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JCI Insight Jun 2024The average time-to-degree for completing a life sciences PhD in the U.S. is longer for single-degree than dual-degree trainees, supporting a perception that the PhD...
The average time-to-degree for completing a life sciences PhD in the U.S. is longer for single-degree than dual-degree trainees, supporting a perception that the PhD training of MD-PhDs is less rigorous or fulsome. To determine whether the duration and impact of graduate training is influenced by degree format, we analyzed data for the 2011-2016 graduates of three Harvard Medical School PhD programs. Linear mixed effects models were used to determine the association between degree type (MD-PhD vs. PhD) and research outcomes, including time-to-degree, time-to-thesis-defense, and publications submitted during the PhD. Although pursuing an MD-PhD was associated with a 1.5-year shorter time-to-PhD-degree, basing this calculation on the official PhD period does not account for completion of early PhD requirements, including research rotations and qualifying coursework, during the first two years of medical school. There was no association between degree format and the total number of first-authored or overall publications, although pursuing a dual degree was associated with increased impact metrics of published papers. The results highlight that despite the optically shorter PhD durations of MD-PhD graduates based on graduate program enrollment period, research training is on par with their single-degree peers, rendering MD-PhD graduates well equipped to become successful scientific investigators.
PubMed: 38917318
DOI: 10.1172/jci.insight.182288 -
PloS One 2024The aim of this research was to evaluate the incidence of congenital syphilis and the ratio between congenital syphilis and syphilis in pregnant women in Brazil...
The aim of this research was to evaluate the incidence of congenital syphilis and the ratio between congenital syphilis and syphilis in pregnant women in Brazil according to socioeconomic indicators (inadequate water supply and sanitation; illiteracy at 15 years of age or older; household income per capita; proportion of poor people; Gini index; human development index; and average health expenditure per inhabitant by the health system) and prenatal quality-of-care indicators. We conducted an ecological study using a sample composed of 257 municipalities, each with ≥ 100,000 inhabitants. Data was collected from four public databases: the Brazilian Institute of Geography and Statistics, comprising socioeconomical data from the 2010 census; and the data of 2019 available in the databases of the Department of Informatics of the Brazilian Health System, Information and Management of Primary Care, and the Electronic Citizen Information System. Descriptive analysis of dependent and independent variables and bivariate analysis by Negative Binomial regression were carried out. The mean incidence of congenital syphilis was 38% higher in municipalities with a Human Development Index up to 0.785 (ratio of means [RM] = 1.38; p = 0.049) and 57% higher among populations where less than 50% of primary healthcare services provided a rapid test for syphilis (RM = 1.57; p < 0.001). The ratio between congenital syphilis and syphilis in pregnant women was 29% higher in municipalities with a low household income per capita (RM = 1.29; p < 0.001) and 28% higher in locations where less than 50% of the primary healthcare services provided a rapid test for syphilis (RM = 1.28; p < 0.001). There was no statistical significance of the quality of prenatal care compared to the outcomes. This result underscores the challenges in detecting syphilis infections among pregnant women during prenatal care, consequently increasing the risk of vertical transmission of the disease to the fetus. Traits of inequality in the occurrence of congenital syphilis also draw attention to strategies to reduce health inequities and improve prenatal care.
Topics: Humans; Pregnancy; Female; Brazil; Syphilis, Congenital; Prenatal Care; Pregnancy Complications, Infectious; Incidence; Adult; Socioeconomic Factors; Syphilis; Adolescent; Young Adult
PubMed: 38917233
DOI: 10.1371/journal.pone.0306120 -
PloS One 2024Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive... (Observational Study)
Observational Study
Influence of frailty on cardiovascular events and mortality in patients with Chronic Obstructive Pulmonary Disease (COPD): Study protocol for a multicentre European observational study.
BACKGROUND
Frailty is a clinical state that increases susceptibility to minor stressor events. The risk of frailty is higher in chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD). Recent studies on COPD have shown that patients living with frailty have an increased risk of mortality. The presence of cardiovascular diseases or conditions are common in COPD and may increase the risk of death.
METHODS
This protocol describes a European prospective cohort study of community-based people, in a stable condition with diagnosis of COPD (as defined by GOLD guidelines) across hospitals in Italy and UK. Frailty prevalence will be assessed using the Clinical Frailty Scale. At 1- and 2-year follow up, primary outcome will be the impact of frailty on the number of cardiovascular events; secondary outcomes: the influence of frailty on cardiovascular mortality, all-cause mortality, and deaths due to COPD. For the primary outcome a zero-inflated Poisson regression will compare the number of cardiovascular events at 1 year. Secondary outcomes will be analysed using the time to mortality.
DISCUSSION
This multicentre study will assess the association between frailty and cardiovascular events and mortality in population with COPD. Data collection is prospective and includes routine clinical data. This research will have important implications for the management of patients with COPD to improve their quality of care, and potentially prognosis.
TRIAL REGISTRATION NUMBER
NCT05922202 (www.clinicaltrials.gov).
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Cardiovascular Diseases; Frailty; Prospective Studies; Aged; Male; Europe; Female; Risk Factors
PubMed: 38917212
DOI: 10.1371/journal.pone.0300945 -
PloS One 2024This study aims to enhance the post-training evaluation of the annual performance agreement (APA) training organized by the Bangladesh Public Administration Training...
This study aims to enhance the post-training evaluation of the annual performance agreement (APA) training organized by the Bangladesh Public Administration Training Centre (BPATC), the apex training institute for civil servants. Utilizing fuzzy-set qualitative comparative analysis (fsQCA) and artificial neural network (ANN) techniques within Kirkpatrick's four-stage model framework, data were collected from a self-administered questionnaire survey of 71 in-service civil servants who participated in the APA training program. This study employs an asymmetric, non-linear model analyzed through a configurational approach and ANN to explore interrelationships among the four Kirkpatrick levels namely, reaction, learning, behavior, and results. Findings indicate that trainees were satisfied across all levels, identifying a non-linear relationship among these levels in post-training evaluation process. The research highlights that "learning skills" are most significant in the APA post-training evaluation, followed by behavior, results, and reaction. Theoretically, this research advances Kirkpatrick's model and adds to the literature on public service post-training evaluation. Practically, it recommends prioritizing strategies that address cognitive barriers to enhance training effectiveness. This study's innovative approach lies in its concurrent use of fsQCA and ANN methods to analyze the success or failure of APA-related trainees, offering alternative pathways to desired outcomes and contrasting traditional quantitative methods that provide a single solution. The findings have practical implications for public service training institutions and bureaucratic policymakers involved in capacity development, guiding the creation of more effective in-service training courses for public officials. The methodology and analysis can be applied in other contexts, allowing bureaucratic policymakers to replicate these findings in their learning institutes to identify unique configurations that lead to successful or unsuccessful training outcomes, adopt effective strategies, and avoid detrimental ones.
Topics: Humans; Neural Networks, Computer; Bangladesh; Surveys and Questionnaires; Male; Female; Adult; Learning
PubMed: 38917194
DOI: 10.1371/journal.pone.0305916 -
PloS One 2024This research work is devoted to investigating new common fixed point theorems on bipolar fuzzy [Formula: see text]-metric space. Our main findings generalize some of...
This research work is devoted to investigating new common fixed point theorems on bipolar fuzzy [Formula: see text]-metric space. Our main findings generalize some of the existence outcomes in the literature. Furthermore, we illustrate our findings by providing some applications for fractional differential and integral equations.
Topics: Fuzzy Logic; Algorithms; Models, Theoretical
PubMed: 38917178
DOI: 10.1371/journal.pone.0305316 -
PloS One 2024Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung...
OBJECTIVES
Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach.
METHODS
The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected, and analyzed. According to whether applied Lu's approach during the VATS operation, patients were divided into the LVATS group and the UVATS group. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. Perioperative variables, including the operation time, intraoperative blood loss, lymph node stations dissected, total drainage volume, drainage duration, postoperative hospital stay, pain score (VAS, Visual Analogue Scale) on the postoperative first day (POD1) and third day (POD3), and incidence of postoperative complications, were compared between the two groups. The data were analyzed statistically with P<0.05 defined as statistically significant.
RESULTS
A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144)min, P <0.001), less intraoperative blood loss(20 (20, 30) VS 25 (20, 50)ml, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50)cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600)ml, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected(5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4)days, P = 0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6)days, P = 0.608), VAS on the POD1(4 (4, 4) VS 4 (4, 4), P = 0.058)and POD3 (3 (3, 4) VS 4 (3, 4), P = 0.219), and incidence of postoperative complications (P = 0.521) between the two groups.
CONCLUSIONS
Lu's approach is a safe and feasible approach for video-assisted thoracoscopic surgery for the lobectomy of NSCLC. This approach can shorten surgical time, reduce incision length and intraoperative blood loss.
Topics: Humans; Thoracic Surgery, Video-Assisted; Male; Female; Middle Aged; Lung Neoplasms; Retrospective Studies; Carcinoma, Non-Small-Cell Lung; Aged; Postoperative Complications; Operative Time; Length of Stay; Pneumonectomy; Propensity Score; Treatment Outcome
PubMed: 38917144
DOI: 10.1371/journal.pone.0300632 -
PloS One 2024Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical... (Observational Study)
Observational Study
BACKGROUND
Danish women-who were HPV-vaccinated as girls-are now reaching an age where they are invited to cervical cancer screening. Because of their expected lower cervical cancer risk, we must reassess our screening strategies. We analyzed Danish HPV-vaccinated women's outcomes after the first screening test at age 23.
METHODS AND FINDINGS
Our study was embedded in Danish routine cytology-based screening. We conducted an observational study and included women born in 1994, offered the 4-valent HPV vaccine at age 14, and subsequently invited to screening at age 23. Cervical cytology was used for diagnostics and clinical management. Residual material was HPV tested with Cobas® 4800/6800. The most severe histology diagnosis within 795 days of screening was found through linkage with the Danish National Pathology Register. We calculated the number of women undergoing follow-up (repeated testing and/or colposcopy) per detected cervical intraepithelial neoplasia (CIN2+). A total of 6021 women were screened; 92% were HPV-vaccinated; 12% had abnormal cytology; 35% were high-risk HPV-positive, including 0.9% HPV16/18 positive, and 20% had follow-up. In women that were cytology-abnormal and HPV-positive (Cyt+/HPV+), 610 (98.5%) had been followed up, and 138 CIN2+ cases were diagnosed, resulting in 4.4 (95% CI 3.9-5.2) women undergoing follow-up per detected CIN2+. In contrast to recommendations, 182 (12.2%) cytology-normal and HPV-positive (Cyt-/HPV+) women were followed up within 795 days, and 8 CIN2+ cases were found, resulting in 22.8 (95% CI 13.3-59.3) women undergoing follow-up per detected CIN2+.
CONCLUSION
Overall, HPV prevalence was high in HPV-vaccinated women, but HPV16/18 had largely disappeared. In the large group of cytology-normal and HPV-positive women, 23 had been followed up per detected CIN2+ case. Our data indicated that primary HPV screening of young HPV-vaccinated women would require very effective triage methods to avoid an excessive follow-up burden.
TRIAL REGISTRATION
Trial registration number: NCT0304955.
Topics: Humans; Female; Denmark; Papillomavirus Vaccines; Uterine Cervical Neoplasms; Papillomavirus Infections; Early Detection of Cancer; Young Adult; Cohort Studies; Uterine Cervical Dysplasia; Adult; Adolescent; Vaccination; Human papillomavirus 18; Mass Screening
PubMed: 38917143
DOI: 10.1371/journal.pone.0306044 -
PloS One 2024Research on prognostic factors for good outcomes in out-of-hospital cardiac arrest (OHCA) survivors is lacking. We assessed whether normal levels of normal... (Observational Study)
Observational Study
Research on prognostic factors for good outcomes in out-of-hospital cardiac arrest (OHCA) survivors is lacking. We assessed whether normal levels of normal neuron-specific enolase (NSE) value would be useful for predicting good neurological outcomes in comatose OHCA survivors treated with targeted temperature management (TTM). This registry-based observational study with consecutive adult (≥18 years) OHCA survivors with TTM who underwent NSE measurement 48 hours after cardiac arrest was conducted from October 2015 to November 2022. Normal NSE values defined as the upper limit of the normal range by the manufacturer (NSE <16.3 μg/L) and guideline-suggested (NSE < 60 μg/L) were examined for good neurologic outcomes, defined as Cerebral Performance Categories ≤2, at 6 months post-survival. Among 226 OHCA survivors with TTM, 200 patients who underwent NSE measurement were enrolled. The manufacturer-suggested normal NSE values (<16.3 μg/L) had a specificity of 99.17% for good neurological outcomes with a very low sensitivity of 12.66%. NSE <60 μg/L predicted good outcomes with a sensitivity of 87.34% and specificity of 72.73%. However, excluding 14 poor-outcome patients who died from multi-organ dysfunction excluding hypoxic brain injury, the sensitivity and specificity of normal NSE values were 12.66% and 99.07% of NSE < 16.3 μg/L, and 87.34% and 82.24% of NSE < 60 μg/L. The manufacturer-suggested normal NSE had high specificity with low sensitivity, but the guideline-suggested normal NSE value had a comparatively low specificity for good outcome prediction in OHCA survivors. Our data demonstrate normal NSE levels can be useful as a tool for multimodal appropriation of good outcome prediction.
Topics: Humans; Phosphopyruvate Hydratase; Out-of-Hospital Cardiac Arrest; Male; Female; Middle Aged; Coma; Aged; Survivors; Prognosis; Hypothermia, Induced; Adult
PubMed: 38917136
DOI: 10.1371/journal.pone.0305771 -
PloS One 2024Opioids administered in hospital during the immediate postoperative period are likely to influence post-surgical outcomes, but inpatient prescribing during the admission...
BACKGROUND
Opioids administered in hospital during the immediate postoperative period are likely to influence post-surgical outcomes, but inpatient prescribing during the admission is challenging to access. Modified-release(MR) preparations have been especially associated with harm, whilst certain populations such as the elderly or those with renal impairment may be vulnerable to complications. This study aimed to assess postoperative opioid utilisation patterns during hospital stay for people admitted for major/orthopaedic surgery.
METHODS
Patients admitted to a teaching hospital in the North-West of England between 2010-2021 for major/orthopaedic surgery with an admission for ≥1 day were included. We examined opioid administrations in the first seven days post-surgery in hospital, and "first 48 hours" were defined as the initial period. Proportions of MR opioids, initial immediate-release(IR) oxycodone and initial morphine milligram equivalents (MME)/day were calculated and summarised by calendar year. We also assessed the proportion of patients prescribed an opioid at discharge.
RESULTS
Among patients admitted for major/orthopaedic surgery, 71.1% of patients administered opioids during their hospitalisation. In total 50,496 patients with 60,167 hospital admissions were evaluated. Between 2010-2017 MR opioids increased from 8.7% to 16.1% and dropped to 11.6% in 2021. Initial use of oxycodone IR among younger patients (≤70 years) rose from 8.3% to 25.5% (2010-2017) and dropped to 17.2% in 2021. The proportion of patients on ≥50MME/day ranged from 13% (2021) to 22.9% (2010). Of the patients administered an opioid in hospital, 26,920 (53.3%) patients were discharged on an opioid.
CONCLUSIONS
In patients hospitalised with major/orthopaedic surgery, 4 in 6 patients were administered an opioid. We observed a high frequency of administered MR opioids in adult patients and initial oxycodone IR in the ≤70 age group. Patients prescribed with ≥50MME/day ranged between 13-22.9%. This is the first published study evaluating UK inpatient opioid use, which highlights opportunities for improving safer prescribing in line with latest recommendations.
Topics: Humans; Analgesics, Opioid; Male; Female; Middle Aged; Aged; Retrospective Studies; Pain, Postoperative; Orthopedic Procedures; Adult; Electronic Prescribing; Inpatients; England; Hospitalization; Aged, 80 and over; Oxycodone; Adolescent
PubMed: 38917135
DOI: 10.1371/journal.pone.0305531 -
PloS One 2024Visceral Leishmaniasis (VL) is a neglected tropical disease (NTD) with the highest regional burden in East Africa. Relapse and Post Kala-azar Dermal Leishmaniasis (PKDL)...
BACKGROUND
Visceral Leishmaniasis (VL) is a neglected tropical disease (NTD) with the highest regional burden in East Africa. Relapse and Post Kala-azar Dermal Leishmaniasis (PKDL) contribute to the spread of VL in endemic areas, making their surveillance imperative for control and elimination. Little is known about long-term patient outcomes in Kenya through follow-up after VL treatment, despite its requirement for control and elimination by the World Health Organization (WHO) and the Kenya Ministry of Health (KMOH).
METHODOLOGY/PRINCIPAL FINDINGS
36 follow-up patients in Tiaty East and West, sub-counties, Kenya, and records from 248 patients at the regional Chemolingot Sub-county Hospital (CSCH) were analyzed separately using Fisher's Exact Tests, two-sample t-tests, and Welch's t-tests in R (Version 4.3.0). The study found a prevalence rate of 88.89% (n = 32) final cure, 5.56% (n = 2) relapse, and 5.56% (n = 2) PKDL in follow-up patients and 92.74% (n = 230) initial cure, 6.86% (n = 17) relapse, and 0.80% (n = 2) PKDL in overall CSCH patients. The mean lengths of time at which follow-up patients relapsed and developed PKDL were 4.5 and 17 months, respectively. Young age (p = 0.04, 95% CI 0.63-24.31), shorter length of time from initial treatment to follow-up (p = 0.002, 95% CI 1.03-∞), lower Hb level at primary treatment (p = 0.0002, 95% CI 1.23-3.24), and living in Tiaty East sub-county (p = 0.04, 95% CI 0.00-1.43) were significantly associated (p<0.05) with VL relapse in follow-up study patients. Female sex (p = 0.04, 95% CI 0.84-∞) and living in Tiaty East sub-county (p = 0.03, 95% CI 0.00-1.43) were significantly associated with PKDL in follow-up study patients.
CONCLUSIONS/SIGNIFICANCE
More research should be done on PKDL in Kenya with active follow-up to understand its true burden. These results on prevalence and risk factors for PKDL and relapse in Kenya should inform knowledge of patient outcomes and interventions in the region.
Topics: Humans; Leishmaniasis, Visceral; Kenya; Male; Female; Adult; Recurrence; Adolescent; Follow-Up Studies; Child; Treatment Outcome; Young Adult; Child, Preschool; Leishmaniasis, Cutaneous; Middle Aged; Antiprotozoal Agents; Prevalence
PubMed: 38917127
DOI: 10.1371/journal.pone.0306067