bluuebunny/crossref_metadata_2025 huggingface dataset:
How self-regulated learning influences undergraduate medical students to conduct student-centred learning: a scoping review protocol
Authors: Shitarukmi Savitri , Claramita Mora , Rahayu Gandes Retno
Published: October 2023

Introduction

Self-regulated learning is one of the influencing factors in successful learning. There is a need to understand the factors influencing self-regulated learning in undergraduate medical students in implementing a student-centred learning curriculum. This scoping review aims to systematically identify and map undergraduate medical students’ self-regulated learning during student-centred learning implementation and to learn the tools used to measure it.

Methods and analysis

The scoping review will use Arksey and O’Malley’s proposed five-stage framework guideline. A search for published literature between 2012 and 2022 in the five electronic databases of EBSCOHost, Science Direct, Scopus, ProQuest and PubMed will be conducted using keywords to identify relevant studies. Articles will be limited to the English language. Mendeley software will eliminate duplicates, and results will be exported into abstracts for two stages of the screening process: title and abstract reviews and full-text reviews. The selection process of eligible literature will be reported using the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist recommendations. Studies using qualitative and quantitative data from all world regions will be considered. To be included, studies should examine medical students’ self-regulated learning in a student-centred learning approach curriculum. A data chart will capture relevant information from all the included studies. As a scoping review, no assessment of the studies’ quality and risk of bias will be made. Results will be presented in tabular form and a narrative report.

Ethics and dissemination

No Ethics Committee or Institutional Board approval is required. The findings of this study will be disseminated through peer-reviewed publications, conference presentations and professional networks.
Role and perspectives of informal care: a qualitative study of informal caregivers in the Republic of Croatia
Authors: Banadinović Maja , Vočanec Dorja , Lukačević Lovrenčić Iva , Lončarek Karmen , Džakula Aleksandar
Published: October 2023

Objectives

Population ageing and the prevalence of multimorbidity represent major challenges for healthcare systems. People who need long-term care have complex conditions requiring both health and social services. Informal caregivers are emerging as an important part of the long-term care ecosystem. This paper aims to explore the position and capacities of informal caregivers in Croatia.

Design

Health and social care legislative documents were analysed using a structured set of keywords. In addition, focus groups were conducted with informal caregivers who cared for a family member. The qualitative method of thematic analysis was used.

Setting and participants

Two focus groups were conducted with 15 caregivers (13 women and 2 men). Geographically, participants came from all four NUTS2 Croatian regions. All participants cared for a close family member. The length of care provision ranged from 3 to 35 years. Focus groups were conducted using the Zoom platform.

Results

The analysis of the documents indicates the fragmentation of national policy into health and social policy. Long-term care as a term is recognised only in health policy. However, some components related to long-term care are part of social policy. Caregivers are recognised in social policy, although not in healthcare. In focus groups, three main themes were identified as follows: (1) position and role of the caregivers in the system and society; (2) types of care based on the recipient’s need and (3) support for the caregivers.

Conclusion

The research showed that the process of exercising certain rights and services for caregivers is not sufficiently clear and feasible in practice. There is a lack of a clearly defined role of caregivers and relationships towards professional care providers in the system. The key to improving long-term care is connecting community services, including health and social services, both formal and informal, with the process of providing care.
Epidemiology of emergency and elective caesarean section and its association with early neonatal mortality in sub-Saharan African countries
Authors: Sandie Arsène Brunelle , Mutua Martin K , Sidze Estelle , Nyakangi Vivian , Sylla El Hadji Malick , Wanjoya Anthony , Njom Nlend Anne Esther , Faye Cheikh
Published: October 2023

Introduction

Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA.

Methods

SSA countries Demographic and Health Surveys data that had collected information on the CS’ timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries’ level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality.

Results

The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4–4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3–3.6). Private health facilities’ elective CS prevalence was estimated at 10.2% (95% CI 9.3–11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0–8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8–4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6–2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64–3.41), while no association was found with elective CS.

Conclusions

Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.
Voice of incarcerated male youths in Malawi’s semi-urban prisons: a qualitative study
Authors: Nkambule Ellen , Wella Kondwani , Mbakaya Balwani Chingatichifwe
Published: October 2023

Objective

Incarcerated male youths in Malawi’s detention facilities face multiple threats to their health and well-being. The most common challenges are overcrowding, poor sanitation and a lack of access to basic needs such as adequate food, bedding and healthcare. In addition, youth are vulnerable to sexual abuse.

Design

A qualitative approach using an exploratory study design was used to explore the experiences of incarcerated male youths in semi-urban prisons.

Setting

Two semi-urban prisons in Malawi.

Participants

Three focus group discussions (each with six participants) with incarcerated youths aged 18 were conducted.

Results

The following four themes emerged from the data: sexual violence perpetuated by other incarcerated persons; the need for sexual violence communication and prevention; trauma associated with incarceration and youth surviving prison life. The incarcerated male youths reported being given incentives such as extra food and adequate sleeping space in exchange for sexual favours with adult incarcerated people or incarcerated individuals with leadership positions. The victims of sexual abuse have had some difficulties reporting the incidences due to a non-existent reporting system for such matters to prison authorities.

Conclusions

This study reveals that the prison environment in Malawi is unsafe, particularly for incarcerated male youths who are at an increased risk of being victims of sexual violence. We recommend that the youths be separated from adults according to the Prison Rape Elimination Act standards. The prison officers should prevent incarcerated youth from having sight or physical contact with adult incarcerated people while in housing units. Policy-makers, prison authorities and researchers must safeguard and empower survivors of sexual violence in prisons.
Identifying the strengths, weaknesses, opportunities and threats (SWOT) of return-of-service bursary schemes for health workforce capacity: a qualitative study of Botswana, Lesotho and Eswatini
Authors: Mabunda Sikhumbuzo A , Durbach Andrea , Chitha Wezile W , Moaletsane Oduetse , Angell Blake , Joshi Rohina
Published: October 2023

Background

Investing in training citizens in return for service is a strategy used by Botswana, Eswatini and Lesotho to strengthen their health workforce. These strategies, known as return-of service (RoS) schemes, offer bursaries in exchange for future service. We aimed to ascertain the strengths, weaknesses, opportunities and threats (SWOT) of RoS schemes in these three Southern African countries to inform ongoing policy debates on the value of the schemes.

Methods

Qualitative semistructured interviews were undertaken via Microsoft Teams to elicit the perspectives of policy-makers who administer RoS schemes in each of these countries. The interview guide was developed from a detailed literature review, and discussions with policy-makers and other researchers. Interviews were conducted over a 17-month period between November 2020 and April 2022. We used deductive and inductive approaches to thematic analysis. Furthermore, we conducted internal and external analysis of the emergent themes using SWOT framework.

Results

We interviewed 9 policy-makers who had work experience that ranged from 5 to 22 years implementing the schemes. The organisational structure of the schemes was a strength compared with seventeen weaknesses, four opportunities and three threats. Prominent weaknesses are the outdated policy documents with some irrelevant and discriminatory conditions, rigid policies, failure to renew bilateral agreements, contextually different training from country of origin, high defaulter rates, poor coordination of schemes, poor monitoring and lack of evaluation of the schemes. Sustainability of the schemes in retaining health professionals is threatened by lack of funds. These schemes present opportunities to invest in effective information systems.

Conclusions

While the intention of the RoS schemes were to educate the citizens, develop the economy through increased employability of the citizenry and build the health workforce, the schemes were poorly planned and coordinated and have never been evaluated. Weak information systems and failure to employ some RoS beneficiaries render the scheme unsustainable.
Chinese herbal medicine combined with cognitive–behavioural therapy for avoidant paruresis: a controlled trial
Authors: Liang Shijie , Zhou Ying , Yu Chao , Gao Xiang , Ji Fangbin , Fang Qianyuan , Zhang Zhihang , Yang Libin , Zhao Youkang , Zhao Yuhui , Yin Renwu , Chen Kaimin , Lu Zheng
Published: October 2023

Background

Avoidant paruresis is a common clinical condition in urology and psychosomatic medicine. However, it has limited treatment options that are safe and effective with few side effects.

Aims

Our study aimed to investigate the effectiveness and safety of the Chinese herbal Yangxin Tongquan decoction combined with cognitive–behavioural therapy (CBT) for avoidant paruresis.

Methods

Sixty-eight patients with avoidant paruresis were divided into a treatment group (33 patients) and a control group (35 patients). The control group was assigned 10 weeks of CBT and systematic desensitisation. In addition to CBT and systematic desensitisation, the treatment group was given the Chinese herbal Yangxin Tongquan decoction during the 10-week study. The Shy Bladder Syndrome Scale (SBS) and the Self-rating Anxiety Scale (SAS) were administered before and after treatment to measure any change.

Results

The overall efficacy in the treatment group (n=30) was 80.0% vs 62.5% in the control group (n=33). Comparing pretreatment and post-treatment measures, both groups showed improvement in SBS scores and SAS scores (treatment group: t(SBS)=8.397, p(SBS)<0.001, t(SAS)=8.216, p(SAS)<0.001; control group: t(SBS)=6.802, p(SBS)<0.001, t(SAS)=5.171, p(SAS)<0.001). Moreover, both groups’ SBS and SAS scores changed significantly over time (SBS scores: Ftime=118.299, p<0.001; SAS scores: Ftime=92.114, p<0.001). However, the treatment group performed better than the control group (SBS scores: Ftime*group=5.709, p=0.020; SAS scores: Ftime*group=7.235, p=0.009).

Conclusions

The Chinese herbal Yangxin Tongquan decoction combined with cognitive–behavioural psychotherapy positively affects the treatment of avoidant paruresis without significant adverse effects.
Pathophysiological insights into machine learning-based subphenotypes of acute heart failure with preserved ejection fraction
Authors: Sotomi Yohei , Tamaki Shunsuke , Hikoso Shungo , Nakatani Daisaku , Okada Katsuki , Dohi Tomoharu , Sunaga Akihiro , Kida Hirota , Sato Taiki , Matsuoka Yuki , Sakamoto Daisuke , Kitamura Tetsuhisa , Komukai Sho , Seo Masahiro , Yano Masamichi , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Ohtani Tomohito , Yasumura Yoshio , Yamada Takahisa , Sakata Yasushi
Published: October 2023

Objective

The heterogeneous pathophysiology of the diverse heart failure with preserved ejection fraction (HFpEF) phenotypes needs to be examined. We aim to assess differences in the biomarkers among the phenotypes of HFpEF and investigate its multifactorial pathophysiology.

Methods

This study is a retrospective analysis of the PURSUIT-HFpEF Study (N=1231), an ongoing, prospective, multicentre observational study of acute decompensated HFpEF. In this registry, there is a predefined subcohort in which we perform multibiomarker tests (N=212). We applied the previously established machine learning-based clustering model to the subcohort with biomarker measurements to classify them into four phenotypes: phenotype 1 (n=69), phenotype 2 (n=49), phenotype 3 (n=41) and phenotype 4 (n=53). Biomarker characteristics in each phenotype were evaluated.

Results

Phenotype 1 presented the lowest value of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C reactive protein, tumour necrosis factor-α, growth differentiation factor (GDF)-15, troponin T and cystatin C, whereas phenotype 2, which is characterised by hypertension and cardiac hypertrophy, showed the highest value of these markers. Phenotype 3 showed the second highest value of GDF-15 and cystatin C. Phenotype 4 presented a low NT-proBNP value and a relatively high GDF-15.

Conclusions

Distinctive characteristics of biomarkers in HFpEF phenotypes would indicate differential underlying mechanisms to be elucidated. The contribution of inflammation to the pathogenesis varied considerably among different HFpEF phenotypes. Systemic inflammation substantially contributes to the pathophysiology of the classic HFpEF phenotype with cardiac hypertrophy.

Trial registration number

UMIN-CTR ID: UMIN000021831.
UK trainees’ perceptions of leadership and leadership development
Authors: Snelling Iain , Brown Hilary , Hardy Louise , Somerset Lara , Bosence Samantha , Thurlow Jane
Published: October 2023

Purpose

This paper reports on trainees’ perceptions of leadership and leadership development, to inform the support that may be provided to them. It draws on a formative evaluation of the new role of clinical leadership mentor (CLM), introduced by Health Education England South-West in 2018. CLMs are responsible for ‘overseeing the process and progress of leadership development among the trainees within their Trust/Local Education Provider’.

Methods

The evaluation was a formative evaluation, based on interviews with CLMs, trainees and trainers and a survey of trainees and trainers. Recruitment was through 8 of the 19 CLMs in the South West. A report for each participating CLM was available to support the development of their individual role. In exploring trainees’ perceptions of leadership and leadership development, this paper draws on data from trainees: 112 survey returns which included over 7000 words of free text data and 13 interviews.

Findings

Our findings suggest a more nuanced understanding of leadership in medical trainees than was previously reported in the literature, and a wider acceptance of their leadership role. We highlight the problem of considering postgraduate doctors as a homogeneous group, particularly with reference to specialty. We also highlight that the organisational context for leadership development can be supportive or non-supportive. Leadership learning through genuine leadership experience with appropriate support from trainers and the wider Trust offers opportunities for both trainees and Trusts.

Practical implications

Trainees are accepting of their roles as leaders. The value of leadership learning through genuine leadership experience was highlighted. Improving the environment for leadership development offers Trusts and trainees opportunities for genuine service improvement.
Mission possible: open innovation in nursing and patient care services at Massachusetts General Hospital
Authors: Nadel Hiyam M , Al-Sultan Nour , Berger Alex , McCree Paula , Banister Gaurdia , Jung Olivia
Published: October 2023

Objectives

Although front-line nurses and staff are uniquely positioned to identify the inefficiencies and gaps in care delivery, formal processes are not always in place to hear from those very employees.

Design

We established a scalable process that embodies open innovation principles, to broaden and distribute the innovation locus.

Setting

Massachusetts General Hospital, Boston, MA.

Particpitants

We invited 8800+ nurses and other direct caregivers to participate in organisational problem solving.

Interventions

We solicited employees to (1) identify pain points and develop solutions and (2) crowd vote to indicate which ideas they want to see implemented.

Results

177 employees submitted 225 ideas, and 928 cast a vote. The 40 participants who submitted top-voted ideas were invited to develop a detailed implementation plan; of those, 27 submitted one. Four ideas emerged as winners.

Conclusions

Formulating a clear call for ideas, securing leadership buy-in and generating excitement about the process were essential to our efforts. Challenges associated with opening the innovation process involved managing a large volume of participants and submissions, and providing on-the-go training to nurses and staff who were not used to being asked to participate in organisational problem solving.
Maternal mental health: a key area for future research among women with congenital heart disease
Authors: Eli Karin , Lavis Anna , Castleman James S , Clift Paul F , Fox Caroline E , Giles Donna , Grocott Laura , Harrison Kirsty , Hudsmith Lucy E , Kaplan Katharina , McDougall Heather , Powell Charlene , Drury Nigel E
Published: October 2023

In this viewpoint, we respond to the recently published national priorities for research in congenital heart disease (CHD) among adults, established through the James Lind Alliance Priority Setting Partnership, with specific attention to priority 3 (mental health) and priority 5 (maternal health). Our recent policy impact project explored how maternal mental health is currently addressed in adult congenital heart disease (ACHD) services in the National Health Service, identified gaps and discussed possible ways forward. Our multidisciplinary discussion groups, which included women with lived experience of CHD and pregnancy, cardiology and obstetrics clinicians and medical anthropologists, found that while pregnancy and the postnatal period increase the mental health challenges faced by women with CHD, current services are not yet equipped to address them. Based on this work, we welcome the prioritisation of both mental health and maternal health in ACHD, and suggest that future research should focus on the overlaps between these two priority areas.
Mental health concerns precede quits: shifts in the work discourse during the Covid-19 pandemic and great resignation
Authors: del Rio-Chanona R. Maria , Hermida-Carrillo Alejandro , Sepahpour-Fard Melody , Sun Luning , Topinkova Renata , Nedelkoska Ljubica
Published: October 2023

To study the causes of the 2021 Great Resignation, we use text analysis and investigate the changes in work- and quit-related posts between 2018 and 2021 on Reddit. We find that the Reddit discourse evolution resembles the dynamics of the U.S. quit and layoff rates. Furthermore, when the COVID-19 pandemic started, conversations related to working from home, switching jobs, work-related distress, and mental health increased, while discussions on commuting or moving for a job decreased. We distinguish between general work-related and specific quit-related discourse changes using a difference-in-differences method. Our main finding is that mental health and work-related distress topics disproportionally increased among quit-related posts since the onset of the pandemic, likely contributing to the quits of the Great Resignation. Along with better labor market conditions, some relief came beginning-to-mid-2021 when these concerns decreased. Our study underscores the importance of having access to data from online forums, such as Reddit, to study emerging economic phenomena in real time, providing a valuable supplement to traditional labor market surveys and administrative data.
Time Image De-Noising Method Based on Sparse Regularization
Authors: Wang Xin , Dong Xiaogang
Published: October 2023

The blurring of texture edges often occurs during image data transmission and acquisition. To ensure the detailed clarity of the drag-time images, we propose a time image de-noising method based on sparse regularization. First, the image pixel sparsity index is set, and then an image de-noising model is established based on sparse regularization processing to obtain the neighborhood weights of similar image blocks. Second, a time image de-noising algorithm is designed to determine whether the coding coefficient reaches the standard value, and a new image de-noising method is obtained. Finally, the images of electronic clocks and mechanical clocks are used as two kinds of time images to compare different image de-noising methods, respectively. The results show that the sparsity regularization method has the highest peak signal-to-noise ratio among the six compared methods for different noise standard deviations and two time images. The image structure similarity is always above which shows that the proposed method is better than the other five image de-noising methods.
A mining industry overview of cobalt in Finland: exploration, deposits and utilization
Authors: Konnunaho Jukka , Eilu Pasi , Törmänen Tuomo , Karinen Tuomo , Ranta Jukka-Pekka , Rasilainen Kalevi , Nykänen Vesa , Pokki Jussi , Dehaine Quentin
Published: October 2023

Finland has a significant role in the European Union cobalt supply, with the largest known cobalt resources and only cobalt-producing mines in Europe. In addition, Finland is a globally significant producer of refined cobalt. However, Finland, along with the rest of Europe, is strongly dependent on cobalt imports. Recycled cobalt covers a small fraction of the country's demand, as well as that of the rest of Europe. Most of the cobalt deposits in Finland can be grouped into five genetic types (± subtypes). The orthomagmatic and Outokumpu types have been among the most important sources of cobalt in Finland. The Talvivaara type hosts the largest known cobalt resource in Europe, mostly in the Terrafame Sotkamo deposit. The most common cobalt minerals in the Finnish deposits are sulfides, and to a lesser extent sulfarsenides. These are concentrated by froth flotation, and the concentrates treated in Finnish cobalt refineries. An exception to this is the Terrafame Sotkamo mine, where bio-heap leaching technology is utilized for metal recovery, and metalliferous liquid is processed to battery-grade chemicals. Assessment of undiscovered mineral resources, prospectivity modelling, the exploration history and recent discoveries highlight the exploration potential for several types of Co-enriched mineral deposits in Finland.

Thematic collection:
This article is part of the energy-critical metals for a low carbon transition collection available at:
https://www.lyellcollection.org/topic/collections/critical-metals
Pesticide Exposure and Effects on Non-Apis Bees
Authors: Raine Nigel E. , Rundlöf Maj
Published: October 2023

Bees are essential pollinators of many crops and wild plants, and pesticide exposure is one of the key environmental stressors affecting their health in anthropogenically modified landscapes. Until recently, almost all information on routes and impacts of pesticide exposure came from honey bees, at least partially because they were the only model species required for environmental risk assessments (ERAs) for insect pollinators. Recently, there has been a surge in research activity focusing on pesticide exposure and effects for non- Apis bees, including other social bees (bumble bees and stingless bees) and solitary bees. These taxa vary substantially from honey bees and one another in several important ecological traits, including spatial and temporal activity patterns, foraging and nesting requirements, and degree of sociality. In this article, we review the current evidence base about pesticide exposure pathways and the consequences of exposure for non- Apis bees. We find that the insights into non- Apis bee pesticide exposure and resulting impacts across biological organizations, landscapes, mixtures, and multiple stressors are still in their infancy. The good news is that there are many promising approaches that could be used to advance our understanding, with priority given to informing exposure pathways, extrapolating effects, and determining how well our current insights (limited to very few species and mostly neonicotinoid insecticides under unrealistic conditions) can be generalized to the diversity of species and lifestyles in the global bee community. We conclude that future research to expand our knowledge would also be beneficial for ERAs and wider policy decisions concerning pollinator conservation and pesticide regulation.
Novel Therapeutic and Program-Based Approaches to Opioid Use Disorders
Authors: Liu Patricia , Korthuis P. Todd , Buchheit Bradley M.
Published: October 2023

Opioid use disorder continues to drive overdose deaths in many countries, including the United States. Illicit fentanyl and its analogues have emerged as key contributors to the complications and mortality associated with opioid use disorder. Medications for opioid use disorder treatment, such as methadone and buprenorphine, are safe and substantially reduce opioid use, infectious complications, and mortality risk, but remain underutilized. Polysubstance use and emerging substances such as xylazine and designer benzodiazepines create additional treatment challenges. Recent clinical and policy innovations in treatment delivery, including telemedicine, bridge clinics, and expanded models for accessing methadone have the potential to increase access to life-saving care for people living with opioid use disorder.
Precision Approaches to Chronic Obstructive Pulmonary Disease Management
Authors: Moll Matthew , Silverman Edwin K.
Published: October 2023

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD heterogeneity has hampered progress in developing pharmacotherapies that affect disease progression. This issue can be addressed by precision medicine approaches, which focus on understanding an individual's disease risk, and tailoring management based on pathobiology, environmental exposures, and psychosocial issues. There is an urgent need to identify COPD patients at high risk for poor outcomes and to understand at a mechanistic level why certain individuals are at high risk. Genetics, omics, and network analytic techniques have started to dissect COPD heterogeneity and identify patients with specific pathobiology. Drug repurposing approaches based on biomarkers of specific inflammatory processes (i.e., type 2 inflammation) are promising. As larger data sets, additional omics, and new analytical approaches become available, there will be enormous opportunities to identify high-risk individuals and treat COPD patients based on their specific pathophysiological derangements. These approaches show great promise for risk stratification, early intervention, drug repurposing, and developing novel therapeutic approaches for COPD.
Hypoxia-Induced Signaling in Gut and Liver Pathobiology
Authors: Solanki Sumeet , Shah Yatrik M.
Published: October 2023

Oxygen (O2) is essential for cellular metabolism and biochemical reactions. When the demand for O2 exceeds the supply, hypoxia occurs. Hypoxia-inducible factors (HIFs) are essential to activate adaptive and survival responses following hypoxic stress. In the gut (intestines) and liver, the presence of oxygen gradients or physiologic hypoxia is necessary to maintain normal homeostasis. While physiologic hypoxia is beneficial and aids in normal functions, pathological hypoxia is harmful as it exacerbates inflammatory responses and tissue dysfunction and is a hallmark of many cancers. In this review, we discuss the role of gut and liver hypoxia-induced signaling, primarily focusing on HIFs, in the physiology and pathobiology of gut and liver diseases. Additionally, we examine the function of HIFs in various cell types during gut and liver diseases, beyond intestinal epithelial and hepatocyte HIFs. This review highlights the importance of understanding hypoxia-induced signaling in the pathogenesis of gut and liver diseases and emphasizes the potential of HIFs as therapeutic targets.
Neurodegenerative Disease Tauopathies
Authors: Creekmore Benjamin C. , Watanabe Ryohei , Lee Edward B.
Published: October 2023

Tauopathies are a diverse group of progressive and fatal neurodegenerative diseases characterized by aberrant tau inclusions in the central nervous system. Tau protein forms pathologic fibrillar aggregates that are typically closely associated with neuronal cell death, leading to varied clinical phenotypes including dementia, movement disorders, and motor neuron disease. In this review, we describe the clinicopathologic features of tauopathies and highlight recent advances in understanding the mechanisms that lead to spread of pathologic aggregates through interconnected neuronal pathways. The cell-to-cell propagation of tauopathy is then linked to posttranslational modifications, tau fibril structural variants, and the breakdown of cellular protein quality control.
Clonal Hematopoiesis, Inflammation, and Hematologic Malignancy
Authors: Kanagal-Shamanna Rashmi , Beck David B. , Calvo Katherine R.
Published: October 2023

Somatic or acquired mutations are postzygotic genetic variations that can occur within any tissue. These mutations accumulate during aging and have classically been linked to malignant processes. Tremendous advancements over the past years have led to a deeper understanding of the role of somatic mutations in benign and malignant age-related diseases. Here, we review the somatic mutations that accumulate in the blood and their connection to disease states, with a particular focus on inflammatory diseases and myelodysplastic syndrome. We include a definition of clonal hematopoiesis (CH) and an overview of the origins and implications of these mutations. In addition, we emphasize somatic disorders with overlapping inflammation and hematologic disease beyond CH, including paroxysmal nocturnal hemoglobinuria and aplastic anemia, focusing on VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Finally, we provide a practical view of the implications of somatic mutations in clinical hematology, pathology, and beyond.
Impedance Spectroscopy and AC Conductivity Analysis of (Ba1−kCak)(Zr0.1Ti0.9)O3, (0.140 ≤ k ≤ 0.160), Ceramics
Authors: Biswas Don , Singh Surendra , Thapliyal Prashant , Rohilla Vishal , Kathait G. S. , Bahuguna A. S. , Sharma Prolay , Panwar N. S.
Published: October 2023

Ceramic pellets of (Ba1−kCak)(Zr1−zTiz)O3, (k = 0.140–0.160, z = 0.9) were prepared via solid-state reaction technique followed by double sintering. The impedance measurements were carried out at different temperatures and frequencies (12–1000 kHz). The NTCR nature exhibits the semiconducting behavior of the prepared BCZT ceramics in the measured temperature range. The temperature also has a considerable impact on the relaxing process. The characteristics of Nyquist plots show that bulk and grain boundary effects exist in BCZT ceramics. The bulk conductivity indicates an Arrhenius-type thermally activated process. The observed impedance spectra, relaxation behavior, and AC conductivity of the prepared compositions of BCZT ceramics will extend the possibilities for using this compound in various optoelectronic applications.
Evaluating an inquiry-based learning program
Authors: Nadkarni Aniket , Costa-Pinto Rahul , Hensman Tamishta , Harman Emily V. , Yanase Fumitaka , Lister Bruce G. , Nickson Christopher P. , Thomas Josephine S.
Published: October 2023

An inquiry-based learning (IBL) program was launched as part of a novel binational intensive care medicine education program. Postgraduate intensive care medicine practitioners participated in this education intervention, where facilitated group discussions explored core intensive care medicine concepts. Survey responses indicated overall satisfaction, engagement with the IBL format, and a constructivist approach to learning. This study provided new insights into the benefits and challenges of an IBL program in the context of practicing clinicians.
Developing a Depression Care Model for the Hill Tribes: A Family- and Community-Based Participatory Research
Authors: Singkhorn Onnalin , Hamtanon Pawadee , Moonpanane Katemanee , Pitchalard Khanittha , Sunsern Rachanee , Leaungsomnapa Yosapon , Phokhwang Chananan
Published: October 2023

A high prevalence of depression has been detected among individuals from the hill tribes in Thailand. However, there are no proper interventions to address this problem. Using a community-based participatory research (CBPR) design, the study team developed a model of depression care for this population. The study involved 45 people in the model development and 65 people in the model testing, who were patients, family members, village health volunteers (VHVs), community and religious leaders, healthcare personnel, NGOs, and local administrative staff. The model development was divided into three phases: understanding the current situation of depression and care, model development, and evaluation of its effectiveness using psychological and relevant outcomes. Questionnaires, observations, focus groups, and in-depth interviews were used for data collection, and content analysis was employed for qualitative data. The Wilcoxon signed-rank test was used to analyze changes in VHVs’ knowledge and skills before and after training. The resulting model, “SMILE,” consists of stakeholders’ readiness (S), external and internal motivations (M), interpersonal relationship (I), life and community assets (L), and empowerment (E). VHVs underwent training on the model, and after training, their knowledge increased significantly from

3.50
±
1.14

to

8.28
±
0.81

(

p
<
0.001

). Moreover, their basic counselling and depression screening skills showed improvement from

3.39
±
1.23

to

7.64
±
3.76

(

p
<
0.001

). The developed model can be applied to other hill tribe communities in Northern Thailand to improve depression care.
Genetic Polymorphisms of UDP-Glucuronosyltransferases and Susceptibility to Antituberculosis Drug-Induced Liver Injury: A Systematic Review and Meta-Analysis
Authors: Chen Xinyu , Hao Zhuolu , Wang Nannan , Zhu Jia , Yi Honggang , Tang Shaowen
Published: October 2023

Background and Aim. UDP-glucuronosyltransferases (UGTs) play an important role in drug metabolism and detoxification by catalyzing the glucuronidation reaction, which is associated with the occurrence of antituberculosis drug-induced liver injury (AT-DILI). The relationship between UGTs polymorphisms and AT-DILI risk has been reported but with inconsistent results. We conducted a systematic review and meta-analysis to summarize the previous study results and evaluate the precise relationships. Methods. The PRISMA statement was strictly followed, and the protocol was registered in PROSPERO (CRD42022339317). The PICOS framework was used: patients received antituberculosis treatment, UGTs polymorphisms (mutants), UGTs polymorphisms (wild), AT-DILI, and case-control studies. Eligible studies were searched through nine databases up to April 27, 2022. The study’s qualities were assessed by the revised Little’s recommendations. Meta-analysis was conducted with a random-effects model using odds ratios (ORs) with 95% confidence intervals (95% CIs) as the effect size. Results. Twelve case-control studies with 2128 cases and 4338 controls were included, and 32 single nucleotide polymorphisms (SNPs) in the seven UGT genes have been reported in Chinese and Korean. All studies were judged as high quality. The pooled results indicated that UGT1A1 rs3755319 (AC vs. AA, OR = 1.454, 95% CI: 1.100–1.921,

P

 = 0.009), UGT2B7 rs7662029 (G vs. A, OR = 1.547, 95% CI: 1.249–1.917,

P

 < 0.0001; GG + AG vs. AA, OR = 2.371, 95% CI: 1.779–3.160,

P

 < 0.0001; AG vs. AA, OR = 2.686, 95% CI: 1.988–3.627,

P

 < 0.0001), and UGT2B7 rs7439366 (C vs. T, OR = 0.585, 95% CI: 0.477–0.717,

P

 < 0.0001; CC + TC vs. TT, OR = 0.347, 95% CI: 0.238–0.506,

P

 < 0.0001; CC vs. TC + TT, OR = 0.675, 95% CI: 0.507–0.898,

P

 = 0.007) might be associated with the risk of AT-DILI. Conclusions. The polymorphisms of UGT1A1 rs3755319, UGT2B7 rs7662029, and UGT2B7 rs7439366 were significantly associated with AT-DILI susceptibility. However, this conclusion should be interpreted with caution due to the low number of studies and the relatively small sample size.
Deformation Characteristics of a Deep Subway Foundation Pit in Hard Rock Strata under a Delayed Supporting Condition
Authors: Li Yang , Ma Zhanguo , Gao Furong , Gong Peng , Gong Zhiqun , Li Kelong
Published: October 2023

In this investigation, deformations of a deep foundation pit in hard rock strata, respectively, under delayed and in-time supporting schemes of one-layer transverse reinforced concrete bracings at the top of the foundation pit, one-layer steel bracings at a depth of 8 m, and one-layer prestressed anchorages at a depth of 22.5 m during excavation were characterized according to lateral deformations of the foundation pit, settlements of the surrounding ground, and axial forces of the steel bracings according to numerical calculations and on-site monitoring. Numerical calculation results showed that the maximum lateral deformations of the foundation pit and settlements of the surrounding ground were, respectively, 10.34 mm and 8.49 mm at an excavation depth of 31 m, which were obviously larger than those under in-time supporting. Meanwhile, under delayed supporting conditions, lateral deformations of the foundation pit and settlements of the surrounding ground were far less than the allowed values, respectively, being 0.3% and 0.15% of the excavation depth, required in the Chinese standard of GB50007-2011, indicating that the foundation pit under delayed supporting conditions had good stability. Therefore, when excavating deep foundation pits in hard rock strata, proper delayed supporting schemes could be considered so that strengths of the surrounding hard rocks could be utilized to the fullest, and at the same time, more spaces for excavation could be freed up, and construction duration and construction costs could thus be lowered.
Long-Term Mortality following Acute Noninvasive Ventilation for Obesity-Related Respiratory Failure: A Retrospective Single-Centre Study
Authors: Krishnan Aditya , Ellis Paul , Antoine-Pitterson Pearlene , Oakes Amy , Jones Bethany , Turner Alice , Mukherjee Rahul
Published: October 2023

Introduction. Determinants of long-term mortality following acute hypercapnic respiratory failure have been extensively studied in patients with chronic obstructive pulmonary disease. However, respiratory failure due to obesity has not been studied to the same extent. This retrospective survey aims to identify whether admission pH is associated with long-term mortality in patients requiring acute noninvasive ventilation (NIV) for obesity-related respiratory failure (ORRF). Methods. Records from April 2013 to March 2020 were accessed from a NIV quality database at an acute teaching hospital. Adults with hypercapnic ORRF requiring acute NIV were included. pH data were grouped by threshold (pH≤ and >7.25) and correlated with time from presentation to death; multivariable analysis was performed using Cox proportional hazards. Results. A total of 277 acute NIV episodes were included. Two-year mortality was similar for patients in both pH categories. Univariable analysis identified pH ≤ 7.25 to increase risk of two-year mortality by 43%. However, multivariable analysis identified that pH was not a significant determinant of long-term mortality, although male sex, older age, and higher admission pCO2 increased the risk of death at two years by 76%, 3% per year of age, and 16% per 1 kPa of pCO2 increase, respectively. Conclusion. Severity of hypercapnia on admission, male sex, and older age are associated with worse two-year mortality in patients requiring acute NIV for ORRF. There is scope for further analyses including investigating the role of domiciliary NIV in ORRF patients.
Nonbacterial Thrombotic Endocarditis of Bioprosthetic Aortic Valve Presenting as Cardioembolic Stroke in a Patient without Predisposing Systemic Disease
Authors: White Samuel J.
Published: October 2023

Nonbacterial thrombotic endocarditis (NBTE) describes a cluster of noninfectious heart valve lesions and is histologically characterised by the presence of sterile platelet and fibrin-rich aggregates. Risk factors include hypercoagulable states such as active malignancy, autoimmune disorders, and prothrombotic haematological conditions. NBTE involving bioprosthetic heart valves is exceedingly rare. We present a case of a 73-year-old man with a bioprosthetic aortic valve and no NBTE risk factors who developed right-sided homonymous hemianopia during an admission for decompensated congestive cardiac failure. After detailed clinical work-up including brain MRI, the man was diagnosed with acute ischemic cardioembolic stroke involving the left posterior cerebral artery territory. He subsequently underwent successful bioprosthetic aortic valve replacement with histologic examination of the explant supporting diagnosis of NBTE. Evidence of new neurological deficit or disturbance in patients with prosthetic heart valves should prompt investigation for cardioembolic stroke. Whilst rare, NBTE should be considered as a differential diagnosis for cardioembolic stroke, even in patients without predisposing systemic disease.
The Identification of Advantages and Deficiencies of Current Digital Health Science Popularization in China: A Qualitative Study in Yangtze River Delta Region
Authors: Ruan Yuhui , Wang Dongfang , Wu Yue
Published: October 2023

Background. Health science popularization, especially digital health science popularization, is essential for development of the Healthy China Strategy. Current studies have focused on interpreting digital education popularization and confirming its positive function; however, reports regarding the limitations and shortcomings thereof are lacking. We aimed to research the current development of digital health science popularization in China, analyze the existing problems, and explore the methods to resolve these problems. Methods. We conducted a qualitative study by mixing in-depth interviews and grounded theory approaches. Participants were recruited according to the inclusion criteria via a snowballing process. Thirty-nine participants, including doctors, nurses, researchers, officers in government, and project leaders, were recruited from the Yangtze River Delta region. Online in-depth interviews with open questions were conducted, and the data were collected. Results. Our results revealed that digital health science popularization has the advantages of convenience, swiftness, friendliness, and social links. However, obvious deficiencies were also exposed, including low authenticity, limited audiences, a lack of manpower, and fragmentation. Conclusions. Current digital health science popularization needs to emphasize public welfare, promote the dissemination of information with professionalism and authority, cultivate cross-border talent, and develop institutional infrastructure to overcome the deficiencies thereof. This remains important to improve the quality and effectiveness of digital health science popularization.
Digestive Tract Cancer-Related Adverse Events Correlated with Proton Pump Inhibitors Use: A Pharmacovigilance Study of the FDA Adverse Event Reporting System
Authors: Gu Sheng-ying , Yu Shi-dan , Zhou Zhen-yu , Wang Shuo-wen , Hu Shan-shan , Shi Chen-yang , Qi Chen-dong , Fan Guo-rong
Published: October 2023

Background. Proton pump inhibitors (PPIs) are widely used to treat digestive system diseases. Previous studies have suggested conflicting results between PPI treatment and the risk for digestive tract cancers (DTCs). This study aimed to assess the effect of PPI use on DTCs by data mining of the FDA Adverse Event Reporting System (FAERS) database. Method. This study examined the correlations between six PPI agents and DTCs by mining the FAERS database from January 2004 to September 2021 by using OpenVigil 2.1. The reporting odds ratio (ROR) defined as the ratio between the odds of reporting a specific adverse event for one drug divided by the corresponding odds for all other drugs, with 95% confidence intervals (CIs), was used to detect statistically significant correlations between PPIs and DTCs. High-level terms (HLTs) and preferred terms (PTs) were defined by the Medical Dictionary for Regulatory Activities 24.0 (MedDRA24.0). Result. A total of 2553 DTC adverse event reports were screened, with positive signals obtained from gastric neoplasms malignant (GNM) (ROR: 1.09, 95% CI: 1.01–1.18) and bile duct neoplasms malignant (BDNM) (ROR: 1.80, 95% CI: 1.44–2.25). Esomeprazole showed the strongest signal (ROR: 1.85, 95% CI: 1.66–2.06) for GNM, while rabeprazole for BDNM (ROR: 2.94, 95% CI: 1.32–6.56), and female PPI users had a higher risk of BDNM (ROR: 2.44, 95% CI: 1.77–3.35). Among subordinate PTs, adenocarcinoma gastric and the combination of “bile duct cancer” and “cholangiocarcinoma” were highly correlated with PPI use. Conclusion. By mining the FAERS database, we provided important clues for the correlation between PPI use and DTC risk.