bluuebunny/crossref_metadata_2025 huggingface dataset:
Progress in the knowledge of the genus Penthicus Faldermann, 1836 (Coleoptera: Tenebrionidae: Opatrini) of Iraq, Iran and Pakistan with descriptions of 17 new species
Authors: NABOZHENKO MAXIM V. , MOFRAD FARHAD ESHRAGHI
Published: January 2025

The darkling beetles of the genus Penthicus Faldermann, 1836 (Tenebrionidae: Blaptinae: Opatrini) from Iraq, Iran and Pakistan are revised. We used male and female genitalia for the first time for taxonomy of Penthicus. The subgenus Stonavus Reitter, 1904, subg. resurr. is resurrected from the synonymy with Penthicus and incudes three species-groups. Composition of all subgenera of Penthicus is given. Seven species don’t pass to any defined subgenus and require revision. The following new synonym is introduced: Penthicus iners (Ménétriés, 1832) = P. obesus (Kulzer, 1964), syn. nov. In total, one species of Penthicus is yet known from Iraq, 30 species from Iran and four species and one subspecies from Pakistan. The following 17 new species are described: in the nomynotypical subgenus: P. germanni sp. nov. (Iran) and P. mesopotamicus sp. nov. (Iran, Iraq); in Stonavus (all from Iran): P. achaemenus sp. nov., P. bam sp. nov., P. captiosus sp. nov., P. flatilatus sp. nov., P. farsistanus sp. nov. (Iran), P. grabantae sp. nov., P. iranensis sp. nov., P. kasatkini sp. nov., P. kermanicus sp. nov., P. khorasanicus sp. nov., P. pazukii sp. nov., P. shokhini sp. nov. (Iran), P. telnovi sp. nov., P. zarudnyi sp. nov.; in Myladion: P. pakistanicus sp. nov. (Pakistan). Penthicus turcomanicus (G.S. Medvedev, 1964) is recorded for Iran for the first time. Lectotypes are designated for Lobothorax oblongopunctatus Reitter, 1904, Lobodera freyi Schuster, 1937, Lobodera similis Schuster, 1937, Lobothorax horni Schuster, 1922, Lobothorax persicus Schuster, 1919, Heliophilus iners Ménétriés, 1832, Opatrum saginatum Ménétriés, 1832, Penthicus remotus Reitter, 1896 and Lobodera tzaidamica Bogatchev, 1951. A key to species from the studied territories is given.
Signaling trustworthiness of internal whistleblowing channels in organizations: temporality matters!
Authors: Vandekerckhove Wim , Fotaki Marianna , Kenny Kate , Özdemir Kaya D. Derya
Published: January 2025

The increase in whistleblowing to a regulator or media has sparked organizational efforts to keep whistleblowing internal to minimize the risk of exposure across various sectors and geographical contexts. However, it is less clear how organizations can make their internal whistleblowing system trustworthy for their internal stakeholders. Research on trust in organizations rarely considers how trustworthiness is signaled in complex organizational situations. In internal whistleblowing channels and procedures, we demonstrate that signaling trustworthiness involves multiple attributions of trustworthiness (ability, benevolence, integrity, transparency, identification) as well as multiple internal stakeholders (workers, middle managers, and top management). This makes whistleblowing an ideal case-in-point for investigating interactions between trustworthiness attributions across stakeholders and how these change across time. This article examines a specific critical issue: how operators of whistleblowing channels attempt to signal trustworthiness through a sequence of interactions with multiple trustors. Our research comprises interviews with 30 operators of internal whistleblowing channels and consultants from four organizations from different sectors (engineering, banking, health care and public administration). Our findings allow us to theorize temporality in signaling trustworthiness of new organizational practices. We suggest that a fundamental ambiguity and contradiction underlies the trustworthiness of internal whistleblowing channels. Within the limited organizational mandate of those who operate whistleblowing channels, this ambiguity is experienced as synchronic and diachronic tensions, requiring specific approaches on the part of actors involved.
Associations of night eating with body mass index and waist circumference among health sciences students living in a post-conflict region
Authors: Aleksic Vojkan , Gazibara Tatjana , Jeremic Biljana , Kulic Ljiljana , Dotlic Jelena , Stevanovic Jasmina , Milovanovic Vesna , Milic Marija
Published: January 2025

Background

Stressors associated with the ongoing ethnic tensions may be the drivers of more frequent night eating, and subsequently, a higher body mass index.

Aim

To examine the association of night eating with body mass index (BMI) and waist circumference among health sciences students in Northern Kosovo.

Methods

A cross-sectional study was carried out at the University of Prishtina in Kosovska Mitrovica from November 2018 to March 2019. Participants completed a socio-demographic questionnaire, the Night Eating Questionnaire (NEQ), the Beck's Anxiety Inventory (BAI) and the Perceived Stress Scale (PSS). Body weight, height, and waist circumference were measured by the research team.

Results

The study sample consisted of 534 students. The night eating score was 14.4 ± 4.5 out of 52 (prevalence of night eating syndrome was 3.0%). Overall, the average BMI was 23.7 ± 4.5 kg/m2 (27.2% of students were overweight and 7.5% were obese). Moderate level of stress as measured by the PSS was observed 61.8% and high level of stress was recorded among 5.8%. Also, 9.2% students reported moderate BAI score and 6.0% students reported severe BAI score. After adjustment for socio-demographic characteristics, health behaviors, sleep, stress and anxiety levels, no association of night eating with BMI and waist circumference was observed.

Conclusion

These findings showed that there is an absence of the association between night eating, BMI and waist circumference among students who live in a post-conflict setting. There may be other factors that mediate the relationship between food intake at night and body mass index.
Unlocking the secrets: How well do nutrition and dietetics students understand diabulimia and health literacy?
Authors: Çelik Zehra Margot , Bayram Hatice Merve
Published: January 2025

Background

Despite the significant health risks associated with it, diabulimia, which involves the omission of insulin for the purpose of weight control in individuals with type 1 diabetes, remains underrecognized.

Aim

This study assessed diabulimia knowledge in third- and fourth-year nutrition and dietetics students and its relationship with health literacy.

Methods

This cross-sectional study included 231 students (90.5% female) in the third (38.5%) and fourth (61.5%) years of the Nutrition and Dietetics Departments at two universities and was carried out between June and July 2024. A questionnaire covering demographic characteristics, Diabulimia Knowledge Level Scale (DKLS) and Turkish Health Literacy Scale (THLS-32) was administered to the students in person. Data analysis was performed using SPSS 28.0.

Results

DKLS scores of third-year students were lower than those of the fourth-year students ( p = 0.014). Similarly, THLS-32 scores were higher in fourth-year students ( p = 0.012). However, there was no statistical significance in DKLS, THLS-32 scores and THLS-32 classification between the universities ( p = 0.307, p = 0.137, and p = 0.491, respectively). No relationship between age, DKLS and THLS-32 was found.

Conclusion

Fourth-year students demonstrated higher diabulimia knowledge and health literacy scores, highlighting the impact of advanced education. However, no differences were found between the universities. These findings underscore the need for further research to explore the factors contributing to knowledge and health literacy development, including curriculum design, teaching methods, and clinical training. Additionally, expanding this investigation to include other healthcare professionals could provide a broader perspective of existing gaps in diabulimia awareness and health literacy.
An effective COVID-19 classification in X-ray images using a new deep learning framework
Authors: Thilagavathi P. , Geetha R. , Jothi Shri S. , Somasundaram K.
Published: January 2025

Background

The global concern regarding the diagnosis of lung-related diseases has intensified due to the rapid transmission of coronavirus disease 2019 (COVID-19). Artificial Intelligence (AI) based methods are emerging technologies that help to identify COVID-19 in chest X-ray images quickly.

Method

In this study, the publically accessible database COVID-19 Chest X-ray is used to diagnose lung-related disorders using a hybrid deep-learning approach. This dataset is pre-processed using an Improved Anisotropic Diffusion Filtering (IADF) method. After that, the features extraction methods named Grey-level Co-occurrence Matrix (GLCM), uniform Local Binary Pattern (uLBP), Histogram of Gradients (HoG), and Horizontal-vertical neighbourhood local binary pattern (hvnLBP) are utilized to extract the useful features from the pre-processed dataset. The dimensionality of a feature set is subsequently reduced through the utilization of an Adaptive Reptile Search Optimization (ARSO) algorithm, which optimally selects the features for flawless classification. Finally, the hybrid deep learning algorithm, Multi-head Attention-based Bi-directional Gated Recurrent unit with Deep Sparse Auto-encoder Network (MhA-Bi-GRU with DSAN), is developed to perform the multiclass classification problem. Moreover, a Dynamic Levy-Flight Chimp Optimization (DLF-CO) algorithm is applied to minimize the loss function in the hybrid algorithm.

Results

The whole simulation is performed using the Python language in which the 0.001 learning rate accomplishes the proposed method's higher classification accuracy of 0.95%, and 0.98% is obtained for a 0.0001 learning rate. Overall, the performance of the proposed methodology outperforms all existing methods employing different performance parameters.

Conclusion

The proposed hybrid deep-learning approach with various feature extraction, and optimal feature selection effectively diagnoses disease using Chest X-ray images demonstrated through classification accuracy.
Diagnostic accuracy of combined screening algorithm for early detection of congenital heart disease among term newborns in India
Authors: Rajani Hassan S. , Narayanappa Doddaiah
Published: January 2025

Objective

To determine the validity of a screening algorithm based on combination of clinical examination and pulse oximetry, for early detection of congenital heart disease (CHD) in term newborns. CHD is the most frequent major congenital anomaly, with prevalence of 6–12 per 1000 live births. Clinical examination alone may fail to detect CHD in more than 50% of affected newborns. Recent studies have concluded that pulse oximetry has a high sensitivity and specificity as a screening tool for critical CHD.

Setting

JSS Hospital, Mysuru, Karnataka, India.

Methods

In this prospective observational study, all term neonates delivered at the hospital were included. The screening algorithm consisted of seven clinical parameters and pulse oximetry screening guidelines recommended by the American Academy of Paediatrics. Term newborns with the presence of any one of the above parameters in the algorithm were considered screen-positive. Echocardiography was done in all screen positives. Newborns were classified into those with and without CHD, based on echocardiography findings at birth and clinical examination and echocardiography findings at follow-up at 6 weeks.

Results

Among 1009 term neonates included in the study, CHD was detected in 57 (5.6%) with cyanotic CHD in 12. The sensitivity and specificity of combined screening to detect CHD was 71.93% and 95.8%, respectively. The positive predictive value was 50.62% and the negative predictive value was 98.28%.

Conclusion

Screening for CHD with a simple comprehensive algorithm, integrating clinical evaluation and pulse oximetry, has moderate sensitivity and high specificity in detecting CHD in term newborns. Further work is needed to evaluate this form of screening.
Recent policy recommendations won’t protect young people from alcohol-related content on social media: what needs to change?
Authors: Patsouras Maree , Kuntsche Emmanuel , Pennay Amy , O’Brien Paula , Riordan Benjamin
Published: January 2025

Objective: The federal Australian government has introduced legislation to require social media platforms to restrict access to their platforms for young people under 16 years of age. Amongst the conversations about protecting the health and wellbeing of young people, we have yet to see discussion on the impact of alcohol imagery as a pervasive ‘unhealthy’ industry on social media. This is problematic because young people consume a large amount of social media content and are exposed to glamorised alcohol depictions and targeted advertising.

Conclusions: According to current regulations, the sponsoring of social media posts by alcohol companies should be declared, but enforcement of these requirements is challenging and most alcohol posts (whether sponsored or not) tend to glorify alcohol use. Better regulation, but not necessarily a social media ban, is needed to protect young viewers from pervasive alcohol exposure on social media.
The brain in Spain: The legacy of Santiago Ramón y Cajal
Authors: Drouin Emmanuel , Martínez Murillo Ricardo , Hautecoeur Patrick
Published: January 2025

The legacy of Santiago Ramón y Cajal, Spain’s first Nobel laureate neuroscientist recognized as the founding father of modern neuroscience, is to be preserved in a new museum in Madrid: the National Museum of Natural Sciences (MNCN), one of the most important scientific research institutes in the country sciences in the scope of natural sciences of the Spanish National Research Council. For a boy who dreamed of being an artist but started his career apprenticed to first a barber and then a cobbler, Santiago Ramón y Cajal made a distinguished mark in science. One of Cajal’s most important contributions to our understanding of the brain was his discovery of the direction of the information flow within neurons and in neural circuits, which he called the “dynamic polarization law,” without a doubt the founding principle of neurosciences. The exposition planned by the MNCN is a perfect occasion to show the academy and, it is hoped, the general public at large the beautiful organization of the nervous system as first acknowledged by modern science. With the highly motivated organizers of this well-planned initiative, neuroscientists at the Cajal Institute are confident that this sample of the Cajal legacy will also be taken as an esthetic experience for those who approach it for the first time. It might be that science and art often go together.
Qui Regit: Electorates, Producer Groups, and Change in Advanced Capitalist Democracies
Authors: Benoit Cyril , Vlandas Tim
Published: January 2025

What explains changes in the economic structures, institutions and policies of Advanced Capitalist Democracies (ACDs)? In this article, we suggest that the various answers to this question in the field of Comparative Political Economy (CPE) are essentially linked to two main approaches. The first approach emphasizes the role of electorates and political parties, their transformations, and their competition in shaping the evolution of ACDs. The second approach highlights the primacy of producer groups as the most powerful actors influencing the trajectory of ACDs. This review article introduces the debate between these two approaches and underscores its enduring relevance. It then discusses four recent important contributions that provide renewed perspectives on what remains a structuring cleavage in CPE, with implications for neighbouring fields in political science research. Through a systematic comparison of their analytical structure accross various dimensions, we show that their conception of the economy critically shapes their understanding of politics.
Systematic review railway infrastructure monitoring: From classic techniques to predictive maintenance
Authors: Bianchi Giovanni , Fanelli Chiara , Freddi Francesco , Giuliani Felice , La Placa Aldo
Published: January 2025

The efficiency and availability of modern railway infrastructure plays an increasingly strategic role in the sustainability, development and prosperity of communities and nations. Recent Artificial Intelligence (AI) algorithms, which enable the use of digital tools such as Data-Driven models that can automatically adapt system operation, make decisions and suggest strategies based on collected data, form the basis of modern Predictive Maintenance (PdM). PdM is considered a key opportunity for accurate Structural Health Monitoring (SHM), especially for railway infrastructure, where the transition from traditional preventive or periodic maintenance to PdM will reduce intervention times and costs. Furthermore, by directly correlating actual infrastructure conditions with measured information, SHM can utilise a limited number of sensors installed on critical components such as insulated rail joints. This review starts by clearly describing the different components that make up the railway infrastructure, the monitoring systems currently in use and the technical performance parameters that indicate their health status and goes on to examine the issues related to the SHM and related modern digital tools. All these topics are summarised to provide an effective theoretical and practical knowledge of SHM for railway infrastructure, to better understand the current transformation of the sector and to predict future developments.
Fluoxetine and fractures after stroke: an individual patient data meta-analysis of three large randomised controlled trials of fluoxetine for stroke recovery
Authors: Mead Gillian Elizabeth , Graham Catriona , Lundström Erik , Hankey Graeme J , Hackett Maree L , Billot Laurent , Näsman Per , Forbes John , Dennis Martin
Published: January 2025

Background

Observational studies have shown that selective serotonin reuptake inhibitors are associated with an increased risk of bone fractures, but the association can be confounded by indication and other sources of systematic bias that can be minimised in randomised controlled trials (RCTs).

Aim

Our aim was to report the rate, site, context, and predictors of fractures after stroke, and whether the fractures modified the effect of fluoxetine on modified Rankin score (mRS) at six months in an individual patient data meta-analysis of 5907 patients enrolled in three RCTs of fluoxetine (20mg for six months) for stroke recovery.

Methods

We classified fractures by treatment allocation, site (and thus likelihood of osteoporosis) and context, then performed multivariable analyses to explore independent predictors of fractures. We explored whether the trend towards a poorer mRS at 6 months was explained by a fracture excess. Risk of bias was assessed using GRADE.

Results

Among 5907 patients randomised at a mean of 6.6 days (SD3.6) post-stroke onset and followed for six months, the number with fractures at 6 months was 93 (3.15%) in the fluoxetine group vs 41 (1.39%) in the control group (difference 1.76%, 95% CI 0.10 to 2.51%). 128 patients with fractures were suitable for further analyses. Of these 102 (80%) were in sites typically affected by osteoporosis; 115 (90%) were associated with falls and one (1%) with a seizure. Independent fracture risk factors were female sex (hazard ratio (HR) 1.96; 95% CI 1.37 to 2.81, p=0.0002), age>70 years (HR 2.30, 95% CI 1.52 to 3.49, p<0.001), previous fractures (HR 0.63 for no previous fractures, 95% CI 0.42 to 0.94, p=0.0227), and randomised treatment (fluoxetine) (HR 2.39; 95% CI 1.64 to 3.49, p<0.001). The common odds ratio for the effect of fluoxetine on mRS at 6 months was unchanged after excluding fracture patients. Risk of bias was high for imprecision.

Conclusion

Fractures were more common in the fluoxetine group but the absolute risk of fractures was small and risk estimates were imprecise. Most fractures occurred with a fall, and in osteoporotic locations. Fractures did not modify the effect of fluoxetine on functional outcome.
Factors associated with individual-level changes in BMI as a result of COVID-19 in the general- and migrant-origin populations in Finland
Authors: Prinkey T. , Lundqvist A. , García Velázquez R. , Lilja E. , Skogberg N.
Published: January 2025

Aims

There is limited information on changes in body mass index (BMI) due to the COVID-19 pandemic among persons of migrant origin. The aim of the present study was to examine factors associated with changes in BMI among the general- and migrant-origin populations in Finland.

Methods

Longitudinal data to explore individual-level changes in self-reported BMI among migrant-origin persons ( N = 3313) were obtained from the FinMonik Survey conducted in 2018 and the MigCOVID Survey conducted 2020–2021. Data for the general population reference group were obtained from the FinHealth 2017 Study conducted 2017–2018 and its follow-up conducted in 2020 ( N = 2982). Logistic regression was applied to examine whether age, sex, education, economic activity, length of residence in Finland, language skills, smoking, alcohol usage, sleep, physical activity, snacking, and fruit and vegetable consumption were associated with an increase or decrease in BMI. A change in BMI was defined as a 5% or greater increase or decrease.

Results

Twenty-seven per cent of the migrant-origin population experienced an increase in BMI, while 14% had a decrease in BMI. These results corresponded to figures observed among the general population in Finland (27% and 14%). Persons of migrant origin who were other than students or employed faced greater odds of an increase in BMI of at least 5% (OR = 1.71). In the general population, an increase in BMI of at least 5% had greater odds of occurring among women (OR = 1.61), those who were other than students or employed (OR = 1.68), those who increased their alcohol intake (OR = 1.64), those who increased their snacking (OR = 1.40) and decreased their fruit and vegetable intake (OR = 1.85).

Conclusions

Most examined factors applied differently to general- and migrant-origin populations and by migrant-origin group. These differences must be considered when planning future public health promotion efforts, particularly those during crisis situations.
Nontraditional Adult Learners’ Experiences and Perceptions of a Relationship Abuse Workshop
Authors: Flores Jessica
Published: January 2025

Research has failed to clarify how nontraditional adult learners experience and perceive relationship abuse curriculum designed to teach the warning signs of unhealthy relationship behaviors and encourage bystander action. The purpose of this transcendental phenomenological study was to understand the experiences and perceptions of nontraditional adult learners who completed a 90-minute relationship abuse workshop. The theoretical framework directing the study focused on program theory, adult learners, and care ethics. The question guiding this study: what are the lived experiences and perceptions of nontraditional adult learners who completed the relationship abuse and violence awareness and prevention workshop? The population and sample included nontraditional adult learners who either completed the workshop in 2019, 2020, or 2021 or participated in a focus group in 2022. Data analysis consisted of the modified Stevick-Colaizzi-Keen method. This study found (1) relationship abuse curriculum is relevant for nontraditional adult learners, (2) more research is necessary to understand how to navigate identifying unhealthy relationships when meeting with others in a virtual environment, and (3) discussing the topic of relationship abuse to increase awareness is beneficial. All members within the higher education space can shape campus environments and make difficult conversations the norm by embracing the reality of the far-reaching impact relationship abuse has on communities. Future research recommendations include extending relationship abuse programs to more nontraditional adult learners and developing knowledge-based guidance for navigating relationship abuse recognition and response in a virtual environment.
Preoperative Risk Assessment for Lumbar Fusion in Patients With Diabetes: Data-Driven Stratification of HbA1c and Same Day Glucose Levels that Predict 90-Day Complication Rates
Authors: Farnham Chloe , Liu Ivan Z. , Agarwal Amil R. , Parel Philip , Quan Theodore , Durand Wesley M. , Raad Michael , Jain Amit
Published: January 2025

Study Designs

Retrospective Database Analysis.

Objectives

Pre-operative glycemic control in diabetic patients undergoing lumbar fusion (LF) is essential for evaluating complication risk. However, current thresholds for preoperative HbA1c and same-day-glucose (SDG) are either non-specific or have low predictive power. This study uses HbA1c and SDG to provide data-driven risk stratification for 90-day major and wound complications in LF patients.

Methods

Using a national database, patients undergoing LF from 2013-2022 with a recorded preoperative HbA1c and SDG level were included for analysis. Multiple HbA1c and SDG strata were identified using stratum specific likelihood ratio analysis (SSLR). Each stratum was then propensity-score matched to the lowest strata and compared using risk ratios. Significance level was set at a P-value <0.05.

Results

12,026 patients met inclusion criteria. For 90-day major complications, SSLR identified 3 predictive HbA1c (4.5-5.4, 5.5-7.9, and 8.0+) and SDG strata (60-159, 160-239, and 240+). Following propensity-matching, the 90-day major complication risk sequentially increased for HbA1c: 5.5-7.9 (1.69; P = 0.001; 95% CI 1.24-2.30), 8.0+(2.31; P < 0.001; 95% CI 1.56-3.43). Following propensity-matching, the SDG strata similarly demonstrated sequentially increasing 90-day major complication risk: 160-239 (1.34; P < 0.001; 95% CI 1.18-1.54), 240+ (1.64; P < 0.001; 95% CI 1.31-2.05). Matched analysis demonstrated a higher relative-risk of 90-day wound complications for the 8.0+ HbA1c strata (2.23; P = 0.001; 95% CI 1.37-3.63) compared to the HbA1c 4.5-5.4 strata. No other strata were identified that predicted differences in 90-day wound complications.

Conclusions

This study identified data-driven HbA1c and SDG strata that better risk-stratify 90-day major complications following LF. Instead of current single-value thresholds, these multiple strata may be utilized for better preoperative guidance.
Antibacterial activity of selenium nanoparticles/copper oxide (SeNPs/CuO) nanocomposite against some multi-drug resistant clinical pathogens
Authors: Asaad Ahmed Morad , Saied Sara A. , Torayah Mohammad M. , Abu-Elsaad N. I. , Awad. Samah Mohammed
Published: January 2025

Background

Recent advances in nanomedicine have derived novel prospects for development of various bioactive nanoparticles and nanocomposites with significant antibacterial and antifungal properties. This study aims to investigate some characteristics of the novel Se-NPs/Cu2O nanocomposite such as morphological, physicochemical, and optical properties, as well as to assess the antibacterial activity of this fabricated composite in different concentrations against some MDR Gram-positive and Gram-negative clinical bacterial isolates.

Methods

The Se-NPs/Cu2O nanocomposite was fabricated using the chemical deposition method. The fabricated nanocomposite was fully characterized by X-Ray diffraction analysis (XRD), fourier transforms infrared spectroscopy (FTIR), and transmission electron microscope (TEM). The antimicrobial activity of Se-NPs/Cu2O was investigated using the standard broth microdilution method. The fabricated Se-NPs/Cu2O nanocomposites were detected as stable and highly crystallized nanospheres with an average size of 98.6 nm.

Results

The Se-NPs/Cu2O nanocomposite showed a potent antimicrobial activity with MIC values ranged from 6.25 to 12.5 µg/ml for Gram-positive isolates, and 25 to 50 µg/ml for gram-negative isolates. The bactericidal activity was higher for gram-negative isolates with MBC/MIC ratios of 1–2 µg/ml for gram-negative, versus 8 µg/ml for gram positive pathogens.

Conclusion

These findings would support further research in development of a novel Se-NPs/Cu2O nanocomposite as a promising alternative therapeutic option for improving the quality of patients’ management.
Combination therapy versus monotherapy: retrospective analysis of antibiotic treatment of enterococcal endocarditis
Authors: Saman Razan , Primus Christopher P. , West Robert , Woldman Simon J. , Sandoe Jonathan A. T.
Published: January 2025

Background

Guidelines suggest treating fully penicillin-susceptible Enterococcus faecalis strains causing infective endocarditis with amoxicillin combined with gentamicin or ceftriaxone, but clinical evidence to support this practice is limited and monotherapy cohorts were excluded from studies. We describe antibiotic treatment, complications, and outcomes in patients with Enterococcus faecalis infective endocarditis, specifically comparing monotherapy versus combination therapy.

Methods

Retrospective analysis of prospectively collected cohort of patients with definite or possible infective endocarditis from 2 English centres between 2006 and 2021. The primary outcome was 30-day mortality. Secondary outcomes included acute kidney injury, relapse, and clinical cure.

Results

178 individuals were included: median age was 72 years (interquartile range 60–79), male sex majority (138, 78%) and mostly native valve endocarditis (108, 61%). Thirty-nine patients (22%) received monotherapy (penicillin/glycopeptide/linezolid/daptomycin), 128 (72%) combination with gentamicin, 11 (6%) combination with ceftriaxone. Patients on combination therapy with gentamicin had a statistically significant lower 30-day mortality than those treated with monotherapy (21 (16.4%) versus 15 (38.5%) p = 0.035) and higher rates of clinical cure (101 (78.9%) versus 23 (59.0%) p = 0.018). Patient receiving gentamicin were more likely to experience acute kidney injury (64 (50%) versus 11 (28.2%) p = 0.057). Ceftriaxone combination was associated with poor outcomes, but the sample size was small.

Conclusion

Patients treated with combination gentamicin therapy had better clinical outcomes than patients treated with monotherapy. Low-dose gentamicin regimens were associated with acute kidney injury. Patients treated with combinations were different to those treated with monotherapy and confounding remains a concern with observational analyses. An adequately powered clinical trial is needed to determine optimal treatment of enterococcal endocarditis.

Clinical trial number

Not applicable.
Three-dimensional sonographic findings of diprosopus: a case report and literature review
Authors: Zhou Qiao , Sha Enbo , Ding Qian , Jing Chunli
Published: January 2025

Background

Diprosopus is one of the rarest anomalies. It typically manifests as bilateral alterations and often involves anomalies within the cranial structures. In this report, we present a case of a fetus with diprosopus diagnosed prenatally. Along with reviewing relevant literature on prenatal ultrasound diagnosis of diprosopus, we aim to raise awareness of its ultrasound characteristics.

Case presentation

We report a case of craniofacial and intracranial abnormalities detected during a 26-week ultrasound examination. Two-dimensional ultrasound (2D ultrasound) demonstrates significant increases in head circumference, widening of the interocular distance, and abnormal echo patterns in the facial structure. Three-dimensional ultrasound (3D ultrasound) revealed the presence of three eye sockets (the lateral eye sockets contained eyeballs, while the central region exhibited fusion without visible eyeballs), two noses, and two mouths, with no abnormalities observed in other areas. The ultrasound findings suggested diprosopus. Following risk counseling at the prenatal diagnosis center, the pregnant woman decided to induce labor. The newborn passed away thirty minutes after delivery. The facial features of the newborn were consistent with the 3D ultrasound imaging, and the appearance of the trunk and limbs was normal. Both CT and MRI scans confirmed the diagnosis of diprosopus.

Conclusion

The prenatal 2D ultrasound revealed intracranial and facial abnormalities in the fetus. 3D ultrasound imaging clearly displayed the facial duplication anomalies, highlighting the advantages of 3D ultrasound in diagnosing diprosopus. We hope to raise awareness of this rare condition and provide insights into prenatal ultrasound diagnosis through this case.
A multidimensional assessment of adverse events associated with paliperidone palmitate: a real-world pharmacovigilance study using the FAERS and JADER databases
Authors: Lou Siyu , Cui Zhiwei , Ou Yingyong , Chen Junyou , Zhou Linmei , Zhao Ruizhen , Zhu Chengyu , Wang Li , Wu Zhu , Zou Fan
Published: January 2025

Objective

Paliperidone palmitate is a second-generation antipsychotic that has undergone extensive investigation in clinical trials. However, real-world studies assessing its safety in large populations are lacking. As such, this study aimed to comprehensively evaluate real-world adverse drug events (ADEs) linked to paliperidone palmitate by employing data mining techniques on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database and the Japanese Adverse Drug Event Report (JADER) database.

Methods

The study retrieved ADE reports from the FAERS database covering the period from 2009 through the third quarter of 2024, and from the JADER database covering the period from 2013 through the second quarter of 2024. Utilizing disproportionality analyses such as the reporting odds ratios (ROR), proportional reporting ratios (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item Poisson shrinkage (MGPS), significant associations between ADEs and paliperidone palmitate were evaluated.

Results

A total of 27,672 ADE reports related to paliperidone palmitate were identified in FAERS, with 285 significantly disproportionate preferred terms (PTs) identified by all four algorithms. Paliperidone palmitate-associated ADEs encompassed 27 System Organ Classes (SOCs). The top three PTs with the highest reported cases were off-label use, drug ineffective, and hospitalization. Common ADEs included increased blood prolactin, galactorrhea, and schizophrenia, which was consistent with drug label. Noteworthy, unexpected signals not listed in the drug label were also identified, such as psychosexual disorders, prolactin-producing pituitary tumors, suicide attempt, and sudden death. The median onset time for all ADEs was 40 days. Furthermore, gender-based difference in risk signals was detected. Females are more likely to experience elevated blood prolactin and weight increase, whereas males are more prone to sexual dysfunction. Among the 1,065 ADE reports from the JADER database, we identified 51 positive signals, 35 of which overlapped with those found in FAERS, including schizophrenia, hyperprolactinemia, and erectile dysfunction.

Conclusion

The study findings from two independent databases serve as crucial references for ensuring the safe of paliperidone palmitate. Additionally, the gender-specific monitoring references provided can enhance clinical surveillance efforts and facilitate more effective risk identification.
Constructing a fall risk prediction model for hospitalized patients using machine learning
Authors: Kang Cheng-Wei , Yan Zhao-Kui , Tian Jia-Liang , Pu Xiao-Bing , Wu Li-Xue
Published: January 2025

Study objectives

This study aimed to identify the risk factors associated with falls in hospitalized patients, develop a predictive risk model using machine learning algorithms, and evaluate the validity of the model’s predictions.

Study design

A cross-sectional design was employed using data from the DRYAD public database.

Research methods

The study utilized data from the Fukushima Medical University Hospital Cohort Study, obtained from the DRYAD public database. 20% of the dataset was allocated as an independent test set, while the remaining 80% was utilized for training and validation. To address data imbalance in binary variables, the Synthetic Minority Oversampling Technique combined with Edited Nearest Neighbors (SMOTE-ENN) was applied. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to analyze and screen variables. Predictive models were constructed by integrating key clinical features, and eight machine learning algorithms were evaluated to identify the most effective model. Additionally, SHAP (Shapley Additive Explanations) was used to interpret the predictive models and rank the importance of risk factors.

Results

The final model included the following variables: Adl_standing, Adl_evacuation, Age_group, Planned_surgery, Wheelchair, History_of_falls, Hypnotic_drugs, Psychotropic_drugs, and Remote_caring_system. Among the evaluated models, the Random Forest algorithm demonstrated superior performance, achieving an AUC of 0.814 (95% CI: 0.802–0.827) in the training set, 0.781 (95% CI: 0.740–0.821) in the validation set, and 0.795 (95% CI: 0.770–0.820) in the test set.

Conclusion

Machine learning algorithms, particularly Random Forest, are effective in predicting fall risk among hospitalized patients. These findings can significantly enhance fall prevention strategies within healthcare settings.
Trends and disparities in the surgical management of spinal fractures in Sweden during 2008–2023
Authors: Barle Niklas , Axenhus Michael
Published: January 2025

Background

Spinal fractures are a group of complex injuries whose management varies according to a number of factors. The aim of this study was to analyze trends in the management of spinal fracture surgery in Sweden from 2008 to 2023 with a focus on disparities based on gender, surgery method, age and geographical location. A secondary aim was to predict future incidence of spinal fracture surgeries.

Methods

Comprehensive open source data was obtained from the Swedish National Board of Health and Welfare. The data was stratified based on gender, surgery method, age and geographical location per year and analyzed for trends. Future trends were projected using regression modeling. The student’s T-test was used to compare means.

Results

The incidence of spinal fracture surgery decreased overall from 2008 to 2023 while maintaining an increased incidence for males compared to females. The highest incidence for osteosynthesis was 2.7 per 100 000 inhabitants in 2008 and 1 in 2023. This trend is projected to be reversed in 2030. Several surgery methods have decreased in usage and are projected to reach close to 0 in 2030. The patient group that underwent spinal fracture surgery had a higher mean age in 2023 compared to 2008. The incidence of spinal fracture surgery varied significantly across Sweden where region Östergötland performed 6.3 surgeries per 100 000 inhabitants and region Örebro performed 1.4.

Conclusions

We found several trends where males may undergo spinal fractures surgery more commonly than females. Probable influencing factors may be increased life-spans and osteoporosis. This may also explain the observed shift towards older age groups in spinal fracture surgery. The decreased use of several surgery methods may reflect changes in operational techniques, demographics, and more standardized care. Geographical disparities may indicate different local health care protocols and uneven healthcare utilization and access.

Trial registration

Not applicable.
Associations of time to the operating room on outcomes in odontogenic infection
Authors: N. James Jeffrey , Bloomquist Ryan , Brown Kiara , Looney Stephen , Walker Dylan , Day Tyler
Published: January 2025

The purpose of this study was to determine if there were correlations between the length of time from hospital admission to surgical intervention and the frequency of complications in patients with odontogenic infections. While odontogenic infection is well studied in terms of interventions and outcomes, less is known about hospital utilization and resource burden of odontogenic infection with respect to timeliness to intervention. A retrospective cohort analysis was used to examine correlations between time from admission to surgical intervention and clinical outcomes. Patients included in this study were divided into three categories of length of time to the operating room: 0–12 h, 12.1–24 h, and greater than 24 h. Time of admission, time of surgical intervention, patient demographics, admission lab values, and space involvement were measured and compared to the primary outcome variables including complications of intubation attempts and type, ICU admission, length of hospitalization, number of changes in antibiotic therapy, and frequency of return to the operating room. We found that the length of time to the OR had a statistically significant association with length of hospital stay (p = 0.003) and number of changes in antibiotic therapy (p = 0.033). While overall length of hospital stay is inherently dependent on length of time to the OR, this relationship highlights the importance of timeliness to definitive intervention in order to reduce hospital burden. This study provides evidence on how to prioritize odontogenic infections in a hospital setting. We recommend treating odontogenic infection in less than 24 h from the time of admission in order to reduce costs and improve outcomes for patients.
Caregivers’ experience of having a child with Down syndrome: a meta-synthesis
Authors: Zhang Xiao Nan , Zhang Shuo , Liu Chun Yan , Ni Zhi Hong , Lv Hai Tao
Published: January 2025

Background

This study aimed to integrate the experiences of caregivers of children with Down syndrome during the care process and understand their feelings and needs.

Methods

We used Page et al.’s (2021) Preferred Reporting Items for Systematic Reviews and Meta-synthesis Statement. Ten databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL, PsycInfo, China Biology Medicine, China National Knowledge Infrastructure, Wanfang Data, and China Science and Technology Journal Database) were searched for relevant studies published from the inception of the database to October 2023. Eight qualitative studies were analysed. The following seven themes were included: ‘feeding pressure’, ‘hope for education’, ‘societal rejection and stigma’, ‘psychological pressure’, ‘caring burden’, ‘family burden’, and ‘family adaptation and self-growth’.

Results

We found that feeding pressures, educational concerns, language difficulties, and discrimination and stigmatisation led to psychological, economic, and family stress in caregivers of children with Down syndrome. We document the need for strong coping mechanisms and support systems for these families from medical and psychological institutions and a need for public education and awareness.

Conclusions

We summarised the daily care experiences of caregivers of children with Down syndrome. Our findings provide a scientific basis for further research focused on reducing physical and mental pressure on caregivers and improving the quality of family life.
Navigating diabetes care inequities: an observational study linking chronic care model’s structural elements to process and outcomes of type 2 diabetes care in Belgium
Authors: Bos Philippe , Danhieux Katrien , Wouters Edwin , Olmen Josefien van , Buffel Veerle
Published: January 2025

Background

Although the Chronic Care Model (CCM) provides the essential structural components of practice organisation to deliver high-quality type 2 diabetes (T2D) care, little is known about which of its elements are most important, and the extent to which it may reduce social inequities in the quality of T2D care. This study aims to assess the association between the implementation of CCM’s structural elements and the quality of T2D care processes and outcomes in Flanders (Belgium), paying specific attention to differences by patients’ socioeconomic vulnerability.

Methods

We developed a longitudinal database combining information on primary care practices’ CCM implementation, with individual-level health insurance and medical lab data. Our sample included 7,593 T2D patients aged 40 years and above from 58 primary care practices in Flanders, followed up from 2017 to 2019. Medical lab data were available for a subsample of 4,549 patients. By estimating a series of hierarchical mixed-effects models, we assessed the association between primary care practices’ CCM implementation and two process and two outcome indicators of T2D care. In addition, we explored cross-level interactions with patients’ socioeconomic vulnerability.

Results

Patients were more likely to have their HbA1c tested twice a year and LDL cholesterol tested yearly in practices with a higher overall CCM implementation. Regarding the different CCM elements, the clinical information system and linkages to the community were significantly associated with higher odds of being up-to-date with HbA1c testing, whereas stronger community linkages was the only dimension significantly associated with yearly LDL cholesterol testing. While socioeconomic vulnerable patients were less likely to have their HbA1c tested twice yearly, this difference disappeared in the highest-scoring practices. Regarding the outcome indicators, only a negligible proportion of variation in HbA1c and LDL cholesterol levels was due to systematic differences between practices, and hence, no clinically relevant associations with the CCM elements were found.

Conclusion

Our pioneering findings support the social capital pathway, as CCM implementation is associated with a reduction in the healthcare inequity gap in the T2D care process. This suggests that promoting CCM implementation may improve healthcare equity, particularly in regions with significant socioeconomic disparities or high concentrations of deprived individuals.
Mixed vulnerabilities: the biological risk of high parity is aggravated by emergency referral in Benin, Malawi, Tanzania and Uganda
Authors: Straneo Manuela , Beňová Lenka , van den Akker Thomas , Abeid Muzdalifat S. , Ayebare Elizabeth , Dossou Jean-Paul , Handing Greta , Kandeya Bianca , Pembe Andrea B. , Hanson Claudia
Published: January 2025

Identification of interacting vulnerabilities is essential to reduce maternal and perinatal mortality in sub-Saharan Africa (SSA). High parity (≥ 5 previous births) is an underemphasized biological vulnerability linked to poverty and affecting a sizeable proportion of SSA births. Despite increased risk, high parity women rarely use hospitals for childbirth. We assessed whether emergency referral during childbirth was associated with adverse events in high parity women in hospitals in Benin, Malawi, Tanzania and Uganda. We used e-registry data collected in 16 hospitals included in the Action Leveraging Evidence to Reduce perinatal morbidity and morTality (ALERT) trial. Main outcomes were severe maternal outcomes and in-facility peripartum death (fresh stillbirth or very early neonatal death). Main exposure was parity; emergency (in-labour) referral was included as effect modifier with potential confounders. We used multivariable logistic regression including parity/referral interaction and post-regression margins analysis. Among 80,663 births, 4,742 (5.9%) were to high parity women. One third reached hospital following emergency referral. Severe maternal outcomes and peripartum mortality were over 2.5-fold higher in high parity women with emergency referral compared to the lowest risk group. To avert these adverse events, emergency referral must be avoided by ensuring high parity women give birth in hospitals. 

Trial registration Pan African Clinical Trial Registry (www.pactr.org): PACTR202006793783148. Registered on 17th June 2020.