bluuebunny/crossref_metadata_2025 huggingface dataset:
Face-up vs face-down positioning after rhegmatogenous macula-off retinal detachment surgery: Hypothesis of better recovery
Authors: Savastano Alfonso , Calabresi Valerio , Crincoli Emanuele , Savastano Maria Cristina , De Vico Umberto Umberto , D’Onofrio Nicola Claudio , Rizzo Stanislao , Govetto Andrea
Published: February 2025

Purpose

To evaluate the differences between two distinct patient postoperative positions following rhegmatogenous macula-off retinal detachment surgery.

Methods

In this consecutive clinical study, 26 patients were placed in either the face-up or face-down postoperative position group. Postoperative follow-ups were conducted at 1, 3, and 6 months using type 1 M-CHARTS, best-corrected visual acuity (BCVA), intraocular pressure, and optical coherence tomography imaging to evaluate the functional and anatomical outcomes after surgery.

Results

The average vision recovery at 6 months was 0.35159 +/- 0.30945 logarithm of the minimum angle of resolution (logMAR) for the face-up group and 0.81521+/- 0.46662 logMAR for the face-down group. At 6 months, the average horizontal type 1 M-CHARTS for the face-up group was 0.1615 +/- 0.1710 and 0.2846 +/- 0.2828 for the face-down group; and the average vertical type 1 M-CHARTS was 0.1615 +/- 0.1557 for the face-up group and 0.2846 +/- 0.1725 for the face-down group.

Conclusion

The face-up position demonstrated significant improvement in both metamorphopsia and BCVA, suggesting that slow reattachment of photoreceptors on the retinal pigment epithelium layer can result in better quality of sight recovery. Further studies with larger sample sizes are warranted to confirm these results. The study adhered to the guidelines of the Declaration of Helsinki.
Comparing Immunotherapy Versus Chemotherapy Alone as Second-Line Therapy for Malignant Tumors of the Biliary Tract: A Retrospective Study
Authors: Jiang Chengzhi , Yang Liu , Kong Ling Yang , Fang Tianyuan , Chang Lele , He Lei , Ma Qian , Cheng YiBo , Wang Wanying , Ma Zhigang , Li Qingwei , Tao Ji
Published: February 2025

Background:

Bile duct carcinoma (BTC) is an uncommon malignant tumor of the gastrointestinal tract. Management is limited after the progress of first-line treatment. Immune checkpoint inhibitors (ICIs) have been proven popular in solid tumors. Immunotherapy plus chemotherapy has been a standard scheme in the management of multiple types of cancer. However, their efficacy and safety still need further exploration in patients who diagnosed BTC. This research mainly discusses the efficacy of immunotherapy in the second-line use of cholangiocarcinoma.

Methods:

In total, 126 individuals with BTC diagnosis from 2014 to 2024, who were treated with first-line or neoadjuvant treatment but were evaluated for progression or intolerance, were retrospectively included. All patients received standard chemotherapy, 57 received ICIs in combination with targeted therapy or not, and 69 did not. Patients were divided into simple chemotherapy (SC) and CT. Differences in efficacy, adverse events, progression-free survival (PFS), overall survival (OS), progressive disease (PD), and efficacy of multiple factors and efficacy were analyzed. The primary endpoint is defined as OS. The secondary endpoint is defined as PFS, objective response rate (ORR), disease control rate (DCR), and treatment-related adverse reactions (TRAEs).

Results:

The PFS and OS of 4.68 and 30.26 months for ICIs with or without targeted therapy were proven statistically significant ( P = .0012; P < .001). The ORR was 5.26% (3/57) in the CT group and 1.45% (1/69) in the SC group, and the DCR was 54.39% (31/57) compared with 33.33% (23/69). Cox analysis showed that TNM stage, T stage, histology grade, CA199 level, and treatment assessment grade were associated with OS ( P < .05). Histologic differentiation ( P = .009) and CA199 reduced ( P = .003) were proven as independent prognostic factors. The highest grade of 3 to 4 adverse reactions (TRAEs) was a reduction in hemoglobin (29.37%).

Conclusion:

Our work concluded that immunocombined chemotherapy with or without specific treatment showed significant antitumor activity and acceptable safety. Immune checkpoint inhibitors are likely to be a reliable second-line therapy for advanced BTC.
Frailty increases the risk of Alzheimer's disease in non-demented individuals: A longitudinal cohort study
Authors: Sheng Ze-Hu , Liu Jia-Yao , Ma Jun-Yi , Mi Yin-Chu , Wang Hao , Guo Fan , Ma Ling-Zhi , Tan Lan ,   Alzheimer's Disease Neuroimaging Initiative §
Published: February 2025

Background

Frailty, which is considered a potential modifiable risk factor for dementia, continues to generate debate when it comes to Alzheimer's disease (AD). Furthermore, the underlying pathological mechanisms linking frailty to AD remain uncertain.

Objective

We aimed to investigate the relationship between frailty and the risk of AD while elucidating the connections between frailty, AD biomarkers, and cognitive function.

Methods

Total of 829 non-frail (261 robust, 568 pre-frail) and 94 frail individuals from the Alzheimer's Disease Neuroimaging Initiative database were recruited. Kaplan–Meier analysis and Cox regression assessed AD risk across diverse frail statuses in 923 non-demented individuals. Multiple linear regression, mixed effects models and causal mediation analyses bootstrapped 10,000 iterations were conducted to examined underlying associations.

Results

The frail group had a 67.7% increased risk of AD than non-frail group (HR = 1.677; 95%CI, 1.179–2.385; p = 0.004), a 61.8% increased risk of AD than pre-frail group (HR = 1.618; 95%CI, 1.131–2.316; p = 0.009) and a far higher risk of AD than robust group (HR = 2.011; 95%CI, 1.263–3.202; p = 0.003). Frailty was associated with cognitive decline (global cognition, memory and executive function), whole brain and hippocampus atrophy, and ventricle dilation. Higher frail degree predicted faster cognitive decline, brain atrophy and ventricle dilation. Frailty's association with cognition was partially mediated by volume of whole brain (29.54%–30.17% of total effect), hippocampus (18.21%–24.55% of total effect), and ventricle (baseline, 7.62%–10.87% of total effect; change rate, 13.30%–24.33% of total effect).

Conclusions

Frailty as a potential risk factor for AD, further mechanisms investigation is warranted; mitigating frailty could potentially contribute to AD prevention.
Association of hippocampal atrophy with tau pathology of temporal regions in preclinical Alzheimer's disease
Authors: Pan Ningning , Liu Shujuan , Ge Xinting , Zheng Yuanjie ,   for Alzheimer's Disease Neuroimaging Initiative
Published: February 2025

Background

Hippocampal atrophy is linked to memory and cognitive deficits, preceding clinical diagnosis of mild cognitive impairment (MCI) by decades. Morphometry changes in the hippocampal formation (HF) and their relationship to tau deposition in non-demented individuals remains unclear.

Objective

To investigate morphometry changes in the HF and their association with tau deposition in a non-demented cohort.

Methods

Eighty-three subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) underwent T1-weighted MRI and Tau-PET scans at baseline and longitudinal follow-up. Participants were divided into amyloid-negative (Aβ−) and amyloid-positive (Aβ+) groups. Hippocampal volume/thickness were measured, and associations with tau deposition in temporal regions were examined using multivariable linear regression.

Results

No significant association was found between the hippocampal volume/thickness and tau deposition of temporal regions for the Aβ− group. For the Aβ+ group, the hippocampal thickness was significantly associated with tau deposition of entorhinal cortex (ERC) for both hemispheres, and temporal pole, inferior temporal, and middle temporal regions for right hippocampi with the longitudinal follow up scans, while no significant association with the baseline scans. It was interesting that there was strong association between the baseline tau deposition of ERC and temporal pole and the longitudinal follow up thickness of left hippocampi, while the associated regions for the right hemisphere were ERC, temporal pole, and inferior temporal regions.

Conclusions

Hippocampal atrophy may precede cognitive symptoms, with tau deposition in adjacent temporal regions contributing to hippocampal changes. The right HF appears more vulnerable than the left, indicating hemispheric differences in pathology.
Navigating financial coverage of healthcare to undocumented migrants at two hospitals in Oslo: a qualitative study
Authors: Fjelltorp-Veland Kristine , Fjeld Heidi E. , Eick Frode
Published: February 2025

Aims:

This study aimed to investigate how hospitals navigate financial coverage of healthcare for undocumented migrants, given the present laws and regulations in Norway.

Methods:

This qualitative study used an explorative approach. We collected and studied hospital guidelines for registering and invoicing foreign patients, and interviewed hospital staff from two university hospitals, and undocumented migrants at one non-governmental clinic in Oslo. The first author collected 14 documents and conducted 14 semi-structured, in-depth interviews. The project team used a thematic-analysis-inspired approach to identify patterns of shared meaning in the guidelines and interviews.

Results:

We found that the hospital guidelines did not account for undocumented migrants. The staff had to navigate between the guidelines and practical implications of undocumented migrant patients not having a resident permit and thus lacking a Norwegian identity number, bank card, or address. We found discrepancies between different staff’s expected roles in the registration of patients and in the assessment of patients’ ability to pay. The guidelines presumed an active patient and required documentation, which undocumented migrants had difficulty meeting.

Conclusions:

The underlying assumption of patients being documented in routines led to a process of othering of undocumented patients and thereby reproducing their marginalised position in the health system, hence depriving them of the right to ‘health care that is absolutely necessary and cannot wait’. We recommend that hospitals increase staff’s knowledge and capacity to ensure undocumented migrants’ right to healthcare.
Educational moods: Exploring the concept of classroom climate from a sensory-phenomenological perspective
Authors: Langmann Elisabet
Published: February 2025

The value of sustaining an open and positive classroom climate for student’s academic and socio-emotional development is well documented in educational research. Referring to the prevailing mood or atmosphere of the classroom, the concept is meant to capture the day-to-day experiences of teachers and students on a collective rather than individual level. At the same time, the notion of ‘classroom climate’ seems to belong to a language of educational impreciseness, rendering it sometimes too vague and at other times too technical for capturing the lived and embodied meaning of classroom life. Inspired by Gert Biesta’s call for a world-centred education, the paper offers a sensory-phenomenological analysis of the concept of classroom climate by unfolding the concept in the double gesture of mapping and reconstructing. By differentiating some of the meanings of classroom climate in previous research, and by drawing on Martin Heidegger’s phenomenology of Stimmung and on Rita Felski’s work on mood and attunement, the paper explores what a more precise and meaningful way of speaking about classroom climate and what matters educationally in sustaining a positive classroom climate may look like. To this end, the notion of ‘educational moods’ offers semantic resources not yet considered within educational research.
Predictors for spontaneous pleurodesis in patients with indwelling pleural catheters for malignant pleural effusion: a safety net hospital experience
Authors: Farooq Saad , Armin Sabiha , Killingsworth Jordan E. , Agrawal Akriti , Rao Adishwar , Estrada-Y-Martin Rosa M. , Cherian Sujith V.
Published: February 2025

Background:

Malignant pleural effusion (MPE) affects approximately 150,000 patients in the United States each year and usually signifies advanced-stage cancer. The optimal treatment remains a challenge but indwelling pleural catheters (IPC) offer several advantages and may help achieve spontaneous pleurodesis (SP) in some patients.

Objectives:

We aim to investigate the predictors of SP among patients with MPE, particularly in a resource-limited community-based safety net hospital.

Design:

This is a retrospective cohort study done at a community-based safety net hospital.

Methods:

Adults diagnosed with or suspected of having MPE between January 2015 and December 2023 who underwent IPC placement were included. Data was collected retrospectively from December 2023 to June 2024. Data encompassed demographics, imaging, post-procedural complications, pleural fluid analysis, oncology treatment history, and utilization of medical thoracoscopy without chemical pleurodesis (MTWCP) for diagnosis.

Results:

A total of 173 patients underwent IPC insertion. Most of our patients were women (64.2%), and Latin American (65.9%), with a mean age of 55.3 years. The most common type of primary cancer was breast (28.9%) followed by lung (23.1%) and lymphoma (6.9%). Pleural fluid characteristics such as glucose, eosinophils, Lactate Dehydrogenase (LDH), and protein concentration were not significantly associated with SP. Most patients had low Eastern Cooperative Oncology Group scores of 0–2 (64.6%) and low LENT (Lactate Dehydrogenase (L), Eastern Cooperative Oncology Group (E) Performance Score, Neutrophil-to-Lymphocyte Ratio (N), and Tumor type (T) score) scores of 0–4 (59%). Lower scores (better functional status) were significantly associated with SP. Post-IPC chemotherapy and/or radiotherapy and immunotherapy were significantly associated with SP, adjusted odds ratio (OR) 7.295 (95% CI: 3.05–17.4, p = 0.001) and adjusted OR 6.261 (95% CI: 2.73–14.36, p = 0.001) respectively. MTWCP was also a predictor of SP with an adjusted OR of 4.031 (95% CI: 1.452–11.19, p = 0.007).

Conclusion:

Our study is the first to assess predictors of SP in a resource-limited safety net hospital representing under-represented and underserved patients. We identify several factors associated with higher rates of SP such as higher functional status, MTWCP, chemotherapy, immunotherapy, and radiation post-IPC placement. The study findings can help clinicians consider IPC placement and guide them regarding the duration and possible complications of IPC. MTWCP appears to improve the success of SP. Further studies are needed to assess these findings further.
Clinical outcomes in immunocompromised adults with COVID-19, based on anti-spike IgG serostatus and monoclonal antibody therapy: a retrospective cohort study in the Omicron period
Authors: Vasishta Shilpa , Aberg Judith , Patel Gopi , Gownivaripally Pooja Anand , Rana Meenakshi
Published: February 2025

Background:

Immunocompromised adults may experience severe COVID-19 outcomes, necessitating a multifaceted treatment approach. Studies from the Delta period showed benefit from monoclonal antibody (mAb) therapy that was most pronounced among anti-spike IgG seronegative individuals. With widespread vaccination and shifting SARS-CoV-2 variants in the Omicron period, clinical predictors of anti-spike IgG seronegativity, and impacts on clinical outcomes, remain incompletely characterized.

Objectives:

We describe outcomes from a cohort of immunocompromised adults with COVID-19 stratified by anti-spike IgG serostatus and receipt of mAb therapy during the Omicron period to evaluate clinical impact.

Design:

This was a retrospective study of immunocompromised adults with mild-moderate COVID-19 presenting between December 2021 and October 2022.

Methods:

Charts were reviewed to assess anti-spike IgG serostatus, receipt of mAb therapy, and 28-day outcomes including conventional oxygen use, high-flow oxygen use, mechanical ventilation, and death.

Results:

A total of 276 individuals were included, of whom 252 (91%) were partially or fully vaccinated, 190 (69%) were anti-spike IgG seropositive, and 225 (82%) received mAb therapy. A majority were solid organ transplant recipients (169, 61%), with anti-spike IgG seronegatively significantly associated with mycophenolate-based immunosuppression or comorbid chronic kidney disease. Conventional oxygen use among seropositive patients receiving mAb, seronegative patients receiving mAb, seropositive patients not receiving mAb, and seronegative patients not receiving mAb were 2/154 (1%), 5/71 (7%), 6/36 (17%), and 4/15 (27%), respectively. Across the cohort, high-flow oxygen use, mechanical ventilation, and death occurred in 6 (2%), 4 (3%), and 3 (1%) individuals, respectively.

Conclusion:

Clinical outcomes in a predominantly vaccinated, immunocompromised cohort with mild–moderate COVID-19 during the Omicron period appeared to vary with anti-spike IgG serostatus and receipt of mAb therapy. Observed trends would benefit from prospective studies during future iterations of COVID-19 therapeutics to inform treatment decisions for immunocompromised adults.
Bystander evil and upstander intervention: the stories of Job and Jesus
Authors: Ki Magdalen Wing-chi
Published: February 2025

Perpetrators are committed to wrongdoing due to four types of evils: individual, diabolical, superego, or institutional evil. Yet bystanders can be just as problematic. First, classic “bystander effect” is often linked to individual or ego-evil. Second, the dark side of human nature can advance bystander diabolism. Third, a law-abiding subject may be (mis)guided by their superego, taking comfort in inhuman bystander legalism. Fourth, institutional dynamics can spearhead bystander groupthink. The stories of Job and Jesus show that bystanders—whether active, passive, or interactive—often play an important role in human affairs. In the darkest hours, individuals can battle bystander evil due to their different attachment patterns and coping methods, championing upstander interventions at the individual or collective level.
Barriers to and enhancement of the utilization of digital mental health interventions in low-resource settings: Perceptions of young people in Uganda
Authors: Mwaka Erisa Sabakaki , Bazzeketa Datsun , Mirembe Joy , Emoru Reagan D. , Twimukye Adelline , Kivumbi Apollo
Published: February 2025

Introduction

Digital mental health (DMH) enhances access to healthcare, particularly in low- and middle-income countries where investment in mental healthcare is low. However, utilization among young people (YP) is low. This study aimed to explore YP's perceptions of the barriers to the using of DMH interventions in low-resource settings.

Methods

A qualitative descriptive approach was used. Six face-to-face focus group discussions were conducted with 50 YP from nine universities in Uganda. The median age was 24 years (range 21–25 years) and respondents were drawn from diverse academic programmes with the majority being medical students (54%). A thematic approach was used to interpret the results.

Results

Three themes were identified from the data including perceptions of using DMH services, the perceived barriers to utilization, and suggestions for enhancement of DMH for YP in low-resource settings. Most respondents had a positive attitude towards DMH. The perceived barriers to utilization of DMH included the fear of stigma, affordability, inequitable access, privacy and confidentiality concerns, and app-related challenges. Access and use of DMH can be enhanced through public engagement, creating awareness, enhanced training, and access to affordable DMH interventions.

Conclusion

DMH was deemed important in extending healthcare to YP, particularly in health systems where traditional mental health services are not readily available. However, several factors hinder equitable access to DMH in low-resource settings. There is a need for long-term investment in digital health technologies.
Analysis of Clinical and Radiological Predictive Factors for Moderate and Severe Pulmonary Impairment in 102 Adolescent Idiopathic Scoliosis (AIS) Patients With Major Cobb Angle ≥45°: A Study of an Asian Population
Authors: Lee Sin Ying , Lee Yu Jie , Chiu Chee Kidd , Chandirasegaran Saturveithan , Hasan Mohd Shahnaz , Chan Chris Yin Wei , Kwan Mun Keong
Published: February 2025

Study Design

Retrospective cohort study.

Objective

To investigate the independent predictive factors for moderate-severe pulmonary impairment (MSPI) among adolescent idiopathic scoliosis (AIS) patients.

Methods

The preoperative pulmonary function tests (PFTs) of 102 AIS patients ( major Cobb angle ≥45°) operated between 2015 and 2020 were retrospectively reviewed. Patients were divided into 2 groups based on the predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV 1 ), respectively. Group 1 had normal/ mild pulmonary impairment ( FVC or FEV 1 >65% predicted) whereas Group 2 had MSPI ( FVC or FEV 1 ≤65% predicted). Multivariate logistic regression analysis was performed to determine the predictive factors for MSPI.

Results

41.2% (N = 42) and 52.0% (N = 53) of the total patients were categorised into Group 2 (MSPI) based on predicted FVC and FEV1, respectively. In general, Group 2 had more patients with a major main thoracic (MT) curve, larger MT curve with lower MT flexibility, a larger MT apical vertebra translation (MT-AVT), and a smaller thoracolumbar-lumbar (TL/L) AVT than Group 1 ( P < . 05). When analyzing the MT Cobb angle for every 10 ° increment, patients with MT Cobb angle ≥70° had MSPI (N = 31.4%). Body mass index (BMI) (FVC: aOR .8; FEV1: aOR .9) and MT Cobb angle ( for every 10° increment, FVC: aOR 1.7; FEV1: aOR 1.8) were the significant independent predictive factors for MSPI.

Conclusion

MSPI was evident in patients with MT Cobb angle ≥70°, with MT Cobb angle and BMI being the significant independent predictive factors.
Rapid Manufacturing, Regulatory Approval, and Utilization of Patient-specific 3D-Printed Titanium Implants for Complex Multistage Spinal Surgeries
Authors: Yahanda Alexander T. , Barot Karma , Ruiz-Cardozo Miguel A. , Pet Mitchell A. , English Ian , Ohman J. Westley , Sanchez Luis A. , Hunt Steven R. , Brogan David M. , O’Keefe Regis J. , Albers Brian , Miller Evan , Goodwin Matthew L. , Molina Camilo A.
Published: February 2025

Study design

Technical note and case series.

Objectives

3D-printed implants (3DPI) for spinal surgery are a relatively recent development. We report on our experience with the rapid creation and regulatory approval of patient-specific 3DPI for use in complex spinal reconstruction, including a novel expedited turnaround time for implant creation.

Methods

Four patients underwent placement of 3DPI to replace osseous anatomy during complex spinal reconstructions. These implants were created and used to replace patient-specific anatomy created by either en bloc tumor resection or by severe neurogenic spinal arthropathy. The surgical planning, implant creation, and postoperative outcomes are outlined.

Results

All patients underwent successful implantation of 3DPI, which was confirmed on postoperative imaging at most recent follow-up. The time to plan, create, obtain regulatory approval, and use the first 3DPI was 28 days. Subsequent 3DPI could be planned, approved, and used in surgery in as little as 4-5 days, which is faster than previously-published reports. Thus, a 3DPI could be generated based on osseous defects created during stage 1 of a multistage surgical plan and implanted during a subsequent stage in an especially expedited manner.

Conclusions

3DPI may be used to effectively replace patient-specific anatomy during complex spinal reconstructions, including for osseous defects that are generated after the initial surgical procedure. These 3DPI may be created, approved, and used in surgery over much faster timelines than have been previously reported. Additional cases utilizing these custom 3DPI will further elucidate their utility during complex reconstructions.
Learning by Doing, and Doing it Right – Building a Multi-Dimensional Social Determinants of Health Curriculum in a Rural Internal Medicine Residency
Authors: Zhang Sophia , Zhu Yibei , Parrilla Lara , Du Kaili
Published: February 2025

OBJECTIVES

While there has been increasing awareness of the importance of social determinants of health (SDOH) learning for internal medicine residents and physicians, only a few residency programs have incorporated training into their curricula. For those who did, the curricula were often didactic and lacked action-driven components or community partnership. Therefore, we built an experiential SDOH curriculum with an action-driven element and emphasis on community partnerships in a newly established residency program in rural New York.

METHODS

Over 24 months, 22 internal medicine residents were engaged in SDOH lectures, workshops, and action-driven learning through implementing screening tools in residency clinics and working with community partners. After the curriculum, residents’ competency in addressing SDOH needs was assessed through Likert-scale questionnaires. Focused interviews were conducted among participating residents and faculty to obtain qualitative feedback on the curriculum.

RESULTS

Participating resident physicians demonstrated competency in recognizing and addressing SDOH needs after curriculum completion (mean competency score = 4.04). A significant increase in residents’ self-rated confidence in addressing SDOH was observed after training ( P = .002). Residents reported enhanced relationships with patients, effective utilization of community resources, and readiness to apply SDOH knowledge and skills to their future practice. Residents and faculty also discussed the SDOH challenges unique to rural primary care through their experiences.

CONCLUSION

This curriculum provides insights into an educational framework that improves residents’ SDOH awareness, integrates SDOH into resident physicians’ daily practice, and facilitates community collaboration. While challenges unique to rural primary care exist, this curriculum demonstrated the feasibility of longitudinal, action-driven, and community-centered SDOH education in rural areas that may inform future programs’ curricular design.
Understanding pedestrian dynamics using machine learning with real-time urban sensors
Authors: Asher Molly , Oswald Yannick , Malleson Nick
Published: February 2025

Quantifying, understanding and predicting the number of pedestrians that are likely be present in a particular place and time (‘footfall’) is critical for many academic, business and policy questions. However, limited data availability and complexities in the behaviour of the underlying pedestrian ‘system’ make it extremely difficult to accurately model footfall. This paper presents a machine learning model that is trained on a combination of hourly footfall count data from sensors across a city as well as important contextual factors that are associated with pedestrian movements such as the structure of the built environment and local weather conditions. The aims are to better understand the relationship between various contextual factors and footfall and to predict footfall volumes across a spatially heterogeneous city. The case study area is the city of Melbourne, Australia, where abundant pedestrian count data exist. Time-related variables, particularly time-of-day and day-of-week, emerged as the most significant predictors. While some built environment factors such as the presence of certain landmarks and weather conditions were influential, they were less so than temporal cycles. Interestingly the model over-estimates footfall in the years following the COVID-19 pandemic, suggesting that urban dynamics have yet to return to pre-pandemic levels (and may never do). The paper also demonstrates how the model can be used to assess the impacts that large events have had on footfall, which has implications for policy makers as they try to encourage foot traffic back into city centres.
Development of Sustainable Multilayer Composite Nonwoven Fibrous Assembly for Thermal Insulation Application
Authors: Palanisamy Sukumar , Yadav Anilkumar , Bajya Mukesh , Choudhary Awadhesh Kumar
Published: February 2025

Insulation offers thermal comfort by blocking the heat flow across the walls of buildings and drastically reduces the cost associated with energy consumed in maintaining temperature inside the buildings. Commercial insulating materials such as fiberglass, polystyrene, and polyurethane foams, although demonstrating long serviceability, are associated with several limitations including non-biodegradability. This study hence presents the development of biodegradable multilayer nonwoven fabrics based on natural fibers for thermal insulation as a sustainable alternative to synthetic non-biodegradable polymers. The nonwoven fabrics of kapok, jute, and banana with thicknesses ranging between 5 and 15 mm were produced by needle punching. The developed needle punched nonwoven fabrics were attached together in different fiber combinations to produce multilayered fabrics. The nonwoven fabrics were investigated for thickness, areal density, porosity, and thermal properties like heat flux, thermal resistance, and thermal conductivity. The relatively low thermal conductivity of kapok, jute, and banana fibers, and presence of air pockets in the needle punched nonwoven fabrics, all together governed the development of a sustainable fibrous assembly for thermal insulation of buildings. The results confirmed that kapok, jute, and banana fiber based nonwoven fabrics can be successfully used as an alternative to conventional non-biodegradable thermal insulating materials.
A clinical case of acute scrotal syndrome on the background of primary scrotal lipoma and literature review
Authors: Lim Raymond Zhun Ming , Soo Tze Hui , Sharin Mohamad Fairuz Mohamad , Ilias Aizat Sabri , Tharek Anas , Abdullah Maizaton Atmadini , Ahmad Adibah
Published: February 2025

Background

Primary scrotal lipomas are exceptionally uncommon entities within the scrotal sac frequently occur in younger males under 40. It usually painless and found incidentally during imaging. They are generally categorized based on their site of origin.

Case presentation

A 36-year-old man presented with an acute onset of severe left scrotal pain at midnight. Clinical examination revealed two scrotal masses in the left hemiscrotum associated with excruciating tenderness on palpation and loss of cremasteric reflex. Ultrasonography showed a well-defined, oval-shaped, isoechoic lesion underlying the median raphe of scrotum alongside bilateral normal testes. Given the intensity of unexplained pain despite high dose of analgesia, urgent scrotal exploration was done. Intra-operatively, a yellowish, firm mass was identified at the upper pole of the left main testis which was excised. Histopathological examination revealed a primary scrotal lipoma with no necrotic area seen.

Conclusions

Ultrasound is typically the first-line imaging technique to exclude more sinister pathology. The atypical presentation of excruciating pain mimicking testicular torsion in our case complicates the diagnostic process. Scrotal lipoma can be and should be excised as the standard treatment albeit found incidentally.
The TANGO-DM randomized controlled trial study protocol: treatment outcomes for gestational diabetes diagnosed according to WHO 2013 or WHO 1999 thresholds
Authors: Rademaker Doortje , de Wit Leon , van der Wel Anne , van den Akker Eline , Braams-Lisman Babette , Dullemond Remke , Evers Inge , Galjaard Sander , Hermsen Brenda , van Hoorn Marion , Huisjes Anjoke , Kaandorp Joepe , Lub Annemiek , Lunshof Simone , van der Made Flip , Nijman Remco , van Laar Judith , Vollebregt Karlijn , Velzel Joost , Vlemmix Floortje , Westerhuis Michelle , Wijnberger Lia , Wouters Maurice , Zwart Joost , Bosmans Judith , Bossuyt Patrick , Duijnhoven Ruben , Lopriore Enrico , de Miranda Esteriek , Verhoeven Corine , Mol Ben Willem , Franx Arie , DeVries J. Hans , van Rijn Bas , Painter Rebecca
Published: February 2025

Introduction

Gestational diabetes mellitus (GDM), or hyperglycemia first diagnosed in pregnancy, affects 7–10% of all pregnancies worldwide. Perinatal risk rises with increasing glycemia at oral glucose tolerance test (OGTT). The new (2013) WHO criteria recommend a lower fasting, and a higher post-load threshold for GDM diagnosis in comparison to the old (1999) WHO criteria. To date, however, outcomes of GDM treatment for those affected by the altered diagnostic criteria, has not been well investigated. We hypothesized that intensive GDM treatment according to the new (2013) GDM criteria would result in a reduction in infants with birth weight > 90th centile (large for gestational age, LGA), in comparison to treatment according to the old criteria (1999).

Methods

The TANGO-DM trial is an open label, multicenter randomized controlled trial. Participants are pregnant with a gestational age between 16 + 0 and 32 + 0 weeks, who underwent a 1-step venous 2- or 3-point 75-gram oral OGTT, were eligible if they had glucose concentrations discordant between the old (1999) and the new (2013) criteria. After informed consent, women are randomized to either intensive GDM treatment, consisting of dietary advice and glucose monitoring and, if euglycemia is not reached, antihyperglycemic agents, or normal obstetric care without GDM treatment. The primary outcome is large-for-gestational-age infants (birth weight > 90th percentile). Secondary outcome measures include maternal complications, obstetric complications, neonatal complications, obstetric interventions, quality of life, and healthcare and societal costs. Outcomes will be analyzed according to the intention-to-treat principle. The study is powered to detect a reduction in LGA from 16% in the untreated to 10% in the treated group, which requires 1032 participants (516 per arm; alpha-error 5% for 80% power).

Discussion

The TANGO-DM trial will provide high-level evidence to support or refute the use of the new 2013 WHO diagnostic criteria in terms of their ability to lower the number of large for gestational age infants and/or improve maternal and perinatal outcomes and/or costs in women with gestational diabetes.

Trial registration

Central Committee on Research Involving Human Subjects (CCMO) (NL63013.018.18). Registered on 22 September 2018.
Better floors, better health: a theory of change for an improved household flooring intervention in rural communities in Kwale and Bungoma counties, Kenya
Authors: Kepha Stella , Legge Hugo , Halliday Katherine E. , Ochwal Victoria , Elson Lynne , Mwongeli Jacinta , Oswald William E. , Kakoi Beatrice , Wambua James , Mwandawiro Charles , Fillinger Ulrike , Pullan Rachel , Njomo Doris
Published: February 2025

Background

Household flooring is increasingly being investigated as a determinant of health, however the pathways through which flooring may impact health and wellbeing are not yet well understood. The SABABU study is a cluster-randomised controlled trial evaluating the impact of an improved flooring intervention on soil-transmitted helminthiasis, tungiasis, and enteric infections in Bungoma and Kwale counties, Kenya. This paper presents the findings from a theory of change development process that was undertaken as part of the formative research phase of the SABABU project.

Methods

A co-creation workshop (n = 1), stakeholder meetings (n = 2), and community meetings (n = 2) were held with a range of participants including community members (n = 36), village-level leaders (n = 28), and local government stakeholders (n = 14) to draft and refine the theory of change framework. These meetings were informed by a previous formative research phase conducted in study communities – comprised of household observations, in-depth interviews, and focus group discussions with community members – to investigate daily routines, use of space within homes, and attitudes towards home improvement.

Results

The theory of change framework demonstrates how the improved household flooring intervention aims to reduce prevalence of soil-transmitted helminthiasis, enteric infections and tungiasis and improve psychological wellbeing among children and caregivers. Reductions in infections are predicated on limited contact between improved floors and animals, regular floor cleaning, and household members conducting their daily routines on the new floors. Gains in psychological wellbeing are tied to increased feelings of pride, self-efficacy, and social progress, as well as improved quality of life through reduced morbidity from enteric and parasitic infections.

Conclusion

This study presents a theory of change framework mapping the pathways through which an improved flooring intervention may impact health and wellbeing. The results can be of use to researchers or programmes that are in the design or evaluation phase of a household flooring project in Kenya or other settings where access to improved floors is limited.
Priority indicators for evaluating the impact of field epidemiology training programs – results of a global modified Delphi study
Authors: Flint James A. , Housen Tambri , Kirk Martyn D. , Durrheim David N.
Published: February 2025

Background

Field Epidemiology Training Programs (FETPs) aim to develop a skilled public health workforce through applied competency-based learning. With 98 programs globally and over 20,000 graduates, these programs play a crucial role in disease preparedness and response activities around the world. Despite their importance, there have been few published evaluations. This paper presents the results of a consensus-building process to develop a preferred array of indicators for evaluating the outputs, outcomes, and impacts of FETPs.

Methods

We conducted a modified Delphi study to reach consensus on preferred evaluation indicators for FETPs. An initial list of evaluation indicators were identified from literature reviews and consultations with impact evaluation experts and FETP professionals. A modified Delphi process was subsequently employed, involving two rounds of surveys and a final expert review meeting, to reach consensus on indicators. The Delphi panel included 23 experts representing diverse global regions and FETP roles.

Results

Consensus was reached to include 134 evaluation indicators in the final impact evaluation framework. These indicators were grouped as output, outcome, and impact indicators.

Conclusions

This study presents the first FETP impact evaluation framework with a comprehensive list of evaluation indicators for FETPs. This list of indicators is intended as a resource to promote and enhance the evaluation of FETPs and thus improve these important training programs which aim to strengthen national, regional and global health security.
How do medical students make sense of internal and external feedback to enhance their Dutch communication skills?
Authors: Yu Hao , Li Zhien , Köhler S. Eleonore , van Merriënboer Jeroen J. G. , Asoodar Maryam
Published: February 2025

Background

Feedback is crucial in medical education for developing communication skills and fostering comprehensive learning. Despite its importance, medical students often face challenges in effectively leveraging feedback. This study investigates how students perceive and make sense of internal and external feedback in a 2nd language (L2) medical Dutch course.

Methods

Sixteen third-year international medical students (mean age = 23) participated in a medical Dutch course that included six structured sessions. Each session encompassed a briefing, simulated patient consultations (SPCs), and a debriefing. The curriculum integrated internal feedback from self-reflections and external feedback from peers, teachers, and simulated patients. Data were gathered through a students’ feedback perception survey and semi-structured interviews and analyzed via inductive thematic analysis.

Results

Survey data indicated a trend where the preference, satisfaction, and trust in external feedback were higher than those for internal feedback. However, both types of feedback were regarded as equally effective in facilitating learning progress. Through thematic analysis, we identified five crucial themes that show how students perceive and make sense of various forms of feedback: proactive engagement with feedback, critically analyzing and utilizing the exchange in dialogues and discussions, self-reflection and progress tracking, value from diverse perspectives, and moment-specific and actionable feedback.

Conclusions

This study emphasizes the vital roles of internal and external feedback in enhancing medical Dutch communication skills among medical students. Internal feedback encourages self-reflection and growth, essential for complex medical communications, while external feedback provides clear, specific and supportive guidance and experience from teachers, simulated patients and peers. These feedback mechanisms together improve students’ skills in medical Dutch communication, leading to better doctor-patient interactions. Future research should focus on adapting these feedback strategies across diverse educational settings to further support the development of medical L2 communication skills in global medical contexts.
Patient coordination during the COVID-19 pandemic in the Amsterdam region: effects on capacity utilization and patient flow
Authors: Berkeveld E. , Rhebergen M. D. F. , Bloemers F. W. , Zandbergen H. R. , van Merode G. G.
Published: February 2025

Background

To manage COVID-19 surge demand, Dutch regional and national task forces were installed to coordinate a proportionate patient distribution. This study examined the effect of centralized COVID-19 patient coordination on hospital capacity utilization during the pandemic.

Methods

A retrospective observational double cohort study compared intra- and interregional patient coordination by the regional task force ROAZ Noord-Holland Flevoland. Coordination was compared to a simulated scenario without coordination based on a queueing model during two time periods from January 1, 2021, until May 1, 2021 and from August 1, 2021, until December 1, 2021. Daily data on patient ICU and clinical COVID-19 patient transfers, number of admissions, and capacity were assessed. The primary outcome was hospital capacity utilization.

Results

Overall, 1,213 patients were transferred both within the eleven regional hospitals and outside the region during cohort I and 528 patients during cohort II. During the first cohort, eight hospitals (ICU patients) and two hospitals (clinical patients) showed a utilization factor exceeding 100% without coordination which reduced to below 100% with coordination. During the second cohort, utilization factors exceeding 100% varied between the scenarios with and without coordination. In both cohorts, the majority of hospitals that showed a utilization factor below 100% in the scenario without coordination, showed an increased utilization factor in the scenario with coordination.

Conclusion

This retrospective double cohort analysis based on regional coordination of COVID-19 patients and a simulated scenario of absent regional coordination, identified that load-balancing of COVID-19 care demand generally resulted in an improved distribution of utilization among hospitals. In a crisis, we suggest a swift upscale from local, regional to national centralized coordination activity to enable inter and intra-regional patient coordination at an early stage. Future research is recommended to explore the applicability of coordination for other patient categories to benefit from regional centralization during a crises.
Location-independent leadership: managers’ experiences leading prehospital emergency care in Sweden – a qualitative study
Authors: Lindlöf Henrik , Savage Carl , Härenstam Karin Pukk , Vicente Veronica
Published: February 2025

Introduction

Research into management and leadership in healthcare has revealed that the organizational context influences quality improvement, which is why research is needed to better understand the particulars of leadership in the relatively unexplored field of prehospital emergency care. This includes aspects of managerial work related to managers' experiences and their understanding of their roles and existing operational routines. Therefore, this study aims to explore managers' experiences with management and leadership in the context of prehospital emergency care in Sweden.

Methods

A qualitative interview study design was conducted with 15 unit managers in prehospital emergency care from four of Sweden’s 21 regions. The transcripts from the in-depth interviews were subjected to inductive content analysis and reported according to the Consolidated Criteria for Reporting Qualitative Research.

Results

Three generic categories related to the managerial role were identified: challenges, openness and trust, and experience-based leadership. The challenges managers faced were a. lack of physical proximity; b. staff needs for knowledge and competency development; c. staff level of responsibility related to operating procedures and guidelines; and d. work culture. Trust was developed through open and personalized communication, trusting relationships, authenticity, and empathic ability. Experience-based leadership was cultivated over time through practice, reflection, guidance from peers, theoretical leadership training, and the adaptation of organizational structures.

Conclusions

We found the managerial role to be location independent, characterized by openness and trust, and cultivated through experience. In an environment characterized by academic training and work at distances, leaders manage individuals and remote teams while respecting individuals’ independence. They supported staff competence development and their desire to take responsibility through open and trusting relationships established through creating opportunities for competency development and a “learning-by-doing” epistemology built upon reflective practice.