bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental and Energy Policy in France
Authors: Halpern Charlotte
Published: January 2023

This chapter examines the profound changes that have taken place in the study of environmental and energy policy (EEP) in and about France. It explains why and how they constitute a challenge from a substantive and an analytic perspective, and, in the French context, it argues that EEP still holds an ambivalent position. This chapter develops two main arguments. First, the emergence of EEP study in the French context is closely related to this policy’s origins and long-held, strong relationships with the ecology movement. Second, EEP in France has long constituted a challenge for both comparative political research and for classic models about the functioning of the state and policymaking in France. This chapter concludes by challenging the idea that EEP in France is sufficiently specific to justify excluding it any longer from comparative political research agendas.
Endoplasmic Reticulum Bodies in the Lateral Root Cap Are Involved in the Direct Transport of Beta-Glucosidase to Vacuoles
Authors: Toyooka Kiminori , Goto Yumi , Hashimoto Kei , Wakazaki Mayumi , Sato Mayuko , Hirai Masami Yokota
Published: January 2023

Programmed cell death (PCD) in lateral root caps (LRCs) is crucial for maintaining root cap functionality. Endoplasmic reticulum (ER) bodies play important roles in plant immunity and PCD. However, the distribution of ER bodies and their communication with vacuoles in the LRC remain elusive. In this study, we investigated the ultrastructure of LRC cells of wild-type and transgenic Arabidopsis lines using an auto-acquisition transmission electron microscope (TEM) system and high-pressure freezing. Gigapixel-scale high-resolution TEM imaging of the transverse and longitudinal sections of roots followed by three-dimensional imaging identified sausage-shaped structures budding from the ER. These were subsequently identified as ER bodies using GFPh transgenic lines expressing green fluorescent protein (GFP) fused with an ER retention signal (HDEL). Immunogold labeling using an anti-GFP antibody detected GFP signals in the ER bodies and vacuoles. The fusion of ER bodies with vacuoles in LRC cells was identified using correlative light and electron microscopy. Imaging of the root tips of a GFPh transgenic line with a PYK10 promoter revealed the localization of PYK10, a member of the β-glucosidase family with an ER retention signal, in the ER bodies in the inner layer along with a fusion of ER bodies with vacuoles in the middle layer and collapse of vacuoles in the outer layer of the LRC. These findings suggest that ER bodies in LRC directly transport β-glucosidases to the vacuoles, and that a subsequent vacuolar collapse triggered by an unknown mechanism releases protective substances to the growing root tip to protect it from the invaders.
Universal bounds on quantum mechanics through energy conservation and the bootstrap method
Authors: Morita Takeshi
Published: January 2023

The range of motion of a particle with certain energy E confined in a potential is determined from the energy conservation law in classical mechanics. The counterpart of this question in quantum mechanics can be regarded as what is the possible range of expectation values of the position operator 〈x〉 of a particle that satisfies E = 〈H〉. This range depends on the state of the particle, but the universal upper and lower bounds, which are independent of the state, must exist. In this study, we show that these bounds can be derived by using the bootstrap method. We also point out that the bootstrap method can be regarded as a generalization of the uncertainty relations, meaning that the bounds are determined by the uncertainty relations in a broad sense. Furthermore, the bounds on possible expectation values of various quantities other than position can be determined in the same way. However, in the case of multiple identical particles (bosons and fermions), we find some difficulty in the bootstrap method. Because of this issue, the predictive power of the bootstrap method in multi-particle systems is limited in the derivation of observables including energy eigenstates. In addition, we argue an application of the bootstrap method to thermal equilibrium states. We find serious issues that temperature and entropy cannot be handled. Although we have these issues, we can derive some quantities in micro-canonical ensembles of integrable systems governed by generalized Gibbs ensembles.
Identification of Disability Subgroups for Patients After Ischemic Stroke
Authors: Edelstein Jessica , Kinney Adam R , Keeney Tamra , Hoffman Amanda , Graham James E , Malcolm Matthew P
Published: January 2023

Objective

The aims of this study were to identify disability subgroups among patients hospitalized for ischemic stroke and to determine the predictors and distal outcomes for the disability subgroups.

Methods

A retrospective, cross-sectional study design was used. Data on patients after ischemic stroke were collected from the electronic health records at 5 hospitals within a single health system. Covariates included social and demographic factors. Disability was characterized according to the Activity Measure for Post-Acute Care assessment. Distal outcomes were physical therapist treatment use, occupational therapist treatment use, and discharge disposition. Latent class analysis was used to identify disability subgroups of patients hospitalized for ischemic stroke.

Results

A total of 1549 patients were included in the analyses. Five disability subgroups were identified and labeled as follows: globally impaired (subgroup 1), impaired dynamic balance (subgroup 2), impaired self-care (subgroup 3), impaired mobility (subgroup 4), and independent (subgroup 5). Physical therapist treatment use (χ24 = 113.21 [P < .001]) and occupational therapist treatment use (χ24 = 122.97 [P < .001]) varied significantly across the disability subgroups. The globally impaired group had the highest probability of physical and occupational therapist treatment use. Similarly, discharge disposition varied across the subgroups (for home without services, χ24 = 246.61 [P < .001]; for home with home health care, χ24 = 35.49 [P < .001]; for institutional discharge, χ24 = 237.18 [P < .001]). The independent subgroup had the highest probability of discharge to home without services.

Conclusion

Five disability subgroups were identified for patients after ischemic stroke. The disability subgroups provide a common language for clinicians to organize the heterogeneity of disability after stroke.

Impact

Using the disability subgroups, the multidisciplinary team might be able to improve the accuracy and efficiency of care decisions. The number of current rehabilitation interventions is indeterminable; these subgroups may help to guide clinicians in selecting the most beneficial interventions for patients based on subgroup membership.
Regulatory Intensity and Firm-Specific Exposure
Authors: Kalmenovitz Joseph
Published: January 2023

Building on administrative data and machine-learning models, I develop a firm-specific measure of regulatory intensity: cost of compliance with all federal paperwork regulations. Regulatory intensity increases the cost of goods sold and overhead spending (SGA). It also incentivizes companies to reduce capital investment, hire fewer employees, and lobby more. The effects are particularly strong among financially constrained firms and those with irreversible investment opportunities, suggesting that regulation affects companies through budgetary pressures and heightened uncertainty. The findings highlight the real effects of regulation and the underlying mechanisms.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
A Phase IB/IIA Study of Ex Vivo Expanded Allogeneic Bone Marrow Derived Mesenchymal Stem Cells for the Treatment of Perianal Fistulizing Crohn’s Disease
Authors: Lightner Amy L. , Reese Jane , Ream Justin , Nachand Douglas , Jia Xue , Dadgar Neda , Steele Scott R. , Hull Tracy
Published: January 2023

BACKGROUND:

Mesenchymal stem cells have been used for the treatment of perianal Crohn’s fistulizing disease by direction injection. However, no studies to date have included patients with proctitis, anal canal involvement, and multiple branching tracts.

OBJECTIVE:

To determine safety and efficacy of mesenchymal stem cells for refractory perianal Crohn’s disease.

DESIGN:

Phase IB/IIA randomized control trial

SETTINGS:

Tertiary inflammatory bowel disease referral center

PATIENTS:

Adult Crohn’s patients with perianal fistulizing disease

INTERVENTION:

75 million mesenchymal stem cells were administered with a 22G needle by direct injection after curettage and primary closure of the fistula tract. A repeat injection of 75 million mesenchymal stem cells at 3 months was given if complete clinical and radiographic healing were not achieved.

MAIN OUTCOMES MEASURES:

Adverse and serious adverse events at post procedure day 1, week 2, week 6, month 3, month 6 and month 12. Clinical healing, radiographic healing per magnetic resonance imaging, and patient reported outcomes at the same time points.

RESULTS:

A total of 23 patients were enrolled and treated; 18 were treatment and 5 were control. There were no adverse or serious adverse events reported related to mesenchymal stem cells therapy. At six months, 83% of the treatment group and 40% of the control had complete clinical and radiographic healing. The perianal Crohn’s disease activity index, Wexner incontinence score, and VanAssche score had all significantly decreased in treatment patients at six months; none significantly decreased in the control group.

LIMITATIONS:

Single institution and single blinded.

CONCLUSIONS:

Bone marrow derived mesenchymal stem cells offer a safe and effective alternative treatment approach for severe perianal fistulizing Crohn’s disease. See Video Abstract at http://links.lww.com/DCR/C128
Stability and Change in Biopsychosocial Factors Associated With Fatigue 6 and 12 Months After Traumatic Brain Injury: An Exploratory Multilevel Study
Authors: Løke Daniel , Andelic Nada , Helseth Eirik , Vassend Olav , Andersson Stein , Ponsford Jennie L. , Tverdal Cathrine , Brunborg Cathrine , Løvstad Marianne
Published: January 2023

Objective:

To explore factors associated with stability and change in fatigue from 6 to 12 months following traumatic brain injury (TBI).

Setting:

Combined in- and outpatient acute care and postacute rehabilitation settings.

Participants:

A total of 103 patients with confirmed intracranial injury were assessed 6 and/or 12 months following TBI.

Design:

A prospective observational study with repeated measures at 2 time points, analyzed with a hybrid mixed-effects model.

Main Measures:

Primary outcomes were the fatigue factor derived from items from several fatigue patient-reported outcome measures (PROMs; Fatigue Severity Scale, Chalder Fatigue Scale, Giessen Subjective Complaints List–fatigue subscale, and Rivermead Post-Concussion Symptoms Questionnaire–fatigue item) Secondary outcomes were PROMs relating to pain, somatic and psychological distress, insomnia, sleepiness, personality traits, optimism, resilience, behavioral activation and inhibition, and loneliness, as well as neuropsychological measures. Demographic variables and injury severity characteristics were included as covariates.

Results:

In multilevel regression, female sex, years of education, and 3 factors related to injury severity, somatic vulnerability, and psychosocial robustness were all significantly associated with variation in fatigue between subjects, and explained 61% of the variance in fatigue that was due to stable between-subject differences. Fatigue levels declined significantly over time. Changes in pain severity, somatic symptom burden, psychological distress, and behavioral inhibition were positively associated with changes in fatigue, explaining 22% of the variance in fatigue within subjects.

Conclusions:

The study demonstrated that several previously implicated factors show robust effects in distinguishing individuals with TBI on levels of fatigue, but only a few show additional within-subject associations across time. Pain severity, somatic symptom burden, psychological distress, and behavioral inhibition correlated with fatigue across time, implicating these factors as crucial targets for rehabilitation of patients with TBI who suffer from persistent fatigue.
A Prospective Cohort Study of the Association Between Preinjury Psychosocial Function and Postconcussive Symptoms in Pediatric Mild Traumatic Brain Injury: An A-CAP Study
Authors: Doan Quynh , Chadwick Leah , Tang Ken , Brooks Brian L. , Beauchamp Miriam , Zemek Roger , Craig William , Gravel Jocelyn , Yeates Keith Owen
Published: January 2023

Objective:

We evaluated the moderating effect of preinjury psychosocial function on postconcussion symptoms for children with mild traumatic brain injury (mTBI).

Design, Setting, and Population:

We conducted a prospective cohort study of children ages 8.0 to 16.9 years with mTBI (n = 633) or orthopedic injury (OI; n = 334), recruited from 5 pediatric emergency departments from September 2016 to December 2018.

Main Measures:

Participants completed baseline assessments within 48 hours of injury, and postconcussion symptoms assessments at 7 to 10 days, weekly to 3 months, and biweekly to 6 months post-injury. Preinjury psychosocial function was measured using parent ratings on the Pediatric Quality of Life Inventory (PedsQL) and the Strengths and Difficulties Questionnaire (SDQ), retrospectively evaluating their child's status prior to the injury. Parent and child ratings on the Health and Behavior Inventory (HBI) (cognitive and somatic subscales) and the Post-Concussion Symptom Interview (PCS-I) were used as measures of postconcussion symptoms. We fitted 6 longitudinal regression models, which included 747 to 764 participants, to evaluate potential interactions between preinjury psychosocial function and injury group as predictors of child- and parent-reported postconcussion symptoms.

Results:

Preinjury psychosocial function moderated group differences in postconcussion symptoms across the first 6 months post-injury. Higher emotional and conduct problems were significantly associated with more severe postconcussion symptoms among children with mTBI compared with OI. Wald's χ2 for interaction terms (injury group × SDQ subscales) ranged from 6.3 to 10.6 (P values <.001 to .043) across parent- and child-reported models. In contrast, larger group differences (mTBI > OI) in postconcussion symptoms were associated with milder hyperactivity (Wald's χ2: 15.3-43.0, all P < .001), milder peer problems (Wald's χ2: 11.51, P = .003), and higher social functioning (Wald's χ2: 12.435, P = .002).

Conclusions:

Preinjury psychosocial function moderates postconcussion symptoms in pediatric mTBI, highlighting the importance of assessing preinjury psychosocial function in children with mTBI.
Incidence Rates of Medically Attended COVID-19 in Infants Less Than 6 Months of Age
Authors: Griffin Isabel , Irving Stephanie A. , Arriola Carmen Sofia , Campbell Angela P. , Li De-Kun , Dawood Fatimah S. , Doughty-Skierski Caroline , Ferber Jeannette R. , Ferguson Nickolas , Hadden Louise , Henderson Jillian T. , Juergens Mary , Kancharla Venkatesh , Naleway Allison L. , Newes-Adeyi Gabriella , Nicholson Erin , Odouli Roxana , Reichle Lawrence , Sanyang Mo , Woodworth Kate , Munoz Flor M.
Published: January 2023

Background:

Studies suggest infants may be at increased risk of severe coronavirus disease 2019 (COVID-19) relative to older children, but few data exist regarding the incidence of COVID-19 episodes and associated risk factors. We estimate incidence rates and describe characteristics associated with medically attended COVID-19 episodes among infants younger than 6 months of age.

Methods:

We analyzed electronic medical record data from a cohort of infants born March 1, 2020–February 28, 2021. Data from 3 health care delivery systems included demographic characteristics, maternal and infant outpatient visit and hospitalization diagnoses and severe acute respiratory syndrome coronavirus syndrome 2 (SARS-CoV-2) test results. Medically attended COVID-19 episodes were defined by positive SARS-CoV-2 clinical tests and/or COVID-19 diagnosis codes during medical care visits. Unadjusted and site-adjusted incidence rates by infant month of age, low and high SARS-CoV-2 circulation periods and maternal COVID-19 diagnosis were calculated.

Results:

Among 18,192 infants <6 months of age whose mothers received prenatal care within the 3 systems, 173 (1.0%) had medically attended COVID-19 episodes. Incidence rates were highest among infants under 1 month of age (2.0 per 1000 person-weeks) and 1 month (2.0 per 1000 person-weeks) compared with older infants. Incidence rates were also higher for infants born to women with postpartum COVID-19 compared with women without known COVID-19 and women diagnosed with COVID-19 during pregnancy.

Conclusions:

Infants of women with postpartum COVID-19 had a higher risk of medically attended COVID-19 than infants born to mothers who were diagnosed during pregnancy or never diagnosed underscoring the importance of COVID-19 prevention measures for their household members and caregivers to prevent infections in infants.
Three dimensions of pain in osteoarthritis: development and validation of the Osteoarthritis Symptom Inventory Scale
Authors: Perrot Serge , Trouvin Anne-Priscille , Bouhassira Didier
Published: January 2023

We describe here the development and validation of the Osteoarthritis Symptom Inventory Scale (OASIS), a new self-administered questionnaire specifically designed to evaluate the various osteoarthritis (OA) pain symptoms with different dimensions related to OA pain mechanisms. The initial development phase and qualitative study generated a list of 17 descriptors reflecting OA pain and other associated symptoms, leading to the first version of the questionnaire (OASIS17). Each item was quantified on a 0 to 10 Numerical Scale. Validation was performed using 123 consecutive patients with OA pain recruited at 28 centers in France, mainly general practitioner offices. Validation involved (1) determining the questionnaire's factorial structure through exploratory and confirmatory analyses, (2) analyzing convergent and divergent validities (ie, construct validity), (3) assessing each item's test–retest reliability, and (4) evaluating OASIS ability to detect treatment effects (ie, sensitivity to change). The final OASIS version includes 9 items discriminating and quantifying 3 distinct, clinically relevant OA pain dimensions sensitive to treatment. OASIS9 psychometric properties suggest that it could improve the characterization of OA pain profiles for 3 clinically relevant domains: localized, neuropathic-like, and deep pain. The OASIS9 questionnaire could be used to phenotype OA pain patients and identify responders to various therapeutic interventions as a function of OA pain dimensions.
Factors Affecting Turnover of Advanced Practice Providers: A University Teaching Hospital Review
Authors: Venegas Brittany , Benitez Elida , Matthews Rachel , Brandt Anna Michelle , Efron Philip , Duckworth Laurie , McGough Edward
Published: January 2023

Goal:

Retention of advanced practice providers (APPs) is an issue of critical importance to healthcare leaders. High APP turnover negatively affects an organization's ability to meet patient needs, maintain quality of care, and control costs. Our goal was to identify any association between intent to leave and specific survey factors; analyze the distribution of scale factors from the survey; and describe differences among the APP roles, specialties, and length of employment.

Methods:

This study used a self-administered questionnaire for APPs at a large university medical center to determine job satisfaction rates and intent to resign. The survey used a modified Misener Nurse Practitioner Job Satisfaction Scale and Anticipated Turnover Scale.

Principal Findings:

We received surveys from 102 providers (for a 38.9% response rate). Results were used to determine the correlation between job satisfaction and intent to leave and to identify possible factors involved in APP commitment to the hospital and intent to stay. We found that APPs reported the most satisfaction in benefits, followed by time (i.e., time available for answering messages, reviewing laboratory and other test results, seeing patients, scheduling work). Intrapractice partnership/collegiality received the lowest satisfaction score. Extrinsic factors such as monetary bonuses available in addition to salary, reward distribution, involvement in research, conflict resolution, and opportunity to receive compensation for services performed outside normal duties were common dissatisfiers.

Practical Applications:

This survey may help hospitals identify in real time the triggers of APP dissatisfaction and intent to resign. In addition, the results may guide possible revisions to hospital policies and practice procedures to improve APP commitment and decrease turnover intent. Additional surveys in similar university teaching hospital systems could confirm comparable intrinsic and extrinsic factors that are relevant to the satisfaction and turnover of APPs.
For-Profit Hospital Reflections on Community Relationships in the Time of COVID-19
Authors: Cronin Cory E. , Choyke Kelly Lynn , Franz Berkeley
Published: January 2023

Goals:

Throughout the COVID-19 pandemic, hospitals and their staffs have been pushed to their limits. Hospitals have had to rethink how they support community health while also providing critical acute care services to combat the morbidity and mortality associated with COVID-19. As anchor institutions, hospitals have a significant effect on not only community health and well-being but also on local economies as primary employers and contractors. This study aimed to understand how the pandemic reshaped interactions with community members, staff, and other community organizations and changed the nature of hospital–community engagement among for-profit hospitals.

Methods:

We recruited leaders of for-profit hospitals, systems, and a business association that represents for-profit hospitals. We interviewed 28 participants in various leadership roles via telephone or videoconferencing and then thematically coded interview transcriptions. The themes identified in early interviews guided the structure of forthcoming interviews.

Principal Findings:

For-profit hospitals appear motivated to address community health needs as anchor institutions in their communities, and these efforts have strengthened and changed in important ways as a result of the COVID-19 pandemic. In this study, three themes emerged regarding the influence of COVID-19 on hospital–community relationships: Hospitals refocused outreach and engagement efforts to support employees, found essential new ways to safely engage with the community through partnerships and collaborations, and were reminded of the critical roles of social and cultural factors in the health and well-being of individuals and communities.

Practical Applications:

Hospitals may be able to use lessons learned during the pandemic to support the growing need for community engagement and attention to social determinants of health. The themes that emerged from this study present valuable opportunities for hospitals to carry forward the lessons learned over the course of the pandemic, as they have the potential to improve the delivery of healthcare and community engagement in day-to-day operations as well as in crises.
Eating Difficulties and Relationship With Nutritional Status Among Patients With Dementia
Authors: CILIZ Ozlem , TULEK Zeliha , HANAGASI Hasmet , BILGIC Basar , GURVIT I. Hakan
Published: January 2023

Background

One of the most common behavioral problems in patients with dementia is eating problems, which are known to increase the risk of malnutrition. However, few studies have been conducted in this patient group regarding the relationship between eating difficulties and nutritional status.

Purpose

This study was designed to determine the eating difficulties faced by patients with dementia and to evaluate the relationship in this population between eating difficulties and malnutrition.

Methods

This study was carried out in a dementia outpatient clinic of a university hospital in Istanbul, Turkey. This cross-sectional, case-control study included 50 patients and 50 healthy controls as participants. Participants were assessed for eating difficulties and for nutritional, cognitive, and functional statuses.

Results

The patients with dementia had more difficulties in terms of self-feeding skills. Although problems related to manipulating food on the plate and the use of utensils were not seen in the control group, these problems were found in 30% of the participants in the dementia group (p < .001). Moreover, 30% of the patients in the dementia group were unable to eat without assistance (p < .001). Associations were found between eating difficulties and age, duration of illness, and cognitive and functional (basic and instrumental activities of daily living) statuses. In addition, self-feeding skills were found to be associated with nutritional status. Rate of malnutrition or risk of malnutrition was higher in patients with dementia than in those in the control group.

Conclusions

In this study, compared with the control group, patients with dementia had more problems in self-feeding skills such as manipulation of food on a plate, use of utensils, need for assistive tools, ability to eat without assistance, and negative eating behaviors (refusal to eat). An association was found between eating difficulties and nutritional status. Evaluating eating difficulties is recommended in patients with dementia to prevent nutritional deterioration.
Low-Load Blood-Flow-Restricted Exercise to Prevent Muscle Atrophy and Decline in Functional Performance in a Patient Recovering From a Malleolus Fracture. A Case Report
Authors: Mortensen Louise , Mechlenburg Inger , Langgård Jørgensen Stian
Published: January 2023

This present case presentation offers supportive evidence that low-load blood-flow-restriction exercise (LL-BFRE) may be a feasible intervention to preserve skeletal muscle mass and, in part, lower-limb muscle function after a fracture of the lateral malleolus. A 28-year-old female patient sustained a radiographically verified stabile fracture of the lateral malleolus and was treated with a walker cast. She was allowed weight bearing on the limb within the limits of her pain threshold and to perform unloaded plantar and dorsiflexion movements of the ankle. The patient performed 12 weeks of home-based LL-BFRE 4 times per week to diminish declines in functional performance, muscle strength, and skeletal muscle atrophy. We observed that LL-BFRE was feasible with no exercise-related adverse events in the early stage of rehabilitation. The patient experienced no-or-low pain during exercise. Vastus lateralis muscle volume, and thigh and calf circumference was preserved.
Implementation of the International Olympic Committee Sport Mental Health Assessment Tool 1: Screening for Mental Health Symptoms in a Canadian Multisport University Program
Authors: Mountjoy Margo , Edwards Carla , Cheung Christian P. , Burr Jamie , Gouttebarge Vincent
Published: January 2023

Objective:

To apply the International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) to determine the prevalence of mental health symptoms in a cohort of university student athletes over an academic year. A secondary objective was to explore the internal consistency of the screening tools from the SMHAT-1.

Design:

Cross-sectional design with 3 repeated measurements over an academic year.

Setting:

A large university multisport program.

Participants:

Five hundred forty-two university-level student athletes from 17 sports.

Intervention:

N/A.

Main Outcome Measures:

On 3 occasions, the participants completed the SMHAT-1, which consists of the Athlete Psychological Strain Questionnaire. If an athlete's score was above the threshold (≥17), the athlete completed step 2, consisting of (1) Generalized Anxiety Disorder-7; (2) Patient Health Questionnaire-9; (3) Athlete Sleep Screening Questionnaire; (4) Alcohol Use Disorders Identification Test Consumption; (5) Cutting Down, Annoyance by Criticism, Guilty Feeling, and Eye-openers Adapted to Include Drugs; and (6) Brief Eating Disorder in Athletes Questionnaire. Internal consistency of the SMHAT-1 was also measured.

Results:

Participants reported mental health symptoms with prevalence of 24% to 40% for distress, 15% to 30% for anxiety, 19% to 26% for depression, 23% to 39% for sleep disturbance, 49% to 55% for alcohol misuse, 5% to 10% for substance use, and 72% to 83% for disordered eating. Female athletes were more likely to suffer psychological strain, depression, and sleep disturbance; male athletes were more likely to report substance use.

Conclusions:

The SMHAT-1 was feasible to implement with good internal consistency. University-level athletes suffer from a variety of mental health symptoms underscoring the necessity for team physicians to have the clinical competence to recognize and treat mental health symptoms.
“Ditch the white coats”: What LGBTQ+ patients prefer in their primary care provider
Authors: Broholm Cindy , Lindell Deborah , Trossello Catherine , Lauren James , Smith Brittany , Harris Alexander B. , Quinn Griffin Mary T. , Radix Asa
Published: January 2023

Background:

Health disparities in lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (LGBTQ+) individuals are well documented, and there is a dearth of primary care providers (PCPs) with the knowledge, skills, and attitudes to sensitively care for this diverse population.

Purpose:

The purpose of this research study was to ask LGBTQ+ patients what qualities they prefer in their PCP. The findings will be used to better prepare nurse practitioners (NPs) to care for this diverse community and inform the training of future NPs to provide patient-centered care to LGBTQ+ individuals.

Methodology:

In this qualitative descriptive study, four focus groups were conducted remotely between December 2020 and January 2021 with self-identified LGBTQ+ patients of an LGBTQ+ health center in the northeast. Thematic analysis of the data elicited codes, categories, and themes. Strategies were implemented to promote trustworthiness of the results.

Results:

Twenty-eight participants shared the qualities they value in their PCP. Analysis revealed four themes: “Ditch the white coats”; “Meet me where I am”; “The relationship is key”; and “Be knowledgeable about and comfortable with LGBTQ+ people and their health care needs.”

Conclusions:

The focus groups elucidated important information on caring for the LGTBQ+ communities and insights into what NPs must do to provide patient-centered care to this diverse population.

Implications:

These findings can improve practice through a better understanding of LGBTQ+ patients' perspectives. Additionally, this study demonstrates the feasibility of directly asking our patients what they want in their health care provider.
Processes of Care and Associated Factors in Patients With Stroke by Immigration Status
Authors: Mkoma George F. , Johnsen Søren P. , Agyemang Charles , Hedegaard Jakob N. , Iversen Helle K. , Andersen Grethe , Norredam Marie
Published: January 2023

Background:

Receiving evidence-based stroke care processes is associated with good clinical outcome. However, data on early stroke care among immigrants are scarce.

Objective:

We investigated whether guideline-recommended acute stroke care and associated factors differ between immigrants and Danish-born residents.

Design:

Patients admitted with ischemic and hemorrhagic stroke diagnoses (n=129,724) between 2005 and 2018 were identified from the Danish Stroke Registry.

Results:

We included 123,928 Danish-born residents and 5796 immigrants with stroke. Compared with Danish-born residents, immigrants were less likely to be admitted to a stroke unit within 24 hours after stroke onset (81.5% vs. 83.9%, P<0.001) and had lower odds of early stroke care including dysphagia screening, physiotherapy, occupational therapy, and nutritional assessment. After adjustment for age, sex, clinical, and sociodemographic factors, immigrants had lower odds of early stroke unit admission (odds ratio [OR]: 0.97; 95% CI, 0.94–0.99), early dysphagia screening (OR: 0.96; 95% CI, 0.93–0.98), early physiotherapy (OR: 0.96; 95% CI, 0.94–0.99), and early occupational therapy (OR: 0.96; 95% CI, 0.93–0.98) than Danish-born residents. Small absolute differences in overall quality of stroke care were found when comparing immigrants and Danish-born residents. Significant factors associated with greater likelihood of stroke care included high income, high education, and cohabitation.

Conclusions:

Immigrants had lower chances of early stroke unit admission and received fewer individual early stroke care processes such as dysphagia screening, physiotherapy and occupational therapy than Danish-born residents. However, the absolute disparities were in general minor and largely influenced by socioeconomic status and cohabitation.
Decoding the fundamental drivers of phylodynamic inference
Authors: Featherstone Leo A. , Duchene Sebastian , Vaughan Timothy G.
Published: January 2023

Despite its increasing role in the understanding of infectious disease transmission at the applied and theoretical levels, phylodynamics lacks a well-defined notion of ideal data and optimal sampling. We introduce a formal method to visualise and quantify the relative impact of pathogen genome sequence and sampling times—two fundamental sources of data for phylodynamics under birth-death-sampling models—to understand how each drive phylodynamic inference. Applying our method to simulations and outbreaks of SARS-CoV-2 and H1N1 Influenza data, we use this insight to elucidate fundamental trade-offs and guidelines for phylodynamic analyses to draw the most from sequence data. Phylodynamics promises to be a staple of future responses to infectious disease threats globally. Continuing research into the inherent requirements and trade-offs of phylodynamic data and inference will help ensure phylodynamic tools are wielded in ever more targeted and efficient ways.
Description of Kratom Exposure Events in Wisconsin as Reported to the Wisconsin Poison Center — January 1, 2010–September 1, 2022
Authors: DeJonge Peter , Gummin David , Titelbaum Nicholas , Meiman Jonathan
Published: January 2023

Background

Consumption of kratom (Mitragyna speciosa), an herbal substance, can result in adverse health effects. We characterized kratom-associated adverse events in Wisconsin to provide pertinent recommendations for clinicians and public health practitioners.

Methods

Using Wisconsin Poison Center (WPC) data, we searched for and summarized all records associated with exposure to “kratom”, “electronic delivery device containing kratom”, or “mitragyna” during January 1, 2010–September 1, 2022.

Results

Kratom-associated exposure calls to WPC increased 3.75 times during 2016–2020. Among all 59 calls, 26 (44.1%) reported concomitant use of another substance, agitation was the most common symptom reported (23, 39%), and 7 persons required critical care. Three unintentional ingestions were reported in infants aged <2 years.

Discussion

Kratom-associated exposure calls to WPC have been generally increasing in frequency since 2011. Wisconsinites who choose to use kratom might benefit from education regarding health risks and safe storage practices to avoid unintentional pediatric exposure.
Early diagnosis of oral cancer and lesions in Fanconi anemia patients: a prospective and longitudinal study using saliva and plasma
Authors: Errazquin Ricardo , Carrasco Estela , Marro Sonia Del , Suñol Anna , Peral Jorge , Ortiz Jessica , Rubio Juan Carlos , Segrelles Carmen , Dueñas Marta , Garrido-Aranda Alicia , Alvarez Martina , Belendez Cristina , Balmaña Judith , Garcia-Escudero Ramon
Published: January 2023

Fanconi anemia (FA) patients display an exacerbated risk of oral squamous cell carcinoma (OSCC) and precursor lesions at young ages, mainly at the oral cavity. As patients have defects in DNA repair mechanisms, standard-of-care treatments to OSCC such as radiotherapy and chemotherapy give rise to severe toxicities. New methods for early diagnosis are urgently necessary to allow treatments in early disease stages and achieve better clinical outcomes. We have conducted a prospective, longitudinal study whereby liquid biopsies from sixteen lesion/tumor-free patients were analyzed for the presence of mutations in cancer genes. DNA from saliva and plasma were sequentially collected and deep-sequenced, and the clinical evolution followed during a median time of around 2 years. In 9/16 FA patients we detected mutations in cancer genes (mainlyTP53) with molecular allele frequencies (MAF) down to 0.07 %. Importantly, all patients having mutations and clinical follow-up data after mutation detection (n=6) developed oral precursor lesions or OSCC. Lead-time between mutation detection and tumor diagnosis ranged from 23 to 630 days. Strikingly, FA patients without mutations display significantly lower risk of developing precursor lesions or OSCC. Therefore, our diagnostic approach could help to stratify FA patients into risk groups, which would allow closer surveillance for OSCC or precursor lesions.
Antibacterial activity of ethanolic and aqueous extracts of Zingiber officinale on Streptococcus pneumoniae and Pseudomonas aeruginosa
Authors: Rukundo Anjellina , Omara Denis , Majalija Samuel , Odur Solomon , Alafi Steven , Okech Samuel George
Published: January 2023

Background

Streptococcus pneumoniae, a capsulated lancet gram-positive bacterium, is the leading cause of mortality and morbidity among children globally and is the primary cause of pneumonia.Pseudomonas aeruginosais an opportunistic human pathogen and the leading cause of nosocomial infections, among patients who are admitted to intensive care units. With the increasing resistance of microorganisms to antibiotics, there is a shift of choice from allopathy to naturopathy, where herbs are common ingredients of medicines and components of treatment protocols. It is against this background that this study aimed to investigate the susceptibility ofP. aeruginosaandS. pneumoniaeto ethanolic and aqueous extracts of ginger using the agar well diffusion technique.

Methodology

Absolute (95%) Ethanol and distilled water were used as solvents to make extracts from the ginger powder. The filtrate was dried, and the resulting substance was used to conduct antimicrobial tests onStreptococcus pneumoniaeandPseudomonas aeruginosaisolates using the agar well diffusion technique. The diameters of inhibition zones were measured, and statistical analysis was done by one-way ANOVA. Minimum inhibitory and bactericidal concentrations were determined by serial dilution.

Freshly prepared sterile distilled water was used as negative control and ciprofloxacin (5μg/disk), an antibiotic was used as positive control.

Results

The test organisms were sensitive to both ethanolic and aqueous extracts of ginger. However, this was highly dependent on the concentrations of the extracts. The ethanolic extract had lower Minimum Inhibitory and Bactericidal Concentrations than aqueous extract on both bacterial species and at a concentration of 2g/ml, the ethanolic extract was 2-fold and 1.6-fold more effective in inhibiting the growth ofP. aeruginosaandS. pneumoniaerespectively than aqueous extract.

Conclusion

With the high susceptibility of the tested bacterial isolates to the ginger extracts used in this study, it is evident that ginger extracts can serve as a suitable antibiotic. However, further studies need to be conducted on the antimicrobial effects of ginger extracts on other bacterial species.
Challenges in estimating waning effectiveness of two doses of BNT162b2 and ChAdOx1 COVID-19 vaccines beyond six months: an OpenSAFELY cohort study using linked electronic health records
Authors: Horne Elsie MF , Hulme William J , Keogh Ruth H , Palmer Tom M , Williamson Elizabeth J , Parker Edward PK , Walker Venexia M , Knight Rochelle , Wei Yinghui , Taylor Kurt , Fisher Louis , Morley Jessica , Mehrkar Amir , Dillingham Iain , Bacon Sebastien , Goldacre Ben , Sterne Jonathan AC ,   The OpenSAFELY Collaborative
Published: January 2023

Quantifying the waning effectiveness of second COVID-19 vaccination beyond six months and against the omicron variant is important for scheduling subsequent doses. With the approval of NHS England, we estimated effectiveness up to one year after second dose, but found that bias in such estimates may be substantial.
Mechanistic view on the influence of fluctuations in outdoor temperature on the worsening of the course of the disease and hospitalizations associated with the SARS-CoV-2 Omicron wave in 2022 in the Tomsk region, Russia
Authors: Ishmatov A.N. , Bart A.A. , Yakovlev S.V.
Published: January 2023

It is well known that low air temperatures negatively affect the human respiratory system and can suppress protective mechanisms in airways epithelial cells.

In this study, we put forward the hypothesis that the ‘compromised airway epithelium’ of infected persons can be extremely sensitive to external influences and therefore can be used as an “indicator” and serve to investigate the impact of low air temperatures (as and other external factors) on the respiratory system.

Here we supposed that a short-term impact of drop in outdoor temperature on the ‘compromised airway epithelium’ should lead to increased symptoms and severity of the disease.

We have analyzed a short-term impact of the air temperature drop on the worsening of disease in patients with COVID-19 (indicated by bursts of daily hospitalizations), which fell on the main epidemic wave in 2022 associated with SARS-CoV-2 Omicron variant.

It was found that even a small and/or short-term impact of drop in outdoor daily temperatures can lead to increased symptoms and severity of the disease (COVID-19).

We have identified 14 characteristic points (days) where the temperature drop was more than 3 degrees during the main pandemic wave in 2022. It was shown that each characteristic points clearly associated with characteristic bursts in the number of daily hospitalizations with a time lag of 1-2 days.

Thus, it was found that the results of the study can be used in predicting a sudden increase in the number of hospitalizations, which can be used to timely warn clinics and medical hospitals for an increase in the number of seriously ill patients.

The findings can be used to improve systems to prevent additional risks connected with impact of drop in air temperature on worsening disease in patients and infected people who do not have or have mild or subtle symptoms of the disease – especially during an epidemic or pandemic wave.
Sero-prevalence of visceral leishmaniasis and its associated factors among asymptomatic pastoral community in Denan district, southeastern Ethiopia
Authors: Ismail Ahmed , Yared Solomon , Dugassa Sisay , Abera Adugna , Animut Abebe , Erko Berhanu , Gebresilassie Araya
Published: January 2023

Background

In the Somali region of Ethiopia, visceral leishmaniasis (VL) is a public health concern. Yet, epidemiology and sand fly vectors of VL were not well studied in various areas of the regional state. Thus, the current study was conducted to determine the sero-prevalence, associated factors and distribution sand fly vectors of VL in Denan district, south-eastern Ethiopia.

Methods

A cross-sectional study was conducted among 187 households between May and September 2021 in six selectedKebelesof Denan district. In total, 187 blood samples were collected from individuals who visited Denan health center using a simple random sampling technique. Blood samples were subjected to Direct Agglutination Test for the detection of antibodies to VL. Pretested structured questionnaire was used to gather information on individual and household level risk factors and other characteristics of knowledge and attitude assessment. Sand flies were also collected from different sampling habitats using light and sticky traps.

Results

The overall sero-prevalence rate was 9.63% (18/187). Sero-prevalence was significantly associated with outdoor sleeping (OR=2.094), presence of damp floor (OR=9.732), and presence of cracked house walls (OR=6.283). Nearly half (53.48%) of the study participants had previously heard about VL. Communities were practicing different methods to prevent VL infection. In total, 823 sand fly specimens comprising 12 species in two genera (PhlebotomusandSergentomyia) were trapped and identified. The most abundant species wasS Sergentomyia clydei(50.18%), followed byPhlebotomus orientalis(11.42%).

Conclusion

The study demonstrated a relatively higher sero-positivity of VL in this new focus, and a remarkable gap in the knowledge, attitude and practices towards VL.P. orientaliswas also detected, which could be a probable vector in this new focus. Thus, public education should be prioritized to improve the awareness of the community on VL and its public health impact. In addition, detailed epidemiological and entomological studies are recommended.
Cross-cultural adaptation of the Arabic version of the Waterloo Footedness Questionnaire-Revised: WFQ-Ar
Authors: Aldaihan Mishal M.
Published: January 2023

Background and purpose

Evaluating footedness is of great importance to clinical and behavioural research. The purpose of the current study is to translate the Waterloo Footedness Questionnaire-Revised (WFQ-R) to the Arabic language and investigate its psychometric properties.

Methods

Two independent forward translations were performed by two native Arabic speakers; and then synthesized into one version. The synthesized version was back translated into English by two independent bilingual translators. An expert committee was formed to review the translation and adaptation process. A final Arabic version of the WFQ-R was obtained. In order to test the internal consistency, reliability, and validity of the Arabic WFQ-R, adult Arabic speakers were recruited to participate in this study.

Results

For the cross-cultural adaptation, only one item was changed in order to express its conceptual meaning. Analysis showed an absence of floor and ceiling effect for the Arabic WFQ-R. Results of construct validity showed that all items of the translated WFQ-R have one dimension. For internal consistency of the Arabic WFQ-R, Cronbach’s alpha was excellent (0.93). ICC values showed excellent test-retest reliability (0.94). The Bland-Altman plot showed acceptable agreement between test and retest scores.

Conclusion

The Arabic WFQ-R is valid, reliable and ready for use among the Arabic speaking population for determining footedness.