PLOS ONEPLOShttps://journals.plos.org/plosone/webmaster@plos.orgaccelerating the publication of peer-reviewed sciencehttps://journals.plos.org/plosone/feed/atomAll PLOS articles are Open Access.https://journals.plos.org/plosone/resource/img/favicon.icohttps://journals.plos.org/plosone/resource/img/favicon.ico2024-03-19T06:10:13ZEvaluating population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings: A systematic review protocolShishi WuOlivia MagwoodQuanfang DongXiaolin Wei10.1371/journal.pone.03007802024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Shishi Wu, Olivia Magwood, Quanfang Dong, Xiaolin Wei</p>
Background <p>Inappropriate antibiotic use contributes significantly to the global challenge of antimicrobial resistance. While government-initiated population-level interventions are fundamental in addressing this issue, their full potential remains to be explored. This systematic review aims to assess the effectiveness of such interventions in reducing inappropriate antibiotic use among antibiotic providers and users in healthcare and community settings.</p> Methods <p>We will conduct a systematic literature search across multiple databases and grey literature sources. We will include studies which evaluate the effectiveness of population-level interventions to reduce inappropriate antibiotic use in healthcare and community settings in both high-income and low- and middle-income countries. This includes government-initiated measures targeting antibiotic use through education, restriction, incentivization, coercion, training, persuasion, context modification, behavior modeling, or barrier reduction. Two reviewers will independently perform screening to select eligible studies, followed by data extraction. The outcomes of interest are various measures of antibiotic prescription and consumption, such as Defined Daily Dose (DDD) or number of prescriptions per year. We anticipate including a broad range of study designs and outcome measures. Therefore, we will narratively synthesize results using the categories of the population-level policy interventions of the Behavior Change Wheel Framework. We will organize outcome data by economic contexts, target populations, and implementation settings.</p> Discussion <p>This review will strengthen the evidence base for the use of population-level interventions to address inappropriate antibiotic use. Drawing lessons from global experiences, the findings will provide valuable guidance to health policymakers, public health authorities, and researchers on tailoring interventions to specific economic contexts, populations, and settings, thereby enhancing their capacity to drive substantial improvement in appropriate antibiotic use.</p>Enhanced echocardiographic assessment of intracardiac flow in congenital heart diseaseBrett A. MeyersJiacheng ZhangJonathan NyceYue-Hin LokePavlos P. Vlachos10.1371/journal.pone.03007092024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Brett A. Meyers, Jiacheng Zhang, Jonathan Nyce, Yue-Hin Loke, Pavlos P. Vlachos</p>
Background <p>4D flow magnetic resonance imaging (4D flow MRI) can assess and measure the complex flow patterns of the right ventricle (RV) in congenital heart diseases, but its limited availability makes the broad application of intracardiac flow assessment challenging. Color Doppler imaging velocity reconstruction from conventional echocardiography is an emerging alternative, but its validity against 4D flow MRI needs to be established.</p> Objective <p>To compare intracardiac flow parameters measured by color Doppler velocity reconstruction (DoVeR) against parameters measured from 4D flow MRI.</p> Methods <p>We analyzed 20 subjects, including 7 normal RVs and 13 abnormal RVs (10 with repaired Tetralogy of Fallot, and 3 with atrial-level shunts). Intracardiac flow parameters such as relative pressure difference, vortex strength, total kinetic energy, and viscous energy loss were quantified using DoVeR and 4D flow MRI. The agreement between the two methods was determined by comparing the spatial fields and quantifying the cross-correlation and normalized difference between time-series measurements.</p> Results <p>The hemodynamic parameters obtained from DoVeR and 4D flow MRI showed similar flow characteristics and spatial distributions. The time evolutions of the parameters were also in good agreement between the two methods. The median correlation coefficient between the time-series of any parameter was between 0.87 and 0.92, and the median L2-norm deviation was between 10% to 14%.</p> Conclusions <p>Our study shows that DoVeR is a reliable alternative to 4D flow MRI for quantifying intracardiac hemodynamic parameters in the RV.</p>Contrary to expectation: The surface urban heat island intensity is increasing in population shrinking region while decreasing in population growing region-A comparative analysis from ChinaLuofu LiuWei Zhang10.1371/journal.pone.03006352024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Luofu Liu, Wei Zhang</p>
Exploring the complex relationship between population change and surface urban heat island (SUHI) effect has important practical significance for the ecological transformation development of shrinking cities in the context of the prevalence of urban shrinkage and the global climate change. This paper compares the population change and SUHI effect between population shrinking region (Northeast Region, NR) and population growing region (Yangtze River Delta, YRD) in China, and explores their differences in driving mechanisms, using GIS spatial analysis and Geodetector model. Our results indicated that there are significant differences in population changes and SUHI intensity between these two regions. About 72.22% of the cities in the NR were shrinking, while their SUHI intensities increased by an average of 1.69°C. On the contrary, the urban population in the YRD shows a linear growth trend, while their SUHI intensities decreased by 0.11°C on average. The results of bivariate Moran’s I index also indicated that the spatial correlation between the urban population changes and the SUHI intensity changes are not significant in the above regions. Furthermore, there are significant differences in the primary drivers of SUHI variations between these two regions. In the NR, underlying surface changes, including the changes of green coverage and built-up areas, are the most important driving factors. However, atmospheric environment changes, such as carbon dioxide emission and sulfur dioxide emission, are the key drivers in the YRD. Northam’s theory of three-stage urbanization and environmental Kuznets curve hypothesis are powerful to explain these differences.Association between smoking, smoking cessation and serum α-klotho levels among American adults: National Health and Nutrition Examination SurveyTing LiuMeihua SongJie LiYumei ZhaoWeiming Zhong10.1371/journal.pone.03005622024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Ting Liu, Meihua Song, Jie Li, Yumei Zhao, Weiming Zhong</p>
α-klotho is an anti-aging protein. The correlation between smoking, smoking cessation and serum α-klotho levels remains controversial. The aim of this study was to investigate the association between smoking, smoking cessation and serum α-klotho levels. This cross-sectional study finally included 4877 participants, aged 40–79 years, who participated in the National Health and Nutrition Examination Survey studies from 2013 to 2016. Of these, 2312 (47.4%) were men and 894 (18.3%) were current smokers, and the mean age of the participants was 57.8±10.7 years. Multivariate linear regression modeling was used to assess the association between smoking, smoking cessation and serum α-klotho levels. After adjustment for multiple confounders, this study observed that smoking was negatively associated with serum α-klotho levels (β: -58.3; 95% confidence interval CI: -82.0 to -34.6; p<0.001), whereas smoking cessation was positively associated with serum α-klotho levels (β: 52.3; 95% CI: 24.1 to 80.6; p<0.001). In subgroup and interaction analyses, <i>p</i>-value for the interaction between smoking and race on serum klotho levels was found to be less than 0.001. The correlation between smoking, smoking cessation and serum α-klotho levels remained stable after propensity score matching (β: -54.1; 95% CI: -81.5 to -26.7; <i>p</i><0.001, β: 54.8; 95% CI: 24.2 to 85.4; <i>p</i><0.001). In a large sample population, the present study found that smoking, smoking cessation and serum α-klotho levels were associated in opposite directions.Perceived self-efficacy to teach comprehensive abortion care among nursing and midwifery faculty in higher learning institutions in Rwanda: A mixed method studyAimable NkurunzizaMichael HabtuMadeleine MukeshimanaTamrat EndaleYvonne Delphine Nsaba UweraReverien RutayisireJustine BagirisanoJean Bosco Henri HitayezuMarie Laetitia Bazakare IshimweJean De Dieu Uwimana10.1371/journal.pone.03005422024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Aimable Nkurunziza, Michael Habtu, Madeleine Mukeshimana, Tamrat Endale, Yvonne Delphine Nsaba Uwera, Reverien Rutayisire, Justine Bagirisano, Jean Bosco Henri Hitayezu, Marie Laetitia Bazakare Ishimwe, Jean De Dieu Uwimana</p>
Introduction <p>Comprehensive abortion care is an emerging intervention being integrated into nursing and midwifery curricula. Yet, no studies have been conducted in Rwanda to determine whether faculty perceive themselves as capable of teaching comprehensive abortion care. This study aims to evaluate the perceived self-efficacy to teach comprehensive abortion care among nursing and midwifery faculty in higher learning institutions in Rwanda.</p> Materials and methods <p>The University of Rwanda College of Medicine and Health Sciences Institutional Review Board approved this study (UR-CMHS-IRB No 335/CMHSIRB/2022). In quantitative, a self-administered questionnaire was administered to 98 study participants. Data were entered into Statistical Package for the Social Sciences (SPSS) version 26 and analyzed using Chi-square test with a p-value of 0.05 set as the significance level. In the qualitative part, an interview guide was developed based on quantitative data to understand comprehensive abortion care teaching fully. Data were collected from four focus group discussions with eight participants in each group, entered in Dedoose, and analyzed thematically.</p> Results <p>Among the 98 study participants who were invited to participate in this study, only 85 filled out the questionnaires. This translates into 86.7% of the response rate. More than half 58.8% had adequate self-efficacy in teaching comprehensive abortion care. A Chi-square test has revealed that being a male, being a midwife, and having more years of working experience in nursing education were significantly associated with self-efficacy in teaching comprehensive abortion care (p value <0.05). In the qualitative phase, 32 study participants participated in four focus group discussions and four themes were identified: a) variability in confidence levels to teach comprehensive abortion care; b) readiness about teaching comprehensive abortion care; c) facilitators of teaching comprehensive abortion care; and d) contextual challenges to teach comprehensive abortion care.</p> Conclusions <p>The findings revealed that faculty’s self-efficacy in teaching comprehensive abortion care was not adequate. Personal and religious beliefs and institutional barriers were also reported to hinder self-efficacy in teaching comprehensive abortion care. Therefore, intensive comprehensive abortion care training for nursing and midwifery faculty in higher learning institutions should be provided, including values clarification and attitude transformation training for attitudes and beliefs. It is also critical for higher learning institutions to develop strategies for overcoming the challenges faculty face when teaching comprehensive abortion care.</p>A single base pair substitution in zebrafish distinguishes between innate and acute startle behavior regulationElelbin A. OrtizPhilip D. CampbellJessica C. NelsonMichael Granato10.1371/journal.pone.03005292024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Elelbin A. Ortiz, Philip D. Campbell, Jessica C. Nelson, Michael Granato</p>
Behavioral thresholds define the lowest stimulus intensities sufficient to elicit a behavioral response. Establishment of baseline behavioral thresholds during development is critical for proper responses throughout the animal’s life. Despite the relevance of such innate thresholds, the molecular mechanisms critical to establishing behavioral thresholds during development are not well understood. The acoustic startle response is a conserved behavior whose threshold is established during development yet is subsequently acutely regulated. We have previously identified a zebrafish mutant line (<i>escapist</i>) that displays a decreased baseline or innate acoustic startle threshold. Here, we identify a single base pair substitution on Chromosome 25 located within the coding sequence of the <i>synaptotagmin 7a</i> (<i>syt7a</i>) gene that is tightly linked to the <i>escapist</i> acoustic hypersensitivity phenotype. By generating animals in which we deleted the <i>syt7a</i> open reading frame, and subsequent complementation testing with the <i>escapist</i> line, we demonstrate that loss of <i>syt7a</i> function is not the cause of the <i>escapist</i> behavioral phenotype. Nonetheless, <i>escapist</i> mutants provide a powerful tool to decipher the overlap between acute and developmental regulation of behavioral thresholds. Extensive behavioral analyses reveal that in <i>escapist</i> mutants the establishment of the innate acoustic startle threshold is impaired, while regulation of its acute threshold remains intact. Moreover, our behavioral analyses reveal a deficit in baseline responses to visual stimuli, but not in the acute regulation of responses to visual stimuli. Together, this work eliminates loss of <i>syt7a</i> as causative for the <i>escapist</i> phenotype and suggests that mechanisms that regulate the establishment of behavioral thresholds in <i>escapist</i> larvae can operate independently from those regulating acute threshold regulation.Priority-setting for hospital funding of high-cost innovative drugs and therapeutics: A qualitative institutional case studyYasmeen RazviSimonne L. HorwitzCeline CressmanDaniel E. WangRandi Zlotnik ShaulAvram Denburg10.1371/journal.pone.03005192024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Yasmeen Razvi, Simonne L. Horwitz, Celine Cressman, Daniel E. Wang, Randi Zlotnik Shaul, Avram Denburg</p>
Objectives <p>Rising costs of innovative drugs and therapeutics (D&Ts) have led to resource allocation challenges for healthcare institutions. There is limited evidence to guide priority-setting for institutional funding of high-cost D&Ts. This study sought to identify and elaborate on the substantive principles and procedures that should inform institutional funding decisions for high-cost off-formulary D&Ts through a case study of a quaternary care paediatric hospital.</p> Methods <p>Semi-structured, qualitative interviews, both virtual and in-person, were conducted with institutional stakeholders (i.e. staff clinicians, senior leadership, and pharmacists) (n = 23) and two focus groups at The Hospital for Sick Children in Toronto, Canada. Participants involved in, and impacted by, high-cost off-formulary drug funding decisions were recruited through stratified, purposive sampling. Participants were approached for study involvement between July 27, 2020 and June 7, 2022. Data was analysed through reflexive thematic analysis.</p> Results <p>Institutional resource allocation for high-cost D&Ts was identified as ethically challenging but critical to sustainable access to novel therapies. Important substantive principles included: 1) clinical evidence of safety and efficacy, 2) economic considerations (direct costs, opportunity costs, value for money), 3) ethical principles (social justice, professional/organizational responsibility), and 4) disease-specific considerations. Multidisciplinary deliberation was identified as an essential procedural component of decision-making. Participants identified tension between innovation and the need for evidence-based decision-making; clinician and institutional responsibilities; and value for money and social justice. Participants emphasized the role of health system-level funding allocation in alleviating the financial and moral burden of decision-making by institutions.</p> Conclusions <p>This study identifies values and processes to aid in the development and implementation of institutional resource allocation frameworks for high-cost innovative D&Ts.</p>Glycoprofiling of proteins as prostate cancer biomarkers: A multinational population studyAndrea PinkeovaAdela TomikovaAniko BertokovaEva FabinyovaRadka BartovaEduard JaneStefania HroncekovaKarl-Dietrich SievertRoman SokolMichal JiraskoRadek KuceraIris E. EderWolfgang HorningerHelmut KlockerPetra ĎubjakováJuraj FilloTomas BertokJan Tkac10.1371/journal.pone.03004302024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Andrea Pinkeova, Adela Tomikova, Aniko Bertokova, Eva Fabinyova, Radka Bartova, Eduard Jane, Stefania Hroncekova, Karl-Dietrich Sievert, Roman Sokol, Michal Jirasko, Radek Kucera, Iris E. Eder, Wolfgang Horninger, Helmut Klocker, Petra Ďubjaková, Juraj Fillo, Tomas Bertok, Jan Tkac</p>
The glycoprofiling of two proteins, the free form of the prostate-specific antigen (fPSA) and zinc-α-2-glycoprotein (ZA2G), was assessed to determine their suitability as prostate cancer (PCa) biomarkers. The glycoprofiling of proteins was performed by analysing changes in the glycan composition on fPSA and ZA2G using lectins (proteins that recognise glycans, <i>i</i>.<i>e</i>. complex carbohydrates). The specific glycoprofiling of the proteins was performed using magnetic beads (MBs) modified with horseradish peroxidase (HRP) and antibodies that selectively enriched fPSA or ZA2G from human serum samples. Subsequently, the antibody-captured glycoproteins were incubated on lectin-coated ELISA plates. In addition, a novel glycoprotein standard (GPS) was used to normalise the assay. The glycoprofiling of fPSA and ZA2G was performed in human serum samples obtained from men undergoing a prostate biopsy after an elevated serum PSA, and prostate cancer patients with or without prior therapy. The results are presented in the form of an ROC (Receiver Operating Curve). A DCA (Decision Curve Analysis) to evaluate the clinical performance and net benefit of fPSA glycan-based biomarkers was also performed. While the glycoprofiling of ZA2G showed little promise as a potential PCa biomarker, the glycoprofiling of fPSA would appear to have significant clinical potential. Hence, the GIA (Glycobiopsy ImmunoAssay) test integrates the glycoprofiling of fPSA (<i>i</i>.<i>e</i>. two glycan forms of fPSA). The GIA test could be used for early diagnoses of PCa (AUC = 0.83; n = 559 samples) with a potential for use in therapy-monitoring (AUC = 0.90; n = 176 samples). Moreover, the analysis of a subset of serum samples (n = 215) revealed that the GIA test (AUC = 0.81) outperformed the PHI (Prostate Health Index) test (AUC = 0.69) in discriminating between men with prostate cancer and those with benign serum PSA elevation.Sustainability evaluation of sports tourism using a linguistic neutrosophic multi-criteria decision-making methodZhenyin ChenSuizhi LuoFeng Zheng10.1371/journal.pone.03003412024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Zhenyin Chen, Suizhi Luo, Feng Zheng</p>
Sports tourism represents a novel industrial manifestation of the profound integration between the tourism and sports sectors. The objective of this research is to examine an innovative multi-criteria decision-making (MCDM) method for the sustainability evaluation of sports tourism. The largest innovations are the expression and treatment of ambiguous data and interdependent evaluation criteria in the sports tourism sustainability evaluation process. On the one hand, intricate assessment data is represented using linguistic neutrosophic numbers (LNNs), which employ three linguistic variables to convey uncertainty and imprecision. On the other hand, to effectively capture the interrelationships among inputs, two novel aggregation operators are proposed. They are devised based on the Einstein operations and Heronian mean operators of LNNs. Subsequently, a linguistic neutrosophic evaluation method utilizing the aforementioned operators is presented. Comparative and sensitivity analyses conclude that great interdependence exists among five different dimensions of sustainability evaluation in sports tourism, and the proposed method can reflect the interrelations among inputs without redundant calculations.Psychological well-being of healthcare workers during COVID-19 in a mental health institutionHoiTing LeungMadeline LimWee Onn LimSara-Ann LeeJimmy Lee10.1371/journal.pone.03003292024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by HoiTing Leung, Madeline Lim, Wee Onn Lim, Sara-Ann Lee, Jimmy Lee</p>
Introduction <p>This study examined the psychological wellbeing of Healthcare Workers (HCWs) during COVID-19 in a mental health setting, associations of psychosocial wellbeing with coping style, and ways that organisations can mitigate the psychosocial burden on HCWs.</p> Methods <p>Thirty-seven Mental HCWs (MHCWs) from infected and non-infected wards (control group), were recruited and assessed at three timepoints. Psychological wellbeing, perceived cohesion, and coping style (Brief-COPE) were assessed. Reports on individual coping and feedback on the organisation were collected through in-depth interview. Comparison between infected and non-infected wards, as well as comparison of psychosocial measures and perceived cohesion, across the three timepoints were made. As there were no significant changes in coping styles across the timepoints, Timepoint 1 (T1) coping style was used to correlate with the psychosocial measures across all timepoints. Thematic analysis was used for qualitative data.</p> Results <p>MHCWs from infected wards reported significantly higher levels of stress, χ<sup>2</sup>(1) = 6.74, p = 0.009, effect size: medium (ε<sup>2</sup> = 0.198), and more severe sleep disturbance (PSQI), χ<sup>2</sup>(1) = 6.20, p = 0.013, effect size: medium (ε<sup>2</sup> = 0.182), as compared to the control group at T2. They also engaged in more problem-focused coping (T2 and T3) and emotion-focused coping (T2). As expected, negative coping style was correlated with negative outcomes except problem-focused coping that was correlated with both negative (sleep disturbance and anxiety symptoms) and positive outcomes (wellbeing). Emotion-focused coping was moderately correlated (T<sub>b</sub> = 0.348, p<0.017) with higher levels of wellbeing at T2. Thematic analyses revealed MHCWs felt supported by the responsiveness of the institution, emotional and informational support, and the availability from direct leaders, presence of team and hospital leaders on the ground, helped build trust and confidence in the leadership.</p> Conclusions <p>MHCWs experienced significantly higher levels of stress and sleep disturbance during COVID-19. The ways that organizations can offset the psychological burden of pandemics on MHCWs are discussed.</p>Impact of rural soundscape on environmental restoration: An empirical study based on the Taohuayuan Scenic Area in Changde, ChinaHui YangShuangQuan Zhang10.1371/journal.pone.03003282024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Hui Yang, ShuangQuan Zhang</p>
Previous studies on environmental restorative effects have mainly focused on visual landscapes, and less on the influence of soundscapes on restorative, but soundscapes play a crucial role in restorative environments, especially rural soundscapes, but there is insufficient existing theoretical evidence on the subject. Therefore, this study aims to investigate the influence of Rural Soundscape Perception on Environmental Restoration Perception, and introduces two affective variables, tourism nostalgia and place attachment, to explore the mechanism of Rural Soundscape Perception on Environmental Restoration Perception, as well as the moderating role of the number of trips is also discussed. Based on the theory of restorative environment, this study took the Taohuayuan Scenic Spot in Changde, Hunan Province, China, as the case site, and selected the rural soundscape in the area as the research object; a total of 506 valid data were collected through questionnaire surveys, and structural equation modeling was used to validate the collected data. It was found that rural soundscape perception had a significant positive effect on tourism nostalgia, place attachment, and environmental restoration perception. The results also showed that tourism nostalgia and place attachment mediated the relationship between rural soundscape perception and environmental restoration perception. Additionally, the results revealed that the number of trips did not play a moderating role in the structural relationship between rural soundscape perception and environmental restoration perception. Last, the results of the study shed light on the complex influence path of "rural soundscape perception→tourism nostalgia→place attachment→environmental restoration perception", which provides a new perspective for understanding the mechanism of the rural environment to people’s health, and also has a certain guiding significance for the landscape planning of rural tourism sites.Health-related quality of life during the COVID-19 pandemic: The impact of restrictive measures using data from two Dutch population-based cohort studiesCheyenne C. E. van HagenAnne J. HuibertsElizabeth N. MutubukiHester E. de MelkerEric R. A. VosJanneke H. H. M. van de WijgertSusan van den HofMirjam J. KnolAlbert Jan van Hoek10.1371/journal.pone.03003242024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Cheyenne C. E. van Hagen, Anne J. Huiberts, Elizabeth N. Mutubuki, Hester E. de Melker, Eric R. A. Vos, Janneke H. H. M. van de Wijgert, Susan van den Hof, Mirjam J. Knol, Albert Jan van Hoek</p>
Objectives <p>We describe health-related quality of life during the COVID-19 pandemic in the general Dutch population and correlations with restrictive measures.</p> Methods <p>Data were obtained from 18–85 year-old participants of two population-based cohort studies (February 2021-July 2022): PIENTER Corona (n = 8,019) and VASCO (n = 45,413). Per cohort, mean scores of mental and physical health and health utility from the SF-12 were calculated by age group, sex and presence of a medical risk condition. Spearman correlations with stringency of measures were calculated.</p> Results <p>Both cohorts showed comparable results. Participants <30 years had lowest health utility and mental health score, and highest physical health score. Health utility and mental health score increased with age (up to 79 years), while physical health score decreased with age. Women and participants with a medical risk condition scored lower than their counterparts. Fluctuations were small over time but most pronounced among participants <60 years, and correlated weakly, but mostly positively with measure stringency.</p> Conclusions <p>During the Dutch COVID-19 epidemic, health utility and mental health scores were lower and fluctuated strongest among young adults compared to older adults. In our study population, age, sex and presence of a medical risk condition seemed to have more impact on health scores than stringency of COVID-19 non-pharmaceutical interventions.</p>Suppression of the alpha, delta, and omicron variants of SARS-Cov-2 in TaiwanHsiao-Hui TsouFang-Jing LeeShiow-Ing WuByron FanHsiao-Yu WuYu-Hsuan LinYa-Ting HsuChieh ChengYu-Chieh ChengWei-Ming JiangHung-Yi ChiouWei J. ChenChao A. HsiungPau-Chung ChenHuey-Kang Sytwu10.1371/journal.pone.03003032024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Hsiao-Hui Tsou, Fang-Jing Lee, Shiow-Ing Wu, Byron Fan, Hsiao-Yu Wu, Yu-Hsuan Lin, Ya-Ting Hsu, Chieh Cheng, Yu-Chieh Cheng, Wei-Ming Jiang, Hung-Yi Chiou, Wei J. Chen, Chao A. Hsiung, Pau-Chung Chen, Huey-Kang Sytwu</p>
Background <p>Taiwan was a coronavirus disease 2019 (COVID-19) outlier, with an extraordinarily long transmission-free record: 253 days without locally transmitted infections while the rest of the world battled wave after wave of infection. The appearance of the alpha variant in May 2021, closely followed by the delta variant, disrupted this transmission-free streak. However, despite low vaccination coverage (<1%), outbreaks were well-controlled.</p> Methods <p>This study analyzed the time to border closure and conducted one-sample t test to compare between Taiwan and Non-Taiwan countries prior to vaccine introduction. The study also collected case data to observe the dynamics of omicron transmission. Time-varying reproduction number,R<sub>t</sub>, was calculated and was used to reflect infection impact at specified time points and model trends of future incidence.</p> Results <p>The study analyzed and compare the time to border closure in Taiwan and non-Taiwan countries. The mean times to any border closure from the first domestic case within each country were -21 and 5.98 days, respectively (P < .0001). The Taiwanese government invested in quick and effective contact tracing with a precise quarantine strategy in lieu of a strict lockdown. Residents followed recommendations based on self-discipline and unity. The self-discipline in action is evidenced in Google mobility reports. The central and local governments worked together to enact non-pharmaceutical interventions (NPIs), including universal masking, social distancing, limited unnecessary gatherings, systematic contact tracing, and enhanced quarantine measures. The people cooperated actively with pandemic-prevention regulations, including vaccination and preventive NPIs.</p> Conclusions <p>This article describes four key factors underlying Taiwan’s success in controlling COVID-19 transmission: quick responses; effective control measures with new technologies and rolling knowledge updates; unity and cooperation among Taiwanese government agencies, private companies and organizations, and individual citizens; and Taiwanese self-discipline.</p>Older adults using social support to improve self-care (OASIS): Adaptation, implementation and feasibility of peer support for older adults with T2D in appalachia: A feasibility study protocolBrittany L. SmallsAaron Kruse-DiehrCourtney L. OrtzKey DouthittChristopher McLouthRachel SheltonZoe TaylorEdith Williams10.1371/journal.pone.03001962024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Brittany L. Smalls, Aaron Kruse-Diehr, Courtney L. Ortz, Key Douthitt, Christopher McLouth, Rachel Shelton, Zoe Taylor, Edith Williams</p>
Introduction <p>The prevalence of type 2 diabetes (T2D) is 17% higher in rural dwellers compared to their urban counterparts, and it increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. In rural Kentucky, up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are vital when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors and clinical and psychosocial outcomes related to T2D; however, literature also suggests self-selected social support can be obstructive when engaging in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used to prioritize older adults, especially those living in rural communities.</p> Method <p>To address this gap, we conducted formative research with stakeholders, and collaboratively identified an acceptable and feasible peer support EBI—peer health coaching (PHC)—that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. The goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. Testing the PHC components of the peer support intervention will be instrumental in promoting care for older adults in Appalachia, as it will allow for a larger scale intervention, which if effective, could be disseminated to community partners in Appalachia.</p> Trial registration <p>This study was registered at www.clinicaltrials.gov (NCT06003634) in August 2023.</p>Strategies to improve delivery of equitable and evidence-informed care for pregnant and birthing people with a substance use disorder in acute care settings: A scoping review protocolCarla KingGregory LaynorJennifer McNeelyAdetayo FawoleMatthew LeeMishka TerplanSugy Choi10.1371/journal.pone.03001832024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Carla King, Gregory Laynor, Jennifer McNeely, Adetayo Fawole, Matthew Lee, Mishka Terplan, Sugy Choi</p>
This protocol outlines a proposed scoping review to characterize evidence on implementation and quality improvement (QI) strategies that aim to improve equitable, evidence-informed care delivery for pregnant and birthing people with substance use disorder (SUD) in acute care. Untreated SUD during pregnancy is associated with an increased risk of overdose and severe maternal morbidity. Acute care settings are one important place to deliver equitable, evidence-informed clinical care. While clinical practice guidelines for substance use treatment and care of pregnant and birthing people with SUD exist, there are gaps in implementation. Our population of interest is pregnant and birthing people with SUD in an acute care setting. We will include US-based studies that describe or evaluate implementation or QI strategies, including experimental, observational, and descriptive studies published from 2016 to 2023. The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews and registered at OSF (registration number: BC4VZ). We will search MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsychInfo (Ovid) for published studies. Conference proceedings and Perinatal Quality Collaborative websites will be searched for grey literature. Two reviewers will independently screen then extract studies that meet inclusion criteria using a data extraction tool. The completion of this scoping review will help illuminate strengths and gaps in research and practice that aim to inform substance use treatment and care in acute care settings for pregnant and birthing people with SUD.Group peer mentoring is effective for different demographic groups of biomedical research faculty: A controlled trialLinda H. PololiArthur T. EvansJanet T. CivianTay McNamaraRobert T. Brennan10.1371/journal.pone.03000432024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Linda H. Pololi, Arthur T. Evans, Janet T. Civian, Tay McNamara, Robert T. Brennan</p>
Introduction <p>Improved mentoring of midcareer researchers in medical schools has been identified as an important potential avenue for addressing low vitality and high burnout rates in faculty, and the scarcity of both underrepresented minority (URM) faculty and women in biomedical research. To address the need for widescale effective mentoring, we sought to determine whether a group peer mentoring intervention (C-Change Mentoring and Leadership Institute) for early midcareer research faculty was effective for different demographic groups in a controlled trial.</p> Methods and materials <p>Thirty-five diverse early midcareer faculty and 70 propensity-matched (PM) control subjects matched to intervention subjects on a) study inclusion criteria; b) gender, race, and ethnicity, degree, rank, years of experience, publications, grants; and c) pretest survey outcome variables, participated in the intervention. The C-Change Participant Survey assessed vitality, self-efficacy in career advancement, research success, mentoring others, valuing diversity, cognitive empathy, and anti-sexism/anti-racism skills at pretest and intervention completion. Analysis using multiple regression models included outcome pretest values and indicator variables for intervention, gender, URM status, and MD vs. PhD. Hypotheses regarding differential effectiveness of the intervention by demographic group were tested by including cross-product terms between the demographic indicator variables and the intervention indicator. Missing data were addressed using chained equations to create 100 data sets.</p> Results and discussion <p>The intervention participants had significantly higher (favorable) scores than PM controls for: self-assessed change in vitality; self-efficacy for career advancement, research, and mentoring others; cognitive empathy; and anti-sexism/racism skills. The benefits of the intervention were nearly identical across: gender, URM vs non-URM faculty, and degree MD/PhD, except vitality significantly increased for non-URM subjects, and not for URM faculty. Self-assessed change in vitality increased for URM and non-URM.</p> Conclusion <p>The intervention worked successfully for enhancing vitality, self-efficacy and cross-cultural engagement across different demographic groups of biomedical research faculty.</p>LEDT and Idebenone treatment modulate autophagy and improve regenerative capacity in the dystrophic muscle through an AMPK-pathwayHeloina Nathalliê Mariano da SilvaEvelyn Mendes FernandesValéria Andrade PereiraDaniela Sayuri MizobutiCaroline CovattiGuilherme Luiz da RochaElaine Minatel10.1371/journal.pone.03000062024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Heloina Nathalliê Mariano da Silva, Evelyn Mendes Fernandes, Valéria Andrade Pereira, Daniela Sayuri Mizobuti, Caroline Covatti, Guilherme Luiz da Rocha, Elaine Minatel</p>
Purpose <p>Considering the difficulties and challenges in Duchenne muscular dystrophy (DMD) treatment, such as the adverse effects of glucocorticoids, which are the main medical prescription used by dystrophic patients, new treatment concepts for dystrophic therapy are very necessary. Thus, in this study, we explore the effects of photobiomodulation (PBM; a non-invasive therapy) and Idebenone (IDE) treatment (a potent antioxidant), applied alone or in association, in dystrophic muscle cells and the quadriceps muscle, with special focus on autophagy and regenerative pathways.</p> Methods <p>For the <i>in vitro</i> studies, the dystrophic primary muscle cells received 0.5J LEDT and 0.06μM IDE; and for the <i>in vivo</i> studies, the dystrophic quadriceps muscle received 3J LEDT and the mdx mice were treated with 200mg/kg IDE.</p> Results <p>LEDT and IDE treatment modulate autophagy by increasing autophagy markers (SQSTM1/p62, Beclin and Parkin) and signaling pathways (AMPK and TGF-β). Concomitantly, the treatments prevented muscle degeneration by reducing the number of IgG-positive fibers and the fibers with a central nucleus; decreasing the fibrotic area; up-regulating the myogenin and MCH-slow levels; and down-regulating the MyoD and MHC-fast levels.</p> Conclusion <p>These results suggest that LEDT and IDE treatments enhance autophagy and prevented muscle degeneration in the dystrophic muscle of the experimental model. These findings illustrate the potential efficacy of LEDT and IDE treatment as an alternative therapy focused on muscle recovery in the dystrophic patient.</p>Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic reviewJamie GrossJonathan Koffman10.1371/journal.pone.02999332024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Jamie Gross, Jonathan Koffman</p>
Background <p>Patient involvement in goals of care decision-making has shown to enhance satisfaction, affective-cognitive outcomes, allocative efficiency, and reduce unwarranted clinical variation. However, the involvement of patients in goals of care planning within hospitals remains limited, particularly where mismatches in shared understanding between doctors and patients are present.</p> Aim <p>To identify and critically examine factors influencing goals of care conversations between doctors and patients during acute hospital illness.</p> Design <p>Realist systematic review following the RAMESES standards. A protocol has been published in PROSPERO (CRD42021297410). The review utilised realist synthesis methodology, including a scoping literature search to generate initial theories, theory refinement through stakeholder consultation, and a systematic literature search to support program theory.</p> Data sources <p>Data were collected from Medline, PubMed, Embase, CINAHL, PsychINFO, Scopus databases (1946 to 14 July 2023), citation tracking, and Google Scholar. Open-Grey was utilized to identify relevant grey literature. Studies were selected based on relevance and rigor to support theory development.</p> Results <p>Our analysis included 52 papers, supporting seven context-mechanism-output (CMO) hypotheses. Findings suggest that shared doctor-patient understanding relies on doctors being confident, competent, and personable to foster trusting relationships with patients. Low doctor confidence often leads to avoidance of discussions. Moreover, information provided to patients is often inconsistent, biased, procedure-focused, and lacks personalisation. Acute illness, medical jargon, poor health literacy, and high emotional states further hinder patient understanding.</p> Conclusions <p>Goals of care conversations in hospitals are nuanced and often suboptimal. To improve patient experiences and outcome of care interventions should be personalised and tailored to individual needs, emphasizing effective communication and trusting relationships among patients, families, doctors, and healthcare teams. Inclusion of caregivers and acknowledgment at the service level are crucial for achieving desired outcomes. Implications for policy, research, and clinical practice, including further training and skills development for doctors, are discussed.</p>Multifunction fluorescence open source <i>in vivo/in vitro</i> imaging system (openIVIS)John M. Branning Jr.Kealy A. FaughnanAustin A. TomsonGrant J. BellSydney M. IsbellAllen DeGrootLydia JamesonKramer KilroyMichael SmithRobert SmithLandon MottelElizabeth G. BranningZoe WorrallFrances AndersonAshrit PanditaradyulaWilliam YangJoseph AbdelmalekJoshua BrakeKevin J. Cash10.1371/journal.pone.02998752024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by John M. Branning Jr., Kealy A. Faughnan, Austin A. Tomson, Grant J. Bell, Sydney M. Isbell, Allen DeGroot, Lydia Jameson, Kramer Kilroy, Michael Smith, Robert Smith, Landon Mottel, Elizabeth G. Branning, Zoe Worrall, Frances Anderson, Ashrit Panditaradyula, William Yang, Joseph Abdelmalek, Joshua Brake, Kevin J. Cash</p>
The widespread availability and diversity of open-source microcontrollers paired with off-the-shelf electronics and 3D printed technology has led to the creation of a wide range of low-cost scientific instruments, including microscopes, spectrometers, sensors, data loggers, and other tools that can be used for research, education, and experimentation. These devices can be used to explore a wide range of scientific topics, from biology and chemistry to physics and engineering. In this study, we designed and built a multifunction fluorescent open source <i>in vivo/in vitro</i> imaging system (openIVIS) system that integrates a Raspberry Pi with commercial cameras and LEDs with 3D printed structures combined with an acrylic housing. Our openIVIS provides three excitation wavelengths of 460 nm, 520 nm, and 630 nm integrated with Python control software to enable fluorescent measurements across the full visible light spectrum. To demonstrate the potential applications of our system, we tested its performance against a diverse set of experiments including laboratory assays (measuring fluorescent dyes, using optical nanosensors, and DNA gel electrophoresis) to potentially fieldable applications (plant and mineral imaging). We also tested the potential use for a high school biology environment by imaging small animals and tracking their development over the course of ten days. Our system demonstrated its ability to measure a wide dynamic range fluorescent response from millimolar to picomolar concentrations in the same sample while measuring responses across visible wavelengths. These results demonstrate the power and flexibility of open-source hardware and software and how it can be integrated with customizable manufacturing to create low-cost scientific instruments with a wide range of applications. Our study provides a promising model for the development of low-cost instruments that can be used in both research and education.Tuberculin skin test and Interferon-gamma release assay agreement, and associated factors with latent tuberculosis infection, in medical and nursing students in Bandung, IndonesiaLika AprianiSusan McAllisterKatrina SharplesIsni Nurul AiniHanifah NurhasanahDwi Febni RatnaningsihAgnes Rengga IndratiRovina RuslamiBachti AlisjahbanaReinout van CrevelPhilip C. Hill10.1371/journal.pone.02998742024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Lika Apriani, Susan McAllister, Katrina Sharples, Isni Nurul Aini, Hanifah Nurhasanah, Dwi Febni Ratnaningsih, Agnes Rengga Indrati, Rovina Ruslami, Bachti Alisjahbana, Reinout van Crevel, Philip C. Hill</p>
Background <p>No gold standard diagnostic test exists for latent tuberculosis infection (LTBI). The intra-dermal tuberculin skin test (TST) has known limitations and Interferon-gamma release assays (IGRA) have been developed as an alternative. We aimed to assess agreement between IGRA and TST, and risk factors for test positivity, in Indonesian healthcare students.</p> Methods <p>Medical and nursing students starting their clinical training were screened using IGRA and TST. Agreement between the two tests was measured using Cohen’s Kappa coefficient. Logistic regression was used to identify factors associated with test positivity.</p> Results <p>Of 266 students, 43 (16.2%) were IGRA positive and 85 (31.9%) TST positive. Agreement between the two tests was 74.7% (kappa 0.33, 95% CI 0.21–0.45, P<0.0001). Students who had direct contact with family or friends with TB were less likely to be test positive using IGRA (AOR 0.18, 95% CI 0.05–0.64) and using TST (AOR 0.51, 95% CI 0.26–0.99).</p> Conclusion <p>Test positivity for LTBI was lower when measured by IGRA than by TST, with poor agreement between the two tests. Known close TB contact was unexpectedly negatively associated with positivity by either test. Longitudinal studies may be required to help determine the best test for LTBI in healthcare students in Indonesia.</p>Obtaining accurate population estimates with reduced workload and lower fish mortality in multi-mesh gillnet sampling of a large pre-alpine lakeSteffen BaderJulia Gaye-SiesseggerBarbara ScholzMário Mota-FerreiraAlexander Brinker10.1371/journal.pone.02997742024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Steffen Bader, Julia Gaye-Siessegger, Barbara Scholz, Mário Mota-Ferreira, Alexander Brinker</p>
The EU Water Framework Directive requires monitoring of the ecological status of lakes, with fish as a relevant class of biotic quality indicator, but monitoring fish populations in large lakes is demanding. This study evaluated use in Lake Constance of a novel multi-mesh gillnet modified to reduce catch numbers. In direct comparison with conventional European Committee for Standardization (CEN) nets we achieved 48% reduction in fish mortality with 38% less labour for tasks directly influenced by fish catch numbers, while maintaining comparable species composition and catch per unit effort. Comparison of mesh sizes indicated no significant reduction in species detection in area-reduced panels of the small mesh sizes, while total observed species richness was greater when using the modified nets. Differences in benthic species communities among depth strata were common, while those of pelagic zones were more homogeneous and did not differ significantly with depth. Catches of different net types from the same depth stratum did not exhibit significant differences. The dominance structure of the most common species, relevant to lake assessment, was similar in catches of both net types, suggesting overall superiority of the modified nets in Lake Constance. Sampling conducted according to standard European CEN protocol, while deploying 60% fewer nets, yielded sufficiently precise abundance estimates for monitoring shallow areas of the benthic zone. A 50% difference in the abundance of dominant species was detected among sampling events with a certainty of 95%. The sample did not provide comparable accuracy in deep benthic strata or the pelagic zone, but was adequate to record complete inventories of species present. Based on this trial data, a new stratified sampling design is proposed for monitoring large lake fish communities for ecological assessment. Depth-dependent fish communities were used to calculate the required number of nets, which resulted in a 69% reduction for the entire lake compared to the CEN calculation method. Using the modified nets increases the feasibility of performing WFD surveys, by reducing effort and cost, while the simultaneous halving of fish mortality minimises the negative impact of fish surveys.Assessing knowledge about hypertension and identifying predictors of inadequate knowledge in Saudi Arabia: A cross-sectional studyAjiad AlhazmiHassan N. MoafaMohammed KotbLouay SayeghHassan BaydhiAbdullaziz HazzaziHassan MoafaAbdulelah Hakami10.1371/journal.pone.02997452024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Ajiad Alhazmi, Hassan N. Moafa, Mohammed Kotb, Louay Sayegh, Hassan Baydhi, Abdullaziz Hazzazi, Hassan Moafa, Abdulelah Hakami</p>
Background <p>Globally, hypertension is among the leading causes of premature mortality. It is a noncommunicable disease characterized by a persistent state of raised blood pressure that increases the risk of cardiovascular diseases and medical conditions affecting the brain and kidneys. There is a paucity of thorough hypertension knowledge assessment among hypertensive patients in the Jazan region of Saudi Arabia. Thus, this study aimed to assess overall and specific knowledge about hypertension and to identify predictors of inadequate knowledge.</p> Methods <p>A cross-sectional study was conducted in the Jazan region of Saudi Arabia between February and April 2023. Data were collected using an online, self-administered questionnaire divided into two sections. In the first section, the characteristics of the participants were collected. In the second section, the Hypertension Knowledge-Level Scale was used to measure overall and specific knowledge areas (subdimensions). The overall and subdimensional means were tested using Mann–Whitney U and Kruskal–Wallis H tests. Furthermore, the binary logistic regression was conducted to determine inadequate knowledge predictors.</p> Results <p>In all 253 hypertensive patients were eligible for participation; almost 70% of whom were male. The mean age of the participants was 45 years (±14.7), and their mean overall knowledge score was 17.60 (±5.09), which was equivalent to 67.7% of the maximum score. In addition, 40.7% of participants had an adequate level of hypertension knowledge. The complications subdimension level of knowledge was borderline optimal. At the same time, an adequate knowledge level was detected only in the lifestyle subdimension.</p> Conclusion <p>Most patients showed inadequate levels of knowledge related to hypertension management. Diet, medical treatment, disease definition, drug compliance, and complications were subsequently the least knowledgeable subdimensions among the study population. Therefore, these subdimensions should be prioritized when planning hypertension educational interventions and during follow-up sessions, especially for patients of younger age groups and those with lower educational levels.</p>Call combination in African forest elephants <i>Loxodonta cyclotis</i>Daniela HedwigAnna Kohlberg10.1371/journal.pone.02996562024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Daniela Hedwig, Anna Kohlberg</p>
Syntax, the combination of meaning-devoid phonemes into meaningful words, which in turn are combined in structurally and semantically complex sentences, is fundamental to the unlimited expressiveness of human languages. Studying the functions of call combinations in non-human species provides insights into the evolution of such syntactic capabilities. Here, we investigated the combination of high amplitude broadband calls with low frequency rumble vocalizations in a highly social species, the African forest elephant <i>Loxodonta cyclotis</i>. Rumbles play an integral role in coordinating social interactions by transmitting socially relevant information, including individual identity. By contrast, broadband calls, such as roars, are thought to function as signals of distress and urgency as they are typically produced in situations of high emotional intensity. Functional changes associated with the combination of these calls remain little understood. We found that call combinations were produced by all age-sex classes but were most prevalent in immature individuals. We found that rumbles used singularly occurred in all five investigated social contexts, whereas single broadband calls were restricted to two resource-related contexts. Call combinations also occurred in all five contexts, suggesting an increase in the functional use of broadband calls when combined with rumbles, analogous to the generativity brought about through syntax in human speech. Moreover, combining calls appeared to lead to functional shifts towards high-stake contexts. Call combinations were more likely in competition contexts compared to single rumbles, and more likely in separation contexts compared to single broadband calls. We suggest that call combination in forest elephants may aide to reduce message ambiguity in high-stake situation by simultaneously communicating distress and individual identity, which may be critical to secure access to resources, reduce the risk of injury and to reunite with or recruit the support of the family group.Design and implementation of a Li River water quality monitoring and analysis system based on outlier data analysisQirong LuJian ZouYingya YeZexin Wang10.1371/journal.pone.02994352024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Qirong Lu, Jian Zou, Yingya Ye, Zexin Wang</p>
The detection of water quality indicators such as Temperature, pH, Turbidity, Conductivity, and TDS involves five national standard methods. Chemically based measurement techniques may generate liquid residue, causing secondary pollution. The water quality monitoring and data analysis system can effectively address the issues that conventional methods require multiple pieces of equipment and repeated measurements. This paper analyzes the distribution characteristics of the historical data from five sensors at a specific time, displays them graphically in real time, and provides an early warning of exceeding the standard; It selects four water samples from different sections of the Li River, based on the national standard method, the average measurement errors of Temperature, PH, TDS, Conductivity and Turbidity are 0.98%, 2.23%, 2.92%, 3.05% and 3.98%.;It further uses the quartile method to analyze the outlier data over 100,000 records and five historical periods are selected. Experiment results show the system is relatively stable in measuring Temperature, PH and TDS, and the proportion of outlier is 0.42%, 0.84% and 1.24%. When Turbidity and Conductivity are measured, the proportion is 3.11% and 2.92%. In the experiment of using 7 methods to fill outlier, K nearest neighbor algorithm is better than others. The analysis of data trends, outliers, means, and extreme values assists in making decisions, such as updating and maintaining equipment, addressing extreme water quality situations, and enhancing regional water quality oversight.The unexplored territory of aesthetic needs and the development of the Aesthetic Needs ScaleAgata Hiacynta ŚwiątekMałgorzata SzcześniakHanna BorkowskaMichał StempieńKarolina WojtkowiakRhett Diessner10.1371/journal.pone.02993262024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Agata Hiacynta Świątek, Małgorzata Szcześniak, Hanna Borkowska, Michał Stempień, Karolina Wojtkowiak, Rhett Diessner</p>
Human needs, and their fulfillment, are the building blocks of human development, personality, and well-being. However, no published paper in the field of psychology has focused on exploring <i>aesthetic needs</i>. Maslow (1986) gave the topic little more than a paragraph; and Dweck [1], in her elegant Unified Theory of Motivation, Personality, and Development, never mentions aesthetic needs. The aim of this article is to describe developing a scale for measuring the intensity of aesthetic needs. The structure, psychometric properties, and criterion-related validity of the scale were verified with three independent samples (total <i>N</i> = 592). The results of an EFA and two CFAs indicated a three-factor structure: 1) the need to aestheticize everyday life (aesthetic experiences of everyday objects and events unrelated to art, such as the presentation of food or the appearance of a workspace, etc.); 2) the need for contact with aesthetic creations (the arts); 3) the need to aestheticize the built and natural environments (urban spaces, architecture, parks, wild nature, etc.). In addition, our criterion-related convergent validity studies have shown that people with high aesthetic needs are characterized by experiencing more intense experiences in contact with works of art, have higher aesthetic competence in art, are more intensely involved in four forms of beauty, have a higher ability to integrate beauty, a stronger trait gratitude, curiosity about nature, greater sensitivity to disgust, and the need for internal and external stimulation. This scale may prove useful in research on individual differences and the psychology of aesthetics.Factors associated with COVID-19 among hospitalized patients with severe acute respiratory infections in Serbia, 2022–2023: A test negative case-control studyMaja StosicDragana PlavsaVerica JovanovicMarko VeljkovicDragan BabicAleksandra KnezevicVladan SaponjicDragana DimitrijevicMiljan RancicMarija MilicTatjana Adzic-Vukicevic10.1371/journal.pone.02992102024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Maja Stosic, Dragana Plavsa, Verica Jovanovic, Marko Veljkovic, Dragan Babic, Aleksandra Knezevic, Vladan Saponjic, Dragana Dimitrijevic, Miljan Rancic, Marija Milic, Tatjana Adzic-Vukicevic</p>
Severe acute respiratory infections (SARI) are estimated to be the cause of death in about 19% of all children younger than 5 years globally. The outbreak of coronaviral disease (COVID-19) caused by SARS-CoV-2, increased considerably the burden of SARI worldwide. We used data from a vaccine effectiveness study to identify the factors associated with SARS CoV-2 infection among hospitalized SARI patients. We recruited SARI patients at 3 hospitals in Serbia from 7 April 2022–1 May 2023. We collected demographic and clinical data from patients using a structured questionnaire, and all SARI patients were tested for SARS-CoV-2 by RT-PCR. We conducted an unmatched test negative case-control study. SARS-CoV-2 infected SARI patients were considered cases, while SARS CoV-2 negative SARI patients were controls. We conducted bivariate and multivariable logistic regression analysis in order to identify variables associated with SARS-CoV-2 infection. We included 110 SARI patients: 74 were cases and 36 controls. We identified 5 factors associated with SARS-CoV-2 positivity, age (OR = 1.04; 95% CI = 1.01–1.07), having received primary COVID-19 vaccine series (OR = 0.28; 95% CI = 0.09–0.88), current smoking (OR = 8.64; 95% CI = 2.43–30.72), previous SARS CoV-2 infection (OR = 3.48; 95% CI = 1.50–8.11) and number of days before seeking medical help (OR = 0.81; 95% CI = 0.64–1.02). In Serbia during a period of Omicron circulation, we found that older age, unvaccinated, hospitalized SARI patients, previously infected with SARS CoV-2 virus and those who smoked, were more likely to be SARS-CoV-2-positive; these patient populations should be prioritized for COVID vaccination.Study protocol for a pilot clinical trial to understand neural mechanisms of response to a psychological treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)Natoshia R. CunninghamMichelle A. AdlerBrittany N. Barber GarciaTaylor AbounaderAlaina K. MillerMariela MonzalvoIsmaeel HashemiRyan CoxSamantha L. ElyYong ZhouMark DeLanoTodd MulderinkMathew J. ReevesJames L. PeughSusmita Kashikar-ZuckRobert C. CoghillJudith E. ArnetzDavid C. Zhu10.1371/journal.pone.02991702024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Natoshia R. Cunningham, Michelle A. Adler, Brittany N. Barber Garcia, Taylor Abounader, Alaina K. Miller, Mariela Monzalvo, Ismaeel Hashemi, Ryan Cox, Samantha L. Ely, Yong Zhou, Mark DeLano, Todd Mulderink, Mathew J. Reeves, James L. Peugh, Susmita Kashikar-Zuck, Robert C. Coghill, Judith E. Arnetz, David C. Zhu</p>
Background <p>Functional abdominal pain disorders (FAPD) are the most common chronic pain conditions of childhood and are made worse by co-occurring anxiety. Our research team found that the Aim to Decrease Pain and Anxiety Treatment (ADAPT), a six-session coping skills program using cognitive behavioral therapy strategies, was effective in improving pain-related symptoms and anxiety symptoms compared to standard care. In follow-up, this current randomized clinical trial (RCT) aims to test potential neural mechanisms underlying the effect of ADAPT. Specifically, this two-arm RCT will explore changes in amygdalar functional connectivity (primary outcome) following the ADAPT protocol during the water loading symptom provocation task (WL-SPT). Secondary (e.g., changes in regional cerebral blood flow via pulsed arterial spin labeling MRI) and exploratory (e.g., the association between the changes in functional connectivity and clinical symptoms) outcomes will also be investigated.</p> Methods <p>We will include patients ages 11 to 16 years presenting to outpatient pediatric gastroenterology care at a midwestern children’s hospital with a diagnosis of FAPD plus evidence of clinical anxiety based on a validated screening tool (the Generalized Anxiety Disorder-7 [GAD-7] measure). Eligible participants will undergo baseline neuroimaging involving the WL-SPT, and assessment of self-reported pain, anxiety, and additional symptoms, prior to being randomized to a six-week remotely delivered ADAPT program plus standard medical care or standard medical care alone (waitlist). Thereafter, subjects will complete a post assessment neuroimaging visit similar in nature to their first visit.</p> Conclusions <p>This small scale RCT aims to increase understanding of potential neural mechanisms of response to ADAPT.</p> Trial registration <p>ClinicalTrials.gov registration: NCT03518216.</p>Bullying victimization among adolescents: Prevalence, associated factors and correlation with mental health outcomesMariem GhardallouAhlem MtiraouiDorra EnnamouchiAmel AmaraAmel GaraMaha DardouriChekib ZediniAli Mtiraoui10.1371/journal.pone.02991612024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Mariem Ghardallou, Ahlem Mtiraoui, Dorra Ennamouchi, Amel Amara, Amel Gara, Maha Dardouri, Chekib Zedini, Ali Mtiraoui</p>
Introduction <p>Knowledge of the risk factors of bullying victimization in adolescents is crucial for the implementation of preventive measures. This study aimed to determine the prevalence and associated factors of bullying victimization and to identify its correlation with mental health outcomes among middle school students in Tunisia.</p> Methods <p>A cross-sectional study was conducted using a multi-stage cluster sampling technique to recruit a sample of 1111 students from 10 middle schools in El kef (Tunisia). The revised Olweus Bully/Victim Questionnaire was used to assess the prevalence and types of bullying victimization and the perceived efforts of others to counteract bullying. The Strengths and Difficulties Questionnaire (SDQ) was used for screening emotional and behavioral problems. Multivariate logistic regression analysis was conducted to determine associated factors of bullying victimization. Additionally, we tested whether emotional and behavioral problems were present for bullying victims.</p> Results <p>The findings reported that 45.8% (95%CI = 45.5–46.0), of the total number of participants experienced school bullying victimization. Multivariate logistic regression analysis, revealed that repeating a grade (OR = 1.82, 95%CI = 1.31–2.54), having a working father (OR = 17.68; 95%CI = 2.29–136,15), and having a working mother (OR = 1.88, 95%CI = 1.39–2.53) were the factors significantly associated with bullying victimization. Nevertheless, a higher mother’s educational level (OR = 0.76, 95%CI = 0.67–0.88) was a protective factor against bullying victimization. The self-reported SDQ revealed that the total difficulties score was significantly higher among victims (17.46 ± 5.30 vs. 20.86 ± 5.06, p<0.01).</p> Conclusions <p>This study showed that the prevalence of bullying in middle schools was high and it significantly led to mental health problems. National policies for bullying prevention within schools are potentially needed. Improving students’ problem-solving and soft skills is also essential.</p>Association between the oxidative balance score and thyroid function: Results from the NHANES 2007–2012 and Mendelian randomization studyLiying SongHaonan ZhouQian YangNingyu HeFeifan FuWeichao LiGuosheng DuanDi WuShuai HaoJiaxing WangJing Liu10.1371/journal.pone.02988602024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Liying Song, Haonan Zhou, Qian Yang, Ningyu He, Feifan Fu, Weichao Li, Guosheng Duan, Di Wu, Shuai Hao, Jiaxing Wang, Jing Liu</p>
Background <p>Oxidative stress is a significant contributor to the development of various diseases, and the oxidative balance score (OBS) is a valuable tool for assessing the impact of dietary and lifestyle factors on oxidative stress in humans. Nevertheless, the precise relationship between OBS and thyroid function in adults remains elusive.</p> Methods <p>This cross-sectional study comprised 6222 adult participants drawn from the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2012. Employing weighted multivariable linear regression modeling, the study estimated the connection between OBS quartiles and thyroid functions. The causal relationship between OBS components and thyroid function was analyzed by Mendelian randomization (MR).</p> Results <p>We found a significant negative correlation between OBS and free thyroxine (FT4) and total thyroxine (TT4). Univariate and multivariate MR Analyses showed a causal relationship between BMI and FT4. Copper, smoking, and riboflavin showed a causal relationship with FT4 after moderation.</p> Conclusion <p>We found that a lifestyle high in antioxidant exposure reduced FT4 and TT4 levels in the population. We suggest that BMI, Copper, and Riboflavin are important factors in the regulation of FT4 levels.</p>Participation and returns from informal service-oriented non-farm enterprises: Evidence from a survey of Nigerian householdsIkechukwu Darlington NwakaOkechukwu Lawrence Emeagwali10.1371/journal.pone.02987942024-03-18T14:00:00Z2024-03-18T14:00:00Z<p>by Ikechukwu Darlington Nwaka, Okechukwu Lawrence Emeagwali</p>
We investigate the factors that influence the selection and productivity of informal service-oriented family enterprises in Nigeria. Using nationally representative micro-data from the Nigerian General Household Survey (2010–2015), we employed random-effect probit and selectivity-adjusted regression models to estimate and analyze the results. The findings reveal that the location of informal Non-Farm Household Enterprises (NFHEs)–whether home-based or non-home-based—significantly impacts the wholesale, retail, personal, and consultancy service sectors operated by informal NFHEs. This impact remains significant even after accounting for variations in individuals, households, or locational characteristics. Furthermore, when considering selectivity in the earnings equation, we found that home-based informal enterprises exhibit lower productivity compared to non-home-based enterprises, a difference that varies across sectors. Overall, factors such as the gender of business owners, educational levels, geopolitical zones, infrastructure, and business characteristics play a crucial role in determining the locational and productivity disparities among service-oriented enterprises in Nigeria. Key recommendations stemming from this study include addressing gender-based segregation and economic disparities, prioritising financial inclusion for small business development, bridging infrastructure gaps, and implementing policies that acknowledge and bolster the informal sector.