten
Published: September 2024

Background

Patients with pathologic complete response (pCR) to neoadjuvant chemotherapy for invasive breast cancer (BC) have better outcomes, potentially warranting less extensive surgical and systemic treatments. Early prediction of treatment response could aid in adapting therapies.

Methods

On-treatment biopsies from 297 patients with invasive BC in three randomized, prospective neoadjuvant trials were assessed (GeparQuattro, GeparQuinto, GeparSixto). BC quantity, tumor-infiltrating lymphocytes (TILs), and the proliferation marker Ki-67 were compared to pre-treatment samples. The study investigated the correlation between residual cancer, changes in Ki-67 and TILs, and their impact on pathologic complete response (pCR) and disease-free survival (DFS).

Results

Among the 297 samples, 138 (46%) were hormone receptor-positive (HR+)/human epidermal growth factor 2-negative (HER2−), 87 (29%) were triple-negative (TNBC), and 72 (24%) were HER2+. Invasive tumor cells were found in 70% of on-treatment biopsies, with varying rates across subtypes (HR+/HER2−: 84%, TNBC: 62%, HER2+: 51%; p < 0.001). Patients with residual tumor on-treatment had an 8% pCR rate post-treatment (HR+/HER2−: 3%, TNBC: 19%, HER2+: 11%), while those without any invasive tumor had a 50% pCR rate (HR+/HER2−: 27%; TNBC: 48%, HER2+: 66%). Sensitivity for predicting residual disease was 0.81, with positive and negative predictive values of 0.92 and 0.50, respectively. Increasing TILs from baseline to on-treatment biopsy (if residual tumor was present) were linked to higher pCR likelihood in the overall cohort (OR 1.034, 95% CI 1.013–1.056 per % increase; p = 0.001) and with a longer DFS in TNBC (HR 0.980, 95% CI 0.963–0.997 per % increase; p = 0.026). Persisting or increased Ki-67 was associated with with lower pCR probability in the overall cohort (OR 0.957, 95% CI 0.928–0.986; p = 0.004) and shorter DFS in TNBC (HR 1.023, 95% CI 1.001–1.047; p = 0.04).

Conclusion

On-treatment biopsies can predict patients unlikely to achieve pCR post-therapy. This could facilitate therapy adjustments for TNBC or HER2 + BC. They also might offer insights into therapy resistance mechanisms. Future research should explore whether standardized or expanded sampling enhances the accuracy of on-treatment biopsy procedures.

Trial registration GeparQuattro (EudraCT 2005-001546-17), GeparQuinto (EudraCT 2006-005834-19) and GeparSixto (EudraCT 2011-000553-23).
Phytochemical composition and green insecticides from Citrus aurantifolia fruit peels against whitefly, Bemisia tabaci
Authors: El-Alfy Mariam S. , Mostafa Mohamed E. , Dawidar Abelaziz M. , Abdel-Mogib Mamdouh
Published: September 2024

Insecticidal potential of extracts of Citrus aurantifolia, family Rutaceae, was evaluated to control whiteflies, Bemisia tabaci. Biocidal activity directed chromatographic separation of chloroform and butanol fractions, with spectral identification (1D-NMR, 2D-NMR, ESIMS) of the active fractions have been resulted in separation and structural elucidation of for previously described coumarins (bergapten 1, limettin 2, isopimpinellin 3, oxypeucedanin hydrate 4) in addition to a new dimeric coumarin (12R, 12’R)-aurantifolin 5, two known limonoids; 21,23-dihydro-23-methoxy-21-oxolimonin 6, 21,23-dihydro-23-methoxy-21-oxonomilin 7, and two known flavonoid glycosides; scoparin 8, and narcissin 9. Amongst these compounds, narcissin 9 was the most effective after 24 h. of treatment while, (12R, 12’R)-aurantifolin 5 was the most potent against B. tabaci, 3rd instar nymphs after 72 h. of treatment and under laboratory conditions, with LC50 values of 33.31and 15.92 ppm, respectively comparing with the positive control azadirachtin.
Development Length Assessment of Bonded Post-Tensioning Slabs with Bulb-Shaped Dead end Anchorage
Authors: Aly Jehan H. , Maree A. Farghal , Kohail Mohamed , Khalil Ayman H.
Published: September 2024

The bond between prestressing strands and concrete within the dead-end zone of a post-tensioned concrete member significantly influences the effectiveness of the strand-concrete system. However, the existing code equations for determining development length rely on studies conducted on pretensioned concrete members rather than post-tensioned ones. As a result, the implementation of development length for prestressing strands with bulb-shaped dead end anchorage in post-tensioning slabs relies on common practice and former experience. Unfortunately, this can sometimes lead to concrete cracks or strand slippage at the dead end zone due to insufficient development length. This paper presents an experimental study on post-tensioning slab segments representing the dead end zone. The aim of this study is to assess the development length of prestressing strands with bulb-shaped dead end that shall guarantee full bond with concrete throughout the member’s service life. The Specimens were divided according to three different concrete compressive strengths 34 MPa, 48 MPa and 70 MPa. The parameters considered included slab thicknesses of 160 mm and 250 mm, as well as strand embedment lengths of 700 mm and 850 mm. Based on the test results, the sufficient development length was determined. Furthermore, a verification was carried out to assess the validity of applying predicted equations from an adopted bond model to determine the bond strength of strand with bulb-shaped dead end anchorage in concrete slabs.
Validating the ChatGPT Usage Scale: psychometric properties and factor structures among postgraduate students
Authors: Nemt-allah Mohamed , Khalifa Waleed , Badawy Mahmoud , Elbably Yasser , Ibrahim Ashraf
Published: September 2024

Background

The rapid adoption of ChatGPT in academic settings has raised concerns about its impact on learning, research, and academic integrity. This study aimed to develop and validate a comprehensive ChatGPT Usage Scale specifically tailored to postgraduate students, addressing the need for a psychometrically sound instrument to assess the multidimensional nature of ChatGPT usage in higher education.

Methods

A cross-sectional survey design was employed, involving 443 postgraduate students from two Egyptian universities. The initial 39-item scale underwent Exploratory Factor Analysis (EFA) using principal component analysis with Varimax rotation. Confirmatory Factor Analysis (CFA) was conducted to assess the model fit and psychometric properties of the final 15-item measure. Internal consistency reliability was evaluated using Cronbach’s alpha and McDonald’s omega.

Results

EFA revealed a three-factor structure explaining 49.186% of the total variance: Academic Writing Aid (20.438%), Academic Task Support (14.410%), and Reliance and Trust (14.338%). CFA confirmed the three-factor structure with acceptable fit indices (χ2(87) = 223.604, p < .001; CMIN/DF = 2.570; CFI = 0.917; TLI = 0.900; RMSEA = 0.060). All standardized factor loadings were statistically significant (p < .001), ranging from 0.434 to 0.728. The scale demonstrated good internal consistency (Cronbach’s α = 0.848, McDonald’s ω = 0.849) and composite reliability (CR = 0.855). The average variance extracted (AVE) was 0.664, supporting convergent validity.

Conclusions

The validated ChatGPT Usage Scale provides a reliable and valid instrument for assessing postgraduate students’ engagement with ChatGPT across multiple dimensions. This tool offers valuable insights into AI-assisted academic practices, enabling more nuanced investigations into the effects of ChatGPT on postgraduate education.
Culture, tradition and healthcare: exploring the Kisiizi Community Health Insurance scheme
Authors: Kakama Alex Ayebazibwe , Atuheire Ambrose , Kahyana Danson
Published: September 2024

In southwestern Uganda, a custom of health and social support has been managed through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their households. Participants pooled financial and food resources, offered emotional assistance, and aided in transporting patients to hospitals. The institution of “free government health amenities” caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services cannot satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to eliminate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health-related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock’s social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Cooperation, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and traditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting premium fees from subscribers, mobilization and registration of participants, and information dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback.
Nothophoma spp. causing leaf blight of ancient Platycladus orientalis
Authors: Jiao Ning , Wang Jiawen , Zhang Zhe , Zhang Ying
Published: September 2024

Ancient Platycladus orientalis holds significant ecological, landscape, historical, and cultural value. In northern China, leaf blight has significantly impacted the growth and ornamental value of ancient P. orientalis. In this study, 26 blight leaf samples of ancient P. orientalis were collected in Beijing, China. Phylogenetic analysis based on the concatenated internal transcribed spacer (ITS), β-tubulin (tub2), and RNA polymerase second largest subunit (rpb2) DNA sequence data combined with fungal morphological characteristics revealed three taxa of Nothophoma, i.e. N. platycladus, N. spiraeae, and N. juglandis. Of which, N. platycladus is a species new to science. Koch’s postulates indicated that all these three species of Nothophoma could cause leaf blight of P. orientalis.
A study on the influence of situations on personal avatar characteristics
Authors: Hube Natalie , Reinelt Melissa , Vidackovic Kresimir , Sedlmair Michael
Published: September 2024

Avatars play a key role in how persons interact within virtual environments, acting as the digital selves. There are many types of avatars, each serving the purpose of representing users or others in these immersive spaces. However, the optimal approach for these avatars remains unclear. Although consumer applications often use cartoon-like avatars, this trend is not as common in work settings. To gain a better understanding of the kinds of avatars people prefer, three studies were conducted involving both screen-based and virtual reality setups, looking into how social settings might affect the way people choose their avatars. Personalized avatars were created for 91 participants, including 71 employees in the automotive field and 20 participants not affiliated with the company. The research shows that work-type situations influence the chosen avatar. At the same time, a correlation between the type of display medium used to display the avatar or the person’s personality and their avatar choice was not found. Based on the findings, recommendations are made for future avatar representations in work environments and implications and research questions derived that can guide future research.
Prevalence of psychiatric comorbidities among adult out-patients living with HIV/AIDS in a tertiary care center, North-Central Nigeria: a cross-sectional study
Authors: Ibraheem AbdulRauf S. , Odeigah Louis O. , Kuranga Ibrahim S. , Amoko Ampitan , Nwosu Chinyere B. , Omowumi Razaki K. , Maiyegun Afisulahi A. , Ayodapo Abayomi O.
Published: September 2024

Background

Psychiatric disorders had been reported with higher prevalence among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), [PLWHA] than the general population and its presence could confer poorer prognosis on infected individuals. However, there is limited research on the above subject matter in the North-Central part of Nigeria. Thus, this study aimed to determine the prevalence of common psychiatric disorders (CPD) among adult out-patients PLWHA at the University of Ilorin Teaching Hospital (UITH), Ilorin, North-Central Nigeria.

Methods

It was a hospital-based descriptive cross-sectional study, conducted among 363 respondents attending the UITH Highly Active Antiretroviral Therapy (HAART) clinic between March and May 2019. Interviewer-administered questionnaires were used to collect data. Mini International Neuropsychiatric Interview (MINI) was used to assess the prevalence of CPD among respondents. Data were analysed using the Statistical Package for Social Sciences version 21 and p value of < 0.05 was taken as statistically significant.

Results

The prevalence of depression was 24.5%, anxiety disorder (AD) was 16.8% and alcohol use disorder (AUD) was 0.6%. Respondents from the extended family type were more depressed 70.4% and about half 43.3% of the nuclear family had AD while a 1.6% prevalence of AUD was found among the nuclear family. The association was statistically significant with a p value of 0.001.

Conclusion

CPD exist among PLWHA with increasing prevalence therefore screening for these disorders should be encouraged during routine management of PLWHA to improve their psychological well-being.
Advancements in ascites management: a comprehensive narrative review of the Alfa Pump system
Authors: Asim Muhammad , Naqvi Nabiha , Karmani Vikash Kumar , Tahir Aima , Banatwala Umm E. Salma Shabbar , Rehman Shahzeb , Aslam Minha , Majeed Aleena , Khan Farhan
Published: September 2024

Ascites remains a significant challenge in patients with cirrhosis, posing difficulties in management and affecting prognosis. This review examines the current understanding of ascites, including its underlying mechanisms, symptoms, and treatment options, with a specific focus on the innovative Alfa Pump device. The review begins by discussing traditional approaches to managing ascites while also addressing their limitations and potential complications. It then explores the emergence of the Alfa Pump system, a novel implantable device designed to tackle refractory ascites by continuously draining fluid from the abdomen while minimizing circulatory issues. Through a synthesis of current literature and clinical evidence, this narrative review underscores the importance of a multidisciplinary approach in the management of ascites, with a particular emphasis on the evolving role of the Alfa Pump in improving outcomes and quality of life for patients with refractory ascites.
Nano-Curcumin improves caffeine-induced cerebral alterations in male Wistar rats by modifying oxidative stress, inflammation, and COX-2/NF-κB/Nrf2 signaling
Authors: Morsy Moustafa M. , Ahmed R. G. , Abdel-Gabbar Mohammed
Published: September 2024

Background

This research aims to determine the probable protective effect of nano-curcumin (N-CUR) on caffeine (1,3,7-trimethylxanthine)-induced neurotoxicity in cerebral rats.

Methods

Twenty-four male Wistar rats were divided into three groups: control, caffeine (150 mg kg−1), and caffeine (150 mg kg−1) treated with N-CUR (300 mg kg−1). All treatments were administrated by gavage every day for a month.

Results

Administration of caffeine significantly elevated the levels of serum interleukins 6 (IL-6), tumor necrosis factor-alpha (TNF-α), vascular endothelial growth factor (VEGF), and cyclooxygenase2 (COX-2). Also, there was a significant increase in levels of cerebral malondialdehyde (MDA), significantly diminished glutathione (GSH), and superoxide dismutase (SOD) activity. Caffeine administration significantly downregulated the gene expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and upregulated the expression of nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB). Administration of N-CUR caused a significant amelioration in TNF-α and IL-6 levels and a significant rise in SOD activity, while it caused a significant downregulation in NF-κB mRNA expression. Additionally, N-CUR has exerted insignificant amelioration of COX-2 and MDA contents and Nrf2 mRNA expression compared to the caffeine-treated group.

Conclusion

N-CUR may have a mild to moderate ameliorative effect on caffeine-induced apoptosis, oxidative stress, and inflammatory response in the cerebrum.
Real-life experience of colonic polyps’ detection rate and adenoma detection rate with their characteristics in a cohort of Egyptian patients
Authors: Abdellatif Abeer Awad , Mogawer Mohamad Sherif , Elkholy Shaimaa , Hagag Hany , Abdelfatah Dalia , Soliman Zeinab Abdellatif Mahmoud , El-sayed Ahmed Mostafa Mostafa , Isa Alhosaeyn Ibrahim , Sebei Omar Mahmoud Ahmed Abou , Shehata Ahmed E. M. , Mohamed Ahmed Khalafalla , Hamed Marwan , Naga Mazen
Published: September 2024

Background

Data on the prevalence of colonic polyps and adenomas in the Egyptian population are scarce. This study aimed to determine the prevalence of colonic polyps among Egyptian patients aged 50 years and older who underwent colonoscopy for a variety of reasons.

Patients and methods

This study is a retrospective one that was conducted with the use of an endoscopic reporting database of patients presenting at Cairo University Hospital. The considered variables were age, gender, clinical presentation, polyps’ characteristics, and diagnosis. Polyps were retrieved and sent for histopathological examination.

Results

Among 4861 patients whose clinical presentation necessitated colonoscopic examination between 2012 and 2019, 850 consecutive patients aged 50 years and older were enrolled in this study. The median age was 65 ± 9 SD. The male gender was slightly predominant (50.8%). The polyp detection rate was 23.1%, while the adenoma detection rate was 14.7%, and they were mostly encountered on the left side of the colon. By regression analysis, the most important predictors of adenoma were age ≥ 65 years, diabetes, and the presence of a polyp in the right colon. Diabetics and older people (≥ 65 years) had two times increased risk for adenoma, while patients with polyps in the right side of the colon had 30 times increased risk of adenoma.

Conclusion

PDR and ADR among the Egyptian population are matched to the target ADR set by the ASGE. We recommend ADR and PDR as key quality indicators of colonoscopy quality.
Methylglyoxal Mediates the Association Between 2-Hour Plasma Glucose and HbA1c With Inflammation: The Maastricht Study
Authors: Sun Dijia , van Greevenbroek Marleen M J , Scheijen Jean L J M , Kelly Jaycey , Schalkwijk Casper G , Wouters Kristiaan
Published: September 2024

Context

Glucose excursions in persons with diabetes may drive chronic inflammation. Methylglyoxal (MGO) is formed from glucose, is elevated in persons with diabetes, and is a potent glycating agent linked with inflammation.

Objective

We investigated whether glucose excursions are associated with low-grade inflammation and whether MGO mediates this association.

Methods

We used data from The Maastricht Study, an extensive phenotyping study into the etiology of type 2 diabetes and its complications. Data of 3017 participants, who underwent an oral glucose tolerance test and where data on MGO levels and inflammation were available, were used. Linear regression analyses, adjusted for potential confounders, evaluated associations between fasting plasma glucose (FPG), 2-hour plasma glucose (2h-PG) and HbA1c, and low-grade inflammation (stdβ, [95% CI]) were calculated from plasma concentrations of C-reactive protein, serum amyloid A, interleukin-6, interleukin-8, tumor necrosis factor, and soluble intercellular adhesion molecule-1. Mediation analyses investigated whether MGO mediated these associations.

Results

2h-PG (0.172, [0.110; 0.234]) and HbA1c (0.148, [0.101; 0.196]), but not FPG (0.049, [−0.002; 0.100]), were associated with low-grade inflammation. 2h-PG and HbA1c were also associated with 2h-MGO (0.471, [0.407; 0.534], and 0.244, [0.195; 0.294], respectively). Furthermore, 2h-MGO was independently and positively associated with low-grade inflammation (0.078, [0.037; 0.120]). 2h-MGO mediated 23% of the association between 2h-PG and inflammation, and 16% of the association between HbA1c and inflammation.

Conclusion

MGO mediates the association between postload glucose excursions and HbA1c with inflammation, providing evidence for a role of postprandial MGO formation to hyperglycemia-induced low-grade inflammation.
Protecting the environment against the impacts of armed conflict
Authors: Πανταζόπουλος Σταύρος-Ευδόκιμος
Published: September 2024

Η προστασία του περιβάλλοντος κατά τη διάρκεια και μετά από ένοπλες συγκρούσεις έχει αποκτήσει σημαντική δυναμική, όπως προκύπτει από την προτεινόμενη συμπερίληψη σχετικής διάταξης στο σχέδιο παγκόσμιου συμφώνου για το περιβάλλον και από τις σχετικές εργασίες της Επιτροπής Διεθνούς Δικαίου των Ηνωμένων Εθνών, οι οποίες κατέληξαν στην πρόσφατη έγκριση σε πρώτη ανάγνωση του σχεδίου αρχών για την προστασία του περιβάλλοντος σε σχέση με τις ένοπλες συγκρούσεις. Από την άλλη πλευρά, είναι κοινός τόπος ότι, κατά τη διάρκεια και µετά τις ένοπλες συγκρούσεις, οι ανθρωπιστικές πτυχές κατέχουν υψηλότερη θέση στην ατζέντα των προτεραιοτήτων της διεθνούς κοινότητας. Σε αυτό το πλαίσιο, υποστηρίζεται ότι η προσέγγιση της πλουραλιστικής διαχείρισης, η οποία λαμβάνει υπόψη την αλληλεπίδραση πολλαπλών συστημάτων αξιών, ενημερώνει και εμπλουτίζει την κατανόηση των συμφερόντων και των δυναμικών που διέπουν το κανονιστικό τοπίο της προστασίας του περιβάλλοντος κατά τη διάρκεια και μετά τις ένοπλες συγκρούσεις. Με την υιοθέτηση αυτής της προσέγγισης, η διατριβή ρίχνει φως στην προστασία του περιβάλλοντος από τις επιπτώσεις της ένοπλης σύγκρουσης. Το κεφάλαιο Ι εισάγει και τοποθετεί την έρευνα, ενώ το κεφάλαιο ΙΙ διερευνά το κανονιστικό πεδίο του διεθνούς ανθρωπιστικού δικαίου (ΔΑΔ) όπως εφαρμόζεται στην προστασία του περιβάλλοντος, τόσο την άμεση όσο και την έμμεση, κατά τη διάρκεια ένοπλης σύγκρουσης. Στη συνέχεια, το κεφάλαιο ΙΙΙ ασχολείται µε τη δυνατότητα συνεχιζόµενης εφαρμογής του διεθνούς περιβαλλοντικού δικαίου (∆Π∆) σε περιόδους ένοπλης σύγκρουσης, υποστηρίζοντας ότι οι διατάξεις του ∆Π∆ µπορούν να προσδώσουν προστιθέµενη αξία στην προστασία που παρέχει το ∆Α∆. Στο ίδιο πλαίσιο, υπογραμμίζεται ότι ο καθορισμός και η συνομολόγηση προστατευόμενων περιβαλλοντικών ζωνών διανοίγουν σημαντικές προοπτικές αυξημένης προστασίας του περιβάλλοντος. Στη συνέχεια, το κεφάλαιο IV εξετάζει το θέμα της περιβαλλοντικής προστασίας μετά από μια ένοπλη σύγκρουση στο εννοιολογικό πλαίσιο του jus post bellum. Στο πρώτο µέρος, περιγράφονται οι γενικές υποχρεώσεις µιας κατοχικής δύναµης όσον αφορά την προστασία του περιβάλλοντος και στη συνέχεια αναλύονται οι υποχρεώσεις µιας κατοχικής δύναµης που απορρέουν από τις διατάξεις του ΔΑΔ για την «εχθρική περιουσία». Όσον αφορά το στάδιο µετά την ένοπλη σύγκρουση stricto sensu, αποδεικνύεται ότι η υποχρέωση συνεργασίας βάσει του ΔΠΔ αποτελεί τη ραχοκοκαλιά των σχετικών διορθωτικών µέτρων.Το τελευταίο κεφάλαιο είναι αφιερωμένο στις επανορθώσεις για περιβαλλοντικές ζημιές κατά τη διάρκεια του πολέμου, περιγράφοντας λεπτομερώς το σχετικό κανονιστικό τοπίο και εμβαθύνοντας στην πρακτική των διεθνών δικαστικών οργάνων. Αν και σταδιακά συντελείται µια αλλαγή σε συγκεκριµένα δικαστικά και µη δικαστικά φόρα, η σηµαντικότερη αλλαγή πρέπει να συµβεί στην κουλτούρα που συνήθως, αν όχι πάντα, θέτει την προστασία του περιβάλλοντος σε χαµηλότερο επίπεδο προτεραιότητας εν συγκρίσει µε άλλες ανάγκες.
ENOVAT: the European Network for Optimization of Veterinary Antimicrobial Treatment
Authors: Damborg Peter , Allerton Fergus , Bousquet-Mélou Alain , Britt Chantal , Cagnardi Petra , Carmo Luis Pedro , Cvetkovikj Iskra , Erhard Marcel , Heuvelink Annet , Jessen Lisbeth Rem , Overesch Gudrun , Pelligand Ludovic , Gómez Raja Jonathan , Scahill Karolina , Timofte Dorina , Vale Ana P , Veldman Kees , Broens Els M
Published: September 2024

The global antimicrobial resistance crisis has been the driver of several international strategies on antimicrobial stewardship. For their implementation at the field level, the veterinary sector encounters several specific challenges and in particular: (i) a shortage of experts in key disciplines related to antimicrobial stewardship, (ii) a lack of evidence-based antimicrobial treatment guidelines, and (iii) inferior diagnostic tests available compared to human medicine. The present white paper describes how the COST Action ENOVAT (the European Network for Optimization of Veterinary Antimicrobial Treatment, CA18217), comprising 332 persons from 51 countries, worked towards solutions to these challenges. Initially, surveys were conducted to explore the present state in Europe in terms of existing antimicrobial use guidelines and microbiology practices performed. Concurrently, various research activities were launched to optimize diagnostics, including development of epidemiological cut-offs, clinical breakpoints and matrix-assisted laser desorption ionization time of flight mass spectrometry interpretive criteria. Also, guidelines drafting groups working towards evidence-based antimicrobial treatment guidelines for six conditions in food-producing and companion animals were established. The processes and outcomes, also in terms of capacity building, are summarized in this white paper where emphasis is placed on sustainability of the activities. Although several ENOVAT initiatives and spin-off projects will continue beyond the Action, we recommend that a new European veterinary research agenda is launched focusing on research and funding leading to long-term impacts on veterinary antimicrobial use.
Examining the development and utilisation of Community-Based Health Information Systems (CBHIS) in Africa: A Scoping Review
Authors: Kuvuna Beatrice , Nyanchoka Moriasi , Guleid Fatuma , Ogutu Michael , Tsofa Benjamin , Nzinga Jacinta
Published: September 2024

Introduction The community-based health information system (CBHIS) is a vital component of the community health system, as it assesses community-level healthcare service delivery and generates data for community health programme planning, monitoring, and evaluation. CBHIS promotes data-driven decision-making, by identifying priority interventions and programs, guiding resource allocation, and contributing to evidence-based policy development. Objective This scoping review aims to comprehensively examine the use of CBHIS in African countries, focusing on data generation, pathways, utilization of CBHIS data, community accessibility to the data and use of the data to empower communities. Methods We utilised Arksey and O'Malley's scoping review methodology. We searched eight databases: PubMed, EMBASE, HINARI, Cochrane Library, Web of Science, Scopus, Google Scholar, and grey literature databases (Open Grey and OAIster). We synthesized findings using a thematic approach. Results Our review included 55 articles from 27 African countries, primarily in Eastern and Southern Africa, followed by West Africa. Most of the studies were either quantitative (42%) or qualitative (33%). Paper-based systems are primarily used for data collection in most countries, but some have adopted electronic/mobile-based systems or both. The data flow for CBHIS varies by country and the tools used for data collection. CBHIS data informs policies, resource allocation, staffing, community health dialogues, and commodity supplies for community health programmes. Community dialogue is the most common approach for community engagement, empowerment, and sharing of CBHIS data with communities. Community empowerment tends towards health promotion activities and health provider-led approaches. Conclusion CBHIS utilizes both paper-based and electronic-based systems to collect and process data. Nevertheless, most countries rely on paper-based systems. Most of the CBHIS investments have focused on its digitization and enhancing data collection, process, and quality. However, there is a need to shift the emphasis towards enabling data utilisation at the community level and community empowerment.
Nested case control study of prevalence and aetiology of dementia in a rural Ugandan population, and a situational analysis of services available for affected families: a protocol. Part of the DEPEND Uganda study (Dementia EPidemiology, unmet Need and co-Developing Solutions)
Authors: Prynn Josephine , Alinaitwe Racheal , Kimono Beatrice , Peto Tunde , Ashton Nicholas J , Steves Claire J , Mugisha Joseph , Prince Martin
Published: September 2024

Background The prevalence of dementia in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a high burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity. Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans. People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families. Methods The study is nested within the existing General Population Cohort run by the MRC/UVRI & LSHTM Research Unit. Currently, all adults aged 60+ (around 1400) are undergoing brief cognitive screening. In Part 1, cohort participants will be selected based on cognitive screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer’s blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia. Part 3 assesses current provision of formal support for people with dementia through review of publicly available literature and expert interviews. Conclusions This is the first study in Africa using blood-based and retinal imaging biomarkers to examine the pathological processes underlying dementia, and it will systematically map services available for people with dementia. This paves the way for effective policy strategies for both dementia prevention and support for people with dementia and their families.
Recreational ketamine use and its impact on health
Authors: Perłowski Jakub , Miśkiewicz Marek , Ptak Jakub , Noga Rafał , Teska Victoria , Marcinkowska Jagoda , Herc Adrian , Koczkodon Karolina , Sawczuk Marcelina , Krompiewski Mariusz
Published: September 2024

Ketamine, also known as 2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone, is a dissociative anesthetic that has gained popularity as a recreational substance among young people, especially in nightclubs and at parties. It acts as a noncompetitive NMDA receptor antagonist, inducing a dissociative state that manifests as catalepsy, unconsciousness and amnesia. Recreational use of ketamine and the number of illicit seizures of ketamine have increased in recent years, prompting a review of current evidence on its toxicity. Recreational ketamine use is associated with a number of toxic effects, both acute and chronic. Predominant among the acute effects are psychotic symptoms, hallucinations and aggression, which can lead to serious injuries. Chronic ketamine use leads to intractable urological problems and neuropsychiatric problems, Long-term effects also include gastrointestinal problems such as abdominal pain and liver function abnormalities. This review summarizes current evidences on the acute and chronic ketamine toxicity associated with its recreational use.
Patient compliance with medications, nasal douching, smoking cessation and long-term outcomes of surgical septorhinoplasty – a prospective series of 56 cases
Authors: Garrard A , Davies T , Walker N , Raja H
Published: September 2024

Introduction

Septorhinoplasty addresses both functional and cosmetic concerns with the nose and has been shown to have consistent, long-term benefits for patients. Nasal irrigation and medication such as antimicrobials are prescribed postoperatively to improve outcomes. Patient compliance with these interventions and outcomes of surgery have not been described. We aim to describe what the effects of compliance with these interventions may be in long-term follow-up.

Methods

Patients undergoing septorhinoplasty were reviewed prospectively from 2015 to 2022. At time of operation, patients were prescribed medications, saline douching and given smoking cessation advice. Patients underwent rhinoplasty outcomes evaluation (ROE) preoperatively, at four weeks, and 3, 12, 24 and 36 months postoperatively. Compliance with postoperative interventions was measured at four weeks. Statistical tests were performed.

Results

A total of 56 patients underwent septorhinoplasty. Preoperative ROE scores were improved significantly at all stages of postprocedure follow-up (p<0.0001). Multiple linear regression found no significant differences in patients who were not compliant with medications (p>0.40), nasal douching (p>0.22), both medication and nasal douching (p>0.40), and a positive smoking status (p>0.11) at four weeks. At 3- and 24-months follow-up, there were no significant differences in ROE scores between compliant patients and those who were noncompliant with medications, nasal douching or both (p>0.13).

Conclusions

Our data represent the only series of patient-reported outcomes from septorhinoplasty patients where compliance with nasal irrigation, smoking cessation and antimicrobials is considered. Compliance with nasal irrigation, topical antimicrobials or smoking cessation did not influence postoperative ROE scores.
What Is It Like to Be a Human?
Authors: Blackwell Mark
Published: September 2024

Abstract: A review of Lynn Festa's Fiction Without Humanity: Person, Animal, Thing in Early Enlightenment Literature and Culture (Philadelphia, 2021).
The 2024 EU Elections: The Far Right at the Polls
Authors: Mudde Cas
Published: September 2024

ABSTRACT: From 6 to 9 June 2024, more than four-hundred-million voters from the 27 member states of the European Union had the opportunity to vote in the 2024 elections for the European Parliament (EP). Far-right parties won roughly a quarter of the vote, building on earlier successes in 2014 and 2019. The far right in the EP, however, remains institutionally divided, spread across three political groups. Despite holding a plurality of seats, the far right will not be able to mobilize as easily as the traditional "centrist" coalition. Thus, while it may become harder to strengthen European under the new Parliament, the EU will continue to muddle through.
How Organized Crime Threatens Latin America
Authors: Corrales Javier , Freeman Will
Published: September 2024

ABSTRACT: Organized crime has emerged as the most important security threat to democratic governance in Latin America. This essay explains why Latin American democracies have been able to curb other security threats (from the military, insurgents, and oligopolists) but are struggling to contain organized crime. Organized crime possesses power assets associated with traditional security threats (military capacity, territorial control, and access to markets). But it also operates innovatively: It infiltrates and coopts the state, which makes it difficult for presidents to rely on state institutions (such as the police, the army, the courts, and prisons) to act in a unified way to fight organized crime. To date, there are no successful cases of Latin American states truly defeating organized crime. But states have means of rendering organized crime less predatory and violent.
‘More Love Letters, Please!’: Portuguese Love and the Literary Legacy of Sincere Feeling
Authors: Mourão Manuela
Published: September 2024

ABSTRACT: This essay traces the formation of the myth of Portuguese Love, and demonstrates both its transcultural reach and its importance for literary history. Sparked by the tragic love of Pedro and Inês de Castro, the notion of Portuguese Love was crystallized in seventeenth-century France by Lettres portugaises , influenced European letters for centuries, and became an enduring myth in Portuguese culture. Anchored by Roland Barthes’s critique of the contemporary disparagement of sentimental love, the essay argues that Portuguese Love’s continued affirmation, from nineteenth-century literary iterations to current manifestations, demonstrates the power of a discourse of genuine feeling to counter ideological appropriation.
All the Islands the Island: The Crafting of Cortázar’s ‘La Isla a Mediodía’
Authors: Moran Dominic
Published: September 2024

ABSTRACT: This essay aims to achieve a better understanding of how Julio Cortázar came to write one of his most iconic stories, ‘La isla a mediodía’, as and when he did by identifying the various literary sources on which he may have drawn, including D. H. Lawrence’s story ‘The Man Who Loved Islands’, various works by Aldous Huxley, and, above all, William Golding’s novel Pincher Martin .