PLoS ONE最新文献

Transcutaneous spinal cord stimulation (tSCS) is becoming a promising neuromodulation technique to promote motor recovery in various neurological conditions, including stroke. As this intervention moves forward into clinical practice, it is important to understand how the elicited neurophysiological measures are related to the functional and neuromuscular deficits of the population of interest in order to personalize tSCS interventions and assess its effectiveness. Specifically, neurophysiological measurements of spinal cord excitability can be achieved by recording with EMG spinal motor evoked responses (sMERs) in muscles after applying single pulses of tSCS to the spinal cord. The objective of this study was to investigate potential correlations between baseline spinal cord excitability, as measured by resting motor threshold (RMT) and peak-to-peak (P2P) amplitude of the sMERs, and various factors including demographic characteristics, severity of spasticity, muscle strength, and gait speed in individuals post-stroke. Additionally, the study sought to explore disparities in excitability between the paretic and non-paretic sides. Fifteen participants with chronic stroke underwent sMER assessments. We observed a strong positive correlation between RMT and body weight, indicating weight as a potential confounding variable when comparing RMTs from sMERs between individuals. Furthermore, paretic muscles exhibited lower RMTs and higher P2P amplitudes compared to non-paretic muscles. The results demonstrate that sMERs hold promise in uncovering disparities in spinal excitability in stroke participants. Furthermore, careful interpretation and analysis of sMERs is advised, particularly as higher RMTs were associated with higher body weight and could impact the clinical feasibility of tSCS for some participants. These results should be considered in future tSCS protocols that aim to develop more personalized interventions across different neurological populations and optimize sMERs' utility as an outcome measure.

Since the Chinese government launched the Belt and Road Initiative, state-owned enterprises and private conglomerates have increased overseas investment. The massive outward foreign direct investment (OFDI) profoundly affects China's regional development to varying degrees. Existing studies have mainly investigated the effect of foreign direct investment inflow on domestic investment (DI), but only a few studies have examined the impact of OFDI on DI. Though most researchers have indicated that OFDI activities can promote (or inhibit) DI in a particular country, they have overlooked how OFDI's geographical distribution and motivation across the Chinese macro-regions have influenced DI. To fill these gaps, this paper examines the impact of such OFDI on DI in China and its macro-regions, using a province-level dataset from 2005 to 2021. It employs panel regression and rigorously tests the data using the generalised method of moments to address endogeneity issues. We also investigate the investment motivations of the top 100 Chinese multinationals with significant FDI outflows from 2015 to 2018. We find that OFDI has positively and markedly influenced DI in eastern coastal and central inland regions but not in western China. Though OFDI has positively affected DI in China, it may not hold in a regional context. Such OFDI seeks to enhance the efficiency of existing investment, expand domestic markets, and look for strategic assets. Our findings indicate that central and provincial governments could develop OFDI policies to cater to significant regional variations. Local governments should also consider the various OFDI motivations of Chinese multinationals and provide adequate support for developing and implementing local investment policies that encourage domestic firms to invest abroad.

Background: The attention towards the relationship between chronic obstructive pulmonary disease (COPD) and dietary intake is escalating. However, the effects of dietary niacin on COPD in middle and older individuals remains unclear. This study aimed to illuminate the connection between dietary niacin intake and COPD.

Methods: This cross-sectional study analyzed 7,170 participants from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013 to 2018. Participants were categorized into four groups based on quartiles of dietary niacin intake. To examine the association between covariates, dietary niacin intake, and COPD, we employed univariate analysis and multivariate logistic regression equations. Additionally, restricted cubic splines were utilized to assess linearity. Furthermore, we conducted stratified and interaction analyses to evaluate the stability of the relationship in diverse subgroups.

Results: Among the 7,170 participants, 11.6% (834/7170) were diagnosed with COPD. The multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for COPD were 0.96 (95% CI: 0.77-1.19, p = 0.706), 0.78 (95% CI: 0.62-0.99, p = 0.038), and 0.76 (95% CI: 0.57-1.00, p = 0.047), respectively, when comparing the second, third, and fourth quartiles of niacin intake levels to the lowest quartile (p for trend = 0.017). An inverse association was observed between the occurrence of COPD and dietary niacin intake (nonlinear: p = 0.347). Stratified analyses revealed no significant differences or interactions.

Conclusion: Our findings suggest a potential link between increased dietary niacin intake and a decreased prevalence of COPD.

Introduction: Clinical governance outlines duties and responsibilities as well as indicators of the actions towards best possible patient outcomes. However, evidence of outcomes on clinical governance interventions is limited in South Africa. This study determined knowledge of clinical staff about the existence of clinical governance protocols/tools that are utilised in selected South African hospitals.

Methods: A cross-sectional study conducted among randomly sampled clinical staff at Nelson Mandela Academic (NMAH), St Elizabeth in the Eastern Cape Province and, Rob Ferreira (RFH) and Themba Hospitals in the Mpumalanga Province of South Africa. A self-administered survey questionnaire was used to collect demographic information and quality improvement protocols/tools in existence at the hospitals. Data were captured in Excel spreadsheet and analysed with STATA. Knowledge was generated based on the staff member's score for the 12 questions assessed.

Results: A total of 720 participants were recruited of which 377 gave consent to participate. Overall, 8.5% (32/377) of the participants got none or only one correct out of the 12 protocols/tools; and 65.5% (247/377) got between two and five correct. The median knowledge scores were 41.7% (interquartile range (IQR) = 16.7%) in three of the hospitals and 33.3% (IQR = 16.7%) at NMAH (p-value = 0.002). Factors associated with good knowledge included more than five years of experience, being a professional nurse compared to other nurses, not working at NMAH as well as being a medical doctor or pharmacist compared to other staff. Overall, 74.0% (279/377) of the respondents scored below 50%; this was 84.4% (92/109) at NMAH and 66.3% (55/83) at RFH and this difference was statistically significant (p-value = 0.017).

Conclusion: Despite clinical governance implementation, there was low knowledge of clinical governance protocols/tools among clinical staff. Therefore, providing more effective, relevant training workshops with an emphasis on importance of local ownership of the concept of clinical governance, by both management and clinical staff is of great importance.

Background: Patients with spontaneous and traumatic intracranial hemorrhage (ICH) are frequently transfused platelets to treat thrombocytopenia, platelet function defects, and reverse antiplatelet drugs. ABO-identical platelet transfusion has been suggested to lead to higher post-transfusion platelet increments compared to major-ABO incompatible transfusion. We hypothesized that patients who received ABO-identical transfusion would have higher post-transfusion platelet increments and superior neurologic outcomes.

Methods: Adults with traumatic or non-traumatic ICH from January 1st 2018 to December 31st 2022 were identified using electronic medical records and international classification of disease (ICD)-10 codes. Patients were excluded if they lacked a platelet count within 24 hours before and within 24 hours after transfusion or if they received multiple platelet transfusions before their platelet count was remeasured. After stratification by ABO-identical, ABO-major incompatible, and ABO-minor incompatible transfusion, post transfusion increments were compared, as were clinical outcomes.

Results: Among 167 patients who received platelet transfusion, 76 (45.5%) received ABO-identical transfusion, 54 (32.3%) received ABO-major incompatible transfusion, and 37 (22.2%) received ABO-minor incompatible transfusion. There were no significant differences in absolute platelet increment between groups. The median increment was 7x109/L for ABO-identical platelets, 10x109/L for ABO-major incompatible platelets, and 11x109/L for ABO-minor incompatible platelets, p = .87. There was no significant difference in the percentage of patients discharged alive with modified Rankin score of 1 or 2 or cerebral performance category 1 or 2 between groups (p = .56 and .39 respectively). After adjusting for confounders in a general linear model there remained no associations between ABO compatibility and platelet increment after transfusion.

Conclusions: Our data support similar efficacy for ABO-identical and ABO-incompatible platelet transfusion in patients with ICH.

Background: In recent years, remarkable progress has been made in the use of machine learning, especially in analyzing prognosis survival data. Traditional prediction models cannot identify interrelationships between factors, and the predictive accuracy is lower. This study aimed to construct Bayesian network models using the tree augmented naïve algorithm in comparison with the Cox proportional hazards model.

Methods: A Bayesian network model and a Cox proportional hazards model were constructed to analyze the prognostic factors of endometrial cancer. In total, 618 original cases obtained from the Surveillance, Epidemiology, and End Results database were used to construct the Bayesian network model, which was compared with the traditional Cox proportional hazards model by analyzing prognostic factors. External validation was performed using a dataset from The First Affiliated Hospital of Shandong First Medical University.

Results: The predictive accuracy, area under the receiver operating characteristic curve, and concordance index for the Bayesian network model were 74.68%, 0.787, and 0.72, respectively, compared to 68.83%, 0.723, and 0.71, respectively, for the Cox proportional hazards model. Tumor size was the most important factor for predicting survival, followed by lymph node metastasis, distant metastasis, chemotherapy, lymph node resection, tumor stage, depth of invasion, tumor grade, histological type, age, primary tumor site, radiotherapy and surgical sequence, and radiotherapy.

Conclusion: The findings indicate that the Bayesian network model is preferable to the Cox proportional hazards model for predicting survival in patients with endometrial cancer.

Objective: This study aimed to assess the knowledge, attitudes, and practices (KAPs) regarding iodine deficiency among the population of Kyrgyzstan, with a focus on pregnant women, and to correlate these factors with the urinary iodine concentration (UIC).

Methods: A cross-sectional study was conducted using structured questionnaires and urine sample analysis to evaluate iodine status. A multistage stratified sampling method ensured a representative sample from both urban and rural areas. Descriptive statistics were used to summarize demographic characteristics and KAP variables, whereas chi-square tests and multivariate logistic regression analysis were used to identify predictors of KAP outcomes.

Results: The study included 690 participants, with balanced representation from both urban and rural areas. The mean knowledge score was moderate, with significant gaps in the understanding of iodine deficiency. The participants generally had positive attitudes toward iodine intake but exhibited suboptimal practices, especially in rural areas. Pregnant women demonstrated greater knowledge, but fewer practical behaviors related to iodine intake. Compared with rural participants, urban participants had higher UIC levels, indicating better iodine nutrition. Multivariate regression analysis revealed that residence, knowledge, attitudes, and practices significantly influenced UIC levels.

Conclusion: Despite existing iodization programs, significant gaps remain in the knowledge and practices related to iodine intake, particularly in rural areas. This study highlights the need for targeted public health interventions to improve iodine nutrition and reduce the burden of iodine deficiency disorders in Kyrgyzstan. Enhancing public health education, improving the accessibility and affordability of iodized salt, and regularly monitoring the iodine status are essential strategies for addressing these issues.

Introduction: Type II Diabetes mellitus (T2DM) patients often do not achieve glycemic control with oral hypoglycemic agents (OHAs). There are two main approaches to address this challenge: transitioning to a triple OHA regimen, or adding Insulin to the existing dual OHA regimen.

Aim: This study aimed to compare the efficacy of adding Insulin to dual OHAs (Sitagliptin + Metformin) against adding a third OHA to Sitagliptin + Metformin in achieving glycemic control among patients with uncontrolled T2DM.

Method: A pre-post study was conducted between 21 September 2023 and 21 December 2023 at Services Hospital Peshawar, Pakistan. Patients with uncontrolled T2DM with >7% HbA1c were divided into group 1 (Sitagliptin + Metformin plus a third OHA), and group 2 (Sitagliptin + Metformin plus pre-mixed Insulin 70/30). Glycemic control based on HbA1c values, fasting and random blood sugar levels, lipid profile, and body weight were evaluated after 3 months of therapy. The pre- and post- effect was compared by using a paired t-test.

Results: The study included n = 80 patients with T2DM. Between groups 1 and 2, no significant difference was found in HbA1c values (9.1 vs. 9, with p = 0.724). However, BMI, cholesterol, and LDL significantly decreased in group 1 compared to group 2 (p<0.001 vs. p = 0.131, p = 0.023 vs. p = 0.896, and p = 0.003 vs. p = 0.395, respectively). Additionally, the incidence of hypoglycemic episodes was significantly lower in group 1 (7.5%) than in group 2 (47.5%, p = 0.004). No significant difference was observed between the triple OHA and dual OHA plus Insulin regimens in achieving glycemic control.

Conclusion: The triple OHA regimen improved BMI, cholesterol, and LDL levels, and reduced hypoglycemic episodes more effectively than dual OHA plus Insulin, despite similar HbA1c outcomes, suggesting it may be preferable for uncontrolled T2DM.

Assessing hydration status outside of laboratories can be challenging given that most hydration measures are invasive, stationary, costly, or have questionable validity. This study investigated the within-day, test-retest reliability, and minimal detectable change (MDC) of the MX3 Hydration Testing System (MX3 Diagnostics), a relatively low cost, noninvasive, and portable method to measure saliva osmolality. Seventy-five adults (44 men, 31 women; 29.6±10.8 yr, 171.1±9.2 cm, 79.1±15.4 kg) presented two saliva samples approximately 3 to 5 minutes apart. Fluid intake was avoided for at least 5 minutes prior to sample collections. For each sample collection, a researcher used the MX3 to tap the tip of a test strip to saliva on a participant's tongue. Intra-class correlation coefficients (ICCs) and MDC were calculated as measures of reliability. Means for the two measurements were 64.3±19.0 mOsm and 65.5±17.9 mOsm (mean difference of -1.2±13.0 mOsm; t = -0.806, p = 0.423). Further analysis with a two-one-sided test procedure revealed equivalence between the two SOSM measurements (p < 0.001 for upper and lower bounds). Within-day repeat measures yielded an ICC of 0.75 and an MDC at the 90% confidence level of 21.3 mOsm. With moderate-to-good reliability, the MX3 appears to be a practical choice for reliably measuring moderate-sized changes (>20 mOsm) in saliva osmolality outside of laboratory constraints.

Introduction: Implementing artificial intelligence (AI) in healthcare, particularly in primary care settings, raises crucial questions about practical challenges and opportunities. This study aimed to explore the perspectives of general practitioners (GPs) on the impact of AI in primary care.

Methods: A convenience sampling method was employed, involving a hybrid workshop with 12 GPs and 4 GP registrars. Verbal consent was obtained, and the workshop was audio recorded. Thematic analysis was conducted on the recorded data and contemporaneous notes to identify key themes.

Results: The workshop took place in 2023 and included 16 GPs aged 30 to 72 of diverse backgrounds and expertise. Most (93%) were female, and five (31%) self-identified as ethnic minorities. Thematic analysis identified two key themes related to AI in primary care: the potential benefits (such as help with diagnosis and risk assessment) and the associated concerns and challenges. Sub-themes included anxieties about diagnostic accuracy, AI errors, industry influence, and overcoming integration resistance. GPs also worried about increased workload, particularly extra, unnecessary patient tests, the lack of evidence base for AI programmes or accountability of AI systems and appropriateness of AI algorithms for different population groups. Participants emphasised the importance of transparency, trust-building, and research rigour to evaluate the effectiveness and safety of AI systems in healthcare.

Conclusion: The findings suggest that GPs recognise the potential of AI in primary care but raise important concerns regarding evidence base, accountability, bias and workload. The participants emphasised the need for rigorous evaluation of AI technologies. Further research and collaboration between healthcare professionals, policymakers, and technology organisations are essential to navigating these challenges and harnessing the full potential of AI.