bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and safety of tirzepatide, dual GLP-1/GIP receptor agonists, in the management of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials
Authors: Zhou Qian , Lei Xingxing , Fu Shunlian , Liu Pan , Long Cong , Wang Yanmei , Li Zinan , Xie Qian , Chen Qiu 
Published: October 2023

Abstract
Background
Glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 are the main incretin hormones, and be responsible for the insulinotropic incretin effect. The addition of a GIP agonist to a GLP-1agonist has been hypothesized to significantly potentiate the weight-losing and glycemia control effect, which might offer a new therapeutic option in the treatment of type 2 diabetes. The current meta-analysis aims to synthesize evidence of primary efficacy and safety outcomes through clinically randomized controlled trials to evaluate integrated potency and signaling properties.

Method
We conducted comprehensive literature searches in Cochrane Library, Web of Science, Embase and PubMed for relevant literatures investigating the efficacy and/or safety of Tirzepatide published in the English as of May 30, 2023 was retrieved. We synthesized results using standardized mean differences (SMDs) and 95% confidence intervals (95 CIs) for continuous outcomes, and odds ratios (ORs) along with 95 Cis for dichotomous outcomes. All analyses were done using Revman version 5.3, STATA version 15.1 and the statistical package ‘meta’.

Results
Participants treated with weekly Tirzepatide achieved HbA1c and body weight target values significantly lower than any other comparator without clinically significant increase in the incidence of hypoglycemic events, serious and all-cause fatal adverse events. However, gastrointestinal adverse events and decreased appetite events were reported more frequently with Tirzepatide treatment than with placebo/controls.

Conclusion
The Tirzepatide, a dual GIP/GLP-1 receptor co-agonist, for diabetes therapy has opened a new era on personalized glycemia control and weight loss in a safe manner with broad and promising clinical implications.
Parents’ perspectives of anorexia nervosa treatment in adolescents: a systematic review and metasynthesis of qualitative data
Authors: Oketah Ngozi O. , Hur Jacqueline O. , Talebloo Jonanne , Cheng Chloe M. , Nagata Jason M. 
Published: October 2023

Abstract
Background
Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents’ views on the treatment and recovery process of anorexia nervosa in their adolescent child.

Method
A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents’ views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis.

Results
A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery.

Conclusion
Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.
Damage assessment and restoration proposal following the 2023 Türkiye earthquakes: UNESCO World Heritage Site Diyarbakır City Walls, Türkiye
Authors: Karataş Lale , Bayhan Beyhan 
Published: October 2023

Abstract
Diyarbakır City Walls, one of the longest defensive structures in the world, following the Great Wall of China, the walls of Antakya, and the walls of Istanbul, is a UNESCO World Heritage site since 2015. With a history of approximately 5000 years, the Diyarbakır City Walls have been affected by consecutive earthquakes centered in Kahramanmaraş in 2023, resulting in damages to various sections. Urgent restoration and repair interventions are needed for these sections of the Diyarbakır City Walls due to earthquake-induced damages. Although there are limited studies presenting stone analysis of the Diyarbakır City Walls in the literature, no studies focusing on mortar analysis have been found. The objectives of this study are as follows: (I) to identify the mechanisms and factors of earthquake damages in the Diyarbakır City Walls, (II) to conduct necessary analyses for the selection of mortar materials for post-earthquake repairs, and (III) to provide restoration and strengthening recommendations to ensure the sustainability of the original structure. Observational, petrographic, chemical, and SEM analysis techniques were used, and the findings were interpreted comparatively. The results demonstrate that the most severe damages after the earthquake in the Diyarbakır City Walls were caused by the inadequate adhesion of missing mortar joints and different types of materials used between double-walled structures. Additionally, the presence of clay minerals identified in the mineralogy of the mortar through experimental analysis was defined as an internal issue causing the loss of mortar due to osmotic pressure created by water absorption. Another factor causing the loss of mortar is the presence of chloride-type salts, which were found to be present in a significant amount in all samples and were attributed to the use of Portland cement in previous faulty repairs. It was also determined that recent faulty repointing works contributed to the loss of mortar. Finally, this article presents original restoration and strengthening recommendations to repair the earthquake-induced damages and prevent their reoccurrence in the future.
The pattern and clinical outcomes of non-diabetic pediatric endocrine disorders, Al-Baha, Saudi Arabia: a retrospective study
Authors: Al-Ghamdi Ahmed Hassan , Fureeh Abdelhamid Ahmed , Alshawikhat Rawan Ibrahim , Jafar Fatimah Ali Alshaikh , Alamri Saad Khalid , Alzahrani Abdulrhman K. , Alzahrani Abdulghani A. , Alghamdi Ahmed Saleh , Almathammi Ali Abdulrraheem 
Published: October 2023

Abstract
Purpose
Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management.

Methods
The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records.

Results
A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients’ ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases.

Conclusions
Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels.
Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data
Authors: Collins Brendan , Downing Jennifer , Head Anna , Comerford Terence , Nathan Rajan , Barr Benjamin 
Published: October 2023

Background
There is uncertainty around the costs and health impacts of undiagnosed mental health problems.

Aims
Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression.

Method
We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions.

Results
Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life.

Conclusions
Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.
Women Writing in Cairo
Authors: Šabasevičiūtė Giedrė 
Published: October 2023

Abstract
While literature produced by Arab women has received sustained academic attention, little commentary exists on the way fiction writing is interspersed with their ordinary lives defined by domesticity. Drawing on ethnographic fieldwork conducted between 2017 and 2020 in Cairo, this article explores fiction writing as a powerful means of midlife self-reinvention among Cairene women. It considers their pursuit of literary careers in light of the recent opening of Egyptian literary markets to new writing publics and as part of women’s midlife transition, defined by their emancipation from outdated versions of their gendered selves. Viewing writing as an embodied practice of self-care, the article argues that fiction provides individuals with an “elsewhere” in which they can escape their rigid selves and reimagine their existence.
Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis
Authors: Zaheer Sidra , Yasmeen Farah 
Published: October 2023

Objective: Breast cancer prevalence in Pakistan is among the highest in Asian countries. Recent changes in the temporal trends of breast cancer are largely unknown and examination of these trends can provide a direction in national planning for future health programs. The aim of this study was to examine recent changes in breast cancer incidence in Pakistan.
Methods: A total of 9,771 diagnosed breast cancer women were registered from 2004 to 2015 in three hospitals of Karachi. Join-point regression analysis was applied to assessing the age-standardized breast cancer presentation trends for each five-year age group. Age-specific average annual percentage changes were also calculated to assess the proportion of women with increased or decreased incidence of breast cancer.
Results: Age-standardized rates of breast cancer steadily increased from 24.7 per 100,000 in 2004, to 45.4 per 100,000 in 2015. The analytical trend based on the join-point model showed an average percentage increase breast cancer prevalence of 5.4 (95% CI = 3.1, 7.8). Significantly higher prevalence rates were identified among women aged 40-44 years and 65-69 years with an average percentage change of 18.5 (95% CI = 2.3, 37.2) and 14.3 (95% CI = 2.2, 27.9) respectively in the four years from 2011 to 2015.
Conclusion: The findings indicate the trend in age-standardized prevalence increased significantly in all age groups with noticeably larger increases observed among older and post-menopausal women from 2011 to 2015. The results warrant the need for more targeted interventions to high-risk groups and a sound foundation for cancer control program planning and policy development in Pakistan to reduce the increasing incidence of breast cancer.
doi: https://doi.org/10.12669/pjms.40.1.7123
How to cite this: Zaheer S, Yasmeen F. Historical trends in breast cancer presentation among women in Pakistan from join-point regression analysis. Pak J Med Sci. 2024;40(1):---------. doi: https://doi.org/10.12669/pjms.40.1.7123
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A Stochastic Sequential Quadratic Optimization Algorithm for Nonlinear-Equality-Constrained Optimization with Rank-Deficient Jacobians
Authors: Berahas Albert S. , Curtis Frank E. , O’Neill Michael J. , Robinson Daniel P. 
Published: October 2023

A sequential quadratic optimization algorithm is proposed for solving smooth nonlinear-equality-constrained optimization problems in which the objective function is defined by an expectation. The algorithmic structure of the proposed method is based on a step decomposition strategy that is known in the literature to be widely effective in practice, wherein each search direction is computed as the sum of a normal step (toward linearized feasibility) and a tangential step (toward objective decrease in the null space of the constraint Jacobian). However, the proposed method is unique from others in the literature in that it both allows the use of stochastic objective gradient estimates and possesses convergence guarantees even in the setting in which the constraint Jacobians may be rank-deficient. The results of numerical experiments demonstrate that the algorithm offers superior performance when compared with popular alternatives. Funding: This material is based upon work supported by the U.S. National Science Foundation’s Division of Computing and Communication Foundations under award [CF-1740796], by the Office of Naval Research under award [N00014-21-1-2532], and by the National Science Foundation under award [2030859] to the Computing Research Association for the CIFellows Project.
The physical, psychological, and social impacts of participation in the Invictus Pathways Program: A qualitative analysis of veterans’ perceptions and experiences
Authors: Post Dannielle , Baker Amy , Milanese Steven , Freegard Suzana , Parfitt Gaynor 
Published: October 2023

Introduction
UniSA’s Invictus Pathways Program (IPP) is motivated by the spirit of the Invictus Games to mobilise the benefits of sport to aid physical, psychological, and social wellbeing. Originally developed to assist veterans to train for and participate in the Invictus Games, the program has extended its scope to promote recovery and wellbeing for all veterans through physical activity. This paper describes the expectations and experiences of the IPP from the perspective of program participants.

Methods
Objective measures of physical and psychological wellbeing were collected by survey, to enable description of the participating veterans’ wellbeing status. Semi-structured interviews were conducted with 15 participants of the IPP who had not participated in an Invictus Games or Warrior Games. Reflexive thematic analysis was used to analyse the interview data. Coding and themes were developed through a mixture of inductive and deductive approaches to analysis. Initial themes related to previous life experience, expectations of participation, and outcomes of participation were preconceived, but the analysis provided scope for an inductive approach to formulate additional themes.

Findings
Five of the participants had very high K10 scores, and scores above the norm for PCL-C, whilst one would be classified with an alcohol disorder. The qualitative analysis identified five higher order themes: Life experiences prior to participation in the IPP, Making a choice to participate in the IPP, Expectations of participation in the IPP, Impact of participation in the IPP, and Future Plans. There were perceptions that the IPP was beneficial for the participating veterans, irrespective of their physical and psychological health status. Participants described the positive impact of the IPP on their physical fitness, their social engagement, and their sense of belonging within the IPP and the university. Participants perceived the IPP to be an opportunity for them to ‘give back’ by contributing to the education of the students delivering the IPP. Participants reported the intention to continue being physically active. For some, this meant selection in an Invictus Games team, for others, this meant getting involved in community sporting organisations.

Conclusion
The Invictus Pathways Program has been shown to have a positive impact on the physical and psychological wellbeing of the veterans who participated in its initial stages. As the program evolves, the longitudinal impact of participation, for veterans and their families, will be assessed.
Use of psychological interventions among healthcare workers over the 2-year period following the COVID-19 pandemic: A longitudinal study
Authors: García-Vázquez Blanca , Martínez-Alés Gonzalo , Fernández-Jiménez Eduardo , Andreo-Jover Jorge , Moreno-Küstner Berta , Minué Sergio , Jaramillo Fabiola , Morán-Sánchez Inés , Martínez-Morata Irene , Ayuso-Mateos José Luis , Bayón Carmen , Bravo-Ortiz María-Fe , Mediavilla Roberto 
Published: October 2023

Introduction
Although healthcare workers (HCWs) have reported mental health problems since the beginning of the COVID-19 pandemic, they rarely use psychological support. Here, we described the use of psychological support among HCWs in Spain over the 2-year period following the initial pandemic outbreak and explore its association with workplace- and COVID-19-related factors measured at baseline, in 2020.

Materials and methods
We conducted a longitudinal study on HCWs working in Spain. We used an online survey to collect information on sociodemographic characteristics, depressive symptoms, workplace- and COVID-19-related variables, and the use of psychological support at three time points (2020, 2021, and 2022). Data was available for 296, 294, and 251 respondents, respectively at time points 1, 2, and 3.

Results
Participants had a median age of 43 years and were mostly females (n = 242, 82%). The percentage of HCWs using psychological support increased from 15% in 2020 to 23% in 2022. Roughly one in four HCWs who did not use psychological support reported symptoms compatible with major depressive disorder at follow up. Baseline predictors of psychological support were having to make decisions about patients’ prioritisation (OR 5.59, 95% CI 2.47, 12.63) and probable depression (wave 2: OR 1.12, 95% CI 1.06, 1.19; wave 3: OR 1.10, 95% CI 1.04, 1.16).

Conclusions
Our results suggest that there is call for implementing mental health promotion and prevention strategies at the workplace, along with actions to reduce barriers for accessing psychological support.
Ethical and legal implications of implementing risk algorithms for early detection and screening for oesophageal cancer, now and in the future
Authors: Brigden Tanya , Mitchell Colin , Redrup Hill Elizabeth , Hall Alison 
Published: October 2023

Background
Oesophageal cancer has significant morbidity and mortality but late diagnosis is common since early signs of disease are frequently misinterpreted. Project DELTA aims to enable earlier detection and treatment through targeted screening using a novel risk prediction algorithm for oesophageal cancer (incorporating risk factors of Barrett’s oesophagus including prescriptions for acid-reducing medications (CanPredict)), together with a non-invasive, low-cost sampling device (CytospongeTM). However, there are many barriers to implementation, and this paper identifies key ethical and legal challenges to implementing these personalised prevention strategies for Barrett’s oesophagus/oesophageal cancer.

Methods
To identify ethical and legal issues relevant to the deployment of a risk prediction tool for oesophageal cancer into primary care, we adopted an interdisciplinary approach, incorporating targeted informal literature reviews, interviews with expert collaborators, a multidisciplinary workshop and ethical and legal analysis.

Results
Successful implementation raises many issues including ensuring transparency and effective risk communication; addressing bias and inequity; managing resources appropriately and avoiding exceptionalism. Clinicians will need support and training to use cancer risk prediction algorithms, ensuring that they understand how risk algorithms supplement rather than replace medical decision-making. Workshop participants had concerns about liability for harms arising from risk algorithms, including from potential bias and inequitable implementation. Determining strategies for risk communication enabling transparency but avoiding exceptionalist approaches are a significant challenge. Future challenges include using artificial intelligence to bolster risk assessment, incorporating genomics into risk tools, and deployment by non-health professional users. However, these strategies could improve detection and outcomes.

Conclusions
Novel pathways incorporating risk prediction algorithms hold considerable promise, especially when combined with low-cost sampling. However immediate priorities should be to develop risk communication strategies that take account of using validated risk algorithms, and to ensure equitable implementation. Resolving questions about liability for harms arising should be a longer-term objective.