bluuebunny/crossref_metadata_2025 huggingface dataset:
Community‐Based Dental Education (CBDE): A Survey of Current Program Implementation at Australian Dental Schools
Authors: Taylor Millicent , Carr Sandra , Kujan Omar
Published: July 2024

Purpose. Community‐based dental education (CBDE) diverges from traditional dental school training methods by integrating dental students into primary care community settings. This immersive approach enables students to refine their clinical and hands‐on skills while serving the oral health needs of underserved populations. This study aimed to identify ways in which Australian dental schools are currently implementing CBDE and compared to current evidence. Materials and Methods. This study utilized a 24‐item, self‐completion survey, adapted from existing questionnaires, which was sent to the CBDE coordinators in the nine eligible dental programs in Australia between mid‐January 2023 and mid‐April 2023. The survey consisted of multiple‐choice, binary, and open‐ended questions, including information on the level of student involvement, types of external clinics used, length of rotations, student supervision and assessment, pre‐rotation preparation, and post‐rotation evaluation, as well as challenges faced in implementing programs. Results. Six of the nine invited coordinators responded, resulting in a 66.7% response rate. All participants confirmed that their schools had a community‐based teaching program. All six respondents reported that participation in external clinics is required for graduation. Implementation of CBDE appears to be influenced by (1) level of student involvement, (2) the types of clinics utilised, (3) allocation and length of rotation, (4) student supervision and assessment, (5) pre‐rotation preparation, and (6) post‐rotation evaluation. Six (n = 6) institutions reported requiring a post‐rotation reflection from students and all respondents reported seeking feedback from clinical supervisors at external sites. Emerging themes from open‐ended questions highlight challenges in coordinating external rosters, securing funding, supervising students at external sites, and ensuring diverse types of student exposure during external rotations. Conclusion. This study provided insights into the implementation of CBDE in Australian dental schools. Results outlined in this research offer valuable insights for dental schools aiming to enhance their programs and improve student learning outcomes.
Comprehensive Assessment of the Genotype‐Environment Interaction and Yield Stability of Boro Rice Genotypes under Four Environments in Bangladesh Using AMMI Analysis
Authors: Islam Shams Shaila , Uddin Sarker Md. Borhan , Rana Md. Masud , Hasan Ahmed Khairul , Karim Md. Rashed , Khomphet Thanet
Published: July 2024

Yield stability, alongside high yield potential and broad adaptation to various agroclimatic environments, is a key objective for rice breeders aiming to ensure food security. This study aimed to explore the most suitable and stable Boro rice genotypes for Bangladesh. Ten Boro rice genotypes underwent testing in four environments during the 2022 Boro season to investigate genotype‐environment interaction (GEI) and yield stability performance. The experiment utilized three replications of a completely randomized block design. Yield stability performance was assessed through combined analysis and the additive main effects and multiplicative interaction (AMMI) model. The combined ANOVA revealed that the environment explained 10.23%, while GEI accounted for 9.17%, and the genotypes captured 80.60% of the variance, significantly impacting grain yield. Significance was observed in the environment, genotype main effects, and GEI. Analysis indicated that BRRI dhan 68 yielded the highest (6,754 kg·ha−1) and BRRI dhan 88 the lowest (5,620 kg·ha−1) among the investigated genotypes. In addition, genotypes BRRI dhan 84, BRRI dhan 81, and BRRI dhan 67 exhibited the highest grain yields. The Rangpur environment demonstrated considerable stability across the four environments with a high mean value of grain yield (7,206 kg·ha−1). Therefore, the AMMI model emerges as a valuable tool for identifying the most suitable and stable Boro rice genotypes with high‐yielding potential across various regions in Bangladesh, as well as under diverse conditions.
A new species of Haminoea in Brazilian coast (Cephalaspidea, Haminoeidae) as part of H. elegans group
Authors: Galvão Filho Hilton de Castro , Lima Patricia Oristanio Vaz de , Simone Luiz Ricardo L.
Published: July 2024

Haminoea maray is introduced as a replacement for what was previously identified as H. elegans, now recognized as a complex comprising several species found on both sides of the Atlantic. This descriptive paper presents a comprehensive phenotypic study based on specimens collected from Ceará to São Paulo, Brazil, and had been previously recognized as a molecular variant. The newly described species inhabits estuarine environments with low salinity, exhibiting distinct conchological and anatomical features compared to other populations of H. elegans and related congeners. https://zoobank.org/936AAD86-91A6-459D-A6ED-9C3DC7F2E8FF.
A toponímia italiana do Oeste de Santa Catarina: um estudo relacional dos nomes de lugares e a (i)migração
Authors: Barros Fernando Hélio Tavares de , Krug Marcelo Jacó
Published: July 2024

The relationship between names and the history, language and identity of a people is a basic interest of contemporary Onomastics. This study is guided by this principle and aims to visualize the marks of Italian identity within the rural toponymy in the west of Santa Catarina. The study considered nuances of variation, modifications, maintenance and loss of names within the migration history of one of the groups that settled in this region: the Italo-Gauchos. Therefore, 342 toponyms were analyzed from a total of 3.826 place names collected for the Toponymic Corpus of the West of Santa Catarina (COTOPOESC), from official IBGE maps. The methodology adopted is that of Dick (1990), since it is the most appropriate taxonomy for this specific dataset. In order to analyze and classify the toponymic forms, the study considered different lexicographical works and specific studies of Brazilian Italianistics. Most of the 342 toponyms are anthropotoponyms (i.e. names of people, mainly surnames) and hagiotoponyms (i.e. names of saints). The study concluded that surnames and Italian devout Catholicism are the most representative characteristics of this toponymy.
Clavícula, cantareira e saboneteira: as variedades do português formosense
Authors: Araujo Karina de Jesus , Santiago-Almeida Manoel Mourivaldo
Published: July 2024

Esta pesquisa tem como objetivo analisar a forma “clavícula” a partir do(s) falar/falares dos moradores/migrantes de Formoso do Araguaia - TO, traçando representações sociolinguísticas no contexto semântico-lexical dos que nasceram ou vivem nessa comunidade. A questão central é compreender de que maneira essa lexia apresenta tais variações. Utiliza-se a abordagem qualitativa, baseada na Dialetologia Pluridimensional e Relacional de Thun (2010) e, a técnica dos três passos: perguntar, insistir e sugerir, a aplicação da questão 106 do QSL: “Como se chama o osso que vai do pescoço até o ombro?” A coleta dividiu-se em dois pontos de inquérito: urbano e rural, com 48 informantes em quatro grupos, das variedades do português: maranhense (PM), gaúcho (PG), caipira (PC) e ribeirinho (PR) e, em duas gerações, mais jovens (GI) e mais velhas (GII), do sexo masculino e feminino. As análises se concentraram na ocorrência, frequência e divergência das lexias. E, foram documentados em mapas polifórmicos e de status da forma. Assim, esta pesquisa contribui ao destacar as lexias predominantes na comunidade, além de oferecer insights relevantes para a sociedade em geral e para os estudos dialetais em todo o país.
Variação morfofonológica da variável (gente) na fala de moradores da comunidade Ariri (Am)
Authors: Margotti Felício Wessling , Azevedo Orlando da Silva , Santos Ilna Kelly Ferreira dos
Published: July 2024

Neste artigo, são descritas as variantes morfofonológicas da variável (gente) na fala de moradores da comunidade Ariri, localizada no rio Coari Grande, que pertence ao município de Coari, no Estado do Amazonas. O corpus foi retirado de oito respostas discursivas que constam no questionário semântico-lexical da tese de Azevedo (2013). Trata-se de um trabalho dialetológico e geolinguístico por trabalhar a variação dialetal no espaço territorial.  A análise descritiva foi feita nas dimensões intralinguística, diatópico-diafásica diatópico-diassexual, diatópico-diastrática e diatópico-diageracional. Os resultados transcritos grafematicamente foram inseridos em cinco cartas morfofonológicas, as quais mostram que os moradores locais usam quatro variantes que testificam um processo de mudança linguística em curso.
Exploring the Function of Epicardial Cells Beyond the Surface
Authors: Wong David , Martinez Julie , Quijada Pearl
Published: July 2024

The epicardium, previously viewed as a passive outer layer around the heart, is now recognized as an essential component in development, regeneration, and repair. In this review, we explore the cellular and molecular makeup of the epicardium, highlighting its roles in heart regeneration and repair in zebrafish and salamanders, as well as its activation in young and adult postnatal mammals. We also examine the latest technologies used to study the function of epicardial cells for therapeutic interventions. Analysis of highly regenerative animal models shows that the epicardium is essential in regulating cardiomyocyte proliferation, transient fibrosis, and neovascularization. However, despite the epicardium’s unique cellular programs to resolve cardiac damage, it remains unclear how to replicate these processes in nonregenerative mammalian organisms. During myocardial infarction, epicardial cells secrete signaling factors that modulate fibrotic, vascular, and inflammatory remodeling, which differentially enhance or inhibit cardiac repair. Recent transcriptomic studies have validated the cellular and molecular heterogeneity of the epicardium across various species and developmental stages, shedding further light on its function under pathological conditions. These studies have also provided insights into the function of regulatory epicardial-derived signaling molecules in various diseases, which could lead to new therapies and advances in reparative cardiovascular medicine. Moreover, insights gained from investigating epicardial cell function have initiated the development of novel techniques, including using human pluripotent stem cells and cardiac organoids to model reparative processes within the cardiovascular system. This growing understanding of epicardial function holds the potential for developing innovative therapeutic strategies aimed at addressing developmental heart disorders, enhancing regenerative therapies, and mitigating cardiovascular disease progression.
Clinical Characteristics and Mechanisms of Acute Myocarditis
Authors: Heymans Stephane , Van Linthout Sophie , Kraus Sarah Mignon , Cooper Leslie T. , Ntusi Ntobeko A.B.
Published: July 2024

Myocarditis is defined by an immune response to infection or injury, most commonly identified after a viral infection or recent exposure to cardiotoxins or drugs. Classic myocarditis may also result from the activation of the immune system by self-antigens without an exogenous trigger. Pathogenic variants of genes encoding sarcolemmal and desmosomal proteins are present in 4% to 44% of myocarditis patients and may relate to persistent cardiac dysfunction and arrhythmias. The most common clinical presentation is acute chest pain resembling an ischemic infarction or pericarditis. Heart failure and syncope from tachy- or brady-arrhythmias are features of a complicated clinical course with substantial risk of future cardiovascular events and death. High-sensitivity troponin, ECG, and echocardiograms are useful but lack sufficient sensitivity and specificity to confirm the diagnosis. Cardiovascular magnetic resonance is indicated to confirm myocarditis in low-risk, uncomplicated cases. Endomyocardial biopsy is indicated to guide therapy in high-risk scenarios. In this review, we discuss the clinical aspects, pathogenesis, genetic susceptibility, and management of uncomplicated, complicated, and fulminant myocarditis related to viral injury. We identify gaps in understanding and suggest prime research questions in the pathogenesis, diagnosis, and treatment of acute myocarditis.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT05335928.
REVEALING THE ENVIRONMENTAL COST OF GLOBALIZATION: AN EMPIRICAL ANALYSIS ON TRADE OPENNESS, FDI, AND CO2 EMISSIONS IN THE APEC COUNTRIES
Authors: (şentürk) Kocakaya Gülşah
Published: July 2024

Recently, the issue of how trade openness affects environmental degradation has gained importance. The fact that about 60% of the world's total CO2 emissions into the atmosphere are from APEC countries has made the economic activities of these countries a source of concern for the world. Although there have been many studies on the relationship between CO2 emissions and trade openness, there has yet to be a consensus. This study investigates how trade volume affects CO2 emissions in APEC countries, which account for a significant share of international trade volume and CO2 emissions. In addition, the empirical model of this research also investigates EKC. The panel data analysis method is used considering the data of APEC countries. According to the results, while trade openness increases CO2 emissions in APEC countries, FDI decreases CO2 emissions. Finally, EKC is valid in APEC countries from 1990 to 2016.
Assessing the Influence of Earthquakes on Sovereign Credit Risk: An Event Study on CDS Market Dynamics of Selected Countries
Authors: Tosunoğlu Şebnem , Kasal Süleyman
Published: July 2024

This study analyzes the effects of earthquakes on sovereign credit default risk. The study examines whether 20 major earthquakes that occurred in Türkiye, Mexico, Chile, South Africa, and Greece after 2010 have made a difference on CDS markets using the event analysis method. The results indicate that the earthquakes increased uncertainty in the CDS markets of all countries. These results prove that uncertainty about the ability of countries to repay their public debt has significantly changed compared to the pre-earthquake period.
Onosma serpentinica (Boraginaceae), a new serpentine endemic species from the South-West Anatolia, Türkiye
Authors: BİNZET RIZA , ÖZDÖL TUĞKAN , YILDIRIM HASAN
Published: July 2024

A new species of Onosma L. (Boraginaceae: Lithospermeae), Onosma serpentinica Yıldırım & Binzet, from Muğla Province, in south-west Anatolia, Türkiye, is described and illustrated. It grows on the ultramafic slopes at Pinus brutia forest clearings near Göcek district of Muğla Province on elevation between 230–290 m a.s.l. Onosma serpentinica is a serpentine endemic belonging to section Onosma subsection Haplotricha (Boiss.) Gürke. The most similar species from Türkiye is O. argentata Hub.-Mor., which is distributed in only two localities from Erzincan province (Eastern Türkiye) and differs from it by the indumentum type, shorter basal and cauline leaves, fewer-flowered cymes, different corolla colour, different corolla indumentum, longer filaments and styles as well as bigger nutlets. Additionally, the geographical distributions and map, an image of the holotype specimen, diagnostic characters, detailed photographs, habitat descriptions, and an identification key for the new species, O. serpentinica, and O. argentata are provided along with a vernacular name and IUCN conservation status for O. serpentinica.
Phenotypes in pulmonary hypertension
Authors: Weatherald Jason , Hemnes Anna R. , Maron Bradley A. , Mielniczuk Lisa M. , Gerges Christian , Price Laura C. , Hoeper Marius M. , Humbert Marc
Published: July 2024

The clinical classification of pulmonary hypertension (PH) has guided diagnosis and treatment of patients with PH for several decades. Discoveries relating to underlying mechanisms, pathobiology and responses to treatments for PH have informed the evolution in this clinical classification to describe the heterogeneity in PH phenotypes. In more recent years, advances in imaging, computational science and multi-omic approaches have yielded new insights into potential phenotypes and sub-phenotypes within the existing clinical classification. Identification of novel phenotypes in pulmonary arterial hypertension (PAH) with unique molecular profiles, for example, could lead to new precision therapies. Recent phenotyping studies have also identified groups of patients with PAH that more closely resemble patients with left heart disease (group 2 PH) and lung disease (group 3 PH), which has important prognostic and therapeutic implications. Within group 2 and group 3 PH, novel phenotypes have emerged that reflect a persistent and severe pulmonary vasculopathy that is associated with worse prognosis but still distinct from PAH. In group 4 PH (chronic thromboembolic pulmonary disease) and sarcoidosis (group 5 PH), the current approach to patient phenotyping integrates clinical, haemodynamic and imaging characteristics to guide treatment but applications of multi-omic approaches to sub-phenotyping in these areas are sparse. The next iterations of the PH clinical classification are likely to reflect several emerging PH phenotypes and improve the next generation of prognostication tools and clinical trial design, and improve treatment selection in clinical practice.
Inhaled alkaline hypertonic divalent salts reduce refractory chronic cough frequency
Authors: Abubakar-Waziri Hisham , Edwards David A. , Bhatta Deen Bhandu , Hull James H. , Rudd Matthew , Small Peter , Chung Kian Fan
Published: July 2024

Background

Treatment of chronic cough remains a challenge. We hypothesised that inhaled alkaline hypertonic divalent salts (alkaline HDS) might provide relief for refractory chronic cough by laryngeal and tracheal hydration.

Methods

We conducted an exploratory, single-blinded, nasal saline-controlled study in 12 refractory chronic cough patients to examine cough suppression efficacy of an alkaline HDS composition (SC001) at pH 8 or pH 9 administered by nasal inhalation. As control, we used nasal saline with the same hand-held pump spray aerosol device. Each subject was monitored continuously using a digital cough monitor watch for 1 week of baseline, 1 week of control treatment and 1 week of active treatment.

Results

Baseline daily cough rates ranged from 4 to 34 coughs·h−1with mean visual analogue score 65±17 pre- and post-baseline testing. Control-adjusted efficacy of cough rate reduction ranged from 15% (p=0.015) (from Day 1) to 23% (p=0.002) (from Day 3). Control-adjusted efficacy was highest with SC001 pH 9 (n=5), ranging from 25% (p=0.03) (from Day 1) to 35% (p=0.02) (from Day 3), and lowest for SC001 pH 8 (n=7), ranging from 9% (p=0.08) (from Day 1) to 16% (p=0.02) (from Day 3). Hourly cough counts and visual analogue score correlated for baseline (r=0.254, p=0.02) and control (r=0.299, p=0.007) monitoring weeks. Treatment improved this correlation (r=0.434, p=0.00006). No adverse events were reported.

Conclusions

Alkaline (pH 9) HDS aerosol is a promising treatment for refractory chronic cough and should be further evaluated.
The effect of sulthiame on potential biomarkers in moderate to severe obstructive sleep apnoea
Authors: Hoff Erik , Musovic Saliha , Komai Ali M. , Zou Ding , Strassberger Christian , Stenlöf Kaj , Grote Ludger , Hedner Jan
Published: July 2024

Background

Obstructive sleep apnoea (OSA) is a common disease with breathing disturbances during sleep. Sulthiame (STM), a carbonic anhydrase (CA) inhibitor, was recently shown to reduce OSA in a significant proportion of patients. CA activity and hypoxia-inducible factor (HIF)-1α are two potential biomarkers reported in severe OSA and hypoxia. Both have been considered to play roles in the development of OSA comorbidities. This study investigated the effects of STM on these biomarkers in OSA.

Methods

This was an exploratory analysis of a randomised, double-blind, placebo-controlled trial of STM in OSA. Patients with moderate to severe OSA, body mass index 20–35 kg·m−2, aged 18–75 years and not accepting positive airway pressure treatment were randomised to 4 weeks with placebo, STM 200 mg or STM 400 mg. CA activity (n=43) and HIF-1α concentration (n=53) were determined at baseline, after 4 weeks of treatment and 2 weeks after treatment completion.

Results

In the 400 mg group, both CA activity and HIF-1α concentration were reduced (median difference −26% (95% CI −32– −12%) and −4% (95% CI −8– −2%); both p<0.05versusplacebo). The reductions were sustained 2 weeks after treatment completion. In the 200 mg group, both CA activity and HIF-1α were numerically reduced. The STM-induced reductions in CA activity and HIF-1α correlated significantly (r=0.443, p=0.023).

Conclusions

STM treatment in OSA induced a reduction of both CA activity and HIF-1α concentration. The effects remained 2 weeks after treatment completion, suggesting prolonged effects of STM in OSA.
Chronic cough as a disease
Authors: Turner Richard D. , Birring Surinder S.
Published: July 2024

Chronic cough is a frequent reason for medical consultation and has significant impact on quality of life. Due to the limited effectiveness of currently available treatments, and delays in accessing care, patients are often inadequately managed. There remains an overreliance by clinicians on outdated management algorithms, addressing chronic cough only as symptom of other medical conditions, and advocating investigation and trials of treatment of diseases which are often not present. This may lead to unnecessary cost, frustration and potential harm. Newer clinical guidelines in essence consider chronic cough as a disease in itself, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. Secondary factors which aggravate chronic cough (smoking, asthma, gastro-oesophageal reflux,etc.) are better considered as treatable traits associated with the primary disease process rather than direct “causes” of cough.

Explicitly approaching chronic cough as a discrete entity is consistent with the way in which “diseases” are generally characterised, and has advantages. The patient should be better able to understand their condition, and may have better confidence in attempts at management. The clinician should have better focus and avoid unfruitful treatments and investigation. In general, considering chronic cough as a disease should help to raise the profile of the condition, improve organisation of health service pathways, increase attention for research, and further the development of new treatments.
A new phenotype of patients with post-COVID-19 condition is characterised by a pattern of complex ventilatory dysfunction, neuromuscular disturbance and fatigue symptoms
Authors: Steinbeis Fridolin , Kedor Claudia , Meyer Hans-Jakob , Thibeault Charlotte , Mittermaier Mirja , Knape Philipp , Ahrens Katharina , Rotter Gabriele , Temmesfeld-Wollbrück Bettina , Sander Leif Erik , Kurth Florian , Witzenrath Martin , Scheibenbogen Carmen , Zoller Thomas
Published: July 2024

Background

Patients with post-COVID-19 condition frequently suffer from chronic dyspnoea. The causes and mechanism for dyspnoea in these patients without evidence of structural lung disease are unclear.

Methods

Patients treated for COVID-19 at Charité University Hospital in Berlin received pulmonary function testing including respiratory muscle strength tests and completed health-related quality-of-life questionnaires during follow-up. Patients with post-COVID-19 condition during outpatient follow-up with fatigue and exertional intolerance (PCF) were compared to patients with post-COVID-19 condition with evidence of chronic pulmonary sequelae (post-COVID-19 restriction (PCR)) as well as to patients without post-COVID-19 condition (NCF).

Results

A total of 170 patients presented for follow-up. 36 participants met criteria for PCF, 28 for PCR and 24 for NCF. PCF patients reported dyspnoea in 63.8%. % predicted value of respiratory muscle strength (median (IQR)) was reduced in PCF (55.8 (41.5–75.9)) compared to NCF and PCR (70.6 (66.3–88.9) and 76.8 (63.6–102.2), respectively; p=0.011). A pattern of reduced forced vital capacity (FVC), but normal total lung capacity (TLC), termed complex ventilatory dysfunction defined as TLC − FVC >10% predicted was observed and occurred more frequently in PCF (88.9%) compared to NCF and PCR (29.1% and 25.0%, respectively; p<0.001).

Conclusion

Dyspnoea in PCF is characterised by reduced respiratory muscle strength and complex ventilatory dysfunction indicating neuromuscular disturbance as a distinct phenotype among patients with post-COVID-19 condition. These observations could be a starting point for developing personalised rehabilitation concepts.
Persistent effectiveness of CGRP antibody therapy in migraine and comorbid medication overuse or medication overuse headache - a retrospective real-world analysis
Authors: Scheffler Armin , Basten Jale , Menzel Lennart , Binz Dominik , Becker Wolfgang Alexander , Breunung Vincent , Schenk Hannah , Kleinschnitz Christoph , Nsaka Michael , Lindner Diana , Holle Dagny
Published: July 2024

Background

Management of patients with migraine who have concomitant medication overuse (MO) or medication overuse headache (MOH) is a major problem in clinical practice. Detoxification of acute analgesics before or during initiation of prophylactic therapy has long been recommended although this concept has recently been questioned. Additionally, relapse after detoxification is a common problem. This real-world study analyses the initial and sustained effectiveness of prophylactic migraine therapy with CGRP (receptor) antibodies without prior detoxification in patients with comorbid MO or MOH for up to one year.

Methods

A retrospective real-world analysis was performed on 291 patients (episodic migraine (EM) with MO (EM-MO; n = 35), EM without MO (EM-noMO; n = 77), chronic migraine (CM) with MOH (CM-MOH; n = 109), CM without MOH (CM-noMOH; n = 70). All patients began treatment with either erenumab (n = 173), fremanezumab (n = 70) or galcanezumab (n = 48) without prior detoxification. Data were available for up to 12 months of treatment. Responder rates for monthly headache days (MHD), monthly migraine days (MMD) and monthly acute medication intake (AMD) were analysed.

Results

All groups showed a significant reduction in MHD, MMD and AMD at the last observed time point compared to baseline. In patients with CM and MOH, 60.6% (66/109) no longer fulfilled the definition of MO or MOH and a further 13.8% (15/109) had only EM-MO. In the EM cohort, 89% (31/35) of MO patients lost their MO during therapy. MHD and AMD 30% responder rates were comparable for CM-MOH and CM-noMOH (MHD: CM-MOH: 56.0% vs. CM-noMOH: 41.4%, p = 0.058, AMD: CM-MOH: 66.1% vs. CM-noMOH: 52.9%, p = 0.077). MMD responder rate did not differ significantly (after Bonferroni adjustment) (CM-MOH: 62.4% vs. CM-noMOH: 47.1%, p = 0.045, α = 0.017). After successful initiation of therapy, 15.4% of the initial CM-MOH patients relapsed and met the criterion for CM-MOH at the end of follow-up. There were no antibody specific differences in response to therapy.

Conclusions

Our data confirms the effectiveness of CGRP antibody treatment in migraine patients with additional MOH or MO in a real-world setting. Low relapse rates after initial successful therapy support an early start of CGRP antibody treatment in patients with MOH or MO.

Trial registration

No registration, retrospective analysis.

Graphical Abstract
Changes of brain functional network in Alzheimer’s disease and frontotemporal dementia: a graph-theoretic analysis
Authors: Wu Shijing , Zhan Ping , Wang Guojing , Yu Xiaohua , Liu Hongyun , Wang Weidong
Published: July 2024

Background

Alzheimer’s disease (AD) and frontotemporal dementia (FTD) are the two most common neurodegenerative dementias, presenting with similar clinical features that challenge accurate diagnosis. Despite extensive research, the underlying pathophysiological mechanisms remain unclear, and effective treatments are limited. This study aims to investigate the alterations in brain network connectivity associated with AD and FTD to enhance our understanding of their pathophysiology and establish a scientific foundation for their diagnosis and treatment.

Methods

We analyzed preprocessed electroencephalogram (EEG) data from the OpenNeuro public dataset, comprising 36 patients with AD, 23 patients with FTD, and 29 healthy controls (HC). Participants were in a resting state with eyes closed. We estimated the average functional connectivity using the Phase Lag Index (PLI) for lower frequencies (delta and theta) and the Amplitude Envelope Correlation with leakage correction (AEC-c) for higher frequencies (alpha, beta, and gamma). Graph theory was applied to calculate topological parameters, including mean node degree, clustering coefficient, characteristic path length, global and local efficiency. A permutation test was then utilized to assess changes in brain network connectivity in AD and FTD based on these parameters.

Results

Both AD and FTD patients showed increased mean PLI values in the theta frequency band, along with increases in average node degree, clustering coefficient, global efficiency, and local efficiency. Conversely, mean AEC-c values in the alpha frequency band were notably diminished, which was accompanied by decreases average node degree, clustering coefficient, global efficiency, and local efficiency. Furthermore, AD patients in the occipital region showed an increase in theta band node degree and decreased alpha band clustering coefficient and local efficiency, a pattern not observed in FTD.

Conclusions

Our findings reveal distinct abnormalities in the functional network topology and connectivity in AD and FTD, which may contribute to a better understanding of the pathophysiological mechanisms of these diseases. Specifically, patients with AD demonstrated a more widespread change in functional connectivity, while those with FTD retained connectivity in the occipital lobe. These observations could provide valuable insights for developing electrophysiological markers to differentiate between the two diseases.
Association between obstructive sleep apnea and arrhythmia and heart rate variability among hypertensive patients
Authors: Xu Shao-dong , Hao Ling-li , Liu Fei-fei , Xu Chuan-zhi
Published: July 2024

Background

The relationship between obstructive sleep apnea (OSA) and the occurrence of arrhythmias and heart rate variability (HRV) in hypertensive patients is not elucidated. Our study investigates the association between OSA, arrhythmias, and HRV in hypertensive patients.

Methods

We conducted a cross-sectional analysis involving hypertensive patients divided based on their apnea-hypopnea index (AHI) into two groups: the AHI ≤ 15 and the AHI > 15. All participants underwent polysomnography (PSG), 24-hour dynamic electrocardiography (DCG), cardiac Doppler ultrasound, and other relevant evaluations.

Results

The AHI > 15 group showed a significantly higher prevalence of frequent atrial premature beats and atrial tachycardia (P = 0.030 and P = 0.035, respectively) than the AHI ≤ 15 group. Time-domain analysis indicated that the standard deviation of normal-to-normal R-R intervals (SDNN) and the standard deviation of every 5-minute normal-to-normal R-R intervals (SDANN) were significantly higher in the AHI > 15 group (P = 0.020 and P = 0.033, respectively). Frequency domain analysis revealed that the low-frequency (LF), high-frequency (HF) components, and the LF/HF ratio were also significantly elevated in the AHI > 15 group (P < 0.001, P = 0.031, and P = 0.028, respectively). Furthermore, left atrial diameter (LAD) was significantly larger in the AHI > 15 group (P < 0.001). Both univariate and multivariable linear regression analyses confirmed a significant association between PSG-derived independent variables and the dependent HRV parameters SDNN, LF, and LF/HF ratio (F = 8.929, P < 0.001; F = 14.832, P < 0.001; F = 5.917, P = 0.016, respectively).

Conclusions

Hypertensive patients with AHI > 15 are at an increased risk for atrial arrhythmias and left atrial dilation, with HRV significantly correlating with OSA severity.
Job satisfaction and turnover of the first group of rural-oriented tuition-waived medical students in Guangxi, China: a mixed-method study
Authors: Chen Wenxu , Xu Wenjia , Chen Yanhua , Xu Chengying , Zheng Jiahui , Zou Yunfeng , Zhou Bo
Published: July 2024

Background

In 2010, China launched a rural-oriented tuition-waived medical education (RTME) programme to train more general practitioners (GPs) to meet the needs of the rural health workforce. Motivating and maintaining GPs is an important consideration for the shortage in the rural health workforce. This study aimed to investigate job satisfaction and turnover among the first group of rural-oriented tuition-waived medical students (RTMSs) who had completed a three-year compulsory service in Guangxi, as well as the factors affecting RTMSs turnover.

Methods

This study adopted a mixed-method approach. A quantitative survey of 129 RTMSs was analysed (81.6% response rate), and qualitative interviews were conducted with 30 stakeholders, including 18 RTMSs, six administrators of the County Health Bureau, and six administrators of township health centers (THCs). A t-test, chi-square test, Fisher’s exact test, and logistic regression analysis were used to examine the quantitative data, and thematic analysis was used to analyse the qualitative data.

Results

Among the 129 participants, the turnover rate was high, with 103 RTMSs reporting turnover (79.84%). Interpersonal relationships scored the highest in job satisfaction (3.63 ± 0.64) among RTMSs, while working conditions were rated the lowest (2.61 ± 0.85). Marital status (odds ratio [OR] = 0.236, 95% confidence interval [95%CI] = 0.059–0.953, P = 0.043), only child status (OR = 8.660, 95%CI = 1.714–43.762, P = 0.009), and job return satisfaction (OR = 0.290, 95%CI = 0.090–0.942, P = 0.039) were significantly associated with turnover. Univariate analyses showed that income had a significant influence on turnover, but the relationship gone by multivariable; however it was deemed important in the qualitative study. Qualitative analysis revealed that turnover was influenced by the working atmosphere, effort-reward imbalance, professional competence, and opportunities for training and promotion.

Conclusions

This study provides insights for the policymakers about the priority areas for retaining GPs in rural locations and provides reference values for the retention of GPs in other regions with a shortage of rural health workers. For RTMSs to continue providing services to rural areas, the government should improve their salaries, balance their income and workload, provide more opportunities for training and career promotion, and managers should recognise their efforts and create an optimistic working atmosphere.
Medical costs of Swedish nursing home residents at the end of life: a retrospective observational registry study
Authors: Salaj Dag , Schultz Torbjörn , Strang Peter
Published: July 2024

Background

There are many studies of medical costs in late life in general, but nursing home residents’ needs and the costs of external medical services and interventions outside of nursing home services are less well described.

Methods

We examined the direct medical costs of nursing home residents in their last year of life, as well as limited to the period of stay in the nursing home, adjusted for age, sex, Hospital Frailty Risk Score (HFRS), and diagnosis of dementia or advanced cancer. This was an observational retrospective study of registry data from all diseased nursing home residents during the years 2015–2021 using healthcare consumption data from the Stockholm Regional Council, Sweden. T tests, Wilcoxon rank sum tests and chi-square tests were used for comparisons of groups, and generalized linear models (GLMs) were constructed for univariable and multivariable linear regressions of health cost expenditures to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs).

Results

According to the adjusted (multivariable) models for the 38,805 studied nursing home decedents, when studying the actual period of stay in nursing homes, we found significantly greater medical costs associated with male sex (RR 1.29 (1.25–1.33), p < 0.0001) and younger age (65–79 years vs. ≥90 years: RR 1.92 (1.85–2.01), p < 0.0001). Costs were also greater for those at risk of frailty according to the Hospital Frailty Risk Score (HFRS) (intermediate risk: RR 3.63 (3.52–3.75), p < 0.0001; high risk: RR 7.84 (7.53–8.16), p < 0.0001); or with advanced cancer (RR 2.41 (2.26–2.57), p < 0.0001), while dementia was associated with lower medical costs (RR 0.54 (0.52–0.55), p < 0.0001). The figures were similar when calculating the costs for the entire last year of life (regardless of whether they were nursing home residents throughout the year).

Conclusions

Despite any obvious explanatory factors, male and younger residents had higher medical costs at the end of life than women. Having a risk of frailty or a diagnosis of advanced cancer was strongly associated with higher costs, whereas a dementia diagnosis was associated with lower external, medical costs. These findings could lead us to consider reimbursement models that could be differentiated based on the observed differences.
Knowledge sharing in virtual communities of practice of family caregivers of people with Alzheimer’s
Authors: Romero-Mas M. , Cox A. M. , Ramon-Aribau A. , Gómez-Zúñiga Beni
Published: July 2024

Introduction

Knowledge sharing can only happen in the context of a trusting and supportive environment, such as evolves in communities of practice and their virtual equivalent, virtual communities of practice. The main objective of this study was to understand knowledge sharing between participants in a virtual community of practice of caregivers of people with Alzheimer’s.

Methods

The authors designed their own mobile application, and two virtual communities of practice were created independently and differentiated by how they were moderated: one by an expert caregiver and the other by three health professionals. 38 caregivers and four moderators were involved in the study, which ran between July 2017 and April 2018. A total of 1925 messages were exchanged within the two communities and used as data in the study. Message data was analysed using LINKS (Leveraging Internet Networks for knowledge sharing).

Results

Participants were more motivated to acquire knowledge related to caring for the person with Alzheimer’s rather than caring for themselves. The purpose of the messages was to inform others about the sender and not to seek answers. It seems that the interaction was more to socialise and to feel heard, than to gain information. Face to face meetings appear to have accelerated community development. On nearly every parameter, behaviour was significantly different in the two communities, reflecting the importance of the character of the moderator. Caring for oneself was a much stronger theme in the community that included health professionals. Experiential knowledge sharing was particularly strong in the group led by a caregiver.

Discussion

Caregivers adapted the virtual community of practice to their own needs and mainly shared social knowledge. This focus on social support, which seems to be more valued by the caregivers than information about the disease, was not an expected pattern. Virtual communities of practice where peers count on each other, function more as a support group, whereas those moderated by health professionals function more as a place to go to acquire information. The level of interactivity points to such communities being important for knowledge sharing not mere knowledge transfer.
Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia
Authors: Yang Chih-Hsiang , Lee Jongwon , Wilcox Sara , Rudisill A. Caroline , Friedman Daniela B. , Hakun Jonathan G. , Neils-Strunjas Jean , Wei Jingkai , Miller Margaret C. , Byers Megan D.
Published: July 2024

Background

With an increasing proportion of older adults and the associated risk of Alzheimer’s Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.

Methods

This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.

Discussion

This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.

Trial registration

ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).
Association between asthma and COVID-19 severity during Omicron epidemic: a retrospective cohort study using real-world data
Authors: Wang Huwen , Jiang Xiaoting , Chan Kate Ching Ching , Wei Yuchen , Hung Chi Tim , Chan Renee Wan Yi , Li Conglu , Leung Eman Yee Man , Yam Carrie Ho Kwan , Chow Tsz Yu , Zhao Shi , Guo Zihao , Li Kehang , Wang Ziqing , Yeoh Eng Kiong , Chong Ka Chun
Published: July 2024

Background

The available evidence presented inconsistencies and inconclusive findings regarding the associations between co-existing asthma and mortality among COVID-19 patients. The objective of the current study is to investigate the relationship between asthma and severe outcomes after SARS-CoV-2 Omicron infection in an infection-naïve population.

Methods

A retrospective cohort study using propensity score matching was conducted. The COVID-19 patients requiring hospitalisation in Hong Kong from January 1, 2022, to November 13, 2022, an Omicron-predominated period, were identified. Severe clinical outcomes were defined as ICU admission and inpatient death after the first positive PCR results as well as a composite outcome of both.

Results

Of the 74,396 hospitalised COVID-19 patients admitted, 1,290 asthma patients and 18,641 non-asthma patients were included in the matched cohort. The rates of death and the composite outcome were 15·3% and 17·2%, respectively, among the non-asthma patients,12·2% and 13·6%, respectively, among the asthma patients, with adjusted hazard ratios equal to 0·775 (95% CI: 0·660–0·909) and 0·770 (95% CI: 0·662–0·895), respectively. The negative association was more apparent in the elderly and female groups. Asthma remained a factor that lowered the risk of disease severity even though the patients were not fully vaccinated with at least two doses.

Conclusions

We used real-world data to demonstrate that asthma was not a risk factor for COVID-19 severity of the infections of Omicron variant, even though the patients were not fully vaccinated.
A secondary abdominal aorta-duodenal fistula accompanied with acquired Immune Deficiency Syndrome presented with recurrent sepsis: a case report
Authors: Hu Xianjin , Yan Libo
Published: July 2024

Background

Abdominal aorta-duodenal fistulas are rare abnormal communications between the abdominal aorta and duodenum. Secondary abdominal aorta-duodenal fistulas often result from endovascular surgery for aneurysms and can present as severe late complications.

Case presentation

A 50-year-old male patient underwent endovascular reconstruction for an infrarenal abdominal aortic pseudoaneurysm. Prior to the operation, he was diagnosed with Acquired Immune Deficiency Syndrome and Syphilis. Two years later, he was readmitted with lower extremity pain and fever. Blood cultures grew Enterococcus faecium, Salmonella, and Streptococcus anginosus. Sepsis was successfully treated with comprehensive anti-infective therapy. He was readmitted 6 months later, with blood cultures growing Enterococcus faecium and Escherichia coli. Although computed tomography did not show contrast agent leakage, we suspected an abdominal aorta-duodenal fistula. Esophagogastroduodenoscopy confirmed this suspicion. The patient underwent in situ abdominal aortic repair and received long-term antibiotic therapy. He remained symptom-free during a year and a half of follow-up.

Conclusions

This case suggests that recurrent infections with non-typhoidal Salmonella and gut bacteria may be an initial clue to secondary abdominal aorta-duodenal fistula.