bluuebunny/crossref_metadata_2025 huggingface dataset:
Crítica e Gênese de Evguiêni Oniéguin nas cartas de Aleksandr Púchkin
Authors: Silva Gabriella de Oliveira
Published: December 2023

O presente artigo apresenta um recorte da correspondência de Aleksandr Serguêievitch Púchkin (1799-1837), priorizando aquela em que há registros sobre a gênese do romance em versos Evguiêni Oniéguin (1833) e a crítica gerada pela obra. No que concerne à sua participação em debates crítico-literários, a correspondência de Púchkin está em pé de igualdade com suas obras de ficção e ensaios críticos. Enquanto deixava muitas questões em aberto em suas obras ficcionais, na correspondência, Púchkin escrevia abertamente sobre suas intenções artísticas. Frequentemente o poeta respondia a resenhas publicadas em revistas com cartas dirigidas aos autores destas. Analisaremos como a correspondência de Púchkin funcionou como um laboratório literário e como pode ajudar na compreensão de suas concepções sobre literatura, crítica, gênese de suas obras, publicações e recepção.
Notes From the Underground, or why were Russian Formalism and Structuralism Resisted by Soviet Non-Marxist Intellectuals?
Authors: Tihanov Galin
Published: December 2023

Este artigo analisa o que denomino de “resistência soviética à crítica”. Baseado em três breves estudos de caso, discuto como essa resistência não se limitou ao Ocidente e à intrínseca exaustão da confiança na linguagem para assegurar o acesso à verdade. Argumento que a resistência específica ao Formalismo Russo e ao Estruturalismo, um dos ramos mais expressivos do qual surgiu justamente fora da tradição marxista, teve sua própria lógica e uma dinâmica sutil na União Soviética, uma sociedade em que a inovação teórica poderia revelar e, por vezes, de fato revelava cumplicidades inesperadas com a corrente ideológica dominante.
Mapping whole brain effects of infrared neural stimulation with positron emission tomography
Authors: Meneghetti Marcello , Gudmundsen Frederik , Jessen Naja S. , Sui Kunyang , Baun Christina , Palner Mikael , Markos Christos
Published: December 2023

The combination of neuroimaging and targeted neuromodulation is a crucial tool to gain a deeper understanding of neural networks at a circuit level. Infrared neurostimulation (INS) is a promising optical modality that allows to evoke neuronal activity with high spatial resolution without need for the introduction of exogenous substances in the brain. Here, we report the use of whole-brain functional [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) imaging during INS in the dorsal striatum, performed using a multifunctional soft neural probe. We demonstrate the possibility to identify multi-circuit connection patterns in both cortical and subcortical brain regions within a single scan. By using a bolus plus infusion FDG-PET scanning protocol, we were able to observe the metabolic rate evolution in these regions during the experiments and correlate its variation with the onset of the INS stimulus. Due to the focality of INS and the large amount of viable molecular targets for positron emission tomography (PET), this novel approach to simultaneous imaging and stimulation is highly versatile. This pilot study can pave the way to further understand the brain connectivity on a global scale.
Weak coupling of neurons enables very high-frequency and ultra-fast oscillations through the interplay of synchronized phase shifts
Authors: Přibylová Lenka , Ševčík Jan , Eclerová Veronika , Klimeš Petr , Brázdil Milan , Meijer Hil G. E.
Published: December 2023

Recently, in the past decade, high-frequency oscillations (HFOs), very high-frequency oscillations (VHFOs), and ultra-fast oscillations (UFOs) were reported in epileptic patients with drug-resistant epilepsy. However, to this day, the physiological origin of these events has yet to be understood. Our study establishes a mathematical framework based on bifurcation theory for investigating the occurrence of VHFOs and UFOs in depth EEG signals of patients with focal epilepsy, focusing on the potential role of reduced connection strength between neurons in an epileptic focus. We demonstrate that synchronization of a weakly coupled network can generate very and ultra high-frequency signals detectable by nearby microelectrodes. In particular, we show that a bistability region enables the persistence of phase-shift synchronized clusters of neurons. This phenomenon is observed for different hippocampal neuron models, including Morris–Lecar, Destexhe–Paré, and an interneuron model. The mechanism seems to be robust for small coupling, and it also persists with random noise affecting the external current. Our findings suggest that weakened neuronal connections could contribute to the production of oscillations with frequencies above 1000 Hz, which could advance our understanding of epilepsy pathology and potentially improve treatment strategies. However, further exploration of various coupling types and complex network models is needed.
Improving Medium-Range Ensemble Weather Forecasts with Hierarchical Ensemble Transformers
Authors: Bouallègue Zied Ben , Weyn Jonathan A. , Clare Mariana C. A. , Dramsch Jesper , Dueben Peter , Chantry Matthew
Published: December 2023

Statistical postprocessing of global ensemble weather forecasts is revisited by leveraging recent developments in machine learning. Verification of past forecasts is exploited to learn systematic deficiencies of numerical weather predictions in order to boost postprocessed forecast performance. Here, we introduce postprocessing of ensembles with transformers (PoET), a postprocessing approach based on hierarchical transformers. PoET has two major characteristics: 1) the postprocessing is applied directly to the ensemble members rather than to a predictive distribution or a functional of it, and 2) the method is ensemble-size agnostic in the sense that the number of ensemble members in training and inference mode can differ. The PoET output is a set of calibrated members that has the same size as the original ensemble but with improved reliability. Performance assessments show that PoET can bring up to 20% improvement in skill globally for 2-m temperature and 2% for precipitation forecasts and outperforms the simpler statistical member-by-member method, used here as a competitive benchmark. PoET is also applied to the ENS-10 benchmark dataset for ensemble postprocessing and provides better results when compared to other deep learning solutions that are evaluated for most parameters. Furthermore, because each ensemble member is calibrated separately, downstream applications should directly benefit from the improvement made on the ensemble forecast with postprocessing.
Exploring the Differences in Kinetic Energy Spectra between the NCEP FNL and ERA5 Datasets
Authors: Li Zongheng , Peng Jun , Zhang Lifeng , Guan Jiping
Published: December 2023

Two global atmospheric circulation datasets (ERA5 and NCEP FNL) with horizontal resolutions of 0.25° × 0.25° are investigated in terms of kinetic energy (KE) spectra at 200 hPa (roughly between 11 and 12 km). The horizontal KE (HKE) in NCEP FNL is larger and flatter than that in ERA5 at subsynoptic scales and mesoscales. Restoring the energy of this wavenumber range to the physical space shows that the HKE in NCEP FNL is larger than that in ERA5 over most areas but smaller mainly in the Indo-Pacific warm pool. The spectral budgets show that at these scales, the positive contribution from net vertical flux in ERA5 is stronger than that in NCEP FNL, while the negative contribution from available potential energy (APE) conversion is smaller; assuming that the atmosphere is in a quasi-stationary state, more dissipation is found in ERA5 than in NCEP FNL, which should be responsible for the HKE spectrum in ERA5 to be steeper and weaker than that in NCEP FNL. Our formulation shows that the APE conversion and net vertical flux are related to the pressure vertical velocity (PVV). The APE conversion and net vertical flux differences between the two datasets, like the PVV difference, are mainly from the tropical region. At large scales, the vertical motion in ERA5 is larger than that in NCEP FNL. The amplitude differences of the PVV spectra between two datasets are consistent with those of the large-scale precipitation spectra associated with microphysics parameterizations. These results support that vertical motion is a key dynamical factor explaining energy discrepancies at mesoscales.

Significance Statement

The atmospheric kinetic energy spectrum reflects energy distribution characteristics in atmospheric motion at different scales. According to the Helmholtz decomposition, the horizontal wind field can be decomposed into two parts: rotational wind field and divergent wind field. We explore the dynamical causes of the atmospheric energy spectra differences among different datasets from the perspective of rotational and divergent components of motion. Our results reveal that the differences in energy spectra and their energy budget at scales below a few hundred kilometers are relatively significant in tropical regions and are closely related to vertical motion. A better understanding of the differences in kinetic energy spectra will contribute to the improvement of atmospheric models.
Discovery of a non-canonical GRHL1 binding site using deep convolutional and recurrent neural networks
Authors: Proft Sebastian , Leiz Janna , Heinemann Udo , Seelow Dominik , Schmidt-Ott Kai M. , Rutkiewicz Maria
Published: December 2023

Background

Transcription factors regulate gene expression by binding to transcription factor binding sites (TFBSs). Most models for predicting TFBSs are based on position weight matrices (PWMs), which require a specific motif to be present in the DNA sequence and do not consider interdependencies of nucleotides. Novel approaches such as Transcription Factor Flexible Models or recurrent neural networks consequently provide higher accuracies. However, it is unclear whether such approaches can uncover novel non-canonical, hitherto unexpected TFBSs relevant to human transcriptional regulation.

Results

In this study, we trained a convolutional recurrent neural network with HT-SELEX data for GRHL1 binding and applied it to a set of GRHL1 binding sites obtained from ChIP-Seq experiments from human cells. We identified 46 non-canonical GRHL1 binding sites, which were not found by a conventional PWM approach. Unexpectedly, some of the newly predicted binding sequences lacked the CNNG core motif, so far considered obligatory for GRHL1 binding. Using isothermal titration calorimetry, we experimentally confirmed binding between the GRHL1-DNA binding domain and predicted GRHL1 binding sites, including a non-canonical GRHL1 binding site. Mutagenesis of individual nucleotides revealed a correlation between predicted binding strength and experimentally validated binding affinity across representative sequences. This correlation was neither observed with a PWM-based nor another deep learning approach.

Conclusions

Our results show that convolutional recurrent neural networks may uncover unanticipated binding sites and facilitate quantitative transcription factor binding predictions.
Exploring the challenges to using telecardiology as perceived by pre-hospital emergency care personnel: a qualitative study
Authors: Bijani Mostafa , Abedi Saeed , Zare Azam , Tavacol Ziba , Abadi Fozieh , Alkamel Abdulhakim
Published: December 2023

Background

Today, using the medical technology of telecardiology, as part of advanced medical services, plays an essential role in providing care to cardiac patients in life-threatening conditions who need emergency care. However, pre-hospital emergency care personnel are faced with certain challenges in using telecardiology, with adverse effects on their performance. Therefore, the present study aimed to investigate the challenges to using telecardiology as viewed by pre-hospital emergency care personnel in Southern Iran.

Methods

The present study is a qualitative work of research with a content analysis approach. Selected using purposeful sampling, 19 pre-hospital emergency care personnel were interviewed on a semi-structured, personal, in-depth basis. The qualitative data obtained were analyzed using the Graneheim and Lundman’s conventional content analysis approach (2004).

Results

Based on the qualitative data analysis, 3 themes and 8 subthemes were obtained. The three main themes included professional barriers (lack of clinical knowledge of telecardiology, lack of clinical skill in telecardiology, violation of patients’ privacy, lack of clinical guidelines on telecardiology), medical equipment and telecommunication barriers (poor reception and ineffective means of communication, low charge on the battery of tele-electrocardiogram machines), and organizational management barriers (serious lack of cardiologists available for medical counseling and lack of continual personal development of the telecardiology personnel).

Conclusion

Senior managers in pre-hospital emergency care services are recommended to use the results of this study to identify the influential factors in using telecardiology and take the necessary measures to eliminate the existing barriers toward making optimal use of telemedicine, thereby improving the quality of care provided for cardiac patients.
Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments
Authors: Källberg Ann-Sofie , Berg Lena M , Skogli Sara , Bjurbo Charlotte , Muntlin Åsa , Ehrenberg Anna
Published: December 2023

Background

Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited.

Aim

To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs.

Methods

The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes.

Results

A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care.

Conclusion

Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.
Threshold growth has a limited role in differentiating hepatocellular carcinoma from other focal hepatic lesions
Authors: Lyu Rong , Wang Di , Hu Weijuan , Gao Zhongsong , Yu Changlu , Wang Jiao , Li Mingge , Jia Kefeng
Published: December 2023

Background and Objective

The role of threshold growth, as one of the major features (MFs) of hepatocellular carcinoma (HCC) in the Liver Imaging Reporting and Data System (LI-RADS) is inconsistent. This study evaluated the LI-RADS diagnostic performance for HCC when threshold growth was removed or replaced by independently significant ancillary features (AFs).

Materials and Methods

This retrospective institutional review board-approved study included patients with a high HCC risk who underwent gadoxetic acid-enhanced MRIs. The MRI findings were consistent with pathologically proven focal hepatic observations. The pathological results were used as the gold standard reference. The sizes of the lesions with and without threshold growth were compared. Univariate and multivariate logistic regression analyses were used to confirm the independently significant AFs of HCC. In addition to the classification criteria of LI-RADS version 2018 (LI-RADS v2018), the lesions were also reclassified according to the following two schemes: scheme A, using all MFs except threshold growth, with threshold growth feature treated as an AF favouring malignancy; and scheme B, replacing the threshold growth feature with independently significant AFs and treated them as new MFs. The diagnostic performance of the above two LI-RADS schemes for HCC was calculated and compared with that of LI-RADS v2018.

Results

A total of 379 patients and 426 observations were included. Threshold growth was not an independent significant MF for HCC diagnosis [odds ratio (OR), 1.0; 95% confidence interval (CI), 0.6–1.8; p = 0.927]. For all three groups of observations (HCCs, non-HCC malignancies, and benign lesions), the mean size with threshold growth was smaller than that without threshold growth (all p < 0.05). The nodule-in-nodule feature was an independent significant AF (OR, 9.8; 95% CI, 1.2–79.3; p = 0.032) and was used to replace threshold growth as a new MF in scheme B. The sensitivities of schemes A and B were 74.0% and 75.6%, respectively. The specificities of schemes A and B were the same (88.6%). None of the diagnostic performance metrics for HCC (sensitivity, specificity, accuracy) of either scheme A or B was significantly different from those of LI-RADS v2018 (all p > 0.05).

Conclusion

Threshold growth is not an independently significant MF for HCC diagnosis. The diagnostic performance of LI-RADS for HCC is not affected regardless of whether threshold growth is removed from the list of MFs or replaced with an independently significant and more HCC-specific AF, which is the nodule-in-nodule feature.
Trends in amount of use to upper limb function in patients with subacute stroke: a cross-sectional study using segmental regression analysis
Authors: Hirayama Koichiro , Matsuda Marina , Teruya Moe , Fuchigami Takeshi , Morioka Shu
Published: December 2023

Background

Hemiparesis affects approximately 33–80% of patients with stroke, and a quarter of these individuals experience difficulty with the voluntary use of their paretic upper limb for performing activities of daily living within five years of stroke onset. Therefore, assessing upper limb functionality and use after a stroke is crucial. The Fugl-Meyer Assessment (FMA) and the Motor Activity Log (MAL) are the two most widely used methods for assessing post-stroke paretic upper limb. While previous research has shown a strong correlation between the FMA of Upper Extremity (FMA-UE) and the MAL scores, to date, no study has investigated the differences in the characteristics and trends of upper extremity usage frequency in the FMA-UE. This study aimed to statistically categorize the FMA-UE scores using segmental regression analysis and identify disparities in the trends of paretic upper extremity utilization frequency in MAL.

Methods

Patients with first-episode subacute stroke were chosen for the cohort study. The primary assessments used were FMA-UE and MAL Amount of Use (MAL-A); age, gender, and time since onset served as secondary assessments. Segmental regression analysis was used, with FMA-UE as the independent variable and MAL-A as the dependent variable. R2 values were calculated using linear and polynomial regression on binary values, and the coefficients of determination were compared using segmental regression analysis.

Results

The study included 203 participants with a mean age of 70.1 ± 13.1 years; 113 were male and 90 female. The mean time since onset was 29.2 ± 14.8 days, the mean FMA-UE score was 43.6 ± 22.3 points, and the mean MAL-A score was 2.3 ± 2.0 points. The segmental regression analysis revealed that the inflection point for FMA-UE was 45.3 points, and the slope of the regression line underwent a transformation before and after the inflection point.

Conclusions

This study indicates that the trend in the amount of use of paretic upper limb utilization changes around inflection point 45 in the FMA-UE. These findings could be useful for designing rehabilitation strategies to improve paretic upper limb utilization by increasing exercise duration in patients with subacute stroke.
Abnormal alterations of regional spontaneous neuronal activity and functional connectivity in insomnia patients with difficulty falling asleep: a resting-state fMRI study
Authors: Jiang Tongfei , Yin Xuejiao , Zhu Liying , Jia Weilin , Tan Zhongjian , Li Bin , Guo Jing
Published: December 2023

Background

Insomnia disorder (ID) seriously affects people’s daily life. Difficulty falling asleep is the most commonly reported complaint in patients with ID. However, the mechanism of prolonged sleep latency (SL) is still obscure. The aim of our present study was to investigate the relationship between prolonged SL and alterations in spontaneous neural activity and brain functional connectivity (FC) in ID patients using functional magnetic resonance imaging (fMRI).

Methods

A total of 52 insomniacs with difficulty falling asleep and 30 matched healthy controls (HCs) underwent resting-state fMRI. The amplitude of low-frequency fluctuation (ALFF) was measured and group differences were compared. The peak areas with significantly different ALFF values were identified as the seed regions to calculate FC to the whole brain. SL was assessed by a wrist actigraphy device in ID patients. The Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), and Hyperarousal Scale (HAS) were evaluated in both ID patients and HCs. Finally, correlation analyses were performed between the clinical features and FC/ALFF values.

Results

ID patients showed higher PSQI, HAMA, HAS scores than HCs. The functional MRI results indicated increased ALFF value in the left insula and right amygdala and decreased ALFF value in the right superior parietal lobe (SPL) in ID patients. The seed-based FC analysis demonstrated increased FC between the left insula and the bilateral precentral gyrus and FC between the right amygdala and the left posterior cingulate cortex (PCC) in patients with ID. Correlation analysis indicated that the increased FC value of the right amygdala-left PCC was positively correlated with SL measured by actigraphy.

Conclusion

This study revealed abnormal regional spontaneous fluctuations in the right amygdala, left insula, and right SPL, as well as increased FC in the left insula-precentral and right amygdala-left PCC. Moreover, the prolonged SL was positively correlated with the abnormal FC in the right amygdala-left PCC in ID patients. The current study showed the correlation between prolonged SL and the abnormal function of emotion-related brain regions in ID patients, which may contribute to a better understanding of the neural mechanisms underlying difficulty falling asleep in patients with ID.

Clinical Trial Registration

http://www.chictr.org.cn., ChiCTR1800015282. Registered on 20th March 2018.
Congenital herpes simplex with ophthalmic and multisystem features: a case report
Authors: Pereira Samuel Montenegro , Lima Rian Vilar , Muniz Maria Carolina Rocha , Araújo Marcus Breno Farias , de Moraes Ferreira Júnior Luiz , de Queiroz Sales Martins Juliana Tiburtino , Luz Cláudia Faustino Coelho , Cid David Antônio Camelo , da Rocha Lucena Daniel
Published: December 2023

Background

Neonatal herpes simplex virus (HSV) infection is rare and has significant morbimortality rates. Approximately 85% of newborns are infected intrapartum, and risk factors for mother-to-child transmission include vaginal delivery, primary maternal infection, and prolonged rupture of membranes. Neonatal HSV can manifest with isolated mucocutaneous lesions, neurological involvement, or disseminated disease. In general, herpetic infection can cause blepharoconjunctivitis or keratitis. We report a rare case of congenital herpes with ophthalmologic manifestations and multisystemic involvement.

Case presentation

A preterm infant, born at 32 weeks and 2 days, with presumed neonatal infection developed intestinal and respiratory complications, as well as hyperemic lesions on the left nostril and oral mucosa. An ophthalmological assessment was requested and brought up the suspicion of HSV infection, indicating empirical treatment with endovenous acyclovir. Later, a new ocular examination was suggestive of panuveitis. Afterward, serum IgM antibodies to HSV-1 and HSV-2 were positive. Proper antiviral therapy led to an improvement in the condition.

Discussion

Neonatal herpes is associated with a high risk of persistent skin lesions, long-term neurological disability and other lasting sequelae. It is essential to consider HSV infection in cases of neonatal conjunctivitis, especially in patients with an epithelial defect and no improvement after initial treatment with topical or systemic antibiotics.

Conclusions

In the management of neonatal HSV, early diagnosis is essential for the timely initiation of antiviral therapy. Our report highlights that ocular assessment can be crucial in the correct diagnostic investigation of this condition.
The relationship between personality traits and dysfunctional attitudes in individuals with or without major depressive disorder: a case control study
Authors: Liu Jin , Zhang Mengqi , Ju Yumeng , Wang Mi , Chen Yanjun , Sun Jinrong , Lu Xiaowen , Dong Qiangli , Zhang Liang , Wan Ping , Guo Hua , Zhao Futao , Liao Mei , Zhang Yan , Liu Bangshan , Li Lingjiang
Published: December 2023

Background

Dysfunctional attitudes, which are characterized by distorted self-cognitions, were considered to be linked to personality traits. It was found that certain personality traits may predict dysfunctional attitudes in patients with major depressive disorder (MDD). Nonetheless, the relationship between personality traits and dysfunctional attitudes remains under-researched.

Aims

The aim of this study is to examine the relationship between specific domains of Sixteen Personality Factor (16PF) and dysfunctional attitudes in Chinese participants with or without MDD. In addition, the present study explores the associations between 16PF and eight subtypes of dysfunctional attitudes, based on the proposed eight-factor structure of the Chinese version of the Dysfunctional Attitude Scale-Form A (C-DAS-A).

Methods

One hundred and sixty-eight participants with MDD and 130 healthy participants were included in the study (Trial Registration Number: ChiCTR1800014591). Personality was assessed using the 16PF Questionnaire. Dysfunctional attitudes were measured through the C-DAS-A.

Results

The 16PF dimensions associated with dysfunctional attitudes and the eight subtypes were mainly concentrated in the four anxiety facets including factors C, L, O, and Q4, in both MDD and HC groups. There were significant differences in the 16 PF dimensions that would explain dysfunctional attitudes between the two groups, which were as follows: factors C, G, and O in the MDD group, and factors L and Q4 in the HC group.

Conclusions

Personality traits, especially the anxiety-related personality traits, were distinctly associated with the development of dysfunctional attitudes in people with or without MDD.
Prevalence and factors associated with inconsistent condom use among female sex workers in Ethiopia: findings from the national biobehavioral survey, 2020
Authors: Rameto Muhammed Ahmed , Abdella Saro , Ayalew Jemal , Tessema Masresha , Bulti Jaleta , Bati Fayiso , Lulseged Sileshi
Published: December 2023

Background

The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor in HIV transmission in the community. However, it has long been known that using condoms correctly and consistently is an extremely cost-effective global method for preventing HIV infection, but inconsistent condom use (ICU) would pose the greatest proximal risk of HIV acquisition and transmission. Understanding the prevalence and associated risk factors of inconsistence condom use among FSWs would inform policymakers to design programmatic interventions in the context of Ethiopia.

Methods

This analysis used data from the ‘National HIV and STIs Bio-behavioral Survey (NHSBS)’, which was conducted between December 2019 up to May 2020 by using a respondent-driven sampling (RDS) technique among FSWs aged 15 years and older who were selling sex in selected major cities and towns in Ethiopia. A multi-level logistic regression model was fitted to assess town and individual-level variations simultaneously to adjust hierarchical variations. Statistical significance was determined by using aP-value less than 0.05 with a 95% confidence interval (CI) not including one.

Results

Overall, 6,085 FSWs from 16 cities and towns participated in the study. The prevalence of inconsistent condom use across the 16 cities and towns was 17.1% [95% CI (16.5, 17.8)]. Inconsistent condom use was significantly higher among FSWs who had depression compared to those without depression [AOR = 1.43; 95% CI (1.13,1.82)], used any drug [AOR = 1.43; 95% CI (1.14–1.79)], had history of sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], changed sex selling location [AOR = 1.27; 95% CI (1.06, 1.51)], longer period of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], ever had anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], had ≥ 2 non-paying sexual partner [AOR = 2.99; 95% CI(2.26, 3.95)], selling sex `in more than two cities [AOR = 3.01;95% CI (2.27, 3.99)], who lacked access to condom [AOR = 2.1; 95% CI (1.69, 2.67)], and did not have HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)].

Conclusion

Inconsistent condom use among FSWs is prevalent in Ethiopia and is associated with marital status, education status, depression, alcohol drinking, drug use, sexual violence, being raped, lack of knowledge about HIV, practising anal sex, selling sex in different locations, having more than two non-paying sexual partners, working in more than two cities, and lack of access to condom at the workplace. Programme interventions to enhance consistent condoms use among FSWs need to take these factors into consideration.
Comparison of clinical characteristics and disease burden between early- and late-onset type 2 diabetes patients: a population-based cohort study
Authors: Wang Mingqi , He Yifei , He Qiao , Di Fusheng , Zou Kang , Wang Wen , Sun Xin
Published: December 2023

Background

The clinical characteristics of early-onset type 2 diabetes (T2D) patients are not fully understood. To address this gap, we conducted a cohort study to evaluate clinical characteristics and disease burden in the new-onset T2D population, especially regarding the progression of diseases.

Methods

This cohort study was conducted using a population-based database. Patients who were diagnosed with T2D were identified from the database and were classified into early- (age < 40) and late-onset (age ≥ 40) groups. A descriptive analysis was performed to compare clinical characteristics and disease burden between early- and late-onset T2D patients. The progression of disease was compared using Kaplan‒Meier analysis.

Results

A total of 652,290 type 2 diabetic patients were included. Of those, 21,347 were early-onset patients, and 300,676 were late-onset patients. Early-onset T2D patients had poorer glycemic control than late-onset T2D patients, especially at the onset of T2D (HbA1c: 9.3 [7.5, 10.9] for early-onset vs. 7.7 [6.8, 9.2] for late-onset, P < 0.001; random blood glucose: 10.9 [8.0, 14.3] for early-onset vs. 8.8 [6.9, 11.8] for late-onset, P < 0.001). Insulin was more often prescribed for early-onset patients (15.2%) than for late-onset patients (14.8%). Hypertension (163.0 [28.0, 611.0] days) and hyperlipidemia (114.0 [19.0, 537.0] days) progressed more rapidly among early-onset patients, while more late-onset patients developed hypertension (72.7% vs. 60.1%, P < 0.001), hyperlipidemia (65.4% vs. 51.0%, P < 0.001), cardiovascular diseases (66.0% vs. 26.7%, P < 0.001) and chronic kidney diseases (5.5% vs. 2.1%, P < 0.001) than early-onset patients.

Conclusions

Our study results indicate that patients with newly diagnosed early-onset T2D had earlier comorbidities of hypertension and hyperlipidemia. Both clinical characteristics and treatment patterns suggest that the degree of metabolic disturbance is more severe in patients with early-onset type 2 diabetes. This highlights the importance of promoting healthy diets or lifestyles to prevent T2D onset in young adults.
The association between creatinine to body weight ratio and the risk of progression to diabetes from pre-diabetes: a 5-year cohort study in Chinese adults
Authors: Li Tong , Cao Changchun , Xuan Xuan , Liu Wenjing , Xiao Xiaohua , Wei Cuimei
Published: December 2023

Objective

Evidence on the association between the creatinine to body weight (Cre/BW) ratio and the risk of pre-diabetes to diabetes development remains limited. Our study aimed to examine the association between the Cre/BW ratio and incident diabetes in pre-diabetic patients.

Methods

This retrospective cohort study included 24,506 pre-diabetic participants who underwent health checks from 2010 to 2016 in China. We used the Cox proportional-hazards regression model to explore the relationship between baseline Cre/BW ratio and diabetes risk in pre-diabetes patients. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between them. We also carried out a number of subgroup and sensitivity analyses.

Results

The age range of the participants included in this study was 20–99 years, with a majority of 16,232 individuals (66.24%) being men. The mean baseline Cre/BW ratio was 1.06 (SD 0.22) umol/L/kg. 2512 (10.25%) participants received a diabetes final diagnosis over a median follow-up period of 2.89 years. After adjusting for covariates, the Cre/BW ratio had a negative association with incident diabetes in participants with pre-diabetes, per umol/L/kg increase in Cre/BM ratio was accompanied by a 55.5% decrease in diabetes risk (HR = 0.445, 95%CI 0.361 to 0.548). The Cre/BW ratio and risk of diabetes had a non-linear connection, with 1.072 umol/L/kg serving as the ratio's inflection point. The HR were 0.294 (95%CI:0.208–0.414) and 0.712 (95%CI:0.492–1.029), respectively, on the left and right sides of the inflection point. The sensitivity analysis demonstrated the robustness of these results. Subgroup analyses indicated that the Cre/BW ratio was strongly associated with the risk of diabetes among participants who were younger than 50 years, as well as among those with diastolic blood pressure (DBP) < 90 mmHg and triglyceride (TG) < 1.7 mmol/L. In contrast, among participants 50 years of age or older, those with DBP ≥ 90 mmHg, and those with TG ≥ 1.7 mmol/L, the relationship between the Cre/BW ratio and the risk of diabetes was attenuated.

Conclusion

This study demonstrates a negative, non-linear relationship between the Cre/BW ratio and the risk of diabetes among the Chinese population with pre-diabetes. From a therapeutic standpoint, it is clinically meaningful to maintain the Cre/BW ratio levels above the inflection point of 1.072 umol/L/kg.
Ethanol extract of Paridis rhizoma attenuates carrageenan-induced paw swelling in rats by inhibiting the production of inflammatory factors
Authors: Xiang Li , Huang Qinwan , Chen Tao , He Qingman , Yao Huan , Gao Yongxiang
Published: December 2023

Context

Inflammation has been identified as a key factor contributing to the development of numerous diseases. Several anti-inflammatory drugs have been developed to treat inflammation-related diseases. However, some of such drugs are associated with varying degrees of side effects. Therefore, it is imperative to develop new anti-inflammatory drugs with reducing side effects for the treatment of inflammation-related diseases. Natural anti-inflammatory drugs have emerged as an important area of research in recent years. The study was to determine the anti-inflammatory mechanism of Paridis rhizoma extract (PRE) in rat models of acute inflammation induced by carrageenan and RAW264.7 cells models induced by lipopolysaccharide (LPS).

Materials and methods

PRE was investigated using the carrageenan-induced paw oedema model on rats in vivo. Histopathology examined the extent of inflammatory infiltration and tissue damage. The effect of PRE on the levels of specific cytokines was determined using enzyme-linked immunosorbent assay (ELISA). The Cell Counting Kit (CCK)-8 assay evaluated the cytotoxic effects of PRE on Raw264.7 cells. The mRNA expression levels of cytokines were quantified using quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR). Western blot measured TNF-α, IL6, TLR4, p-P65, p-IKB, HO1, SOD1 and SOD2. Fluorescence measured the cellular levels of reactive oxygen species (ROS).

Results

PRE treatment reduced interstitial edema and structural damage in a dose-dependent manner in vivo. PRE inhibited inflammatory responses in vivo and in vitro, as evidenced by the decreased expression of inflammatory factors, production of ROS, and increased expression of SOD1, SOD2, and HO1. Moreover, PRE inhibited the activity of the nuclear factor kappa B (NF-kB) pathway.

Conclusion

The anti-inflammatory activity and potential mechanism of PRE were demonstrated according to the results. PRE reduced LPS-induced inflammation in RAW264.7 cells by inhibiting the NF-KB signaling pathway and ROS production in vitro. PRE alleviated interstitial edema and structural damage in the carrageenan-induced paw edema model on rats in vivo. This study provided an idea for future development of PR-based anti-inflammatory drugs.
Construction of nursing-sensitive quality indicator system for cardiac rehabilitation of patients undergoing percutaneous coronary intervention based on structure-process-outcome model
Authors: Kang Lei , Wang Min-hui , Wu Sheng-jia
Published: December 2023

Background

Coronary heart disease (CHD) is a cardiovascular disease with high mortality. At present, percutaneous coronary intervention (PCI) is considered as the main effective treatment for CHD due to less trauma, shorter course of treatment, and better curative effect. However, PCI alone is not a permanent cure, so cardiac rehabilitation (CR) is needed for a supplement. Nowadays, the evaluation of the nursing-sensitive quality of CR after PCI focuses on the outcomes of patients, lacks a complete evaluation indicator system, and is prone to problems such as nursing management imbalance.

Objective

A scientific, sensitive, comprehensive and practical nursing-sensitive quality indicator system based on the structure-process-outcome model was constructed to provide a reference for evaluating nursing-sensitive quality of CR after PCI.

Methods

Firstly, through literature analysis and semi-structured interview, the indicator system was collected, screened and determined. Then, the framework of the indicator system was established, and the draft of nursing-sensitive quality indicator system of CR after PCI was formed. Subsequently, the nursing-sensitive quality indicator system of CR after PCI was initially established using Delphi method. Finally, the specific weight was determined by analytic hierarchy process (AHP), and the nursing-sensitive quality indicator system of CR after PCI was established and perfected.

Results

Two rounds of expert consultations were separately given 15 questionnaires, and all these questionnaires were returned, with a questionnaire response rate of 100%. Such result indicated that experts were highly motivated. Besides, the authoritative coefficients for two rounds of expert consultations were 0.865 and 0.888, and the coordination coefficients were 0.491 and 0.522, respectively. Hence, the experts’ authority and coordination were high and the results were reliable. After the second round of expert consultation, the nursing-sensitive quality indicator system of CR after PCI was established, eventually. This system consisted of 3 first-level indicators (structural indicator, process indicator and outcome indicator), 11 s-level indicators and 29 third-level indicators.

Conclusion

A relatively complete and reliable nursing-sensitive quality indicator system of CR after PCI has been established in this study. Such system is scientific and reliable and can provide a reference for the evaluation of clinical teaching quality of CR after PCI.
Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context
Authors: Skumsnes Randi , Thygesen Hilde , Groven Karen Synne
Published: December 2023

Background

People with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services.

Methods

A qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data.

Results

The complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication.

Conclusion

The intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.
Exploring the determinants of health service utilization among people living with HIV: a qualitative study in Iran
Authors: SoleimanvandiAzar Neda , Karimi Salah Eddin , Ahmadi Sina , Irandoost Seyed Fahim , Amirkafi Ali , Azimi Amir
Published: December 2023

Background

Health service utilization among people living with HIV is vital for their survival and quality of life. This study aims to exploring the determinants influencing health service utilization among people living with HIV.

Methods

We conducted a qualitative study involving 16 men and women aged 18–64 living with HIV in Tehran. Data were collected between September and December 2021 through semi-structured interviews conducted via telephone and online platforms, utilizing the purposeful sampling method. Data were analyzed by MAXQDA-2018 software using conventional content analysis approaches and the Granheim and Landman method.

Results

Two main themes, seven categories, and 21 subcategories were obtained from the interviews. The main themes included facilitators of health service utilization (positive personality traits, social factors, and structural-behavioral determinants) and inhibitors of health service utilization (personal conditions, insufficient knowledge and understanding of the disease, negative consequences of disease disclosure, and difficult access to services).

Conclusion

This study underscores the need to invest and expand specialized services for people living with HIV by policy makers, while simultaneously increasing public awareness to reduce the social stigma.
Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis
Authors: Moran Valerie , Suhrcke Marc , Nolte Ellen
Published: December 2023

Background

Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance.

Methods

We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010–2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics.

Results

Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider.

Conclusions

Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.