bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-related medication nonadherence in adults with COPD in the United States 2013–2020
Authors: Wen Xin , Qiu Hongbin , Yu Bo , Bi Jinfeng , Gu Xia , Zhang Yiying , Wang Shanjie
Published: March 2024

Background

Cost-related medication nonadherence (CRN) is associated with poor prognosis among patients with chronic obstructive pulmonary disease (COPD), a population that requires long-term treatment for secondary prevention. In this study, we aimed to estimate the prevalence and sociodemographic characteristics of CRN in individuals with COPD in the US.

Methods

In a nationally representative survey of US adults in the National Health Interview Survey (2013–2020), we identified individuals aged ≥18 years with a self-reported history of COPD. Cross-sectional study.

Results

Of the 15,928 surveyed individuals, a weighted 18.56% (2.39 million) reported experiencing CRN, including 12.50% (1.61 million) missing doses, 13.30% (1.72 million) taking lower than prescribed doses, and 15.74% (2.03 million) delaying filling prescriptions to save costs. Factors including age < 65 years, female sex, low family income, lack of health insurance, and multimorbidity were associated with CRN.

Conclusions

In the US, one in six adults with COPD reported CRN. The influencing factors of CRN are multifaceted and necessitating more rigorous research. Targeted interventions based on the identified influencing factors in this study are recommended to enhance medication adherence among COPD patients.
Development of an integrated milestone assessment tool across multiple early-adopter programs for breaking bad news: a pilot project
Authors: Turner Anisha , Gopakumar Sricharan , Minard Charles , Guffey Danielle , Allen Nathan , Kuo Dick , Poszywak Kelly , Pillow M. Tyson
Published: March 2024

Background

The transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol.

Methods

The IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be “easy” and “intermediate” in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cases in sessions held in November 2013 and May 2014. Standardized patients completed an assessment checklist to evaluate each resident’s performance in breaking bad news based on their use of the SPIKES protocol and IMA tool. Residents answered post-encounter questions about their training and comfort in breaking bad news. The association between SPIKES and IMA scores was investigated by simple linear regression models and Spearman rank correlations.

Results

There were 136 eligible medical residents: 108 (79.4%) participated in the first session and 97 (71.3%) participated in the second session, with 96 (70.6%) residents participating in both sessions. Overall, we were able to identify residents that performed at both extremes of the assessment criteria using the integrated milestone assessment (IMA) and the SPIKES protocol. Interestingly, residents rated themselves below “comfortable” on average.

Conclusion

We developed an integrated milestone assessment (IMA) that was better than the SPIKES protocol at assessing the skill of breaking bad news. This collaborative assessment tool can be used as supplement tool in the era of milestone transformation. We aim assess our tool in other specialties and institutions, as well as assess other shared milestones across specialties.
Development, implementation, and evaluation of an undergraduate family medicine program in the United Arab Emirates
Authors: Sulaiman Nabil , Shorbagi Sarra , Guraya Salman Yousuf
Published: March 2024

Background

Healthcare systems rely on well-trained family medicine physicians who can offer continuous quality services to their communities and beyond. The American Academy of Family Physicians and the World Organization of Family Doctors recommend that medical curricula should have adequately supervised education and training of the learners in family medicine during their preclinical and clinical placements. However, some medical schools don’t have a comprehensive family medicine program to prepare graduates who can meet the community needs. This work aims to report the essential steps for the development, implementation, and evaluation of the family medicine program at the College of Medicine at the University of Sharjah in United Arab Emirates.

Methods

We used the Kern’s 6-step model to describe the development, implementation, and evaluation of the family medicine program. This includes problem identification, needs assessment, goals setting, educational strategies, implementation, and evaluation. During 2014–2022, we longitudinally collected essential information about the family medicine program from different stakeholders including the feedback of clinical coordinators, adjunct clinical faculty, and medical students at the end-of-clerkship. All responses were analysed to determine the effective implementation and evaluation of the family medicine program.

Results

Over the course of 8 academic years, 804 medical students, 49 adjunct clinical faculty and three College of Medicine faculty participated in the evaluation of the family medicine program. The majority of respondents were satisfied with various aspects of the family medicine program, including the skills gained, the organisation of program, and the variety of clinical encounters. The medical students and adjunct clinical faculty suggested the inclusion of e-clinics, faculty development program, and the expansion of more clinical sites for the effectiveness of the family medicine program.

Conclusions

We report a successful development, implementation, and evaluation of the family medicine program in United Arab Emirates with a positive and impactful learning experience. More attention should be paid towards a suitable representation of family medicine program in the medical curriculum with focused and targeted educational plans for medical students.
Increasing pediatric radiation oncology capacity in sub-saharan Africa using technology: a pilot of a pediatric radiation oncology virtual training course
Authors: Joseph Adedayo O. , Akinsete Adeseye M. , Ajose Azeezat O. , Oladipo Aishat T. , Maliki Adeola , Akindele Korede , Mangongolo Michelle , Adeneye Samuel , Ngwa Wilfred
Published: March 2024

Background

The shortage of skilled healthcare professionals in pediatric oncology and the limited access to training programs remain significant challenges in Nigeria and sub-Saharan Africa. The the Pediatric Radiation Oncology (Virtual) Course, ‘PedROC’ project aims to contribute to improving pediatric cancer outcomes in Nigeria by increasing the capacity of radiation oncology professionals. To address the gap in access to pediatric radiation oncology professional development, the PedROC project was created, harnessing technology to improve radiation oncology training via a curriculum delivered through web-conferencing. This study aimed to evaluate the effectiveness of the PedROC pilot in enhancing the capacity, confidence, and skill of radiation oncologists in decision-making, prescribing, and treatment planning of radiotherapy for children diagnosed with cancer.

Methods

A multidisciplinary faculty of specialists in radiation oncology, pediatric oncology, oncology nursing, radiation therapy technology, and medical physics collaborated to identify the key learning needs in pediatric radiation oncology in the country. The team collaborated to develop a comprehensive curriculum covering the most common pediatric cancers in sub-Saharan Africa for the training program. The training course was conducted over two days, delivering twenty-four half-hour sessions for a total of 12 h, from July 31 to August 01, 2021.

Results

Analysis of pre and post - training surveys showed a significant increase in self-reported confidence measures across all domains among radiation oncologists. The program successfully improved participants’ knowledge and confidence levels in managing common pediatric cancers using radiotherapy, particularly addressing radiotherapy-specific issues such as appropriate dose, target volume delineation, treatment planning, dose constraints, and plan evaluation.

Conclusion

The PedROC pilot showed the efficacy of this model in enhancing the capacity and confidence of radiation oncology professionals involved in the treatment of pediatric cancer. The findings indicate that technology holds significant potential to increase pediatric radiation oncology capacity in Africa, ensuring improved access to proper treatment and ultimately improving pediatric cancer outcomes.
Transcranial alternating current stimulation improves quality of life in Parkinson’s disease: study protocol for a randomized, double-blind, controlled trial
Authors: Zhang Hong-yu , Hou Ting-ting , Jin Zhao-hui , Zhang Tian , Wang Yi-heng , Cheng Zi-hao , Liu Yong-hong , Fang Jin-ping , Yan Hong-jiao , Zhen Yi , An Xia , Du Jia , Chen Ke-ke , Li Zhen-zhen , Li Qing , Wen Qi-ping , Fang Bo-yan
Published: March 2024

Background

The neural cells in the brains of patients with Parkinson’s disease (PWP) display aberrant synchronized oscillatory activity within the beta frequency range. Additionally, enhanced gamma oscillations may serve as a compensatory mechanism for motor inhibition mediated by beta activity and also reinstate plasticity in the primary motor cortex affected by Parkinson’s disease. Transcranial alternating current stimulation (tACS) can synchronize endogenous oscillations with exogenous rhythms, thereby modulating cortical activity. The objective of this study is to investigate whether the addition of tACS to multidisciplinary intensive rehabilitation treatment (MIRT) can improve symptoms of PWP so as to enhance the quality of life in individuals with Parkinson’s disease based on the central-peripheral-central theory.

Methods

The present study was a randomized, double-blind trial that enrolled 60 individuals with Parkinson’s disease aged between 45 and 70 years, who had Hoehn-Yahr scale scores ranging from 1 to 3. Participants were randomly assigned in a 1:1 ratio to either the tACS + MIRT group or the sham-tACS + MIRT group. The trial consisted of a two-week double-blind treatment period followed by a 24-week follow-up period, resulting in a total duration of twenty-six weeks. The primary outcome measured the change in PDQ-39 scores from baseline (T0) to 4 weeks (T2), 12 weeks (T3), and 24 weeks (T4) after completion of the intervention. The secondary outcome assessed changes in MDS-UPDRS III scores at T0, the end of intervention (T1), T2, T3, and T4. Additional clinical assessments and mechanistic studies were conducted as tertiary outcomes.

Discussion

The objective of this study is to demonstrate that tACS can enhance overall functionality and improve quality of life in PWP, based on the framework of MIRT. Additionally, it seeks to establish a potential correlation between these therapeutic effects and neuroplasticity alterations in relevant brain regions. The efficacy of tACS will be assessed during the follow-up period in order to optimize neuroplasticity and enhance its potential impact on rehabilitation efficiency for PWP.

Trial registration

Chinese Clinical Trial Registry ChiCTR2300071969. Registered on 30 May 2023.
On the maximum principle for relaxed control problems of nonlinear stochastic systems
Authors: Mezerdi Meriem , Mezerdi Brahim
Published: March 2024

We consider optimal control problems for a system governed by a stochastic differential equation driven by a d-dimensional Brownian motion where both the drift and the diffusion coefficient are controlled. It is well known that without additional convexity conditions the strict control problem does not admit an optimal control. To overcome this difficulty, we consider the relaxed model, in which admissible controls are measure-valued processes and the relaxed state process is governed by a stochastic differential equation driven by a continuous orthogonal martingale measure. This relaxed model admits an optimal control that can be approximated by a sequence of strict controls by the so-called chattering lemma. We establish optimality necessary conditions, in terms of two adjoint processes, extending Peng’s maximum principle to relaxed control problems. We show that relaxing the drift and diffusion martingale parts directly as in deterministic control does not lead to a true relaxed model as the obtained controlled dynamics is not continuous in the control variable.
Primary care involvement in clinical research – prerequisites, motivators, and barriers: results from a study series
Authors: Wangler Julian , Jansky Michael
Published: March 2024

Background

Long-term reinforcement in the role of primary care and improvement the healthcare system as a whole requires the involvement of GPs in clinical research processes. However, many clinical studies fail due to failure to achieve sample population targets amongst GPs and their patients. This issue has been identified and discussed, but effective strategies to overcome it are still lacking. One of the reasons is that the positions, requirements, and experiences of GPs on participating in clinical research have hardly been examined up to now.

Methods

The years 2021 and 2022 saw three quantitative and qualitative surveys amongst GPs in Germany with the aim of shedding light on the attitudes, experiences, and potential issues regarding the involvement of primary care in clinical research projects and participation in cluster-randomised controlled trials (cRCTs) in a general sense. This overview summarises and abstracts conclusions gained from the exploratory series of studies and compares the results with the current research situation. From here, this contribution will then develop an approach towards optimising the integration of GPs into clinical research.

Results

Most of the GPs asked associated clinical research with opportunities and potential such as closing gaps in healthcare, using evidence-based instruments, optimising diagnostic and therapeutic management, and reinforcement of multiprofessional healthcare. Even so, many GPs unsure as to how far primary care in particular would stand to benefit from studies of this type in the long term. Respondents were also divided on willingness to participate in clinical research. GPs having already participated in Innovation Fund projects generally saw a benefit regarding intervention and cost–benefit relationship. However, some also reported major hurdles and stress factors such as excessive documentation and enrolment requirements, greater interference in practice routines, and sometimes poor integration into project processes such as in communication and opportunities to play an active role in the project.

Conclusions

Results from the studies presented provide indications as to how GPs perceive clinical research projects and cRCTs as a whole and from their existing project experience, and on the requirements that studies would have to meet for GPs to be willing to participate. In particular, making sure that clinical studies fully conform with GPs would play a major role; this especially applies to freedom to make medical decisions, limitation of documentation obligations, interference in regular practice routine, greater involvement in research planning, and long-term reinforcement in the role of primary care. Clinical research projects and cRCTs should be planned, designed, and communicated for clear and visible relevance to everyday primary care.
Under the surface of teacher occupational wellness and effectiveness in higher education: a look into the mediator roles of work passion and emotion regulation via SEM analysis
Authors: Yu Xiumin , Ying Tongxiu
Published: March 2024

Teacher occupational wellness and effectiveness are crucial aspects of a teacher's capacity to contribute to the advancement of excellence in education. Nevertheless, there is a dearth of considerable studies regarding the interconnections between work passion and emotion regulation in higher education. This study developed a model to demonstrate the interplay between the above-mentioned constructs to fill this research gap. To gather this information, the required scales were sent to 401 different university professors. Based on the findings of Structural Equation Modelling (SEM) and Confirmatory Factor Analysis (CFA), it is suggested that work passion and emotion regulation have the potential to enhance teacher occupational wellness and effectiveness in higher education. In the end, implications and directions for the future were presented to educators and researchers who are enthused about the potential of work passion, emotion regulation, and self-compassion for improving instructive practices.
Development of a modified 3D region proposal network for lung nodule detection in computed tomography scans: a secondary analysis of lung nodule datasets
Authors: Lin Chia-Ying , Guo Shu-Mei , Lien Jenn-Jier James , Tsai Tzung-Yi , Liu Yi-Sheng , Lai Chao-Han , Hsu I-Lin , Chang Chao-Chun , Tseng Yau-Lin
Published: March 2024

Background

Low-dose computed tomography (LDCT) has been shown useful in early lung cancer detection. This study aimed to develop a novel deep learning model for detecting pulmonary nodules on chest LDCT images.

Methods

In this secondary analysis, three lung nodule datasets, including Lung Nodule Analysis 2016 (LUNA16), Lung Nodule Received Operation (LNOP), and Lung Nodule in Health Examination (LNHE), were used to train and test deep learning models. The 3D region proposal network (RPN) was modified via a series of pruning experiments for better predictive performance. The performance of each modified deep leaning model was evaluated based on sensitivity and competition performance metric (CPM). Furthermore, the performance of the modified 3D RPN trained on three datasets was evaluated by 10-fold cross validation. Temporal validation was conducted to assess the reliability of the modified 3D RPN for detecting lung nodules.

Results

The results of pruning experiments indicated that the modified 3D RPN composed of the Cross Stage Partial Network (CSPNet) approach to Residual Network (ResNet) Xt (CSP-ResNeXt) module, feature pyramid network (FPN), nearest anchor method, and post-processing masking, had the optimal predictive performance with a CPM of 92.2%. The modified 3D RPN trained on the LUNA16 dataset had the highest CPM (90.1%), followed by the LNOP dataset (CPM: 74.1%) and the LNHE dataset (CPM: 70.2%). When the modified 3D RPN trained and tested on the same datasets, the sensitivities were 94.6%, 84.8%, and 79.7% for LUNA16, LNOP, and LNHE, respectively. The temporal validation analysis revealed that the modified 3D RPN tested on LNOP test set achieved a CPM of 71.6% and a sensitivity of 85.7%, and the modified 3D RPN tested on LNHE test set had a CPM of 71.7% and a sensitivity of 83.5%.

Conclusion

A modified 3D RPN for detecting lung nodules on LDCT scans was designed and validated, which may serve as a computer-aided diagnosis system to facilitate lung nodule detection and lung cancer diagnosis.
Magnetic resonance imaging in dental implant surgery: a systematic review
Authors: Al-Haj Husain Adib , Zollinger Marina , Stadlinger Bernd , Özcan Mutlu , Winklhofer Sebastian , Al-Haj Husain Nadin , Schönegg Daphne , Piccirelli Marco , Valdec Silvio
Published: March 2024

Purpose

To comprehensively assess the existing literature regarding the rapidly evolving in vivo application of magnetic resonance imaging (MRI) for potential applications, benefits, and challenges in dental implant surgery.

Methods

Electronic and manual searches were conducted in PubMed MEDLINE, EMBASE, Biosis, and Cochrane databases by two reviewers following the PICOS search strategy. This involved using medical subject headings (MeSH) terms, keywords, and their combinations.

Results

Sixteen studies were included in this systematic review. Of the 16, nine studies focused on preoperative planning and follow-up phases, four evaluated image-guided implant surgery, while three examined artifact reduction techniques. The current literature highlights several MRI protocols that have recently investigated and evaluated the in vivo feasibility and accuracy, focusing on its potential to provide surgically relevant quantitative and qualitative parameters in the assessment of osseointegration, peri-implant soft tissues, surrounding anatomical structures, reduction of artifacts caused by dental implants, and geometric accuracy relevant to implant placement. Black Bone and MSVAT-SPACE MRI, acquired within a short time, demonstrate improved hard and soft tissue resolution and offer high sensitivity in detecting pathological changes, making them a valuable alternative in targeted cases where CBCT is insufficient. Given the data heterogeneity, a meta-analysis was not possible.

Conclusions

The results of this systematic review highlight the potential of dental MRI, within its indications and limitations, to provide perioperative surgically relevant parameters for accurate placement of dental implants.

Graphical Abstract
Research on cooling load estimation through optimal hybrid models based on Naive Bayes
Authors: Xu Ying
Published: March 2024

Cooling load estimation is crucial for energy conservation in cooling systems, with applications like advanced air-conditioning control and chiller optimization. Traditional methods include energy simulation and regression analysis, but artificial intelligence outperforms them. Artificial intelligence models autonomously capture complex patterns, adapt, and scale with more data. They excel at predicting cooling loads influenced by various factors, like weather, building materials, and occupancy, leading to dynamic, responsive predictions and energy optimization. Traditional methods simplify real-world complexities, highlighting artificial intelligence’s role in precise cooling load forecasting for energy-efficient building management. This study evaluates Naive Bayes-based models for estimating building cooling load consumption. These models encompass a single model, one optimized with the Mountain Gazelle Optimizer and another optimized with the horse herd optimization algorithm. The training dataset consists of 70% of the data, which incorporates eight input variables related to the geometric and glazing characteristics of the buildings. Following the validation of 15% of the dataset, the performance of the remaining 15% is tested. Based on analysis through evaluation metrics, among the three candidate models, Naive Bayes optimized with the Mountain Gazelle Optimizer (NBMG) demonstrates remarkable accuracy and stability, reducing prediction errors by an average of 18% and 31% compared to the other two models (NB and NBHH) and achieving a maximum R2 value of 0.983 for cooling load prediction.
Μεταβολομική και λιπιδομική ανάλυση στη μελέτη καρδιαγγειακών και μεταβολικών παθήσεων σε ασθενείς και μοντέλο ζωών
Authors: Μουσκεφτάρα Θωμαή
Published: March 2024

Η μεταβολομική και η λιπιδομική ανάλυση συμβάλλουν καθοριστικά στην κατανόηση του ρόλου που διαδραματίζουν συγκεκριμένοι μεταβολίτες μικρού μοριακού βάρους και λιπίδια στις μεταβολικές διαταραχές που σχετίζονται με τις καρδιαγγειακές και μεταβολικές παθήσεις. Στο πρώτο κεφάλαιο αυτής της διατριβής, διερευνήθηκαν τα προφίλ των λιπιδίων των ασθενών με βάση την ύπαρξη ή όχι της αποφρακτικής στεφανιαίας νόσου (ΣΝ). Τα δείγματα του ορού αίματος αναλύθηκαν με την τεχνική LC–MS Orbitrap από όπου ταυτοποιήθηκαν 517 είδη λιπιδίων. Με τη μονοπαραμετρική και πολυπαραμετρική στατιστική ανάλυση ανεδείχθη η διάκριση μεταξύ των ασθενών με αποφρακτική και χωρίς αποφρακτική ΣΝ. Πιο συγκεκριμένα, τα επίπεδα των γλυκεροφωσφολιπιδίων, σφιγγολιπιδίων και γλυκερολιπιδίων ήταν σημαντικά διαφοροποιημένα στους ασθενείς με αποφρακτική ΣΝ. Τέλος, ο αλγόριθμος Μηχανικής Μάθησης XGBoost εντόπισε ένα πάνελ 17 βιοδεικτών στον ορό αίματος ικανό να προβλέψει την αποφρακτική ΣΝ. Στο δεύτερο κεφάλαιο της διατριβής, πραγματοποιήθηκε η λεπτομερής διερεύνηση των αλλαγών στο προφίλ λιπιδίων του ήπατος και του λιπώδους ιστού σε μοντέλο μυών Μη Αλκοολικής Λιπώδους Νόσου του Ήπατος (ΜΑΛΝΗ) που επάγεται έπειτα από δίαιτα υψηλής περιεκτικότητας σε λιπαρά με ταυτόχρονη χορήγηση 5% High Corn Fructose Syrup. Στόχος ήταν να διερευνηθούν οι αλλαγές που προκαλούνται από την άσκηση και την απώλεια βάρους στα λιπίδια του ήπατος και του λιπώδους ιστού των μυών με τη μη στοχευμένη UΗPLC-TOF-MSMS λιπιδομική ανάλυση. Αρκετές κατηγορίες λιπιδίων συνέβαλαν στη διάκριση των ομάδων όπως τα γλυκερολιπίδια, τα γλυκεροφωσφολιπίδια, τα σφιγγολιπίδια και τα λιπαρά οξέα όσον αφορά τα δείγματα ήπατος, ενώ τα τριγλυκερίδια ήταν η μοναδική κατηγορία λιπιδίων που βρέθηκε διαταραγμένη στον λιπώδη ιστό. Τα λιπίδια που βρέθηκαν απορυθμισμένα σχετίζονται με καθιερωμένες μεταβολικές οδούς που εμπλέκονται στη βιοσύνθεση των PCs και PEs και στο μεταβολισμό των TGs. Στο τελευταίο κεφάλαιο της διατριβής πραγματοποιήθηκε μια ολοκληρωμένη μελέτη του μεταβολικού προφίλ των ασθενών με ΜΑΛΝΗ και των υγιών μαρτύρων στα δείγματα πλάσματος, βιοψίας ήπατος και ούρων. Οι αναλύσεις των δειγμάτων πραγματοποιήθηκαν με στοχευμένες HILIC-MSMS, RPLC-MSMS και GC-MS μεθόδους όπως επίσης και με τη μη στοχευμένη UΗPLC-TOF-MSMS λιπιδομική ανάλυση. Τα δεδομένα χρησιμοποιήθηκαν για την ανάπτυξη ενός προγνωστικού αλγορίθμου, ο οποίος εντόπισε ένα σύνολο 15 βιοδεικτών στο πλάσμα αίματος που μπορούν να προβλέψουν την εξέλιξη της μη αλκοολικής στεατοηπατίτιδας. Η μελέτη των δειγμάτων της βιοψίας του ήπατος παρουσίασε διαφοροποιήσεις μεταξύ ειδών τριγλυκεριδίων και λιπαρών οξέων. Τέλος, αναπτύχθηκε μια γρήγορη απλή και αξιόπιστη μέθοδος για τον ποσοτικό προσδιορισμό 48 οργανικών οξέων στα ούρα των ασθενών με ΜΑΛΝΗ και των υγιών μαρτύρων. Η μέθοδος βελτιστοποιήθηκε όσον αφορά τις συνθήκες ανάλυσης στην οργανολογία GC-MSMS, τις μεθόδους εκχύλισης και παραγωγοποίησης των οργανικών οξέων, ενώ επικυρώθηκε με βάση τις τρέχουσες οδηγίες για βιοαναλυτικές μεθόδους.
Adapted systematic review of implementation science strategies applied to digital health interventions (DHIs) in low middle income countries (LMICs): Impact on adoption and utilisation
Authors: Odoh Lynda , Aimiosior Obehi
Published: March 2024

Background Post the COVID-19 pandemic and with rising connectivity, digital health Interventions (DHIs) are being leveraged by innovators in Low middle-income countries (LMICs), to address healthcare challenges. Despite huge investments, interventions are poorly utilised due to health systems complexities, limited digital readiness and socioeconomic factors. Evolving evidence suggests that implementation science strategies can play a significant role in reducing the complexities within the sociotechnical domains. This study aims to understand how implementation science strategies are being applied to patient-focused DHIs in LMICs, its impact on adoption and utilisation. Methods A triangulated search was conducted on five electronic databases using a pretested strategy. A heterogeneous range of study types on patient-focused DHIs was included to capture different research methodologies used to describe implementation. The screening was done by two reviewers using inclusion/exclusion criteria registered on PROSPERO. Quality was accessed using the JBI appraisal tool for case studies, the CASP quality assessment tool for systematic reviews and qualitative studies, and the ROBIN-I tool for quasi-experimental studies. Synthesis was by Popay et al's guidance on narrative synthesis. Results Eleven studies from eight countries met the inclusion criteria. Through the lens of the NASSS framework and the ERIC clusters, forty-five implementation science strategies out of seventy-three were identified of which only twenty-seven percent of included studies applied more than fifty percent of the identified strategies. Conclusions The trend revealed that DHIs with higher and strategic application patterns tackled more sociotechnical system complexities and experienced better adoption/ utilisation. For the basics, we identified four heavy weight favorability factors that should be considered when choosing implementation strategies in this context. Large scale randomised interventional studies are however recommended to further measure impact. PROSPERO Registration number: CRD42023388786
Building BPJS Image, Public Trust and Intention to Use JKN Mobile Services During the Covid Pandemic
Authors:   Faculty of Economics and Business, Mahasaraswati Denpasar University, Widiani Elly , Kusuma I Gusti Agung Eka Teja , Widnyana I Wayan
Published: March 2024

Abstract. Purpose: to analyze the ability of the National Health Insurance mobile service quality to build BPJS brand image and public trust to increase intention to use online services during the Covid period. The background of this research is based on the phenomenon in the form of complaints on the quality of online services and research gaps on the effect of service quality on the intention to use online services. Brand image and trust are offered as a mediation for gaps in previous research results. Design/methodology/approach: The type of research is quantitative, using a pre-existing measurement scale related to mobile service quality, brand image, trust and intention. Involving a sample of 140 BPJS users during the Covid pandemic. It is difficult to identify the population size, the sample size is determined by the formulation of a constant value of 5 multiplied by 28 indicators. The technique of selecting respondents was carried out by means of non-probability random sampling. PLS SEM model as an analysis tool. Findings: The results of this study indicate that the direct relationship of mobile service quality on brand image, trust and intention shows significant positive results. Furthermore, the influence of brand image on trust shows significant results. The influence of brand image and trust on intention is also found to be significantly positive. Practical/implications: although management policies encourage customers to use mobile services more, the public still considers the trustworthy image of BPJS to develop their intention to use mobile application services. The government must remain consistent in ensuring that the quality of mobile service is not compromised because the implications for BPJS image and public trust are at stake. Through the person in charge at BPJS, the government must continue to consistently evaluate and improve the system and educate the public regarding this BPJS health mobile service system. Originality/value: This research offers new insights, filling gaps in studies on national health insurance mobile services during the Covid-19 Pandemic Keywords: BPJS Health, Mobile JKN, Image, Trust, Intention
Are Content Marketing and Switching Barriers Decisive in Building Consumer Satisfaction, Trust and Loyalty on Ride-Hailing Services in Indonesia
Authors:   Faculty of Economics and Business, Tanjungpura University, Pontianak, Indonesia, Ramadania Ramadania , Hartono Hartono , Juniwati Juniwati , Hendra Hendra ,   International Marketing Management Study Program, Politeknik Wilmar Bisnis Indonesia, Deli Serdang, Indonesia, Reswari Rianti Ardana ,   Faculty of Economic & Business, Universitas Panca Bhakti
Published: March 2024

Abstract. This study is aimed to investigate factors influencing customer loyalty of community-based ride-hailing service in Indonesia. More specifically, this study examines the relationship between content marketing, switching barriers, customer trust, and satisfaction toward customer loyalty. Data was collected through a survey of 180 respondents. Proposed hypothesis is tested using Partial Least Squares - Structural Equation Modelling. The variables in this study are content marketing and switching barriers as exogenous variables, trust and satisfaction as endogenous intervening variables and customer loyalty being final endogenous variables. The measurement scale uses a Likert scale from 1-5. The results show a positive influence between content marketing on customer trust and satisfaction, then there is also positive influence between satisfaction and trust on customer loyalty. However, switching barriers have no effect on trust, satisfaction, and loyalty of community-based ride hailing service users in Indonesia. The technique of collecting data through online media does not allow researchers to conduct in-depth interviews with respondents. Most of the existing research so far does not emphasize the importance of building loyalty through content marketing strategies. This study emphasizes the importance of content marketing strategies in building loyalty through intermediary satisfaction and trust in community-based ride hailing service businesses. Keywords: Content marketing, switching barriers, satisfaction, trust, loyalty, community-based ride hailing service.
Nursing care for a 41-year-old patient suffering from breast cancer in a hospital setting
Authors: Ryś Bogusława , Czul Aleksandra , Bąk Ewelina
Published: March 2024

Breast cancer is the most common cause of cancer-related deaths among women in the world. Its occurrence is mainly influenced by environmental factors, and to a lesser extent by genetic factors. The gold standard in diagnosis is mammography, but special attention should be paid to the need to educate women at an increasingly younger age in the field of breast self-examination. Treatment for breast cancer includes surgery, radiotherapy, chemotherapy and hormone therapy.
Predictors of maternal satisfaction with childbirth experience among first-time mothers in Phalombe District, Malawi
Authors: Chilikutali Andrew , Kumbani Lily , Kafulafula Ursula
Published: March 2024

Background/Aims

Assessing maternal satisfaction with care improves healthcare professionals' understanding of women's needs at maternal healthcare services and can encourage future use of hospital-based intrapartum care. This study's aim was to explore predictors of maternal satisfaction with their childbirth experience at health facilities in Phalombe District, Malawi.

Methods

A cross-sectional study was conducted with 254 first-time mothers, recruited using systematic random sampling. Data were collected using questionnaires and analysed using bivariate and multivariate analyses to determine predictors of maternal satisfaction.

Results

Only half (49.2%) of participants were satisfied with their childbirth experience. Welcoming and encouraging doctors/midwives (P<0.001) and being kept informed during labour (P=0.001) were the main predictors of maternal satisfaction.

Conclusions

Maternal satisfaction is impacted by a woman's relationship with her care providers and the information imparted during care. To improve maternal satisfaction with care at the study site, there is a need for healthcare providers to improve their interpersonal relationships with labouring women and provide adequate information during care.
Cross-sectional study of perceptions of competence and confidence in feline handling
Authors: White Gillian L , Fontaine Samantha J
Published: March 2024

Background:

Cats may be difficult to manage in the clinical environment as a result of behavioural responses to fear and stress, which can be misinterpreted as aggression. Registered veterinary nurses require both attributes of competence and confidence when working with feline patients.

Methods:

152 registered veterinary nurses working in small animal practice were recruited to this cross-sectional mixed-methods online survey study.

Results:

The results show that perceptions of competence and confidence are high, and both attributes are linked. Perceived competence and confidence across different scenarios were scored, with both attributes positively correlating – this was significantly higher with participant enjoyment and when handling amenable cats. Scores for handling difficult cats were significantly impacted by participant age, qualification, time qualified, ownership and previous experience. However, sample bias cannot be discounted, and the sample size was small.

Conclusions:

Registered veterinary nurses should be supported to develop both competence and confidence over time, especially when working with challenging patients. Overcoming negative experiences may be important for improving feline care, and further training may be one way to support this.
Qualitative, statistical, and extreme properties of spectral indices of signable pseudo-invertible graphs
Authors: Pavlikova Sona , Sevcovic Daniel
Published: March 2024

In this paper, we investigate the Moore-Penrose inversion of a simple connected graph. We analyze qualitative, statistical, and extreme properties of spectral indices of signable pseudo-invertible graphs. We introduce and analyze a wide class of signable pseudo-invertible simple connected graphs. It is a generalization of the classical concept of positively integrally invertible graphs due to Godsil. We present several constructions of signable pseudo-invertible graphs. We also discuss statistical properties of various spectral indices of the class of signable pseudo-invertible graphs.
Extreme Learning Machine Predicts High-Frequency Stream flow and Nitrate-N Concentrations in a Karst Agricultural Watershed
Authors: McGill Timothy , Ford William Isaac
Published: March 2024

Highlights

A novel high-frequency dataset of streamflow, nitrate-N concentration, and soil moisture at depths throughout and below the root zone highlighted tight connectivity between soil moisture dynamics and nitrate-N concentrations spanning event to seasonal timescales.

A TELM model successfully predicted both flow rate and nitrate exports from these complex systems because the time lag associated with the soil conditions was represented in model training.

The inclusion of soil moisture and temperature data below the effective root zone was important to accurately capture the storm event hysteresis dynamics observed in the exported nitrate signals.

Abstract. Efforts to reduce nitrogen contributions from karst agroecosystems have had variable success, in part due to an incomplete understanding of nitrogen source, fate, and transport dynamics in karst watersheds. Recent advancements in environmental sensors and data-driven artificial intelligence models may be useful in improving our understanding of system behavior and the linkages between soil hydrologic processes and karst nitrate loading dynamics. We collected 35 months of high-resolution streamflow, nitrate-N concentration, soil moisture and temperature (from 10-100 cm depths), and meteorological data in a karst agricultural watershed in the Inner-Bluegrass region of Central Kentucky. Two-layer extreme learning machine (TELM) models were developed to predict nitrate-N concentrations and flow rates as a function of meteorological and soil parameter inputs. Results suggest tight linkages between soil moisture gradients at different depths and nitrate-N concentrations at the watershed outlet. TELM modeling results supported visual observations from the high-frequency data and suggest that inclusion of both soil moisture and temperature parameters at all soil depths improved predictions of both flow rate and nitrate-N concentration (with optimal NSE values of 0.93 and 0.94, respectively, when all inputs were considered). Hysteresis analysis suggested that inclusion of the deepest soil layer (100 cm) was necessary to predict hysteresis observed during storm events. The findings of the study highlight the importance of variable activation of matrix waters in preferential flows throughout events and seasons and its subsequent impacts on nitrate-N concentrations. Results suggest that management models should incorporate vertical variability in soil hydrology to accurately characterize nitrate source and transport dynamics. Further, the results of hysteresis analysis underscore the importance of inclusion of hysteresis indices, in addition to typical model evaluation statistics, to ensure accurate representation of nutrient flow pathways. Keywords: Extreme learning machine, Karst agroecosystem, Nitrate, Water resources.
El proceso creador colectivo como estrategia de la pedagogía social: de John Dewey a Elizabeth Ellsworth
Authors: Martínez Cano Silvia
Published: March 2024

INTRODUCCIÓN. El modo de pensamiento y construcción del conocimiento hasta el siglo XX en Occidente ha sido mayoritariamente lineal, lógico, unidireccional, cerrado. Esto suponía una limitación en el aprendizaje que se centraba en una construcción del conocimiento individual y reproductivo de lo recibido de las instancias poseedoras del conocimiento. La pluralidad del siglo XXI nos invita a desarrollar un pensamiento en red, subjetivo, multidireccional, abierto y crítico. Estas características son propias de las artes, que abordan la creación como un proceso multidimensional para conocer un problema, intervenir en él y darle solución. En el proceso creador, que pone en relación la percepción y la observación, lo manipulativo y lo experimental sacan al sujeto de la pasividad reproductora y lo empujan hacia la creación de nuevos conocimientos. Se construye, así, un tiempo de tránsito entre lo que uno ha sido y lo que puede llegar a ser. MÉTODO. El artículo realiza una aproximación filosófica a la relación entre proceso creador y proceso de aprendizaje de lo social con el propósito de describir cuáles son los elementos del proceso creador que contribuyen hoy a una pedagogía social más inclusiva y democrática. Para ello, relacionamos dos autores de épocas distintas J. Dewey y E. Ellsworth que tienen un interés común por una sociedad inclusiva y colaborativa. RESULTADOS. La reflexión busca facilitar la implementación en los entornos educativos del proceso creador de tal manera que favorezca un aprendizaje respetuoso con la diversidad y capaz de asumir pedagogías sociales como prácticas políticas propias del paradigma plural contemporáneo. DISCUSIÓN. La presencia de procesos creadores comunitarios en el lugar educativo ofrece un espacio intermedio de libertad al alumnado, donde se incorpora un pensamiento crítico que invita colectivamente a la construcción de alternativas sociales que sean patrimonio de todo ser humano.
Accessory Extensor Pollicis Longus Spanning the Fourth Dorsal Compartment of the Wrist: A Case Report
Authors:   Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA,, Saade Aziz , Seaver Thomas ,   Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA,, Kompel Andrew ,   Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA, Deune Eagen Gene ,   Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts, USA,
Published: March 2024

Introduction: Variations of the extensor pollicis longus (EPL) tendon of the hand are not uncommon. Yet, this anatomic structure exhibits the least variations among the extensors of the upper extremity. Case Report: This article highlights the presence of an accessory EPL tendon in the fourth dorsal compartment, which was presented as an incidental finding during an elective wrist arthrodesis in a woman in her 40s. Conclusion: Knowledge of this anatomic variation can guide surgical planning and mitigate iatrogenic injury by anticipating potential challenges. Keywords: Extensor pollicis longus, anatomic variation, wrist arthrodesis.
Intraspinal Extradural Degenerative Cervical Cyst Treated by Anterior Cervical Discectomy and Fusion: A Surgical Alternative to the Posterior Approach, about One Case
Authors:   [1] Department of Neurosurgery, Rouen University Hospital, F-76000 Rouen, France, [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France,, Lozouet Mathieu , Derrey Stéphane ,   [1] Department of Neurosurgery, Rouen University Hospital, F-76000 Rouen, France, [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France,, Garrido Elisabeth ,   [1] Department of Neurosurgery, Rouen University Hospital, F-76000 Rouen, France, [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France,, Slimane Mourad Ould ,   [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France, [3] Department of Orthopaedic Surgery, Rouen University Hospital, F76000 Rouen, France., Cantogrel Pauline ,   [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France, [3] Department of Orthopaedic Surgery, Rouen University Hospital, F76000 Rouen, France., Curey Sophie ,   [1] Department of Neurosurgery, Rouen University Hospital, F-76000 Rouen, France, [2] Department of Spine surgery Rouen University Hospital, Spine Institute, F76000 Rouen, France,
Published: March 2024

Introduction: Intraspinal extradural arthrosynovial cysts, which belong to the spectrum of degenerative spinal diseases are mainly located at lumbar level and their location at cervical level joint is therefore unusual. The most common surgical approach for symptomatic arthrosynovial cervical cyst remains a direct resection of the cyst by a cervical hemilaminectomy with or without a posterior arthrodesis. However, another surgical approach may also be discussed when considering the cyst as a result of a local spinal instability or hypermobility. Case Report: We report in this work the case of a patient with cervical radiculopathy due to intraspinal extradural compressive arthrosynovial cervical cyst which was treated by anterior discectomy and fusion without direct resection of the cyst. The post-operative radiological control performed at 3 months showed a complete regression of the cyst with a patient pain-free. To the best of our knowledge, this is the first case of intraspinal cervical degenerative cyst at C7-T1 level treated by anterior approach and fusion without direct cyst resection. Conclusion: For the treatment of a joint spinal cervical cyst, the anterior approach is a relevant option that gives the advantages to respect the posterior cervical muscles and articular structures. Keywords: Intraspinal cervical cyst, anterior discectomy and fusion, hemilaminectomy.
Fog and Filthy Air
Authors: Harris Jonathan Gil
Published: March 2024

Abstract: Building on the recent work of Dipesh Chakrabarty, this essay thinks about how Macbeth 's Witches introduce into the play an imagination that is both global and planetary. But whereas the global is a largely anthropocentric concept, mapping the world in terms of fixed states and cities such as Aleppo, the planetary is a frame that embeds the human within churning assemblages with nonhuman entities and elements. The "fog and filthy air" of Macbeth , and of my location in contemporary New Delhi, demand to be seen in this way.
Translations and Intertexts in Preti Taneja's We That Are Young : A Pedagogical Commentary
Authors: Lahiri Ray
Published: March 2024

Abstract: This piece examines the intertextual dynamics of Preti Taneja's "translation" of King Lear , act I, scene iv in We That Are Young . This passage, structurally Shakespearean and voiced through a translated hymn from the Rigveda, reactivates the colonial history of interpretation and contestation that has shaped both Shakespeare and Vedas. Such moments of intertextual abundance and proliferation offer pedagogically rich opportunities to dwell upon the history of translation and canonicity. Through the medium of commentary, students may examine the situatedness of their own engagement with Shakespeare—and the contemporary ethical and political binds to which Taneja has addressed her work.