bluuebunny/crossref_metadata_2025 huggingface dataset:
It's not simply luck: The impact of network strategy, schedule padding, and operational improvements on domestic on‐time performance in the US airline industry
Authors: Manchiraju Chandrasekhar , Sohoni Milind G. , Deshpande Vinayak
Published: August 2023

Airlines showcase their on‐time performance (OTP), a globally accepted operational performance metric, to demonstrate punctuality, service reliability, and attract air travelers. Airlines can adopt passive strategies, such as “schedule padding,” and active strategies, such as making “operational changes/improvements,” to improve their OTP. While there is a high degree of variation in airlines' OTP from year to year, it is unclear if and the extent to which airlines' active or passive actions impact their OTP because of factors, like weather, outside an airline's control. We develop a framework in this paper to study the impact of these active and passive actions on the OTP of airlines. Additionally, we study the effect of these strategies on OTP rankings, routinely used to compare airlines. Our methodology builds on the structural estimation model developed in prior literature and replicates the typical schedule planning process observed in the airline industry. We use an 11‐year panel data of flights operated by US domestic carriers from 2005 to 2015 to measure OTP changes, schedule padding, and operational changes. Broadly, active actions include (i) changes to the airline's network structure (e.g., flight routes and schedules) and (ii) other operational changes to improve flight performance (operational improvement). We demonstrate through our analysis that operational improvements have the highest association with both the change in OTP and OTP rankings of airlines, followed by schedule padding; the impact of network changes on OTP and OTP rankings is the lowest. Our framework also accounts for the impact of competition on an airline's OTP ranking. We show that while an airline's own actions can improve its OTP ranking, a competitor's action may negatively affect the ranking. In fact, a competitor's passive strategy of schedule padding may have a higher impact than an airline's own active strategy of changes in network structure. Our results also indicate that the potential impact of operations improvements is the highest for full‐service airlines and the lowest for leisure airlines. Furthermore, we show that the impact of operational improvements and buffer adjustments decreases with an increase in the variability of the travel time of a route.
Dynamics between warehouse operations and vehicle routing
Authors: Rijal Arpan , Bijvank Marco , de Koster René
Published: August 2023

When scheduling the distribution of ordered items from a warehouse to customers, the transportation planning is generally done first and serves as input for planning warehouse operations. Such a sequential approach can lead to substantial inefficiencies when the customer deliveries are restricted by time windows, and the warehouse has limited resources available (both order pickers and space in the staging area). This paper studies the trade‐offs between warehouse operations and transportation planning. The goal is to understand the impact of three specific managerial interventions: adopting an integrated planning approach, expanding the available staging space, and expanding the delivery time windows. To this end, we propose a mathematical model for a general vehicle routing problem that incorporates order batching, order picker scheduling, staging, and vehicle loading. We introduce a novel idea to express the picking time of an order batch as a function of the batch size and develop a metaheuristic to solve this integrated problem. Furthermore, we develop exact algorithms to provide optimal solutions for the individual warehouse and transportation problems in a sequential planning approach. Managerial insights are distilled from case studies in two warehouses, one for ambient products and the other for refrigerated products, of a leading grocery retailer in the Netherlands. Our results show that integrated planning outperforms the other managerial interventions and generates cost savings between 9% and 11%. Savings are generally realized by executing larger order batch sizes to be picked in the warehouses at the expense of additional routing cost (around 2–3%). The second intervention in the form of time window expansions of only 15 minutes for customer deliveries can lead to cost savings between 4% and 6%, which results from a reduction in both transportation and warehousing cost. Expanding the capacity of the staging area is only meaningful when the staging space is highly utilized and only results in cost savings for the warehouse operations.
Managing presales with two payments and return policy when consumers are time‐inconsistent
Authors: Kuang Yunjuan , Jiang Li
Published: August 2023

We consider a firm using presales with two payments—including an upfront deposit and a postponed arrear—to sell a product to time‐inconsistent consumers under various return policies. With the passage of time, consumers decide whether to preorder the product by paying the deposit, whether to settle the balance by paying the arrear by the due date, and, when returns are allowed, whether to return a fully paid product for a refund after its fitness is revealed. Canceling a preorder before settling the balance or failing to settle the balance on time causes a deposit payer to lose deposit. Consumers use quasi‐hyperbolic discounting to weigh intertemporal utilities and exhibit time inconsistency when making purchase decisions. Our results indicate that, as consumers' time inconsistency weakens, the firm manages the deposit and the arrear to induce no, some, and all deposit payers, in that sequence, to settle the balance. It has mixed effects on the profit of the firm and consumer surplus but always causes social welfare to improve since actual sales increase. Regarding the choice of return policy, the firm prefers full returns while consumers prefer no returns when consumers are time‐inconsistent; they share similar preferences when consumers are time‐consistent. Moreover, we find that consumers' imbalance (caused by time‐inconsistent preference) is less likely to occur as consumers are more sophisticated, as the presales period shortens, as the product value increases, or as the product is more likely to be a good fit. In addition, allowing a quick refund for fully paid but not yet delivered products can completely deter imbalance, while this option harms the firm and may or may not benefit consumers. All this yields novel insights into managing presales with two payments and returns when consumers are time‐inconsistent.
Global agricultural supply chains under tariff‐rate quotas
Authors: Hezarkhani Behzad , Arisian Sobhan , Mansouri Afshin
Published: August 2023

The tariff rate quota (TRQ) is a widely utilized market access instrument in global agricultural trade that allows a predetermined quantity of a product to be imported at a lower tariff rate than the usual rate. This study examines the design and administration of TRQ systems from an operations management perspective and analyzes their impact on market access, fill rates, and revenue for policymakers. We investigate the two most common TRQ administration methods, namely, licensing and first‐come, first‐served (FCFS) systems. We characterize the Nash equilibria (NE) of importers' strategies and observe how information delays and lead times can result in under‐utilization (i.e., imports being less than the quota limit) in licensing and over‐utilization (i.e., imports exceeding the quota limit) in FCFS TRQ systems. We introduce a dual TRQ system and demonstrate its superiority over licensing and FCFS systems. We study the effects of stock‐keeping options through customs‐bonded warehouses and the choice of logistics channels on arrival patterns and fill rates. We conduct a case study of the United Kingdom and the European Union imported beef market using customs data. Our numerical study provides an explanation for the suboptimality of the current TRQ systems and proposes modifications to transform the existing systems. Our findings offer practical directions for agricultural traders to reassess their supply chain strategies by considering the logistical implications of TRQ systems and understanding their competition. This study also urges policymakers to adopt an integrative approach in (re)designing TRQ systems, recognizing the pivotal role of supply chains in global agricultural trade.
Games of supplier encroachment channel selection and e‐tailer's information sharing
Authors: Tang Yanli , Sethi Suresh P. , Wang Yulan
Published: August 2023

We consider an e‐tailer's upstream supplier who wants to encroach into retailing to earn additional revenue. The supplier needs to decide whether or not to enter the retail market by either selling to consumers on the e‐tailer's platform by paying commission fees (agency encroachment) or opening an independent online/offline retail store (direct encroachment). The e‐tailer has private demand information and decides whether or not to share it with the supplier. Two leadership scenarios—the supplier‐leads (i.e., the supplier selects the channel before the e‐tailer decides whether to share information) and the e‐tailer‐leads (i.e., the supplier selects the channel after the e‐tailer decides whether to share information)—are examined. Our main findings are as follows. First, we show that the e‐tailer has no incentive to share information under no encroachment and direct encroachment. Interestingly, this result holds in both leadership scenarios. Second, a medium commission rate gives rise to an equilibrium of agency encroachment with information sharing by the e‐tailer. This equilibrium is more likely to sustain in the supplier‐leads scenario than in the e‐tailer‐leads scenario. Third, agency encroachment brings the supplier the highest sales volume (at retail in the encroaching channel plus on wholesale to the e‐tailer) when the two parties compete in quantity while direct encroachment does so for a price competition. Fourth, supplier encroachment always improves consumer surplus, but it is not necessarily welfare‐improving. Last, we find that the e‐tailer is more willing to share information to induce the supplier to encroach through his agency channel if he has a significant selling cost advantage over the supplier or can endogenously determine the commission rate.
Dialetheism in Deleuze's event
Authors: Shores Corry
Published: August 2023

Deleuze never explicitly formulates his philosophy of logical truth‐values. It thus remains an open question as to the number and types he held there to be. Despite his explicit comments on these matters, additional textual evidence suggests that in his thinking on the event, he favored a third truth‐value, holding either the analetheic view that some truth‐bearers can be truth‐valueless or the dialetheic view that some truth‐bearers can be both true and false. I first argue that taking a logical approach to Deleuze's thinking is feasible, despite his and others' claims that might suggest otherwise. Next, I examine his explicit statements to show that they cannot be taken at face value and that, rather, we need to transpose his claims into contemporary terminology in order to accurately assess them. I lastly turn to his Leibniz‐inspired philosophy of time to argue that the affirmations involved in this conception strongly suggest a dialetheic tendency in his thinking.
Relationship between COVID‐19‐related stress and social inhibition among university students in China: The mediating role of psychological richness
Authors: Gu Yu , Tao Lixin , Zheng Wen
Published: August 2023

Throughout the COVID‐19 pandemic, the mental health issues of university students received increasing attention. However, little is known about the effect of COVID‐19‐related stress on social inhibition among Chinese university students and its psychological mechanism in the context of the COVID‐19 pandemic. This study aimed to explore the relationship between COVID‐19‐related stress and social inhibition as well as the mediating role of psychological richness. In late 2022, 1250 Chinese university students were recruited for participation in an online survey. Modified SARS‐Stress Scale, Social Inhibition Questionnaire, and Psychologically Rich Life Questionnaire were used to assess participants' COVID‐19‐related stress, social inhibition, and psychological richness. The Results indicate that COVID‐19‐related stress positively predicts social inhibition and negatively predicts psychological richness. Meanwhile, Psychological richness negatively predicts social inhibition. Mediation analysis shows that the relationship between COVID‐19‐related stress and social inhibition was partially mediated by psychological richness. The results indicate the significant predictive value of psychological richness when studying mental health issues.
A gamma tail statistic and its asymptotics
Authors: Iwashita Toshiya , Klar Bernhard
Published: August 2023

Asmussen and Lehtomaa [Distinguishing log‐concavity from heavy tails. Risks 5(10), 2017] introduced an interesting function which is able to distinguish between log‐convex and log‐concave tail behavior of distributions, and proposed a randomized estimator for . In this paper, we show that can also be seen as a tool to detect gamma distributions or distributions with gamma tail. We construct a more efficient estimator based on ‐statistics, propose several estimators of the (asymptotic) variance of , and study their performance by simulations. Finally, the methods are applied to several datasets of daily precipitation.
Rapid antimicrobial resistance detection methods for bloodstream infection in solid organ transplantation: Proposed clinical guidance, unmet needs, and future directions
Authors: Turbett Sarah E. , Banach David B. , Bard Jennifer Dien , Gandhi Ronak G. , Letourneau Alyssa R. , Azar Marwan M.
Published: August 2023

Recent advances in antimicrobial resistance detection have spurred the development of multiple assays that can accurately detect the presence of bacterial resistance from positive blood cultures, resulting in faster institution of effective antimicrobial therapy. Despite these advances, there are limited data regarding the use of these assays in solid organ transplant (SOT) recipients and there is little guidance on how to select, implement, and interpret them in clinical practice. We describe a practical approach to the implementation and interpretation of these assays in SOT recipients using the best available data and expert opinion. These findings were part of a consensus conference sponsored by the American Society of Transplantation held on December 7, 2021 and represent the collaboration between experts in transplant infectious diseases, pharmacy, antimicrobial and diagnostic stewardship, and clinical microbiology. Areas of unmet need and recommendations for future investigation are also presented.
Transfusion‐transmission of hepatitis E virus through red blood cell transfusion but not through platelet concentrates: A case report from Spain
Authors: Ojea Ana María , Seco Carolina , Mata Pablo , Muñoz María del Carmen , Álvarez Argüelles Marta Elena , Rodríguez‐Frías Francisco , Quer Sivila Josep , Rando Segura Ariadna , García‐Gala José María , Rodriguez Mercedes
Published: August 2023

Background

Few cases of transfusion‐transmitted hepatitis E virus (HEV) have been published in Spain. Here, we describe a well‐characterized lookback investigation of a transfusion‐transmitted HEV case at the Community Centre for Blood and Tissues of Asturias (Spain).

Case Report

A female patient with chronic myeloid leukemia underwent an allogeneic bone marrow transplant in March 2019 and showed alterations in liver function shortly afterwards. This patient received blood components from 30 different donors in the 3 months before the transplant. Frozen plasma samples from these donations were investigated for the presence of HEV‐RNA. One frequent donor was identified as asymptomatic HEV RNA‐positive at the time of his whole blood donation. The investigation revealed that this donor's plasma unit, originally intended for the fractionation industry, had a viral RNA concentration of 1.9 × 104 copies/mL. HEV RNA was detected initially in the index patient who received the red cell concentrate from this donor 25 days after the transfusion. HEV RNA isolated from both donor and recipient were identified as subtype 3f. The recipient of platelet concentrate (PC), treated with a riboflavin‐based pathogen reduction technology (PRT) was not infected, being negative for the presence of HEV IgM, IgG, and HEV RNA before and after the transfusion.

Conclusion

This case study shows that HEV was transmitted through red cell transfusion to a recipient, while the patient who received riboflavin/UV light treated PC did not develop signs of infection. A causal relationship between PRT treatment of the PC and the non‐transmission of HEV remains to be established.
Magnesium in Saline Gypsum-Bearing Soils of Russia
Authors: Chernousenko G. I. , Khitrov N. B. , Pankova E. I.
Published: August 2023

Statistical analysis of 3802 samples of saline soils from different regions of Russia made it possible to substantiate preliminary conclusions about a higher proportion of magnesium in soils containing gypsum in comparison with gypsum-free saline soils. Gypsum is not a toxic salt and its presence does not cause an increase in salinity. Salinization is mainly related to sodium and magnesium salts, with the sodium percentage often exceeding the magnesium percentage. It is statistically substantiated that in the studied saline soils without gypsum, sodium often dominates among cations in the soil water extract (1 : 5) at any degree of salinity, The appearance of gypsum in the soil profile is accompanied by a significant increase in the proportion of magnesium. In slightly or moderately saline horizons with more than 1% of gypsum, the proportion of magnesium in the water extract (1 : 5) often exceeds 50% of the sum of sodium and magnesium according to the median, arithmetic mean, upper quartile, and maximum values. Even in strongly and very strongly saline soil horizons containing gypsum, the proportion of magnesium is significant with the median of 43 and 31%, respectively, which is 5.8–6.7 times higher than the proportion of magnesium in gypsum-free horizons of the same degree of salinity.
Comparison of Areal and Profile Distribution of Magnetic Susceptibility in Steppe Soils of the Russian Plain
Authors: Malyshev V. V. , Alekseev A. O.
Published: August 2023

A comparative analysis of areal and profile measurements of magnetic susceptibility was carried out on the plots pf 100 m2 in order to improve methods of surface soil sounding for mapping purposes and for identification of anomalies associated with anthropogenic pollution or disturbance of the surface soil layer. Two sites with Haplic Chernozems and one site with Haplic Kastanozem (Endosalic, Cambic) were studied. Additionally, a catena on the Yergeni Upland with different landscape positions (eluvial, transeluvial, transeluvial–accumulative) was studied. A comparison of the areal and profile magnetic susceptibility measured to a depth of 30 cm showed a direct correlation (R2 = 0.7). The areal survey was found to correctly determine the volumetric magnetic susceptibility ($${{\varkappa }_{{\text{s}}}}$$) to a depth of 30 cm. The $${{\varkappa }_{{\text{s}}}}$$ variation at sites with different types of soils reflects soil–climatic zonality and spatial lithological heterogeneity expressed in different textures and mineralogical compositions of the upper (0–30 cm) soil layer within the test area of 10 × 10 m. The areal magnetic susceptibility of soils can be an important additional indicator capable of reflecting the features of soil-forming, lithological, and geochemical processes occurring in the upper soil layer. The $${{\varkappa }_{{\text{s}}}}$$ variation at sites in different landscape positions is due to the development of sheet erosion and changes in the direction of iron oxidogenesis depending on the position of the soil profile in the relief. The set of areal and profile magnetic susceptibility measurements can be used to study soil inhomogeneities caused by anthropogenic, paleocryogenic, geomorphological, and lithogenic factors. In particular, this approach can be applied to the study of polluted soils and monitoring of agricultural lands.
Retrospective Analysis of the History of Agricultural Development and Evaluation of Soil Erosion Rates in the Lokna River Basin, Tula Oblast
Authors: Ivanova N. N. , Fomicheva D. V. , Rukhovich D. I. , Shamshurina E. N.
Published: August 2023

Abstract—

According to published and archival data, the dynamics of soil plowing in Tula oblast in general and in its particular districts has been traced. It has been found that the active agricultural development in the southern part of the modern Tula oblast began no earlier than in the middle of the 17th century. According to the maps of different years, changes in the area of arable land in the Lokna River basin (Plavsk district of Tula oblast) from the end of the 18th century until the present time have been determined. The reliability of our data on the history of plowing of the territory is confirmed by the literature data. The composition of field crops and changes in farming systems during the period under review have been reconstructed, and a significant conservatism of these indicators has been revealed: the fallow three-field system dominated throughout the 19th century and the first half of the 20th century; the predominance of rye among winter crops and oats among spring crops remained until the 1970s. According to the WaTEM/SEDEM and using historical data on changes in the main factors of soil erosion as input parameters, the intensity and volumes of rainfall runoff for the selected stages of development of the Lokna River basin have been calculated. In order to compare the results with the literature data for the period of 1980–1993, the rates and volumes of snowmelt washout have been estimated. An assessment of the reliability of the reconstructed model parameters for remote historical epochs has been carried out. The analysis of historical changes in the factors and rates of erosion indicates that the maximum extent of plowed area and the maximum intensity of erosional processes in Lokna River took place in the last quarter of the 19th–early 20th centuries. The influence of particular geomorphic positions of arable land on the rates and volumes of soil erosion has been revealed.
Primary School Mathematics in the Context of Digitalization
Authors: Muranov A. A. , Polikarpov S. A. , Rudchenko T. A.
Published: August 2023

We consider the content and methods of teaching mathematics in primary school in the context of digitalization. The necessity of a significant updating of the curriculum is shown. In particular, this implies the use of digital tools as an object of study and a way of significantly improving the content and effectiveness of learning mathematics to prepare children for the future life and work.
Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole
Authors: Sircar Anita D , Tran Mai-Chi N , Vaidya Sagar A , Goldstein Ellie JC , Wheat L Joseph
Published: August 2023

Histoplasmosis is an endemic fungal infection caused by the dimorphic fungus,Histoplasma capsulatum,which is treated with intravenous amphotericin B and oral itraconazole as first-line and second-line therapy. We report a case of a man in his early 70s treated with methotrexate and infliximab for rheumatoid arthritis who developed disseminated histoplasmosis. The patient was unable to absorb itraconazole due to intractable diarrhoea and developed a severe, anaphylactoid reaction or an immune reconstitution inflammatory syndrome when treated with liposomal amphotericin B. He was subsequently treated with isavuconazole and steroids and made a full recovery.

A literature review revealed other cases of histoplasmosis which were treated with isavuconazole including both primary pulmonary and disseminated presentations. Cases of blastomycosis which were treated with isavuconazole are also reviewed including those with severe immunocompromised statuses including solid-organ transplant and tumour necrosis factor-alpha antagonist recipients. Our report describes the potential role of isavuconazole in cases of histoplasmosis where first-line and second-line therapies have failed or are contraindicated (excluding meningitis).
Amelanotic melanoma in a patient with trisomy 21: clinical and dermoscopic presentation
Authors: Leahy Marion , Reidy Karen , Laing Mary
Published: August 2023

Amelanotic melanoma is an uncommon form of melanoma; accounting for 2%–8% of all melanoma cases. In the human population, the incidence of melanoma in patients with trisomy 21 is relatively unknown. It is theorised that having an extra copy of chromosome 21 is protective against melanoma development as people with trisomy 21 also carry an extra copy of the genes on that chromosome including any that protect against cancer. A literature review revealed four other reported cases of cutaneous melanoma in persons with trisomy 21. To the authors’ knowledge, this is the first case of amelanotic melanoma presenting in a patient with trisomy 21 and the fifth case of melanoma overall reported in a patient with trisomy 21.This case highlights the need for specialist referral of all new skin lesions where the diagnosis is unclear.
Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial
Authors: Razdar Sara , Panahi Yunes , Mohammadi Ramtin , Khedmat Leila , Khedmat Hossein
Published: August 2023

Objective

Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance. In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine).

Design

In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed.

Results

Post-treatment reduction in haemorrhoid grade was significant in the case group (p=0.02). This ratio was insignificant in the control group (p=0.139). Flavonoid lotion (p<0.05) significantly reduced the signs and symptoms of haemorrhoids more than anti-haemorrhoid ointment.

Conclusion

According to the results, flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patien
Depression, violence and socioeconomic outcomes among refugees in East Africa: evidence from a multicountry representative survey
Authors: Pozuelo Julia R , Bradenbrink Raphael , Stierna Maria Flinder , Sterck Olivier
Published: August 2023

Background

Existing research on refugee mental health is heavily skewed towards refugees in high-income countries, even though most refugees (83%) are hosted in low-income and middle-income countries. This problem is further compounded by the unrepresentativeness of samples, small sample sizes and low response rates.

Objective

To present representative findings on the prevalence and correlates of depression among different refugee subgroups in East Africa.

Methods

We conducted a multicountry representative survey of refugee and host populations in urban and camp contexts in Kenya, Uganda and Ethiopia (n=15 915). We compared the prevalence of depression between refugee and host populations and relied on regression analysis to explore the association between violence, depression and socioeconomic outcomes.

Findings

We found a high prevalence of elevated depressive symptoms (31%, 95% CI 28% to 35%) and functional impairment (62%, 95% CI 58% to 66%) among the refugee population, which was significantly higher than that found in the host population (10% for depressive symptoms, 95% CI 8% to 13% and 25% for functional impairment, 95% CI 22% to 28%) (p<0·001). Further, we observed a dose–response relationship between exposure to violence and mental illness. Lastly, high depressive symptoms and functional impairment were associated with worse socioeconomic outcomes.

Conclusion

Our results highlight that refugees in East-Africa—particularly those exposed to violence and extended exile periods—are disproportionately affected by depression, which may also hinder their socioeconomic integration.

Clinical implications

Given the high prevalence of depression among refugees in East Africa, our results underline the need for scalable interventions that can promote refugees’ well-being.
Effects of a culturally adapted counselling service for low-income ethnic minorities experiencing mental distress: a pragmatic randomised clinical trial
Authors: Suen Yi Nam , Chen Eric Yu Hai , Wong Yik Chun , Ng Winnie , Patwardhan Shilpa , Cheung Charlton , Hui Christy Lai Ming , Wong Stephanie Ming Yin , Wong Michael Tak Hing , Mahtani Shalini
Published: August 2023

Background

Culturally competent early mental health interventions for ethnic minorities (EMs) with no formal diagnoses are needed.

Objectives

To determine whether 8–12 weeks culturally adapted counselling (CAC) is better than waiting (waitlist (WL) group) to reduce depressive and anxiety symptoms and stress levels among EMs with elevated mental distress.

Methods

Hong Kong EMs with mild and above-mild mental distress were randomly assigned to CAC or WL in this pragmatic, randomised, WL-controlled trial. The CAC group received the intervention after randomisation and the WL group received the intervention after 8–12 weeks (T1). The prespecified primary outcomes were depressive and anxiety symptoms and stress levels measured by the Depression, Anxiety and Stress subscales of the Depression, Anxiety and Stress Scale (DASS-D, DASS-A and DASS-S, respectively) at postintervention (T1, 8–12 weeks).

Findings

A total of 120 participants were randomly assigned to either CAC (n=60) or WL (n=60), of whom 110 provided primary outcome data. At T1, CAC led to significantly lower depressive and anxiety symptom severity and stress levels compared with waiting, with unstandardised regression coefficients of −8.91 DASS-D points (95% CI −12.57 to −5.25; d=−0.90),–6.33 DASS-A points (95% CI −9.81 to −2.86; d=−0.68) and −8.60 DASS-S points (95% CI −12.14 to −5.06; d=−0.90).

Conclusions

CAC clinically outperformed WL for mild and above-mild levels of mental distress in EMs.

Clinical implications

Making CAC routinely available for EMs in community settings can reduce healthcare burden.

Trial registration number

NCT04811170.
Is a novel digital system for arm and hand rehabilitation suitable for stroke survivors? A qualitative process evaluation of OnTrack
Authors: Taylor Elizabeth , Fusari Gianpaolo , Darzi Ara , Jones Fiona
Published: August 2023

Objectives and design

National guidelines emphasise the need to enhance arm and hand recovery poststroke. OnTrack is a 12-week package aiming to address this need. Feasibility was evaluated in a single-arm feasibility study (reported separately). This paper presents findings from a nested process evaluation. The objectives were to explore users’ experiences of OnTrack and fidelity of delivery, in order to inform a definitive trial of effectiveness and future delivery.

Setting

Participants were interviewed in a range of settings in hospital, home or via telephone, at the end of their intervention cycle. Session observations for a selection of coaching sessions were carried out in person at home or remotely, post-COVID-19.

Participants

Eleven participants who completed the intervention following a stroke were interviewed. Seven coaching sessions were observed.

Intervention

This process evaluation was part of a larger feasibility study of OnTrack, which involves setting movement targets and monitoring activity using a tracker on the wrist, motivational messaging via a Smartphone and self-management coaching. Preliminary analysis of data collected was conducted with a public and patient involvement group formed of stroke survivors. This informed changes in intervention delivery.

Results

Participants reported finding the OnTrack programme beneficial, with the coaching role seen as particularly important. Participants found activity tracking motivating, but some noted discrepancies between tracked movement and what they considered useful activity. Motivational messages were sometimes irritating. Most felt ready to sustain their own activity practice at the end of the programme.

Conclusions

This process evaluation supported initial theoretical assumptions that OnTrack would enable activity practice through the use of remote monitoring. There was a strong emphasis on the coaching role as a mechanism of impact supporting the technological intervention. These findings will inform the next stages of delivery in a definitive trial.

Trial registration number

NCT03944486.
Burden and seasonal distribution of malaria in Ziquala district, Northeast Ethiopia: a 5-year multi-centre retrospective study
Authors: Debash Habtu , Bisetegn Habtye , Ebrahim Hussen , Tilahun Mihret , Dejazmach Zelalem , Getu Nigatu , Feleke Daniel Getacher
Published: August 2023

Objective

This study was aimed to determine the 5-year trend of malaria positivity rate in Ziquala district, Northeast Ethiopia.

Methods

Review of blood film reports from health institutions’ laboratory record books using predesigned checklists was done as part of an institution-based retrospective study to assess the 5-year (2016/2017–2020/2021) trend of malaria. To display data and analyse patterns in the trend of malaria over the course of years, months and seasons, descriptive statistics were used. The results of the data analysis were displayed in tables and figures using SPSS V.26.0. P values under 0.05 were considered as statistically significant for all comparisons.

Results

A total of 46 365 blood films from malaria suspected individuals were diagnosed using microscopy over the last 5 years. Of the diagnosed individuals, 14 429 (31.1%) were confirmed positive for Plasmodium infection.Plasmodium falciparum(59.7%) andPlasmodium vivax(37.0%) were the dominant species. The positivity rate of mixed infection (P. falciparumandP. vivax) was 3.3%. The maximum (3598; 29.6%) and minimum (2085; 29.1%) number of cases were reported in 2019/2020 and 2020/2021, respectively. Of the total cases, 9206 (63.8%) were in males. Moreover, the highest malaria positivity rate was observed in the age group of 15–45 (4040; 28.0%). Among the six health facilities, Ziquala district hospital had the highest malaria positivity rate (35.8%), followed by Tsitsika health centre (27.3%) and Mishra health centre (14.2%).

Conclusion

WithP. falciparumbeing the most common species, malaria remains a severe public health threat in the district. Therefore, the district health office and other concerned bodies should strengthen and implement evidence-based malaria prevention and control measures.
Long-term efficacy and safety of erenumab in Japanese patients with episodic and chronic migraine: results from a 28-week open-label treatment period of a randomised trial
Authors: Hirata Koichi , Takeshima Takao , Sakai Fumihiko , Numachi Yotaro , Yoshida Ryuji , Koukakis Reija , Hasebe Miki , Yui Daishi , da Silva Lima Gabriel Paiva , Cheng Sunfa
Published: August 2023

Objectives

To evaluate the 1-year efficacy and safety of once-monthly erenumab 70 mg following a 24-week double-blind treatment period (DBTP) of a phase III randomised study of Japanese patients with episodic migraine (EM) or chronic migraine (CM).

Design

Multicentre open-label study.

Setting

A total of 41 centres in Japan.

Participants

Patients completing the DBTP continued into the 28-week open-label treatment period (OLTP). 254 of 261 (97.3%) randomised patients continued into the OLTP; 244 (93.5%) completed treatment.

Interventions

Once-monthly subcutaneous erenumab 70 mg.

Main outcome measures

Changes from baseline in monthly migraine days (MMD) and monthly acute migraine-specific medication treatment days (MSMD) reported via patient eDiary; proportion of ≥50% and ≥75% responders in MMD reduction from baseline; incidence and exposure-adjusted incidence of treatment-emergent adverse events (TEAEs).

Results

At week 24 of the DBTP, the mean (SE) change from baseline in MMD for the erenumab group was –3.8 (0.4) days (EM, –3.0 (0.4); CM, –5.2 (0.8)); in MSMD, –2.6 (0.4) days (EM, –2.1 (0.4); CM, –3.4 (0.7)). At the end of the OLTP (52 weeks postbaseline), the mean (SE) change from baseline in MMD was –4.7 (0.3) days (EM, –3.4 (0.3); CM, –6.9 (0.6)); in MSMD, –3.3 (0.3) days (EM, –2.4 (0.3); CM, –4.6 (0.5)). The proportion of ≥50% responders for MMD reduction in the erenumab group was 34.1% at week 24; 44.4% at week 52. The exposure-adjusted incidence of TEAEs was 219.7 per 100 patient-years during the OLTP (DBTP, 251.0 for the erenumab group). The most common TEAEs during the OLTP were nasopharyngitis, constipation and influenza. No new safety concerns were identified.

Conclusions

Erenumab treatment was associated with reduced migraine frequency in Japanese patients with EM or CM for up to 1 year. Overall safety results from the OLTP were consistent with DBTP results.

Trial registration number

NCT03812224.
Is the process of withdrawal of life-sustaining measures in the intensive care unit different for deceased organ donors compared with other dying patients? A secondary analysis of prospectively collected data
Authors: Shahin J , Scales Nathan B , Johara F , Hogue M , Hornby Laura , Shemie Sam , Schmidt M , Waldauf P , Duska F , Wind Tineke , Van Mook W N , Dhanani Sonny
Published: August 2023

Objective

To investigate whether observable differences exist between patterns of withdrawal of life-sustaining measures (WLSM) for patients eligible for donation after circulatory death (DCD) in whom donation was attempted compared with those patients in whom no donation attempts were made.

Setting

Adult intensive care units from 20 centres in Canada, the Czech Republic and the Netherlands.

Design

Secondary analysis of quantitative data collected as part of a large, prospective, cohort study (the Death Prediction and Physiology after Removal of Therapy study).

Participants

Patients ≥18 years of age who died after a controlled WLSM in an intensive care unit. Patients were classified as not DCD eligible, DCD eligible with DCD attempted or DCD eligible but DCD was not attempted.

Primary and secondary outcome measures

The process of WLSM (timing and type and, if applicable, dosages of measures withdrawn, dosages of analgesics/sedatives) was compared between groups.

Results

Of the 635 patients analysed, 85% had either cardiovascular support stopped or were extubated immediately on WLSM. Of the DCD eligible patients, more were immediately extubated at the initiation of WLSM when DCD was attempted compared with when DCD was not attempted (95% vs 61%, p<0.0001). Initiation of WLSM with the immediate cessation of cardiovascular measures or early extubation was associated with earlier time to death, even after adjusting for confounders (OR 2.94, 95% CI 1.39 to 6.23, at 30 min). Other than in a few patients who received propofol, analgesic and sedative dosing after WLSM between DCD attempted and DCD eligible but not attempted patients was not significantly different. All patients died.

Conclusions

Patients in whom DCD is attempted may receive a different process of WLSM. This highlights the need for a standardised and transparent process for end-of-life care across the spectrum of critically ill patients and potential organ donors.
Experiences and preferences for psychosocial support: a qualitative study exploring the views of patients with chronic haematological cancers
Authors: Sheridan Rebecca , McCaughan Dorothy , Hewison Ann , Roman Eve , Smith Alexandra , Patmore Russell , Howell Debra
Published: August 2023

Objectives

Patients with chronic haematological cancers are often treated on a relapsing-remitting pathway, which may extend for many years. Such diagnoses are associated with uncertainties that often cause anxiety and distress, meaning patients (and families) are susceptible to potentially prolonged emotional difficulties, across the cancer journey. Experiences and preferences regarding psychosocial needs and support over time are relatively unexplored, which this study aimed to address.

Setting and design

Set within the UK’s Haematological Malignancy Research Network (an ongoing population-based cohort that generates evidence to underpin improved clinical practice) a qualitative, exploratory study was conducted, using semistructured interviews. Reflexive thematic analysis was used to assess the interview data via an exploratory, inductive approach, underpinned by the research questions.

Participants

Thirty-five patients were included with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma; 10 of whom were interviewed alongside a relative.

Results

Five themes were identified from the data: (1) accessing support, (2) individual coping behaviour affecting support preferences, (3) divergent and fluctuating thoughts on patient support forums, (4) the role, influence and needs of family and friends and (5) other sources of support and outstanding needs. Findings suggest that patients’ individual attitudes towards support varied over time. This also influenced whether support was perceived to be available, and if it was then used.

Conclusion

This study highlighted the variation in preferences towards psychosocial support among patients with chronic haematological cancers. As patients can live for many years with significant emotional difficulties, they may benefit from frequent monitoring of their psychosocial well-being, as well as signposting to holistic support, if this is needed.
Comparison of surgical strategies in patients with chronic subdural haematoma: a protocol for a network meta-analysis
Authors: Li Yujian , Yang Xiang , Zhou Huiqing , Hui Xuhui , Li Hao , Zheng Jun
Published: August 2023

Introduction

Chronic subdural haematoma (CSDH) is one of the most common neurosurgical emergencies, especially in the elderly population. Surgery is the mainstay of treatment for CSDH. Some studies have suggested that some specific surgical strategies can have potential benefits for patients with CSDH; however, the best surgical method is still controversial. For a better understanding of surgical treatment for these patients, it is necessary to conduct a network meta-analysis to comprehensively compare the effects of medical treatment and different surgical methods.

Methods and analysis

This protocol has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Related studies published up to April 2023 will be searched in the following databases: PubMed, Embase, Scopus, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, VIP and Wanfang. Randomised controlled trials and non-randomised prospective studies comparing at least two different interventions for patients with CSDH will be included. Quality assessment will be conducted using Cochrane Collaboration’s tool or the Newcastle–Ottawa Scale based on study design. The primary outcome will be the recurrence rates, and the secondary outcome will be the functional outcome at the end of follow-up. Pairwise and network meta-analyses will be conducted using STATA V.14 (StataCorp, College Station, Texas, USA). Mean ranks and the surface under the cumulative ranking curve will be used to evaluate each intervention. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed.

Ethics and dissemination

Ethics approval is not necessary because this study will be based on publications. The results of this study will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42022376829.
Protocol for a multicentre cross-sectional, longitudinal ambulatory clinical trial in rheumatoid arthritis and Parkinson’s disease patients analysing the relation between the gut microbiome, fasting and immune status in Germany (ExpoBiome)
Authors: Hansen Bérénice , Laczny Cédric C , Aho Velma T E , Frachet-Bour Audrey , Habier Janine , Ostaszewski Marek , Michalsen Andreas , Hanslian Etienne , Koppold Daniela A , Hartmann Anika M , Steckhan Nico , Mollenhauer Brit , Schade Sebastian , Roomp Kirsten , Schneider Jochen G , Wilmes Paul
Published: August 2023

Introduction

Chronic inflammatory diseases like rheumatoid arthritis (RA) and neurodegenerative disorders like Parkinson’s disease (PD) have recently been associated with a decreased diversity in the gut microbiome, emerging as key driver of various diseases. The specific interactions between gut-borne microorganisms and host pathophysiology remain largely unclear. The microbiome can be modulated by interventions comprising nutrition.

The aim of our clinical study is to (1) examine effects of prolonged fasting (PF) and time-restricted eating (TRE) on the outcome parameters and the immunophenotypes of RA and PD with (2) special consideration of microbial taxa and molecules associated with changes expected in (1), and (3) identify factors impacting the disease course and treatment by in-depth screening of microorganisms and molecules in personalised HuMiX gut-on-chip models, to identify novel targets for anti-inflammatory therapy.

Methods and analysis

This trial is an open-label, multicentre, controlled clinical trial consisting of a cross-sectional and a longitudinal study. A total of 180 patients is recruited. For the cross-sectional study, 60 patients with PD, 60 patients with RA and 60 healthy controls are recruited at two different, specialised clinical sites. For the longitudinal part, 30 patients with PD and 30 patients with RA undergo 5–7 days of PF followed by TRE (16:8) for a period of 12 months. One baseline visit takes place before the PF intervention and 10 follow-up visits will follow over a period of 12 months (April 2021 to November 2023).

Ethics and dissemination

Ethical approval was obtained to plan and conduct the trial from the institutional review board of the Charité-Universitätsmedizin Berlin (EA1/204/19), the ethics committee of the state medical association (Landesärztekammer) of Hessen (2021–2230-zvBO) and the Ethics Review Panel (ERP) of the University of Luxembourg (ERP 21–001 A ExpoBiome). The results of this study will be disseminated through peer-reviewed publications, scientific presentations and social media.

Trial registration number

NCT04847011.