What do patients want to know about gender-affirming surgery? Analysis of common patient concerns and online health materials

PURPOSE

Patients considering gender-affirming surgery often utilize online health materials to obtain information about procedures. However, the distribution of patient concerns and content of online resources for gender-affirming surgery have not been examined. We aimed to quantify and comprehensively analyze the most searched questions of patients seeking gender-affirming surgery and to examine the quality and readability of associated websites providing the answers.

METHODS

Questions were extracted from Google using the search phrases "gender-affirming surgery," "transgender surgery," "top surgery," and "bottom surgery." Questions were categorized by topic and average search volume per month was determined. Websites linked to questions were categorized by type, and quality of the health information was evaluated utilizing the DISCERN instrument (16-80). Readability was assessed with the Flesch Reading Ease Score and Flesch-Kincaid Grade Level.

RESULTS

Ninety questions and associated websites were analyzed. Common questions were most frequently answered by academic websites (30%). Topics included cost (27%), technical details of surgery (23%), and preoperative considerations (11%). Median (interquartile range) DISCERN score across all website categories was 42 (18). The mean readability was of a 12th-grade level, well above the grade six reading level recommended by the American Medical Association.

CONCLUSIONS

Online gender-affirming surgery materials are difficult to comprehend and of poor quality. To enhance patient knowledge, informed consent, and shared decision-making, there is a substantial need to create understandable and high-quality online health information for those seeking gender-affirming surgery.

Analysis the characterization of climate change and its impacts on smallholder farmers in Eastern Ethiopia

The impact of climate change on agriculture and food production is manifested through alterations in agro-ecological factors. The region of sub-Saharan Africa is particularly susceptible to the effects of climate change and variability, given its reliance on rainfall-dependent agriculture and inadequate adaptive capabilities. The objective of this study was to analysis of the characterization of climate change and its impacts on smallholder farmers in eastern Ethiopia. Historical daily rainfall, maximum and minimum temperature in 1991-2021 years of 12 weather station were collected from National Meteorological Institute of Ethiopia and NASA/POWER. Data quality control, trend test and outlier detection test were used. Climate characterization (onset, cessation, LGS and Dry/wet spell length) and precipitation concentration index were examined. The earliest, and latest start of rainy season in Kombolcha and Haramaya were 81DOY (March 21) and 225DOY (August 13) within mean 130DOY and 125DOY, respectively. In study area the minimum and maximum length of growing period of was recorded in Chinakesen and Haramaya by the values of 32DOY and 253DOY (Days of the year) respectively. In this arid and semi-arid areas, growing period was recorded under the short season crop maturity while long cropping season maturity does no satisfy crop water requirement due to moisture stress. The coefficient of variation of length of growing season from Mieso and Chinakesen were 36.2% and 47.9% which implies that the areas were highly vulnerable to climate extreme events of drought. Length of growing season (LGS) of Gemechis district was decreasing by a factor -2.533 shows highly significant at alpha value of 0.05 confidence level. Dry spell length probability occurrence of 5 days during the main cropping rainy season is significantly very high. The 30 years of data record suggests that a 29-48% precipitation concentration index of kiremt (JJAS) and belg (FMAM) seasonal rainfall which are demonstrating irregular precipitation. kiremt (JJAS) rainfall trend tests of Babile, Kurfa chale and Mieso districts were increasing by a factor of 2.016, 2.043 and 2.117, respectively and statistically significant at 95% confidence level, in the time period of 1991-2021 years. If furtherstudy will be examined climate extreme indices and adaptation strategies designed to simulate the impacts and variability of climate change in the study area.

Neuroimaging in acute ischemic stroke: Trends, disparities, and clinical impact

INTRODUCTION

Clinical studies over the past decade expanded the eligibility criteria for endovascular therapy, with advanced imaging selection and new devices leading to higher rates of good outcomes. Herein, we explore the current trends in neuroimaging, associated factors, and impact on treatment and clinical outcomes.

MATERIALS AND METHODS

This is a retrospective study of consecutive acute ischemic stroke patients, admitted to a comprehensive stroke center from 2016 to 2020. Patient characteristics, including age, sex, race, arrival method, admission National Institutes of Health Stroke Scale score and last known well to arrival time; imaging and treatment utilization; and discharge outcome by modified Rankin Scale and disposition were extracted from medical records. Trend and multivariable logistic regression analyses were performed, and trends were stratified by patient characteristics.

RESULTS

Of 4,125 acute ischemic stroke episodes, 15.1% received intravenous thrombolysis only, and 7.5% received endovascular thrombectomy from 2016 to 2020. Neuroimaging utilization trends significantly increased for computed tomography angiography (CTA) (48.7% to 75.2%, p < 0.001) and computed tomography perfusion (CTP) (0.26% to 32.9%, p < 0.001), and decreased for magnetic resonance angiography (MRA) (43.2% to 24.7%, p < 0.001). These trends held after adjusting for patient characteristics. Endovascular thrombectomy and intravenous thrombolysis were significantly more common in patients with CTA and CTP (p < 0.0001), and these treatments were associated with good clinical outcomes after controlling for patient characteristics.

CONCLUSION

We found significantly increased trends in CTA and CTP imaging, which were associated with endovascular thrombectomy and intravenous thrombolysis utilization, in acute ischemic stroke patients from 2016 to 2020.

Multi-decadal analysis of water resources and agricultural change in a Mediterranean semiarid irrigated piedmont under water scarcity and human interaction

Mediterranean piedmonts are an important hydro-agricultural systems. They constitute the junction between the mountains, where the streamflow is generated, and the surrounding plains, where the water is used. In Morocco, these traditional systems extend largely along the High Atlas Mountains. Yet, changing conditions in the Mediterranean basin as well as recurrent droughts in recent decades remain poorly understood in terms of hydrological and agricultural impacts, particularly in traditional hydro-agro-systems. The combined effects of climate variability and ineffective management of water resource dynamics may lead to increased water scarcity in these regions. The present work aims to assess the effects of climate variability and associated agricultural changes on water resources in a traditional irrigated piedmont of the Moroccan High Atlas. To that end, a trend analysis, together with change points detection, was carried out on annual and monthly precipitation, and streamflow from 1965 to 2018. Then, the standardized precipitation index (SPI) was employed to identify meteorological droughts. Also, groundwater, and spring discharge data were analyzed and discussed from 1973 to 2021. SPI outcomes revealed three major droughts, in 1981-1988, 1999-2008, and 2013-2018. Although the precipitation data showed no significant trend, except for Tahannaout station, the average annual precipitation over the piedmont area decreased by 28%. Similarly, streamflow decreased significantly by almost 40% for all stations, as did the Abainou spring's discharge. Consistent with that, groundwater level has declined dramatically over the past decades in the downstream piedmont. These decreases in water cycle components were tightly aligned with droughts. Yet, irrigation diversions were maintained in both dry and wet periods. Paradoxically, this decrease in water resources was associated with an agricultural transition from seasonal crops (cereals) to perennial crops (olive trees). This conversion is likely to amplify the water shortage, leading to groundwater resources overexploitation to satisfy the growing agricultural demand.

Current trends in cancer immunotherapy: a literature-mining analysis

Cancer immunotherapy is a rapidly growing field that is completely transforming oncology care. Mining this knowledge base for biomedically important information is becoming increasingly challenging, due to the expanding number of scientific publications, and the dynamic evolution of this subject with time. In this study, we have employed a literature-mining approach that was used to analyze the cancer immunotherapy-related publications listed in PubMed and quantify emerging trends. A total of 93,033 publications published in 5055 journals have been retrieved, and 141 meaningful topics have been identified, which were further classified into eight distinct categories. Statistical analysis indicates a mean annual increase in the number of published papers of approximately 8% in the last 20 years. The research topics that exhibited the highest trends included "immune checkpoint inhibitors," "tumor microenvironment," "HPV vaccination," "CAR T-cells," and "gene mutations/tumor profiling." The top identified cancer types included "lung," "colorectal," and "breast cancer," and a shift in popularity from hematological to solid tumors was observed. As regards clinical research, a transition from early phase clinical trials to randomized control trials was recorded, indicating that the field is entering a more advanced phase of development. Overall, this mining approach provided an unbiased analysis of the cancer immunotherapy literature in a time-conserving and scale-efficient manner.