bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Clinical and Genetic Determinants of Treatment OutCome In EGFR Mutation Positive Advanced Lung Adenocarcinoma
Authors: Jokic Vera , Savic-Vujovic Katarina , Spasic Jelena , Bukumiric Zoran , Marinkovic Mladen , Radosavljevic Davorin , Cavic Milena
Published: August 2022

Background

The aim of this research was to evaluate clinical and low-cost genetic determinants of treatment outcome in EGFR mutation positive advanced lung adenocarcinoma patients.

Material and Methods

EGFR mutation testing and EGFR 181946C>T genotyping were performed in 101 advanced lung adenocarcinoma patients using qRT-PCR and PCR-RFLP, respectively. Progression-free survival was defined as the time from the start of TKI therapy to date of progression, and overall survival as the time from diagnosis to death from any cause. Pain level was evaluated using a Numerical Rating Scale and the Verbal Descriptor Scale. Statistical significance was considered for P < .05.

Results

Patients were treated with EGFR-TKIs for a period of 1–39months (median 9), with a median PFS of 12.0 months (10.4-13.6, CI 95%), and a median OS of 19.0 months (15.1-22.7, CI 95%). The presence of pain was significantly correlated with the existence of bone ( P < .001) and adrenal glands metastases ( P = .029). Genetic factors did not have a direct impact on pain management but had a significant effect on the response to TKIs leading to pain alleviation.

Conclusions

EGFR mutation subtype and the EGFR 181946 C>T SNP had a significant effect on the response to TKI inducing an indirect anti-dolorous effect.
The second randomized controlled ENhanced Control of Hypertension ANd Thrombectomy strokE stuDy (ENCHANTED2): Protocol and progress
Authors: Song Lili , Yang Pengfei , Zhang Yongwei , Zhang Xiaoxi , Chen Xiaoying , Li Yunke , Shen Hongjian , Zhang Lei , Li Zifu , Zhang Yongxin , Xing Pengfei , Zhang Ping , Zhou Yihan , Ren Xinwen , Billot Laurent , Wang Xia , Parsons Mark W , Butcher Ken , Campbell Bruce , Robinson Thompson , Goyal Mayank , Dippel Diederik , Roos Yvo , Majoie Charles , Liu Jianmin , Anderson Craig S ,   for ENCHANTED-MT Investigators
Published: August 2022

Background:

Uncertainty exists over the optimal level of blood pressure (BP) after mechanical thrombectomy (MT) for acute ischemic stroke (AIS).

Objectives:

We aim to determine the effectiveness and safety of intensive BP-lowering following MT reperfusion of large-vessel occlusion (LVO)-related AIS.

Design:

The second ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED2) is an investigator-initiated, multicenter, prospective, randomized, open, blinded-endpoint (PROBE) trial of intensive systolic BP (SBP) control in reperfused (extended treatment in cerebral infarction (eTICI) classification 2b/2c/3) LVO-AIS patients with persistent hypertension (SBP ⩾ 140 mmHg) at 60+ sites in China, and Australia and the United Kingdom. Eligible patients are centrally randomly allocated to more- (target SBP ⩽ 120 mmHg within 1 h) or less-intensive (target SBP 140–180 mmHg) BP management, to be maintained for 72 h. Primary outcome is an ordinal shift analysis of scores on the modified Rankin scale (mRS) at 90 days. Sample size of 2257 patients provides 90% power to detect a 6.5% absolute reduction in poor outcome from more-intensive BP-lowering using ordinal logistic regression.

Progress:

Recruitment started in China in July 2020. At a meeting of the independent Data and Safety Monitoring Board in March 2022 to review primary outcome data available for 347 patients, they recommended suspension of recruitment due to safety concerns in the more-intensive group; which was implemented by the Trial Steering Committee (TSC) with 817 randomized patients only in China. The TSC then stopped recruitment after the safety concerns persisted on further review of the data in June 2022. The TSC will make a decision on restarting the trial with modification of the protocol when the results are made public.

Discussion:

ENCHANTED2 will provide further randomized evidence on the role of intensive BP-lowering after reperfusion in MT-treated AIS patients.

Trial registration:

ClinicalTrials.gov NCT04140110; registered 25 October 2019.
Concanamycin H from the soil actinomycete Streptomyces sp. R1706-8
Authors: Li Guo-Li , Qi Hui-Min , He Yi-Lin , Shen Yu-Kai , Shen Tong
Published: August 2022

The actinomycete strain R1706-8 is isolated from a soil sample collected from the nest of the horned-face bee ( Osmia cornifrons) and identified as Streptomyces sp. based upon the results of 16SrRNA sequence analysis. Two concanamycin derivatives obtained from the solid fermentation have been determined by analysis of the infrared, high-resolution electrospray ionization mass spectrometry, 1D and 2D NMR spectra as well as by comparison with literature data. Of the two derivatives, one is a new compound, named concanamycin H, and the other is the known compound, concanamycin G. These compounds are assayed for antibacterial activity, with concanamycins H and G displaying inhibitory activity against Bacillus subtilis (minimum inhibitory concentration = 0.625 µg mL−1).
Analysis of Factors Historically Affecting Innovation in Hospital Building Design
Authors: Moslehian Anahita Sal , Tucker Richard , Kocaturk Tuba , Andrews Fiona
Published: August 2022

Purpose:

This article aims to complement the historical literature on the evolution of hospital buildings via a holistic analysis of the contextual factors triggering hospital design innovation over the past 100 years.

Background:

Innovation in hospital building design should be considered as a complex ecosystem with a heterogeneous set of actors.

Methods:

A novel hybrid research design to the Mixed Grounded Theory methodology, with Charmaz’s constructivist paradigm, was developed to explore, construct, and interpret concepts and the interconnections between them.

Results:

Six hundred seventeen interconnections between 146 factors, classified across 14 categories, were developed to explain the individual and combined impacts of all components of the design innovation ecosystem.

Conclusions:

This study provides hospital building designers, researchers, policy makers, and stakeholders with a systemic understanding of the innovation ecosystem and their potential role in this system. This knowledge suggests the need for interdisciplinary education to address complex and quickly evolving real-world building design problems.
Against the self-regulated child: Early childhood pedagogies in neoliberal times
Authors: Diaz-Diaz Claudia
Published: August 2022

This article examines the curriculum and pedagogies for ethical practice in a childcare centre in Vancouver, Canada. I draw on Smith’s new model of childhood to examine narratives and practices around the ‘responsible child’ in a context where child developmental theories continue to influence pedagogical decisions. I argue that the elevation of self-regulation strategies as a pedagogical approach narrows children’s sense of responsibility to a mere individual trait. In addition, it fails to cultivate children’s interdependence and multiple relationships with humans and more-than-human others. Self-regulation-centred pedagogies also reinforce neoliberal and colonial discourses of the child anchored in human exceptionality, choice, autonomy and rationality. This article proposes that pre-service and in-service early childhood education needs to support educators in doing the analytical, embodied and reflective work to shift from educational paradigms founded in neoliberal and colonial rationalities towards an ethic that acknowledges children and educators’ interdependence and that cultivates good relations with humans and more-than-human others.
Digital health transformation in Saudi Arabia: A cross-sectional analysis using Healthcare Information and Management Systems Society’ digital health indicators
Authors: Al-Kahtani Nouf , Alrawiai Sumaiah , Al-Zahrani Bnan Mohammed , Abumadini Rahaf Ali , Aljaffary Afnan , Hariri Bayan , Alissa Khalid , Alakrawi Zahra , Alumran Arwa
Published: August 2022

Background

The digital revolution has had a huge impact on healthcare around the world. Digital technology could dramatically improve the accuracy of diagnosis, treatment, health outcomes, efficiency of care, and workflow of healthcare operations. Using health information technology will bring major improvements in patient outcomes.

Purpose

This study aims to measure the readiness for digital health transformation at different hospitals in the Eastern Province, Saudi Arabia in relation to Saudi Vision 2030 based on the four dimensions adopted by the Healthcare Information and Management Systems Society: person-enabled health, predictive analytics, governance and workforce, and interoperability.

Methods

The study was conducted with a cross-sectional design using data collected through an online questionnaire from 10 healthcare settings, the questionnaire consists of the four digital health indicators. The survey was developed by Healthcare Information and Management Systems Society for the purpose of assessing the level of digital maturity in healthcare settings.

Results

Ten healthcare facilities in the Eastern Province, both private and governmental, were included in the study. The highest total scores for digital health transformation were reported in private healthcare facilities (median score for private facilities = 77, public facilities = 71). The ‘governance and workforce’ was the most implemented dimension among the healthcare facilities in the study (median = 80), while the dimension that was least frequently implemented was predictive analytics (median score = 70). In addition, tertiary hospitals scored the least in digital transformation readiness (median = 74) compared to primary and secondary healthcare facilities in the study.

Conclusion

The results of the study show that private healthcare facilities scored higher in digital health transformation indicators. These results will be useful for promoting policymakers’ understanding of the level of digital health transformation in the Eastern Province and for the creation of a strategic action plan.
Applications of Intersectionality Theory to Enhance Career Development Interventions in Response to COVID-19
Authors: Wright Galaxina G. , Chan Christian D.
Published: August 2022

The school counseling profession has an ethical responsibility to provide and advocate for individual students’ career planning and development, while expanding school counselors’ own multicultural and social justice advocacy to become effective culturally competent professionals. Additional literature is needed to identify how school counselors can adapt their career counseling approaches to fit the unique challenges and barriers of historically marginalized students both during and after the global COVID-19 pandemic. We describe how school counselors can use intersectionality theory as a framework for career development with marginalized populations in response to COVID-19 and its impact on the economic decline.
The Impact of Racial Trauma on Black Students’ College and Career Outcomes: An Antiracist Approach
Authors: Edwin Mary , Daniels Aubrey D.
Published: August 2022

Black students experience a unique form of pervasive trauma based on their racial identity. Discrimination—a social determinant of health (Social determinants of health)—results in racial trauma that negatively affects students’ college and career outcomes, such as career adaptability, career thoughts, career decision making, and postsecondary attainment. We share recommendations for school counselors to adopt an antiracist and trauma-informed approach to implementing career development interventions that address SDOH-related challenges for Black students.
Profiling Authentic Self-Development: Associations With Basic Need Satisfaction in Emerging Adulthood
Authors: Lopez Frederick G. , Rice Kenneth G. , Durán Barbara S. , Hong Jihee
Published: August 2022

Research on dispositional authenticity has accelerated in recent years. Using the Authenticity Scale and drawing upon Self-Determination Theory, we conducted a Latent Profile Analysis to determine whether two or more distinct classes of authentic self-development were identifiable across separate samples (Ns = 344 and 378) of emerging adults (18–22 year olds). We also tested whether multidimensional perfectionism and attachment insecurity were correlated with the classes of authentic self-development, and examined the association between class membership and levels of psychological need satisfaction and frustration. Our findings supported the presence of a 3-class configuration which we respectively labelled “Consolidated Authenticity,” “Unintegrated Authenticity,” and “Pre-Emergent Authenticity.” This class structure was replicated in a separate, independent sample. Results highlighted relevant variation in authentic self-development across the identified classes and yielded support for our model involving hypothesized influences on, as well as contemporary outcomes associated with, participants’ class membership.
Implantation Site of a Port Delivery System With Ranibizumab: Anterior Segment Optical Coherence Tomography Evaluation
Authors: Ericksen Connor J. , Christensen Cory A. , Berger Brian , Gune Shamika , Nielsen Jared S.
Published: August 2022

Purpose: To determine whether anterior segment optical coherence tomography (AS-OCT) can be used to obtain noninvasive high-resolution images for monitoring the implantation site of a port delivery system with ranibizumab (PDS). Methods: Six eyes from the Archway phase 3 trial were imaged with AS-OCT after surgical implantation of the PDS and at regular follow-up visits. Results: AS-OCT was helpful in monitoring the status of the overlying conjunctiva and Tenon capsule after implantation of the PDS. Minimal qualitative thinning was observed over the implants at the longest follow-up. No cases of conjunctival erosion were noted. Conclusions: AS-OCT can be used to help to monitor PDS implants and potential associated complications.
What is There in pH?: A Soap Opera
Authors: Jayakrishnan S.
Published: August 2022

In 2021, Sebamed’s campaign appealed to consumers that ‘Do not listen to Film stars, Listen to Science’ ( Film stars kee Nahi, science kee suno—in Hindi). The campaign intended to persuade consumers to make more informed choices when they buy personal care products and to compare Sebamed’s attributes (pH) with its competitors—Dove and Lux (Hindustan Unilever—HUL). Sebamed highlighted the pH as an attribute and how soap’s high pH value (7 and more) can be harmful to the skin. The campaign was comparing the pH value of Sebamed with HUL’s Dove and Lux. HUL reacted to this campaign and highlighted the research, development and testing process adopted for its different products. HUL also did a counter-campaign highlighting that water also has a pH of 7 and suggested that consumers use common sense when buying soaps. Even though the campaign by Sebamed was interesting it did not have any significant impact on the sales of HUL brands—Dove and Lux. The interesting question is: what should be the focus of campaigns in a hypercompetitive market?
The Unhappy Gastric Conduit: A Medical Perspective
Authors: Codipilly D. Chamil , Snyder Diana L.
Published: August 2022

The gastric conduit is commonly created after esophagectomy to restore intestinal continuity. In this review, we discuss several complications that can arise and can be managed by a gastroenterologist. We highlight endoscopic management of anastomotic leaks and strictures. We also describe the work up and management of reflux disease, delayed gastric conduit emptying, and dumping syndrome, all of which can complicate short- and long-term outcomes in patients receiving a gastric conduit.
How I Teach It: Minimally Invasive Esophagectomy
Authors: Lima Pedro Guimaraes Rocha , Laliberte Anne-Sophie
Published: August 2022

In this era of new and emerging technology, surgical procedures evolve at an astounding pace. The minimally invasive esophagectomy is no exception. This article, and accompanying video, focus on technical steps involved and the elements crucial for teaching residents and peers a minimally invasive esophagectomy. Teamwork and good communication play a major role in maintaining patient safety but also have significant impact on the teaching and learning experience. The aim of this article is to review the teaching steps of minimally invasive Ivor-Lewis esophagectomy. It is important to consider there are technical differences between surgeon and that we learn from each other.
The Unhappy Conduit: GI and Surgical Problems Post Esophagectomy: Surgical Perspective
Authors: Azari Feredun , Kennedy Gregory T. , Dempsey Daniel T.
Published: August 2022

Operations for esophageal and proximal gastric cancers are increasing. The most common surgical intervention performed for this patient population is esophagectomy. Regardless of the technical approach pursued, creation of a neo-esophageal conduit imposes various anatomic and physiologic challenges. These patients often undergo additional endoscopic and surgical revision procedures to improve their quality of life. Some of the most common complications encountered by medical professionals managing these challenging patients include para-conduit hiatal hernias, acid and biliary reflux, and redundant or dysfunctional neo-esophageal conduit. As survival and long-term outcomes improve, clinicians are encountering novel complications including conduit neoplasia and tracheal conduit fistulas. This review highlights some of the common complications post esophagectomy with focus on initial diagnosis and management strategies.
Body mass index increase: a risk factor for forced expiratory volume in 1 s decline for overweight and obese adults with asthma
Authors: Bermúdez Barón Nicolás , Kankaanranta Hannu , Hedman Linnea , Andersson Martin , Stridsman Caroline , Lindberg Anne , Rönmark Eva , Backman Helena
Published: August 2022

Background

With increasing prevalence of overweight and obesity, it is important to study how body mass index (BMI) change may affect lung function among subjects with asthma. There are few prospective studies on this topic, especially with separate analyses of those with normal and high BMI. The aim of the present study was to prospectively study the association between annual BMI change and annual lung function decline, separately among those with normal initial BMI and overweight/obesity, in an adult asthma cohort.

Methods

A population-based adult asthma cohort was examined at study entry between 1986 and 2001 and at follow-up between 2012 and 2014 (n=945). Annual BMI change was analysed in association with annual decline in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC separately in those with normal weight (BMI 18.5–24.9) and overweight/obese subjects (BMI ≥25) at study entry. Regression models were used to adjust for sex, age, smoking, inhaled corticosteroids use and occupational exposure to gas, dust or fumes.

Results

Overweight/obese subjects had lower FEV1and FVC but slower annual FEV1and FVC decline compared to those with normal weight. After adjustment through regression modelling, the association between BMI change with FEV1and FVC decline remained significant for both BMI groups, but with stronger associations among the overweight/obese (FEV1B[Overweight/obese]=−25 mLversusB[normal weight]=−15 mL). However, when including only those with BMI increase during follow-up, the associations remained significant among those with overweight/obesity, but not in the normal-weight group. No associations were seen for FEV1/FVC.

Conclusions

BMI increase is associated with faster FEV1and FVC decline among overweight and obese adults with asthma in comparison with their normal-weight counterparts.
Vasoreactive phenotype in children with pulmonary arterial hypertension and syncope
Authors: Linder Alexandra N. , Hsia Jill , Krishnan Sheila V. , Rosenzweig Erika B. , Krishnan Usha S.
Published: August 2022

Background

Syncope in Group 1 pulmonary arterial hypertension (PAH) is an independent predictor of poor prognosis in adults, but this is not well studied in children. We hypothesise that syncope in children with PAH often occurs in association with a reactive pulmonary vascular bed with sudden vasoconstriction in response to adverse stimuli. In the current study, we sought to determine the association of syncope with acute vasoresponsiveness and outcomes in children with Group 1 PAH.

Methods

A retrospective chart review of children with PAH at a single pulmonary hypertension centre from 1 January 2005 to 31 October 2018 was performed. Data included demographics, symptoms, imaging, haemodynamics, and outcomes at baseline and follow-up.

Results

169 children had Group 1 PAH; 47 (28%) had syncope at presentation or follow-up. Children with significant shunts were excluded from the analysis. Children with syncope were older at diagnosis (7.5versus5.0 years; p=0.002) and had a higher incidence of chest pain (p=0.022) and fatigue (p=0.003). They had higher pulmonary vascular resistance at baseline (14.9versus9.1 WU·m2; p=0.01). More children with syncope were vasoresponders to inhaled nitric oxide (33%versus22%; p=0.08–NS). Children with syncope and acute vasoresponsiveness had the highest survival, and non-responders with syncope on medications had the worst long-term survival.

Conclusions

Children with syncope had higher rates of vasoreactivity compared to those without. This suggests that in some children with PAH, syncope may simply reflect acute pulmonary vasoconstriction to an adverse stimulus. Larger prospective studies are warranted to further assess syncope as a marker for a vasoreactive phenotype with implications for treatment and long-term outcomes.
Complete response to anti-interleukin-5 biologics in a real-life setting: results from the nationwide Danish Severe Asthma Register
Authors: Soendergaard Marianne Baastrup , Hansen Susanne , Bjerrum Anne-Sofie , Hilberg Ole , Lock-Johansson Sofie , Håkansson Kjell Erik Julius , Ingebrigtsen Truls Sylvan , Johnsen Claus Rikard , Rasmussen Linda Makowska , von Bülow Anna , Assing Karin Dahl , Schmid Johannes Martin , Ulrik Charlotte Suppli , Porsbjerg Celeste
Published: August 2022

Background

Phase III regulatory trials show that anti-interleukin (IL)-5 biologics efficiently reduce exacerbations and the use of maintenance oral corticosteroids (mOCS) in patients with severe eosinophilic asthma. However, patients eligible for these trials differ significantly compared with real-life severe asthma populations. Therefore, our aim was to explore efficacy in a real-life setting. The Danish Severe Asthma Register (DSAR) is a complete, nationwide register that comprises all Danish patients on biological therapy for severe asthma.

Methods

This prospective study identified patients in the DSAR who were complete responders to anti-IL-5 biologics after 1 year of treatment. A complete response was defined as resolution of the parameter setting the indication,i.e.recurrent exacerbations and/or use of mOCS.

Results

A total of 289 out of 502 (58%) patients were complete responders to anti-IL-5 biologics after 12 months. Complete responders had greater improvements in forced expiratory volume in 1 s and Asthma Control Questionnaire (ACQ) score compared with noncomplete responders (Δ 210versus30 mL; p<0.0001 and Δ −1.04versus−0.68; p=0.016, respectively). A complete response was predicted by age at onset, less severe disease at baseline (i.e.no mOCS and lower ACQ score) and higher blood eosinophils.

Conclusions

More than half of Danish patients treated with anti-IL-5 biologics for severe asthma achieve a complete response to treatment, thereby becoming free from asthma exacerbations and the need for mOCS. Complete responders also achieved superior effects on lung function and symptoms compared with noncomplete responders.
Phase I studies of BI 1015550, a preferential phosphodiesterase 4B inhibitor, in healthy males and patients with idiopathic pulmonary fibrosis
Authors: Maher Toby M. , Schlecker Christina , Luedtke Doreen , Bossert Sebastian , Zoz Donald F. , Schultz Armin
Published: August 2022

Introduction

BI 1015550 is a phosphodiesterase 4 (PDE4) inhibitor that has antifibrotic properties. Phase I and Ic studies were conducted to investigate the safety, tolerability and pharmacokinetics of BI 1015550 in healthy male subjects and patients with idiopathic pulmonary fibrosis (IPF).

Methods

In the phase I study, 42 subjects were partially randomised to receive placebo or BI 1015550 in single rising doses of 36 mg and 48 mg, or multiple rising doses of 6 mg and 12 mg twice daily over 14 days. In the phase Ic study, 15 patients with IPF were randomised to receive 18 mg BI 1015550 or placebo twice daily for up to 12 weeks. For both studies, the primary endpoint was the number of subjects with drug-related adverse events (AEs).

Results

In the Phase I study, drug-related AEs were reported for 50.0% of healthy male subjects treated with a single dose of BI 1015550, compared with 16.7% receiving placebo. For those receiving multiple doses, drug-related AEs were reported for 37.5% of those treated with BI 1015550 and 12.5% receiving placebo. The most frequently reported AEs by organ class were nervous system disorders, which were largely driven by headache. In the Phase Ic study, drug-related AEs were reported in 90.0% of patients treated with BI 1015550, compared with 60.0% of those receiving placebo. The most frequent AEs by organ class were gastrointestinal AEs.

Conclusions

BI 1015550 had an acceptable safety profile in healthy male subjects and male and female patients with IPF, supporting further development in larger trials.
A deep learning framework for identifying essential proteins based on multiple biological information
Authors: Yue Yi , Ye Chen , Peng Pei-Yun , Zhai Hui-Xin , Ahmad Iftikhar , Xia Chuan , Wu Yun-Zhi , Zhang You-Hua
Published: August 2022

Background

Essential Proteins are demonstrated to exert vital functions on cellular processes and are indispensable for the survival and reproduction of the organism. Traditional centrality methods perform poorly on complex protein–protein interaction (PPI) networks. Machine learning approaches based on high-throughput data lack the exploitation of the temporal and spatial dimensions of biological information.

Results

We put forward a deep learning framework to predict essential proteins by integrating features obtained from the PPI network, subcellular localization, and gene expression profiles. In our model, the node2vec method is applied to learn continuous feature representations for proteins in the PPI network, which capture the diversity of connectivity patterns in the network. The concept of depthwise separable convolution is employed on gene expression profiles to extract properties and observe the trends of gene expression over time under different experimental conditions. Subcellular localization information is mapped into a long one-dimensional vector to capture its characteristics. Additionally, we use a sampling method to mitigate the impact of imbalanced learning when training the model. With experiments carried out on the data of Saccharomyces cerevisiae, results show that our model outperforms traditional centrality methods and machine learning methods. Likewise, the comparative experiments have manifested that our process of various biological information is preferable.

Conclusions

Our proposed deep learning framework effectively identifies essential proteins by integrating multiple biological data, proving a broader selection of subcellular localization information significantly improves the results of prediction and depthwise separable convolution implemented on gene expression profiles enhances the performance.
Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches
Authors: Presseau Justin , Kasperavicius Danielle , Rodrigues Isabel Braganca , Braimoh Jessica , Chambers Andrea , Etherington Cole , Giangregorio Lora , Gibbs Jenna C. , Giguere Anik , Graham Ian D. , Hankivsky Olena , Hoens Alison M. , Holroyd-Leduc Jayna , Kelly Christine , Moore Julia E. , Ponzano Matteo , Sharma Malika , Sibley Kathryn M. , Straus Sharon
Published: August 2022

Background

Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective.

Methods

We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights.

Results

We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08).

Conclusions

Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future.

Trial registration

Open Science Framework Registration: osf.io/qgh64.
Developing an Unstructured Supplementary Service Data-based mobile phone app to provide adolescents with sexual reproductive health information: a human-centered design approach
Authors: Macharia Paul , Pérez-Navarro Antoni , Inwani Irene , Nduati Ruth , Carrion Carme
Published: August 2022

Background

Adolescent pregnancies and sexually-transmitted infections continue to impact 15 – 19-year-olds across the globe. The lack of sexual reproductive health information (SRH) in resource-limited settings due to cultural and societal attitudes towards adolescent SRH could be contributing to the negative outcomes. Innovative approaches, including mobile phone technologies, are needed to address the need for reliable adolescent SRH information.

Objective

The study aimed to co-design a Unstructured Supplementary Service Data (USSD) based mobile app prototype to provide confidential adolescent SRH information on-demand and evaluate the mobile app’s usability and user experience.

Methods

A human-centered design methodology was applied. This practice framework allowed the perspectives and feedback of adolescent users to be included in the iterative design process. To participate, an adolescent must have been 15 to 19 years old, resided in Kibra and would be able to access a mobile phone. Adolescents were enrolled for the alpha and field testing of the app prototype at different time-points. The Mobile Application Rating Scale (MARS) a multidimensional mobile phone evaluation tool was used to access the functionality, engagement, aesthetics and quality of information in the app. Responses from the MARS were reported as mean scores for each category and a mean of the aggregate scores making the app’s quality score. The MARS data was also evaluated as categorical data, A Chi square test of independence was carried out to show significance of any observed differences using cumulative and inverse cumulative distribution functions.

Results

During the usability test, 62/109 (54.9%) of the adolescents that were followed-up had used the app at least once, 30/62 (48.4%) of these were male participants and 32/62 (51.6%) female. On engagement, the app had a mean score of 4.3/5 (SD 0.44), 4.6/5 (SD 0.38) on functionality, 4.3/5 (SD 0.57) on aesthetics and 4.4/5 (SD 0.60) on the quality of information. The overall app quality mean score was 4.4/5 (SD 0.31). The app was described as ‘very interesting’ to use by 44/62 (70.9%) of the participants, 20/44 males and 24/44 females. The content was deemed to be either ‘perfectly’ or ‘well targeted’ on sexual reproductive health by 60/62 (96.7%) adolescents, and the app was rated ‘best app’ by 45/62 (72.6%) adolescents, 27/45 females and 18/45 males, with a p-value = 0.011.

Conclusions

Adolescents need on-demand, accurate and trusted SRH information. A mobile phone app is a feasible and acceptable way to deliver adolescent SRH information in resource-limited settings. The USSD mobile phone technology shows promise in the delivery of much needed adolescent SRH information on-demand..
A simple pooling method for variable selection in multiply imputed datasets outperformed complex methods
Authors: Panken A. M. , Heymans M. W.
Published: August 2022

Background

For the development of prognostic models, after multiple imputation, variable selection is advised to be applied from the pooled model. The aim of this study is to evaluate by using a simulation study and practical data example the performance of four different pooling methods for variable selection in multiple imputed datasets. These methods are the D1, D2, D3 and recently extended Median-P-Rule (MPR) for categorical, dichotomous, and continuous variables in logistic regression models.

Methods

Four datasets (n = 200 andn = 500), with 9 variables and correlations of respectively 0.2 and 0.6 between these variables, were simulated. These datasets included 2 categorical and 2 continuous variables with 20% missing at random data. Multiple Imputation (m = 5) was applied, and the four methods were compared with selection from the full model (without missing data). The same analyzes were repeated in five multiply imputed real-world datasets (NHANES) (m = 5,p = 0.05,N = 250/300/400/500/1000).

Results

In the simulated datasets, the differences between the pooling methods were most evident in the smaller datasets. The MPR performed equal to all other pooling methods for the selection frequency, as well as for the P-values of the continuous and dichotomous variables, however the MPR performed consistently better for pooling and selecting categorical variables in multiply imputed datasets and also regarding the stability of the selected prognostic models. Analyzes in the NHANES-dataset showed that all methods mostly selected the same models. Compared to each other however, the D2-method seemed to be the least sensitive and the MPR the most sensitive, most simple, and easy method to apply.

Conclusions

Considering that MPR is the most simple and easy pooling method to use for epidemiologists and applied researchers, we carefully recommend using the MPR-method to pool categorical variables with more than two levels after Multiple Imputation in combination with Backward Selection-procedures (BWS). Because MPR never performed worse than the other methods in continuous and dichotomous variables we also advice to use MPR in these types of variables.
Haemostatic profile of children with nephrotic syndrome attending University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria
Authors: Odimegwu Chioma L. , Ikefuna Anthony N. , Okafor Henrietta U. , Nwagha Theresa , Ubesie Agozie , Chinawa Josephat M.
Published: August 2022

Background

Haemostatic derangements are thought to be due to an imbalance between hepatic synthesis of pro-coagulants and urinary losses of anticoagulants.

Objectives

This study evaluated the coagulation profile of Nigerian children with nephrotic syndrome and examined the relationship between coagulation variables, disease state and steroid responsiveness.

Methods

A cross- sectional hospital based study on evaluation of coagulation profile of children with nephrotic syndrome compared with their age- and gender- matched controls.

Results

The median fibrinogen level in subjects and controls was the same (2.9 g/L). Sixteen of 46 (35%) children with nephrotic syndrome had hyperfibrinogenaemia. The median fibrinogen level of children in remission was 2.3 g/L and differed significantly when compared with those of children in relapse (p = 0.001). The median APTT of children with nephrotic syndrome was 45.0 s and differed significantly compared with those of controls (42.0 s) (p value = 0.02). The median prothrombin time in children with and without nephrotic syndrome were 12.0 and 13.0 s respectively, (p = 0.004). About 90% of children with nephrotic syndrome had INR within reference range. Thrombocytosis was found in 15% of children with nephrotic syndrome. The median platelet count in children with new disease was 432 × 103cells/mm3 and differed significantly when compared with those of controls (p = 0.01).

INR was significantly shorter in children with steroid resistant nephrotic syndrome (SRNS) (median 0.8 s; IQR 0.8 -0.9 s) compared with controls (median 1.0 s; IQR 1.0 -1.1 s) (p = 0.01). Steroid sensitivity was the strongest predictor of remission in children with nephrotic syndrome; steroid sensitive patients were 30 times more likely to be in remission than in relapse (OR 30.03; CI 2.01 – 448.04).

Conclusion

This study shows that the haemostatic derangements in childhood nephrotic involve mostly fibrinogen, APTT, PT, INR and platelet counts. Antithrombin levels are largely unaffected. Variations in fibrinogen, APTT, PT and INR values may be due to the heterogeneous nature of the disease.
Female breast cancer incidence predisposing risk factors identification using nationwide big data: a matched nested case-control study in Taiwan
Authors: Liu Ping-Hung , Wei James Cheng-Chung , Wang Yu-Hsun , Yeh Ming-Hsin
Published: August 2022

Background

Breast cancer is an umbrella term referring to a group of biologically and molecularly heterogeneous diseases originating from the breast. Globally, incidences of breast cancer has been increasing dramatically over the past decades. Analyses of multiple clinical “big data” can aid us in clarifying the means of preventing the disease. In addition, predisposing risk factors will be the most important issues if we can confirm their relevance. This study aims to provide an overview of the predisposing factors that contribute to a higher possibility of developing breast cancer and emphasize the signs that we ought to pay more attention to.

Methods

This is a matched nested case-control study. The cohort focused on identifying the eligible risk factors in breast cancer development by data screening (2000-2013) from the Taiwan National Health Insurance Research Database (NHIRD) under approved protocol. A total of 486,069 females were enrolled from a nationwide sampled database, and 3281 females was elligible as breast cancer cohort, 478,574 females who had never diagnosed with breast cancer from 2000 to 2013 were eligible as non-breast cancer controls, and matched to breast cancer cases according to age using a 1:6 ratio.

Results

We analyzed 3281 breast cancer cases and 19,686 non-breast cancer controls after an age-matched procedure. The significant predisposing factors associated with breast cancer development including obesity, hyperlipidemia, thyroid cancer and liver cancer. As for patients under the age of 55, gastric cancer does seem to have an impact on the development of breast cancer; compared with their counterparts over the age of 55, endometrial cancer appears to exhibit an evocative effect.

Conclusions

In this nationwide matched nested case-control study, we identified obesity, hyperlipidemia, previous cancers of the thyroid, stomach and liver as risk factors associated with breast cancer. However, the retrospective nature and limited case numbers of certain cancers still difficult to provide robust evidence. Further prospective studies are necessitated to corroborate this finding in order to nip the disease in the bud.

Trial registration

The studies involving human participants were reviewed and approved by the China Medical University Hospital [CMUH104-REC2-115(AR-4)].
Long-term air pollution levels modify the relationships between short-term exposure to meteorological factors, air pollution and the incidence of hand, foot and mouth disease in children: a DLNM-based multicity time series study in Sichuan Province, China
Authors: Luo Caiying , Qian Jian , Liu Yaqiong , Lv Qiang , Ma Yue , Yin Fei
Published: August 2022

Background

Epidemiological studies have investigated the short-term effects of meteorological factors and air pollution on the incidence of hand, foot, and mouth disease (HFMD). Several meteorological indicators, such as relative humidity and the diurnal temperature range (DTR), significantly modify the relationship between short-term exposure to temperature and HFMD incidence. However, it remains unclear whether (and how) long-term air pollution levels modify the short-term relationships of HFMD incidence with meteorological factors and air pollution.

Methods

We obtained daily data on meteorological factors, air pollutants, and HFMD counts in children from 21 prefecture-level cities in Sichuan Province in Southwest China from 2015 to 2017. First, we constructed a distributed lag nonlinear model (DLNM) at each prefecture-level site to evaluate the short-term impacts of meteorological variables and air pollutants on HFMD incidence. Then, we assessed the pooled effects of the exposures and incorporated long-term city-specific air pollutant indicators as meta-predictors to examine their potential modification effects by performing multivariate meta-regression models.

Results

We found that long-term SO2 and CO concentrations significantly modified the short-term relationships between climatic variables and HFMD incidence. Specifically, high concentrations of CO (P = 0.027) and SO2 (P = 0.039) reduced the risk of HFMD at low temperatures. The relationship between relative humidity and HFMD incidence was weakened at high SO2 concentrations (P = 0.024), especially when the relative humidity was below the median level. When the minimum relative humidity (32%) was compared to the median relative humidity (77%), the risk ratio (RR) was 0.77 (95% CI: 0.51–1.17) in the 90th percentile of SO2 (19.6 μg/m3) and 0.41 (95% CI: 0.27–0.64) in the 10th percentile of SO2 (10.6 μg/m3).

Conclusion

Our results indicated that long-term SO2 and CO levels modified the short-term associations between HFMD incidence in children and meteorological variables. These findings may inform health authorities to optimize targeted public health policies including reducing ambient air pollution and reinforcing self-protective actions to weaken the adverse health impacts of environmental factors on HFMD incidence.
Leave events among Aboriginal and Torres Strait Islander people: a systematic review
Authors: Coombes J , Hunter K , Bennett-Brook K , Porykali B , Ryder C , Banks M , Egana N , Mackean T , Sazali S , Bourke E , Kairuz C
Published: August 2022

Background

Leave events are a public health concern resulting in poorer health outcomes. In Australia, leave events disproportionally impact Aboriginal and Torres Strait Islander people. A systematic review was conducted to explore the causes of leave events among Aboriginal and Torres Strait Islander people and strategies to reduce them.

Methods

A systematic review was conducted using Medline, Web of Science, Embase and Informit, a database with a strong focus on relevant Australian content. Additionally, we examined the references of the records included, and performed a manual search using Google, Google scholar and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. Two independent reviewers screened the records. One author extracted the data and a second author reviewed it. To appraise the quality of the studies the Mixed Methods Appraisal Tool was used as well as the Aboriginal and Torres Strait Islander Quality Appraisal Tool. A narrative synthesis was used to report quantitative findings and an inductive thematic analysis for qualitative studies and reports.

Results

We located 421 records. Ten records met eligibility criteria and were included in the systematic review. From those, four were quantitative studies, three were qualitative studies and three reports. Five records studied data from the Northern Territory, two from Western Australia, two from New South Whales and one from Queensland. The quantitative studies focused on the characteristics of the patients and found associations between leave events and male gender, age younger than 45 years and town camp residency. Qualitative findings yielded more in depth causes of leave events evidencing that they are associated with health care quality gaps. There were multiple strategies suggested to reduce leave events through adapting health care service delivery. Aboriginal and Torres Strait Islander representation is needed in a variety of roles within health care provision and during decision-making.

Conclusion

This systematic review found that multiple gaps within Australian health care delivery are associated with leave events among Aboriginal and Torres Strait Islander people. The findings suggest that reducing leave events requires better representation of Aboriginal and Torres Strait Islander people within the health workforce. In addition, partnership with Aboriginal and Torres Strait Islander people is needed during the decision-making process in providing health services that meet Aboriginal and Torres Strait Islander cultural needs.