bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of a simple clinical tool for screening of acute lacunar stroke—A substudy of the WAKE-UP trial
Authors: Arba Francesco , Rinaldi Chiara , Jensen Märit , Endres Matthias , Fiebach Jochen B , Lemmens Robin , Muir Keith W , Nighoghossian Norbert , Pedraza Salvador , Simonsen Claus Z , Thijs Vincent , Gerloff Christian , Wardlaw Joanna M , Thomalla Götz
Published: April 2024

Introduction:

Lacunar stroke represents around a quarter of all ischemic strokes; however, their identification with computed tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging.

Methods:

We analyzed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by National Institutes of Health Stroke Scale (NIHSS) < 7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score.

Results:

We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6) years, 325 (65%) males, median (IQR) NIHSS = 6 (4–9); 108 (22%) lacunar infarcts were identified on magnetic resonance (MR), patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score was negative in 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7, p < 0.001), higher systolic (157 vs 151 mmHg, p = 0.001) and diastolic (86 vs 83 mmHg, p = 0.013) blood pressure and smaller infarct volume (2.4 vs 9.5 mL, p < 0.001). Performance of lacunar score was as follows: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; and accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts.

Conclusion:

Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials.

Data access statement:

Data supporting the results of this paper are available upon reasonable request to the corresponding author.
The visual representation of Ukrainian and Afghan refugees in the Spanish press
Authors: Prieto-Andrés Antonio , Fernández Cayetano , López-Avilés Alma
Published: April 2024

The public’s understanding of the situation of refugees largely depends on how they are represented by the media. This article analyses this representation by studying photographs that appear in four mainstream Spanish newspapers of varied political orientation, comparing two paradigmatic examples: that of Afghan refugees versus Ukrainian refugees. The objective of this analysis is to determine the differences and similarities between how each case is covered, using a mixed quantitative and qualitative content analysis method to determine the images’ denotative and connotative aspects, based on ‘framing theory’. Findings show that, although all the refugees are presented primarily from a human-interest angle, there is a significant degree of depersonalization in their photographic presentation due to the framing and stylistic elements employed. Also, Afghans are viewed with greater suspicion than Ukrainians, with a quarter of their images being associated with the idea of conflict.
Addressing health inequalities in times of austerity: implementation of a place-based approach in multitiered local government
Authors: Lee C , Buswell M , Coker J , Buckner S , Cowan A , Lhussier M
Published: April 2024

Aims:

This article focuses on how local authorities in England are tackling wider determinants of health and inequalities in their population’s outcomes while budgets for public services are diminishing.

Methods:

It reports the experience from one case study engaged in rolling out a devolved, place- and asset-based strategy over multiple tiers of local government. Relating these findings to relevant social theory, we draw out aspects of context and mechanisms of change. We offer plausible hypotheses for the experiences observed, which supports transferability and implementation of place-based strategies in other local authority areas struggling with similar challenges.

Results:

Findings highlight the importance of high-level and political buy-in, as well as the role of the COVID-19 pandemic as a potential catalyst to rollout. Creating the foundations for a new, place-based working was important for achieving coherence among partners around what local government was trying to achieve. These included investment in infrastructure, both relational and tangible inputs such as organisational and human resources, to establish the conditions for systemic change towards early intervention and prevention.

Conclusion:

This study identified clear foundations for place-based action, plus enablers and barriers to significant transformation of practice towards asset-based approaches between local authorities, partners and the public.
Trend of mortality and length of stay in the emergency department following implementation of a centralized sepsis alert system
Authors: Grosman-Rimon Liza , Rivlin Leon , Spataro Rosa , Zhu Zhiqiang , Casey Jane , Tory Susan , Solanki Jhanvi , Wegier Pete
Published: April 2024

Introduction

Sepsis alerts based on laboratory and vital sign criteria were found insufficient to improve patient outcomes. While most early sepsis alerts were implemented into smaller scale operating systems, a centralized new approach may provide more benefits, overcoming alert fatigue, improving deployment of staff and resources, and optimizing the overall management of sepsis. The objective of the study was to assess mortality and length of stay (LOS) trends in emergency department (ED) patients, following the implementation of a centralized and automated sepsis alert system.

Methods

The automated sepsis alert system was implemented in 2021 as part of a hospital-wide command and control center. Administrative data from the years 2018 to 2021 were collected. Data included ED visits, in-hospital mortality, triage levels, LOS, and the Canadian Triage and Acuity Scale (CTAS).

Results

Mortality rate for patients classified as CTAS I triage level was the lowest in 2021, after the implementation of the automated sepsis alert system, compared to 2020, 2019, and 2018 ( p < 0.001). The Kaplan–Meier survival curve revealed that for patients classified as CTAS I triage level, the probability of survival was the highest in 2021, after implementation of the sepsis alert algorithm, compared to previous years (Log Rank, Mantel–Cox, χ²=29.742, p < 0.001). No significant differences in survival rate were observed for other triage levels.

Conclusion

Implementing an automated sepsis alert system as part of a command center operation significantly improves mortality rate associated with LOS in the ED for patients in the highest triage level. These findings suggest that a centralized early sepsis alert system has the potential to improve patient outcomes.
Entrepreneurship Education and Entrepreneurial Intention Among Tourism and Hotel Management Students: The Mediating Role of Entrepreneurial Self-Efficacy and the Moderating Role of Grit
Authors: Zhang Hong-xin , Chen Hongxia
Published: April 2024

The present study aims to examine effective measures to enhance the effects of entrepreneurship education (EE) on university students’ entrepreneurial intention (EI) through entrepreneurial self-efficacy (ESE) and grit. The survey used a convenient sample of 758 tourism and hotel management students in China. SPSS macro program PROCESS (Model 4) was used to test the mediating effect, and PROCESS (Model 7) was further used to verify the moderated mediation model. The results indicated that: (1) there was statistically significant and positive relationship among EE, ESE, grit, and EI among tourism and hotel management students; (2) EE significantly and positively predicted EI; (3) ESE played a partial mediating role in the link between EE and EI; (4) grit moderated the indirect effect of EE on students’ EI via their ESE. EE is a significant predictor of EI of tourism and hotel management students. Particularly, to improve the influence of EE, entrepreneurial policy makers should design incentive policies that ensure that universities provide EE across various majors. Also, educators should create a supportive and effective education environment so as to improve students’ ESE and grit.
Implementation of a COVID-19 Closed/Open POD Partnership: A Creative Professional Practice Exemplar for Occupational and Environmental Health Nurses
Authors: Gooder Valerie , Lowe London
Published: April 2024

Background:

For more than 15 years, the U.S. Centers for Disease Control and Prevention has recommended that all community agencies and workplace environments create structured communication and collaborative plans for emergency or disaster events (2008). This recommendation is aligned with the U.S. Department of Homeland Security’s (2022) National Infrastructure Protection Plan. The Coronavirus Disease 2019 (COVID-19) pandemic ultimately demonstrated the importance of having organized plans and processes in place for the effective and rapid dispensing of medical countermeasures (MCMs) to the general populace. Occupational and environmental health nurses (OHNs) can utilize examples of successful MCM dispensing programs and adjust details to fit individual organizational needs.

Methods:

This report examines a closed point of dispensing (Closed POD) mass vaccination program as a guide for designing successful workplace partnerships.

Findings:

Closed PODs are public or private sites that have set up a memorandum of understanding (MOU) with local health authorities to dispense MCMs to their populations during a public health emergency. The desired outcome of a closed POD agreement is the facilitation of employee health and safety, as well as enabling workplace continuity of operations.

Conclusions/Applications to Practice:

OHNs will play a pivotal role in any future disaster or emergency event. Because OHNs understand the critical need for anticipatory planning, they are in a prime position to drive the creation and implementation of a closed POD partnership between their workplace and their local health department.
The Ruse of Recognition: Black Labor in the Afterlife of Slavery
Authors: Green Venus , de Leon Cedric
Published: April 2024

Given the abolitionism professed by successive labor leaders in the years following the U.S. Civil War, why did the cause of interracial solidarity fail to gain traction in postbellum organized labor? Drawing on archival and secondary data on the encounter of Black and White labor from Reconstruction to the turn of the twentieth century, we trace the failure of interracial solidarity to the labor movement’s refusal to reckon institutionally with what Hartman calls the “nonevent of emancipation” and the “afterlife of slavery” for Black populations. Enslaved artisans dominated the skilled trades before the war, and White unions emerged correspondingly to exclude Black labor. When, after the Civil War, the formerly enslaved began to argue that they were being excluded from unions, White labor used emancipation as an anti-Black discursive technology to deny those claims. White labor also employed violence to exclude Black people from the labor movement. By addressing the research puzzle in this way, we offer a novel synthesis of Black studies and the sparse but important body of work on the sociology of slavery to reframe the mainstream approach to interracial solidarity in the sociology of labor and labor movements.
Enhancing Nursing Education to Address LGBTQ+ Healthcare Needs: Perspectives from the Philippines
Authors: Alibudbud Rowalt
Published: April 2024

Enhancing healthcare professionals’ education and training to effectively manage the healthcare needs of People Identifying as Lesbian, Gay, Bisexual, Transgender, Queer, and other Sexual and Gender Minorities (LGBTQ+) is imperative. Recognizing the importance of mitigating LGBTQ+ health disparities, healthcare associations have affirmed their commitment to providing inclusive and culturally competent healthcare. However, despite these efforts, there is still a gap in LGBTQ+-specific teaching within nursing and other healthcare professionals’ schools, resulting in healthcare professionals being ill-equipped to meet the unique needs of LGBTQ+. To address this gap, we suggest integrating LGBTQ+ health content into healthcare training programs, focusing on the Philippine nursing curriculum. Drawing from various reports, including insights from discussions with the local LGBTQ+, the suggested topics include LGBTQ+ identities, sexual health, trans health, mental health, and social determinants of LGBTQ+ health. By fostering understanding and competence through education, equitable and inclusive healthcare practices for LGBTQ+ can be better cultivated, helping to ensure that the unique healthcare needs of LGBTQ+ are met effectively. Furthermore, it is necessary to share best practices for providing health services to LGBTQ+ people. Additionally, future studies can explore the median time allocated to LGBTQ+ teaching, the optimal number of teaching hours for LGBTQ+ content, and the specific contents of local nursing curricula that can better address their needs. By undertaking these steps, we can move toward effectively addressing the unique healthcare needs of LGBTQ+.
Public Awareness of Major Climate Change Reports and Potential Political Connections
Authors: Whitley Cameron T.
Published: April 2024

Climate change will affect all life. Sociologists contribute to major climate change reports and are interested in how people are engaging these documents. Major climate change reports coming from the Intergovernmental Panel on Climate Change and the National Climate Assessment are used by scientists, policy makers, and localities to assess climate vulnerability and create climate action plans. Although sociologists have been at the forefront of understanding climate change perception, there is limited understanding about how the public interacts with these reports or whether they are even aware of them. The author uses survey data ( n = 1,013) to assess public awareness of these reports. The results suggest that conservative think tanks may be doing a better job at marketing reports to advance their agendas. This is important information as scientists continue to think about how to reach the public to advance mitigation and adaptation efforts and counter climate denialism.
Always growing? Mapping population change in urban China for 2010-2020
Authors: Liu Xiang , Fan Jing , Liu Zongshi
Published: April 2024

The geographic assessment of population changes provides fundamental insights into understanding urban development and addressing future urbanization challenges. In this graphic, we produced a Dorling cartogram to geo-visualize population changes at the city level across China between 2010 and 2020. The cartogram illustrates how internal migration fuels China’s growing population concentration and regional disparity, leading to significant population loss in lower administrative-level cities and escalating intercity imbalances across the country.
The Challenge of Gender Diversity for Case-Based Instruction in Entrepreneurship Education
Authors: Batchelder Susan , Kuratko Donald F. , Brush Thomas , Karlin Michael
Published: April 2024

The purpose of this study was to address case-based instruction in entrepreneurship education from multiple instructors’ perspectives and describe their experiences with this approach as it relates to gender diversity. This study answers the call for more substantive research focused on issues related to entrepreneurship education, including an examination of specific teaching methods and an in-depth exploration of gender and entrepreneurship education. The findings suggest the role that case-based instruction can play in efforts to advance gender equality as part of the diversity imperative in education. Instructors considered gender diversity in case selection but found it to be a challenge. Moreover, the descriptions of the entrepreneurs and their venture behaviors in the cases were gendered, which might have resulted in unintended discriminatory gender lessons. While none of the women were portrayed in a specifically negative light, underlying assumptions about gender roles infused the cases. While the instructors considered gender diversity in case selection, they did not necessarily consider gender stereotypes, which is problematic because gender stereotypes are cognitive schemas that influence the ways in which individuals make sense of their social world and may discourage some women’s aspirations to become business owners.
Corticospinal Modulation of Precision Movements
Authors: Marino Francesca , Moreno-López Yunuen , Hollis Edmund
Published: April 2024

Recently we demonstrated a critical role for temporal coding of corticospinal activity in a prehension movement requiring precise forelimb control. Learning of precision isometric pull drives large-scale remodeling of corticospinal motor networks. Optogenetic modulation of corticospinal activity and full transection of the corticospinal tract disrupted critical functions of the network in expert animals resulting in impaired modulation of precise movements. In contrast, we observed more widespread corticospinal co-activation and limited temporal coding on a similar, yet more simplistic prehension task, adaptive isometric pull. Disrupting corticospinal neuron activity had much more limited effects on adaptive isometric pull, which was found to be corticospinal independent by transection of the corticospinal tract. Here we discuss these results in context of known roles for corticospinal and corticostriatal neurons in motor control, as well as some of the questions our study raised.
Conceptualizing COVID-19 syndemics: A scoping review
Authors: Bulled Nicola , Singer Merrill
Published: April 2024

Background

COVID-19’s heavy toll on human health, and its concentration within specific at-risk groups including the socially vulnerable and individuals with comorbidities, has made it the focus of much syndemic discourse. Syndemic theory recognizes that social factors create the conditions that support the clustering of diseases and that these diseases interact in a manner that worsens health outcomes. Syndemics theory has helped to facilitate systems-level approaches to disease as a biosocial phenomenon and guide prevention and treatment efforts. Despite its recognized value, reviews of syndemics literature have noted frequent misuse of the concept limiting its potential in guiding appropriate interventions.

Objective

To review how the term ‘syndemic’ is defined and applied within peer-reviewed literature in relation to COVID-19.

Design

A scoping review of definitions within COVID-19 literature published between January 1, 2020 to May 15, 2023 was conducted. Searches took place across six databases: Academic Search Premier, CINAHL, JSTOR, MEDLINE/Pubmed, PsycINFO and Scopus. PRISMA-ScR guidelines were followed.

Results

Content analysis revealed that COVID-19 has varied clustered configurations of communicable–non-communicable diseases and novel communicable disease interactions. Spatial analysis was presented as a new strategy to evidence syndemic arrangements. However, syndemics continue to be regarded as universal, with continued misunderstanding and misapplication of the concept.

Conclusion

This review found that current applications of syndemics remain problematic. Recommendations are made on the design of syndemic studies. A syndemic framework offers an opportunity for systems-level thinking that considers the full complexity of human-disease interactions and is useful to inform future pandemic preparations and responses.
Evaluation of Apixaban Use in Patients With Advanced Kidney Disease
Authors: McClain Conner , Buckallew Amanda R. , Armbruster Anastasia L.
Published: April 2024

Background: Current guidelines and literature suggest apixaban may be used in patients with severe kidney disease and atrial fibrillation (AF) for stroke and systemic embolism risk reduction (SSE) or patients with acute venous thromboembolism (VTE). Limited data is available for long-term safety and efficacy outcomes in this patient population. Objective: Evaluate the use of apixaban for AF or VTE in patients with advanced kidney disease. Methods: This single-center, retrospective, Investigational Review Board approved study evaluated patients ≥18 years of age with severe kidney disease on apixaban therapy for VTE or AF from March 1, 2018, to December 31, 2020. The primary outcome was major bleeding from apixaban initiation/continuation until 12 months after discharge. The secondary outcomes included a composite bleed (major bleeding, clinically relevant non-major bleeding, and minor bleeding), the occurrence of VTE or SSE, and death during hospitalization from any cause other than bleeding. Results: Overall, 156 patients met inclusion criteria. Six patients experienced major bleeding (3.8%). Composite bleeding occurred in 16 patients (10.3%); no patients had SSE or VTE, and 4 patients died from causes other than bleeding (2.6%). Limitations included the small sample size and retrospective nature of the study. Conclusion: This study demonstrated that patients with advanced chronic kidney disease on apixaban for AF or VTE had low major bleeding and similar overall bleeding rates compared with previously published literature. When considering the use of apixaban in this population, risks and benefits should be weighed in addition to the consideration of FDA-label dosing guidance.
On the utility of story loss functions for regional seismic vulnerability modeling and risk assessment
Authors: O’Reilly Gerard J , Shahnazaryan Davit
Published: April 2024

Vulnerability functions relate loss to seismic intensity and can be developed via several approaches. They are a fundamental part of seismic risk assessment on a regional level and support decision-making and intervention strategies aimed at reducing risk. This article discusses a prominent analytical approach to developing seismic vulnerability models for buildings based on equivalent single-degree-of-freedom (SDOF) modeling, fragility function, and damage-to-loss model integration. The fundamental assumptions are scrutinized, and their principal drawbacks are highlighted. An alternative approach also based on an equivalent SDOF modeling approach is discussed but instead capitalizes on story loss functions (SLFs) as a means to more accurately compute economic losses and their sources. The main benefit is that the contribution of floor acceleration-based losses can be directly considered, and the disaggregation of losses is fully represented. A case study comparison is presented to highlight the similarities and key benefits. It is seen that the SLF-based approach can provide a much more comprehensive means to compute and communicate loss contributions among different element groups (i.e., structural, non-structural, and contents) and individual stories along the building height. Existing models can simply be adjusted to this approach and provide a more holistic view of risk. The benefits and potential applications in the (re)insurance sector are also discussed.
Optimizing spatio-temporal correlation structures for modeling food security in Africa: a simulation-based investigation
Authors: Bofa Adusei , Zewotir Temesgen
Published: April 2024

This study investigates the impact of spatio- temporal correlation using four spatio-temporal models: Spatio-Temporal Poisson Linear Trend Model (SPLTM), Poisson Temporal Model (TMS), Spatio-Temporal Poisson Anova Model (SPAM), and Spatio-Temporal Poisson Separable Model (STSM) concerning food security and nutrition in Africa. Evaluating model goodness of fit using the Watanabe Akaike Information Criterion (WAIC) and assessing bias through root mean square error and mean absolute error values revealed a consistent monotonic pattern. SPLTM consistently demonstrates a propensity for overestimating food security, while TMS exhibits a diverse bias profile, shifting between overestimation and underestimation based on varying correlation settings. SPAM emerges as a beacon of reliability, showcasing minimal bias and WAIC across diverse scenarios, while STSM consistently underestimates food security, particularly in regions marked by low to moderate spatio-temporal correlation. SPAM consistently outperforms other models, making it a top choice for modeling food security and nutrition dynamics in Africa. This research highlights the impact of spatial and temporal correlations on food security and nutrition patterns and provides guidance for model selection and refinement. Researchers are encouraged to meticulously evaluate the biases and goodness of fit characteristics of models, ensuring their alignment with the specific attributes of their data and research goals. This knowledge empowers researchers to select models that offer reliability and consistency, enhancing the applicability of their findings.
An autosomal recessive variant in PYGM causes myophosphorylase deficiency in Red Angus composite cattle
Authors: Batt Mackenzie C. , Venzor Leila G. , Gardner Keri , Reith Rachel R. , Roberts Kelsey A. , Herrera Nicolas J. , Fuller Anna M. , Sullivan Gary A. , Mulliniks J. Travis , Spangler Matthew L. , Valberg Stephanie J. , Steffen David J. , Petersen Jessica L.
Published: April 2024

Background

Between 2020 and 2022, eight calves in a Nebraska herd (composite Simmental, Red Angus, Gelbvieh) displayed exercise intolerance during forced activity. In some cases, the calves collapsed and did not recover. Available sire pedigrees contained a paternal ancestor within 2–4 generations in all affected calves. Pedigrees of the calves’ dams were unavailable, however, the cows were ranch-raised and retained from prior breeding seasons, where bulls used for breeding occasionally had a common ancestor. Therefore, it was hypothesized that a de novo autosomal recessive variant was causative of exercise intolerance in these calves.

Results

A genome-wide association analysis utilizing SNP data from 6 affected calves and 715 herd mates, followed by whole-genome sequencing of 2 affected calves led to the identification of a variant in the gene PYGM (BTA29:g.42989581G > A). The variant, confirmed to be present in the skeletal muscle transcriptome, was predicted to produce a premature stop codon (p.Arg650*). The protein product of PYGM, myophosphorylase, breaks down glycogen in skeletal muscle. Glycogen concentrations were fluorometrically assayed as glucose residues demonstrating significantly elevated glycogen concentrations in affected calves compared to cattle carrying the variant and to wild-type controls. The absence of the PYGM protein product in skeletal muscle was confirmed by immunohistochemistry and label-free quantitative proteomics analysis; muscle degeneration was confirmed in biopsy and necropsy samples. Elevated skeletal muscle glycogen persisted after harvest, resulting in a high pH and dark-cutting beef, which is negatively perceived by consumers and results in an economic loss to the industry. Carriers of the variant did not exhibit differences in meat quality or any measures of animal well-being.

Conclusions

Myophosphorylase deficiency poses welfare concerns for affected animals and negatively impacts the final product. The association of the recessive genotype with dark-cutting beef further demonstrates the importance of genetics to not only animal health but to the quality of their product. Although cattle heterozygous for the variant may not immediately affect the beef industry, identifying carriers will enable selection and breeding strategies to prevent the production of affected calves.
Connection of pre-competition anxiety with gut microbiota and metabolites in wrestlers with varying sports performances based on brain-gut axis theory
Authors: Fu Pengyu , Wang Cuiping , Zheng Shuai , Qiao Lei , Gao Weiyang , Gong Lijing
Published: April 2024

Objective

The purpose of this study is to investigate the connection of pre-competition anxiety with gut microbiota and metabolites in wrestlers with different sports performances.

Methods

One week prior to a national competition, 12 wrestlers completed anxiety questionnaires. Faecal and urine samples were collected for the analysis of gut microbiota and metabolites through the high-throughput sequencing of the 16 S rRNA gene in conjunction with untargeted metabolomics technology. The subjects were divided into two groups, namely, achievement (CP) and no-achievement (CnP) wrestlers, on the basis of whether or not their performances placed them in the top 16 at the competition. The relationship amongst the variations in gut microbiota, metabolites, and anxiety indicators was analyzed.

Results

(1) The CP group exhibited significantly higher levels of “state self-confidence,” “self-confidence,” and “somatic state anxiety” than the CnP group. Conversely, the CP group displayed lower levels of “individual failure anxiety” and “sports competition anxiety” than the CnP group. (2) The gut microbiota in the CP group was more diverse and abundant than that in the CnP group. Pre-competition anxiety was linked to Oscillospiraceae UCG_005, Paraprevotella, Ruminococcaceae and TM7x. (3) The functions of differential metabolites in faeces and urine of the CP/CnP group were mainly enriched in caffeine metabolism, lipopolysaccharide biosynthesis and VEGF and mTOR signaling pathways. Common differential metabolites in feces and urine were significantly associated with multiple anxiety indicators.

Conclusions

Wrestlers with different sports performance have different pre-competition anxiety states, gut microbiota distribution and abundance and differential metabolites in faeces and urine. A certain correlation exists between these psychological and physiological indicators.
Human nasal microbiota shifts in healthy and chronic respiratory disease conditions
Authors: Konovalovas Aleksandras , Armalytė Julija , Klimkaitė Laurita , Liveikis Tomas , Jonaitytė Brigita , Danila Edvardas , Bironaitė Daiva , Mieliauskaitė Diana , Bagdonas Edvardas , Aldonytė Rūta
Published: April 2024

Background

An increasing number of studies investigate various human microbiotas and their roles in the development of diseases, maintenance of health states, and balanced signaling towards the brain. Current data demonstrate that the nasal microbiota contains a unique and highly variable array of commensal bacteria and opportunistic pathogens. However, we need to understand how to harness current knowledge, enrich nasal microbiota with beneficial microorganisms, and prevent pathogenic developments.

Results

In this study, we have obtained nasal, nasopharyngeal, and bronchoalveolar lavage fluid samples from healthy volunteers and patients suffering from chronic respiratory tract diseases for full-length 16 S rRNA sequencing analysis using Oxford Nanopore Technologies. Demographic and clinical data were collected simultaneously. The microbiome analysis of 97 people from Lithuania suffering from chronic inflammatory respiratory tract disease and healthy volunteers revealed that the human nasal microbiome represents the microbiome of the upper airways well.

Conclusions

The nasal microbiota of patients was enriched with opportunistic pathogens, which could be used as indicators of respiratory tract conditions. In addition, we observed that a healthy human nasal microbiome contained several plant- and bee-associated species, suggesting the possibility of enriching human nasal microbiota via such exposures when needed. These candidate probiotics should be investigated for their modulating effects on airway and lung epithelia, immunogenic properties, neurotransmitter content, and roles in maintaining respiratory health and nose-brain interrelationships.
Problematic meta-analyses: Bayesian and frequentist perspectives on combining randomized controlled trials and non-randomized studies
Authors: Moran John L. , Linden Ariel
Published: April 2024

Purpose

In the literature, the propriety of the meta-analytic treatment-effect produced by combining randomized controlled trials (RCT) and non-randomized studies (NRS) is questioned, given the inherent confounding in NRS that may bias the meta-analysis. The current study compared an implicitly principled pooled Bayesian meta-analytic treatment-effect with that of frequentist pooling of RCT and NRS to determine how well each approach handled the NRS bias.

Materials & methods

Binary outcome Critical-Care meta-analyses, reflecting the importance of such outcomes in Critical-Care practice, combining RCT and NRS were identified electronically. Bayesian pooled treatment-effect and 95% credible-intervals (BCrI), posterior model probabilities indicating model plausibility and Bayes-factors (BF) were estimated using an informative heavy-tailed heterogeneity prior (half-Cauchy). Preference for pooling of RCT and NRS was indicated for Bayes-factors > 3 or < 0.333 for the converse. All pooled frequentist treatment-effects and 95% confidence intervals (FCI) were re-estimated using the popular DerSimonian-Laird (DSL) random effects model.

Results

Fifty meta-analyses were identified (2009–2021), reporting pooled estimates in 44; 29 were pharmaceutical-therapeutic and 21 were non-pharmaceutical therapeutic. Re-computed pooled DSL FCI excluded the null (OR or RR = 1) in 86% (43/50). In 18 meta-analyses there was an agreement between FCI and BCrI in excluding the null. In 23 meta-analyses where FCI excluded the null, BCrI embraced the null. BF supported a pooled model in 27 meta-analyses and separate models in 4. The highest density of the posterior model probabilities for 0.333 < Bayes factor < 1 was 0.8.

Conclusions

In the current meta-analytic cohort, an integrated and multifaceted Bayesian approach gave support to including NRS in a pooled-estimate model. Conversely, caution should attend the reporting of naïve frequentist pooled, RCT and NRS, meta-analytic treatment effects.
Arrhythmia detection by the graph convolution network and a proposed structure for communication between cardiac leads
Authors: Andayeshgar Bahare , Abdali-Mohammadi Fardin , Sepahvand Majid , Almasi Afshin , Salari Nader
Published: April 2024

One of the most common causes of death worldwide is heart disease, including arrhythmia. Today, sciences such as artificial intelligence and medical statistics are looking for methods and models for correct and automatic diagnosis of cardiac arrhythmia. In pursuit of increasing the accuracy of automated methods, many studies have been conducted. However, in none of the previous articles, the relationship and structure between the heart leads have not been included in the model. It seems that the structure of ECG data can help develop the accuracy of arrhythmia detection. Therefore, in this study, a new structure of Electrocardiogram (ECG) data was introduced, and the Graph Convolution Network (GCN), which has the possibility of learning the structure, was used to develop the accuracy of cardiac arrhythmia diagnosis. Considering the relationship between the heart leads and clusters based on different ECG poles, a new structure was introduced. In this structure, the Mutual Information(MI) index was used to evaluate the relationship between the leads, and weight was given based on the poles of the leads. Weighted Mutual Information (WMI) matrices (new structure) were formed by R software. Finally, the 15-layer GCN network was adjusted by this structure and the arrhythmia of people was detected and classified by it. To evaluate the performance of the proposed new network, sensitivity, precision, specificity, accuracy, and confusion matrix indices were used. Also, the accuracy of GCN networks was compared by three different structures, including WMI, MI, and Identity. Chapman’s 12-lead ECG Dataset was used in this study. The results showed that the values of sensitivity, precision, specificity, and accuracy of the GCN-WMI network with 15 intermediate layers were equal to 98.74%, 99.08%, 99.97% & 99.82%, respectively. This new proposed network was more accurate than the Graph Convolution Network-Mutual Information (GCN-MI) with an accuracy equal to 99.71% and GCN-Id with an accuracy equal to 92.68%. Therefore, utilizing this network, the types of arrhythmia were recognized and classified. Also, the new network proposed by the Graph Convolution Network-Weighted Mutual Information (GCN-WMI) was more accurate than those conducted in other studies on the same data set (Chapman). Based on the obtained results, the structure proposed in this study increased the accuracy of cardiac arrhythmia diagnosis and classification on the Chapman data set. Achieving such accuracy for arrhythmia diagnosis is a great achievement in clinical sciences.
The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis
Authors: Ito Masami , Tajika Aran , Toyomoto Rie , Imai Hissei , Sakata Masatsugu , Honda Yukiko , Kishimoto Sanae , Fukuda Memori , Horinouchi Noboru , Sahker Ethan , Furukawa Toshi A.
Published: April 2024

Background

Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions.

Methods

We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality.

Results

We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible.

Conclusions

Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.
Evolution of public funding since primary care research was considered as a priority research domain in france
Authors: Scheer Jordan , Leroy Taylor , Guillo Sylvie , Tubach Florence , Rozès Antoine , Verga-Gérard Amandine , Guillemin Francis , Lapeyre-Mestre Maryse , Chapron Anthony
Published: April 2024

Purpose

Annually, the French Ministry of Health funds clinical research projects based on a national call for projects. Since 2013, the Ministry has prioritized funding of primary care. Projects selected for funding are made public without distinguishing the specific area of research. The objective of this study was to identify and describe the evolution of the primary care research projects funded by the Ministry of Health between 2013 and 2019.

Method

We reviewed all of the 1796 medical research projects funded between 2013 and 2019 and categorized projects as primary care projects by using a list of specific keywords. This list was established through two approaches: (1) selected by an expert committee, the RECaP primary care working group, and (2) using an automated textual analysis of published articles in the field. The keywords were used to screen the titles of the medical research projects funded. The abstracts (at www.clinicaltrials.gov) or details (from project leaders) were then analyzed by two independent reviewers to determine true primary care projects.

Results

Finally, 49 primary care projects were identified, representing 2.7% of all medical research projects funded, without any significant change over the period. These projects were predominantly interventional (69%), with a median number of patients expected per project of 902.

Conclusion

Despite the prioritization of primary care research in 2013 by the French ministry of health, the number and proportion of projects funded remains low, with no significant change over the years.

Trial registration

Not applicable.
Opening the black box of registration practice for self-harm and suicide attempts in emergency departments: a qualitative study
Authors: Jakobsen Sarah Grube , Andersen Pernille Tanggaard , Lauritsen Jens , Larsen Christina Petrea , Stenager Elsebeth , Christiansen Erik
Published: April 2024

Background

The World Health Organization has called for improved surveillance of self-harm and suicide attempts worldwide to benefit suicide prevention programs. International comparisons of registrations are lacking, however, and there is a need for systematically collected, high-quality data across countries. The current study investigated healthcare professionals’ perceptions of registration practices and their suggestions for ensuring high-quality registration of self-harm and suicide attempts.

Methods

Qualitative interviews (N = 20) were conducted among medical secretaries, medical doctors, nurses, and registration advisers from psychiatric and somatic emergency departments in all regions of Denmark between September 2022 and March 2023. Content analysis was performed using NVivo.

Results

Despite great efforts to standardize and assure the quality of registration in Denmark, almost all the healthcare professionals perceived registration practice as inconsistent and unreliable. Codes are often misclassified or unused due to insufficient time, non-standardized training, or insufficient information. The interview informants suggested that coding guidelines should be simplified and made more visible, alongside technical solutions in the electronic health record system.

Conclusion

The study findings resulted in eight overall recommendations for clinical practice that aim at improving the registration of patients presenting with self-harm or suicide attempts. This would be expected to help improve surveillance and prevention programs.
The feasibility of integrating a home telehealth model for older persons living with hemodialysis
Authors: Pungchompoo Wanicha , Parinyachitta Saowaros , Pungchompoo Sirirat , Udomkhwamsuk Warawan , Suwan Panadda
Published: April 2024

Background

In Thailand, there is a rapidly increasing population of older persons living with hemodialysis (OPLWH) for whom quality of life and clinical outcomes are their main focus. This study aims to assess the feasibility of an integrated home telehealth model on quality of life and laboratory parameters of OPLWH.

Methods

In this study, the second phase of a mixed methods exploratory sequential design was conducted using a repeated measures experimental design. Participants met the inclusion criteria, which included being an OPLWH at a single hemodialysis center of one hospital in Chiang Mai province, Thailand, during the experimental period between 1 April and 30 September 2018, and willing to participate in the study. The 54 participants were purposively selected and randomly assigned to receive either an intervention (n = 24) consisting of health education and health monitoring using a telehealth device (an iPad) and a web application, or usual care (n = 30). The instruments included a demographic data form, which was analyzed using the chi-square test. The health-related quality of life questionnaire (the 9-item Thai Health Status Assessment questionnaire) and blood chemistry (BUN, Cr, Hb, Hct, Alb, K, Kt/V, and nPCR) were compared and measured at baseline, and at 3 and 6 months after enrolment using independent t-test and one-way repeated measures ANOVA.

Results

The comparison of quality of life between the two groups at the two points of repeated measurement (after 3 months) showed a statistically significant difference in mental health scores at P < 0.05. Six months after the intervention, mean scores for health outcomes and patients’ quality of life improved; however, this change did not reach statistical significance.

Conclusions

An integrated home telehealth model implemented by a hemodialysis nurse is a feasible holistic care approach for OPLWH. However, the absence of statistical significance may partly be associated with the clinical characteristics of frailty and risk factors such as increased age, hypertension, diabetes, heart disease, longer dialysis time, and inadequacy of Kt/V. Large-scale multi-centre trials are warranted to fully examine the acceptability of the model. The duration and long-term effects of the telehealth model are also recommended for further investigation.

Patient or public contribution

The development of a home telehealth model was a collaborative process between patients, caregivers, healthcare professionals from the hemodialysis unit, and the research team.