bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk assessment in systemic lupus erythematosus-associated pulmonary arterial hypertension: CSTAR-PAH cohort study
Authors: Wang Qian , Qian Junyan , Li Mengtao , Zhang Xiao , Wei Wei , Zuo Xiaoxia , Zhu Ping , Ye Shuang , Zhang Wei , Zheng Yi , Qi Wufang , Li Yang , Zhang Zhuoli , Ding Feng , Gu Jieruo , Liu Yi , Huang Can , Zhao Jiuliang , Liu Yongtai , Tian Zhuang , Wang Yanhong , Zhang Miaojia , Zeng Xiaofeng
Published: July 2022

Objective:

This study evaluated the prognostic value of the multivariable risk assessment for systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH).

Methods:

A multicenter prospective cohort of SLE-associated PAH (CSTAR-PAH cohort) diagnosed based on right heart catheterization (RHC) was established. Baseline and follow-up records were collected. Three methods of risk assessment, including (1) the number of low-risk criteria, based on World Health Organization functional class (WHO FC), 6-min walking distance (6MWD), right atrial pressure (RAP), and cardiac index (CI); (2) the three-strata stratification based on the average risk score of four variables (WHO FC, 6MWD, RAP, and CI); and (3) the four-strata stratification based on COMPARE 2.0 model were applied. A risk-assessment method using three noninvasive low-risk criteria was applied at the first follow-up visit. Survival curves between patients with different risk groups were compared by Kaplan–Meier’s estimation and log-rank test.

Results:

Three-hundred and ten patients were enrolled from 14 PAH centers. All methods of stratification at baseline and first follow-up significantly discriminated long-term survival. Survival rates were also significantly different based on the noninvasive risk assessment in first follow-up visit. Survival deteriorated with the escalation of risk from baseline to first follow-up. Patients with baseline serositis had a higher rate of risk improvement in their follow-up.

Conclusion:

The risk assessment has a significant prognostic value at both the baseline and first follow-up assessment of SLE-associated PAH. A noninvasive risk assessment can also be useful when RHC is not available during follow-up. Baseline serositis may be a predictor of good treatment response in patients with SLE-associated PAH.
Adolescents’ opinions on the use of a smartphone application as an oral health education tool: A qualitative study
Authors: Ab Mumin Nazirah , Yusof Zamros Yuzadi Mohd , Marhazlinda Jamaludin , Obaidellah Unaizah
Published: July 2022

Developing health-related smartphone applications for oral health education should consider the end-user's perspectives to ensure they will be usable. This study aimed to explore the opinions of secondary school students in Selangor, Malaysia regarding the use of a smartphone application for oral health education and to identify the features for an oral health education smartphone application from the perspectives of adolescents. Focus group discussions were conducted among Form Two (14-year-old) and Form Four (16-year-old) students from selected government secondary schools in Selangor utilising a semi-structured topic guide until data saturation was achieved. Data were analysed using framework analysis. Ten focus group discussions were conducted involving 77 participants. Mixed opinions were recorded on the use of health-related smartphone applications for oral health education. The preferred features in a health-related smartphone application are disease detection, have games and rewards, educational and fun, access to a dentist, reminders, and user-friendliness. Adolescents are aware of the positive aspect of using health-related smartphone applications for oral health education; however, they are wary of the need to install one. Nevertheless, identifying adolescents’ preferred features of an oral health education app is the first step in developing an application tailored to their needs. Smartphone application could be a timely strategy to improve oral health education delivery and behaviour improvement for this age group.
“Saving Our Boys!”: Do Chinese Boys Have a Masculinity Crisis?
Authors: Zhu (祝刚) Gang , Zhang (张爱东) Aidong , Cheng (程力) Li , Shi (史可媛) Keyuan , Wang (王语婷) Yuting
Published: July 2022

Highlights

The issue of the boy (masculinity) crisis was examined in both the global and Chinese contexts. To examine the authenticity of the masculinity crisis in China, we first historicized the debate on the boy crisis between Yunxiao Sun (孙云晓) and An'qi Xu (徐安琪) in China and its implications. Then, we examined the contributing factors to the masculinity crisis from the social-ecological perspective, which encompasses the familial (helicopter parenting style), educational (burdensome academic pressure), and societal (feminine and misleading social media) factors. We concluded that the Chinese masculinity crisis has evolved into a socio-cultural issue in recent years. We suggest the potentials of gender-relevant pedagogy and the collective capability among various stakeholders in addressing the boy crisis.
Clustering of Social Determinants of Health Among Patients
Authors: Schiltz Nicholas K. , Chagin Kevin , Sehgal Ashwini R.
Published: July 2022

Introduction/Objectives:

Many health systems screen patients for social determinants of health and refer patients with social needs to community organizations for assistance. Understanding how social determinants cluster together may help guide assistance programs.

Methods:

This study examined patients screened by The MetroHealth System in Cleveland, Ohio for 9 social determinants, including food insecurity, financial strain, transportation limitations, inability to pay for housing or utilities, intimate partner violence, social isolation, infrequent physical activity, daily stress, and lack of internet access. Clustering analyses were performed to determine which combination of social determinants occurred together more often than would be expected if each determinant were independent of each other.

Results:

Among 23 161 screened patients, there were 19 dyads, 13 triads, and one tetrad of social determinants that clustered together. The most prevalent triad of food insecurity, social isolation, and inability to pay for housing or utilities occurred among 1095 patients but would be expected to occur among 284 patients, for an observed/expected ratio of 3.85 (95% confidence interval 3.64-4.07). In multivariate analyses, younger, Black, and lower income patients were 2 to 3 times more likely to have this triad compared to older, White, and wealthier patients.

Conclusions:

Social determinants of health frequently cluster together, and such clustering is associated with patient demographic characteristics. Further work is needed to determine how social determinant clusters impact health and cost outcomes and to develop programs that can address multiple co-existing social needs.
Postoperative Opioid Use and Prescribing Patterns among Patients Undergoing Cervical Laminectomy with Instrumented Fusion versus Cervical Laminoplasty with Reconstruction
Authors: Shankar Dhruv S. , Kim Jinseong , Bienstock Dennis M. , Gao Michael , Lee Yunsoo , Zubizarreta Nicole J. , Poeran Jashvant , Lin James D. , Chaudhary Saad B. , Hecht Andrew C.
Published: July 2022

Study Design

Retrospective cohort study.

Objective

To compare patterns in opioid usage and prescriptions between patients who undergo cervical laminectomy with instrumented fusion (LF) vs cervical laminoplasty with reconstruction (LP) within single surgeon and national database cohorts.

Methods

We identified patients with cervical myelopathy undergoing primary LF or LP in both a single-surgeon series cohort (2004-2018) and a nationally representative cohort drawn from the IBM® Marketscan® database (2014-2016). We recorded opioid usage within 6 months of surgery and identified differences in unadjusted opioid use rates between LF and LP patients. Multivariable logistic regression was used to evaluate the association between procedure type and postoperative opioid use.

Results

Without adjusting for covariates, LF patients had a higher rate of 6-month opioid use in the single-surgeon cohort (15.7% vs 5.1%, P = .02). After adjusting for covariates, LF patients had higher odds of 6-month postoperative opioid use (OR 2.8 [95% CI 1.0-7.7], P = .04). In the national cohort, without adjusting for covariates, there was no significant difference in 6-month opioid use between LF and LP patients. Even after adjusting for covariates, we found no significant difference in odds.

Conclusions

Findings from a single-surgeon cohort reveal that LF is associated with a higher rate of 6-month opioid use than LP. This is at odds with findings from a national database cohort, which suggested that LP and LF patients have similar rates of opioid usage at 6-months postoperatively. To prevent overuse of narcotics, surgeons must consider the distinct pain requirements associated with different procedures even in treatment of the same condition.
Impact of “Distance” on Corporate Social Responsibility: Evidence from an Emerging Market
Authors: Yadav Kartik , Tokas Kalpana
Published: July 2022

Multinational enterprises resort to several market and nonmarket strategies to overcome the liability of foreignness (LOF) faced by them in overseas markets. A lesser explored nonmarket strategy to overcome LOF and gain legitimacy in the host country is through corporate social responsibility (CSR) expenditure. This paper empirically examines the role of “distance” on the CSR practices of foreign subsidiaries in India. Further, the study explores the role of market potential of the emerging market host country as proxied by the Gross Domestic Product in moderating the relation between distance variables and CSR expenditure. Our sample consists of CSR expenditure data of 69 foreign subsidiaries in India from 17 countries over the period from 2014 until 2018. The results show that cultural and economic distances impact the CSR expenditure of foreign subsidiaries positively and significantly. This relationship is negative and significant for administrative distance and insignificant for the case of geographic distance. Furthermore, it is observed that the market potential of the host country can make the foreign subsidiaries overlook the existence of distances.
Does Trust Mediate in Corporate Social Responsibility (CSR) and Brand Equity Nexus? Empirical Evidence from the Banking Sector
Authors: Jannat Muhsina , Haque Md. Mahmudul , Chowdhury Mohammad Ashraful Ferdous
Published: July 2022

The purpose of this study is to examine the role of trust on the CSR and brand-equity nexus in the banking sector of Bangladesh. Using the convenient sampling method and structured questionnaire, the study conducted an online survey of 275 customers of private commercial banks from Bangladesh. This study applied structural equation modelling (SEM) to define the complete structural model to analyse the direct and indirect relationships between study constructs. The results reveal a positive and significant impact of CSR on brand equity. Regarding the mediating effect of trust, the study found a significant impact of trust on the CSR components and the brand-equity nexus. The study’s outcomes enrich the existing literature as a dimension of trust is added as mediating effect on the CSR and brand equity relationship in Bangladesh.
Beamforming and Single-Microphone Noise Reduction: Effects on Signal-to-Noise Ratio and Speech Recognition of Bimodal Cochlear Implant Users
Authors: Stronks H. Christiaan , Briaire Jeroen J. , Frijns Johan H.M.
Published: July 2022

We have investigated the effectiveness of three noise-reduction algorithms, namely an adaptive monaural beamformer (MB), a fixed binaural beamformer (BB), and a single-microphone stationary-noise reduction algorithm (SNRA) by assessing the speech reception threshold (SRT) in a group of 15 bimodal cochlear implant users. Speech was presented frontally towards the listener and background noise was established as a homogeneous field of long-term speech-spectrum-shaped (LTSS) noise or 8-talker babble. We pursued four research questions, namely: whether the benefits of beamforming on the SRT differ between LTSS noise and 8-talker babble; whether BB is more effective than MB; whether SNRA improves the SRT in LTSS noise; and whether the SRT benefits of MB and BB are comparable to their improvement of the signal-to-noise ratio (SNR). The results showed that MB and BB significantly improved SRTs by an average of 2.6 dB and 2.9 dB, respectively. These benefits did not statistically differ between noise types or between the two beamformers. By contrast, physical SNR improvements obtained with a manikin revealed substantially greater benefits of BB (6.6 dB) than MB (3.3 dB). SNRA did not significantly affect SRTs per se in omnidirectional microphone settings, nor in combination with MB and BB. We conclude that in the group of bimodal listeners tested, BB had no additional benefits on speech recognition over MB in homogeneous noise, despite the finding that BB had a substantial larger benefit on the SNR than MB. SNRA did not improve speech recognition.
Is There a Bamboo Ceiling? The Asian-White Gap in Managerial Attainment for College-Educated Workers
Authors: Shao Di
Published: July 2022

While public perceptions allege the existence of a “bamboo ceiling,” that is, a disadvantage in managerial attainment experienced by Asian workers, academic research on this question is relatively scarce and provides inconsistent findings. This study proposes that the opportunity of achieving managerial positions varies not only between White and Asian workers, but also across Asian subgroups defined by their place of birth and education. Using the data from the 2017 National Survey of College Graduates, this study finds significant inequalities in the probabilities of managerial attainment among Asians. Foreign-born Asians who have received no American education or only higher education in the United States are significantly disadvantaged relative to U.S.-born Whites and other Asians. This study also shows that this pattern of inequality associated with the place of one’s education is more salient among East Asian immigrants than among their counterparts from South Asia. These findings extend and enrich the theoretical understanding of the shaping of the “bamboo ceiling” and suggest directions of future studies.
“Sometimes You're Going to Be Uncomfortable”: Pre-service Elementary Teachers’ Generative Orientations Toward Facilitating Critical Conversations Around Texts
Authors: Diaz Amanda R. , Schutz Kristine M. , Woodard Rebecca
Published: July 2022

Grounded in our commitment to support preservice teachers (PSTs) in an urban elementary teacher education program to develop anti-bias pedagogies, we engaged in a design-based study aimed at enacting critical conversations about texts that foster dialogue about power and privilege. In this analysis, we explore how PSTs engaged with children during discretionary moments within critical conversations in their field placements. We asked: What generative orientations are visible in PSTs’ analysis of and reflection on their facilitation of critical conversations with children? Findings reveal that PSTs who extended dialogue during these moments in critical conversations—rather than avoiding or ignoring children’s contributions—displayed an orientation toward seeing children as sensemakers; flexibly responded to encourage dialogue; and recognized the value of feeling uncomfortable.
Between Hip Hop and Me: Podcast Process Texts as Tools of Cultural Brokerage for Community Cultural Wealth
Authors: Griffith Jason J. , Celaya Anthony S. , Sweet Joseph D.
Published: July 2022

This research features a discourse analysis of two podcasts: the “Mobb Deep, Shook Ones, Pt. II” episode of Song Exploder and the “Rap on Trial” episode of Hidden Brain. We selected these podcasts through an abductive method of what we call “fortuitous listening” because of how they reveal community cultural wealth (CCW) through their descriptions of the creative process. Specifically, our study addressed two questions: (1) What does an examination of two Hip Hop podcast process texts reveal about CCW? (2) How could a discussion of the CCW that is revealed through descriptions of creative process inform literacy practices? Findings demonstrate how linguistic, familial, navigational, and aspirational capital exhibited in first-person descriptions of rap composition helped to showcase Hip Hop texts as what Bettina Love calls a “complex personhood” well-beyond simplified or stereotypical critiques. Because of how these process texts demonstrate the ways that Hip Hop feature Alim's ill-literacies criteria of being based on intimate, lived, and liberatory experiences, we posit them to be effective tools of cultural brokerage, particularly for educators wishing to enact Hip Hop-Based Education.
Computed tomographic perfusion abnormalities in acute migraine with aura: Characteristics and comparison with transient ischemic attack
Authors: Strambo Davide , Nannoni Stefania , Rebordão Leonor , Dunet Vincent , Michel Patrik
Published: July 2022

Introduction:

Migraine with aura (MA) accounts for up to 10% of “stroke mimics” and can present cerebral perfusion abnormalities. We aimed to compare perfusion-CT (PCT) findings in acute-onset MA mimicking an ischemic stroke with those observed in transient ischemic attack (TIA).

Methods:

We retrospectively studied patients admitted to our hospital between 2002 and 2014 with suspicion of acute ischemic stroke, having PCT and receiving a final diagnosis of MA. We visually assessed PCT for the presence and extent of focal hypoperfusion (FHP). MA patients with FHP were compared with consecutive TIA patients showing FHP. We performed both qualitative and quantitative analysis of PCT.

Results:

Of 47 patients with MA (median age = 33 years, 55% females), 16 (34%) displayed FHP. Compared to MA patients without FHP, MA patients with FHP had similar headaches and aura features, but a less frequent history of MA ( p = 0.010). Compared to 74 TIA patients with FHP (median age = 69 years, 43% females), MA patients with FHP showed hypoperfusion that more frequently involved adjacent vascular territories or a whole hemisphere ( p < 0.001). In addition, hypoperfusion in MA patients had a less pronounced increase in rMTT (1.2 vs 1.8, p < 0.001) and rTTP (1.1 vs 1.2, p < 0.001), and a lesser decrease in rCBF (0.8 vs 0.6, p < 0.001) compared to hypoperfusion in TIA. rMTT displayed the best discriminative ability to differentiate MA from TIA.

Conclusion:

Focal perfusion abnormalities in acute MA often involve adjacent vascular territories and hypoperfusion is less pronounced than in TIA. MA can be best differentiated from TIA by a smaller rMTT increase.
Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery and Higher Ambulation Rates Than Below-Knee Amputation
Authors: Ordaz Angel , Trimm Conner , Pedowitz Jason , Foran Ian M.
Published: July 2022

Background:

Selecting the level of amputation for patients with severe foot pathology can be challenging. The surgeon is sometimes confronted with an option between transmetatarsal amputation (TMA) and below-knee amputation (BKA). Recent studies have suggested that minor foot amputations have high revision rates and need for higher level of amputation. This study sought to compare the revision rates, need for higher level of amputation, postoperative ambulatory rate, and the demographic factors between these 2 operations.

Methods:

We retrospectively reviewed the records of patients undergoing either BKA or TMA at a single academic institution during an 8-year period. Demographic characteristics and medical history were collected and included in a binary logistic regression model to evaluate for independent predictors of needing revision surgery or needing higher-level amputation. Secondary outcomes included ambulatory status and wound status at last follow-up.

Results:

There was a total of 367 patients who underwent either BKA (n=293) or TMA (n=74). On binary logistic regression, the only significant independent predictor of needing revision surgery was undergoing TMA (odds ratio [OR] 2.30, CI 1.199-4.146, P = .011). The presence of PAD trended toward significance (OR 2.12, CI 0.99-4.493, P = .051). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.117, CI 1.9-8.9, P < .001) and presence of PAD (OR 4.85, CI 1.59-14.85, P = .006). More TMA patients were ambulatory (56.8%) on last follow-up compared with BKA patients (30.9%).

Conclusion:

Transmetatarsal amputation has a higher risk of reoperation and need for revision amputation compared with below-knee amputation. Transmetatarsal amputation has a higher chance of returning patients to independent ambulation. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations.

Level of Evidence:

Level III, retrospective case review.
At the Root of 3 “Long” Diseases: Persistent Antigens Inflicting Chronic Damage on the Brain and Other Organs in Gulf War Illness, Long-COVID-19, and Chronic Fatigue Syndrome
Authors: James Lisa M , Georgopoulos Apostolos P
Published: July 2022

Several foreign antigens such as those derived from viruses and bacteria have been linked to long-term deleterious effects on the brain and other organs; yet, health outcomes subsequent to foreign antigen exposure vary depending in large part on the host’s immune system, in general, and on human leukocyte antigen (HLA) composition, in particular. Here we first provide a brief description of 3 conditions characterized by persistent long-term symptoms, namely long-COVID-19, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and Gulf War Illness (GWI), followed by a brief overview of the role of HLA in the immune response to foreign antigens. We then discuss our Persistent Antigen (PA) hypothesis and highlight associations between antigen persistence due to HLA-antigen incongruence and chronic health conditions in general and the 3 “long” diseases above in particular. This review is not intended to cover the breadth and depth of symptomatology of those diseases but is specifically focused on the hypothesis that the presence of persistent antigens underlies their pathogenesis.
The discipline that came in from the cold: American human geography becomes a Cold War social science
Authors: Barnes Trevor J
Published: July 2022

The high–Cold War period – from the Truman doctrine to the Cuban missile crisis – brought not only profound changes in geography but also profound changes to Geography. The discipline moved from a museum-like, fusty subject to aspiring to be a Cold War, cutting-edge hybrid social science (or behavioural science) ‘cross-bred’ with physical and applied sciences. The vehicle was social physics. Its origins were in the 17th century, but the actual name was not coined until 1835 and then in French, ‘Physique Sociale’, by the Belgian astronomer, statistician and social tabulator, Adolphe Quetelet (1796–1874). As a project, social physics rested on the belief of monism in which the same formal explanatory scientific principles held in both natural and social worlds. In the particular case of Cold War geography, monism meant asserting that specifically Newtonian equations describing the movements of celestial bodies in the heavens could explain equally as well movements of human bodies down on earth. In American human geography, social physics was pioneered from the early 1950s by William Warntz, who collaborated early on with the Princeton astrophysicist, John Stewart, who, in turn, had previously worked with the Harvard linguist, George Zipf. Together Warntz and Stewart using home-made early computing devices and drawing on Newtonian formulations of potential cast geography as social physics, extolling its virtues as ‘macrogeography’ and on par with other disciplines that already had entered the Pantheon of Cold War social science.
Consensus clustering for Bayesian mixture models
Authors: Coleman Stephen , Kirk Paul D. W. , Wallace Chris
Published: July 2022

Background

Cluster analysis is an integral part of precision medicine and systems biology, used to define groups of patients or biomolecules. Consensus clustering is an ensemble approach that is widely used in these areas, which combines the output from multiple runs of a non-deterministic clustering algorithm. Here we consider the application of consensus clustering to a broad class of heuristic clustering algorithms that can be derived from Bayesian mixture models (and extensions thereof) by adopting an early stopping criterion when performing sampling-based inference for these models. While the resulting approach is non-Bayesian, it inherits the usual benefits of consensus clustering, particularly in terms of computational scalability and providing assessments of clustering stability/robustness.

Results

In simulation studies, we show that our approach can successfully uncover the target clustering structure, while also exploring different plausible clusterings of the data. We show that, when a parallel computation environment is available, our approach offers significant reductions in runtime compared to performing sampling-based Bayesian inference for the underlying model, while retaining many of the practical benefits of the Bayesian approach, such as exploring different numbers of clusters. We propose a heuristic to decide upon ensemble size and the early stopping criterion, and then apply consensus clustering to a clustering algorithm derived from a Bayesian integrative clustering method. We use the resulting approach to perform an integrative analysis of three ’omics datasets for budding yeast and find clusters of co-expressed genes with shared regulatory proteins. We validate these clusters using data external to the analysis.

Conclustions

Our approach can be used as a wrapper for essentially any existing sampling-based Bayesian clustering implementation, and enables meaningful clustering analyses to be performed using such implementations, even when computational Bayesian inference is not feasible, e.g. due to poor exploration of the target density (often as a result of increasing numbers of features) or a limited computational budget that does not along sufficient samples to drawn from a single chain. This enables researchers to straightforwardly extend the applicability of existing software to much larger datasets, including implementations of sophisticated models such as those that jointly model multiple datasets.
Impact of COVID-19 lockdown on physical exercise among participants receiving the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention: a repeated measure study
Authors: Di Lorito Claudio , van der Wardt Veronika , O’Brien Rebecca , Gladman John , Masud Tahir , Harwood Rowan H.
Published: July 2022

Background

The potential decrease in daily physical activity associated with the COVID-19 pandemic lockdowns may have a negative impact on people living with dementia. Given the limited literature around the effects of home confinement in people living with dementia, this study investigated changes in physical exercise levels of participants in the intervention arm of the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) Randomised Controlled Trial during the first COVID-19 national lockdown. It hypothesised that participants would maintain physical exercise levels.

Methods

A repeated measure (three time points) study involving 30 participants (mean age = 78.0 years, 15 male and 15 female, 22 (73.0%) living with their primary caregiver), from four regions in England receiving the PrAISED intervention. PrAISED is an individually tailored intervention of physical exercises and functional activities. Trained therapists deliver therapy sessions over a period of 52 weeks. Study participants received therapy sessions via phone or video calling during the COVID-19 lockdown. This study investigated self-reported minutes of physical exercise recorded on study calendars for the months of February (i.e., baseline – pre-lockdown), May (i.e., T1 – during lockdown), and August (i.e., T2—post-lockdown) 2020.

Results

Participants reported a statistically significant increase in activity levels between February and May (Wilcoxon Z = -2.013,p = 0.044) and a statistically significant decrease between May and August (Wilcoxon Z = -2.726,p = 0.004). No significant difference was found in the physical activity levels from pre- to post-lockdown (Wilcoxon Z = 0.485,p = 0.620).

Conclusion

Despite concerns that the restrictions associated with the COVID-19 pandemic might lead to reductions in physical exercise, participants in receipt of the PrAISED intervention increased their amount of physical exercise during lockdown. Our findings support the potential of remote support for people living with dementia to help them maintain physical exercise levels in circumstances where face-to-face service provision is not possible.

Trial registration

The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee.

The Clinical Trial Identifier for PrAISED is: ISRCTN15320670 (https://doi.org/10.1186/ISRCTN15320670). Registration was made on 04/09/2018.
Dynamic molecular choreography of circadian rhythm disorders (DMCRD): a prospective cohort study protocol
Authors: Chen Xiaoli , Li Dongze , Jia Yu , Liu Yanmei , Ma Yan , Zeng Rui , Wan Zhi , Ye Lei
Published: July 2022

Background

Circadian rhythm disorders (CRDs) are closely associated with the occurrence and development of various diseases, such as inflammatory and cardiovascular diseases, as well as tumors. The impact of a CRD on bodily health is a complex and comprehensive process, and its molecular mechanisms and signaling pathways are still unclear. We therefore aimed to investigate the molecular mechanism variation and adverse outcomes associated with CRDs in a prospective cohort of CRD cases and controls at term using multiomics data. The study has been tasked with developing a precise health promotion model for the prevention and management of CRDs.

Methods

This will be a 5-year prospective cohort study centered on the health management of individuals with CRDs. One hundred volunteers were recruited and had undergone baseline specimen collection, health examination, and health assessment. All of them will be followed up every year using the same protocol, and their biological specimens will be subjected to multiomics analysis after standardized processing.

Discussion

Longitudinal health examination, health assessment, and multiomics data will be analyzed to study the impact of CRDs on the volunteers’ health status. The results of this study will promote the development of targeted health management programs based on precision medicine.

Trial registration

The clinical study registration has been completed (Trial Registration No. ChiCTR2100047242).
Relationship of caffeine regimen with osteopenia of prematurity in preterm neonates: a cohort retrospective study
Authors: Kumar Manoj , Ali Amin , Khan Muhammad Azeem , Sohail Sadia , Saleem Syed Muzafar , Khan Midhat , Naz Fizzah , Khan Wasif Ahmed , Salat Muhammad Sohail , Hussain Kashif , Ambreen Gul
Published: July 2022

Background

Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life.

Methods

This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression.

Results

From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified.

Conclusion

The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.
Assessing the potential determinants of national vitamin A supplementation among children aged 6–35 months in Ethiopia: further analysis of the 2019 Ethiopian Mini Demographic and Health Survey
Authors: Lucha Tadele Abate , Engida Teklu Assefa , Mengistu Admassu Ketsela
Published: July 2022

Background

Vitamin A is a nutrient that is required in a small amount for normal visual system function, growth and development, epithelia’s cellular integrity, immune function, and reproduction. Vitamin A has a significant and clinically important effect since it has been associated with a reduction in all-cause and diarrhea mortality. The aim of this study was to determine factors associated with national vitamin A supplementation among children aged 6–35 months.

Method

The data for this study was extracted from the 2019 Ethiopian Mini Demographic and Health Survey. A total weighted sample of 2242 women with children aged 6–35 months was included in the study. The analysis was performed using Stata version 14.2 software. Applying sampling weight for descriptive statistics and complex sample design for inferential statistics, a manual backward stepwise elimination approach was applied. Finally, statistical significance declared at the level of p value < 0.05.

Result

The overall coverage of vitamin A supplementation among children aged 6–35 months for the survey included was 44.4 95% CI (40.15, 48.74). In the multivariable analysis, mothers who had four or more antenatal visits [AOR = 2.02 (95% CI: 1.34, 3.04)] were two times more likely to receive vitamin A capsules for their children than mothers who had no antenatal visits. Children from middle-wealth quintiles had higher odds of receiving vitamin A capsules in comparison to children from the poorest wealth quintile [AOR = 1.77 (95% CI: 1.14, 2.73)]. Older children had higher odds of receiving vitamin A capsules than the youngest ones. Other factors that were associated with vitamin A supplementation were mode of delivery and region.

Conclusion

The coverage of vitamin A supplementation in Ethiopia remains low and it is strongly associated with antenatal visit, household wealth index and age of child. Expanding maternal health services like antenatal care visits should be prioritized.
The Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment (PROSPECTS) study: protocol for an inception cohort study
Authors: Rundell Sean D. , Saito Ayumi , Meier Eric N. , Danyluk Stephanie T. , Jarvik Jeffrey G. , Seebeck Kelley , Friedly Janna L. , Heagerty Patrick J. , Johnston Sandra K. , Smersh Monica , Horn Maggie E. , Suri Pradeep , Cizik Amy M. , Goode Adam P.
Published: July 2022

Background

Lumbar spinal stenosis (LSS) is a common degenerative condition that contributes to back and back-related leg pain in older adults. Most patients with symptomatic LSS initially receive non-operative care before surgical consultation. However, there is a scarcity of data regarding prognosis for patients seeking non-surgical care. The overall goal of this project is to develop and evaluate a clinically useful model to predict long-term physical function of patients initiating non-surgical care for symptomatic LSS.

Methods

This is a protocol for an inception cohort study of adults 50 years and older who are initiating non-surgical care for symptomatic LSS in a secondary care setting. We plan to recruit up to 625 patients at two study sites. We exclude patients with prior lumbar spine surgeries or those who are planning on lumbar spine surgery. We also exclude patients with serious medical conditions that have back pain as a symptom or limit walking. We are using weekly, automated data pulls from the electronic health records to identify potential participants. We then contact patients by email and telephone within 21 days of a new visit to determine eligibility, obtain consent, and enroll participants. We collect data using telephone interviews, web-based surveys, and queries of electronic health records. Participants are followed for 12 months, with surveys completed at baseline, 3, 6, and 12 months. The primary outcome measure is the 8-item PROMIS Physical Function (PF) Short Form. We will identify distinct phenotypes using PROMIS PF scores at baseline and 3, 6, and 12 months using group-based trajectory modeling. We will develop and evaluate the performance of a multivariable prognostic model to predict 12-month physical function using the least absolute shrinkage and selection operator and will compare performance to other machine learning methods. Internal validation will be conducted using k-folds cross-validation.

Discussion

This study will be one of the largest cohorts of individuals with symptomatic LSS initiating new episodes of non-surgical care. The successful completion of this project will produce a cross-validated prognostic model for LSS that can be used to tailor treatment approaches for patient care and clinical trials.
Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis
Authors: Laios Alexandros , Otify Mohamed , Papadopoulou Argyro , Gallos Ioannis D. , Ind Thomas
Published: July 2022

Background

Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice.

Methods

A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy.

Results

There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83–100), 89% (95% CI 80–99) of women who did not develop ovarian cysts, and 99% (95% CI 1–5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76–113), 84% (95% CI 69–103) of women who did not develop ovarian cysts, and 99% (95% CI 82–120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55–69), and 95% (95% CI 85–107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group.

Conclusions

In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
Potential inequities in availability of care from breast care nurses: a qualitative study reporting the experiences and perspectives of women with metastatic breast cancer in Australia
Authors: Smith Andrea L. , Boyle Frances , Lewis Sophie
Published: July 2022

Background

International consensus guidelines recommend patients with metastatic breast cancer have access to a nurse experienced in the treatment of metastatic breast cancer. This study aimed to explore women’s experiences of supportive care from breast care nurses, including their perspectives on the role breast care nurses currently play in providing support to people with metastatic breast cancer.

Methods

Multiple semi-structured qualitative interviews with 38 women with metastatic breast cancer in Australia. Data relating to nursing care were extracted and analysed using thematic analysis.

Results

Three themes were identified: (1) feeling that supportive care needs are unrecognised; (2) confusion about role and relevance of breast care nurse to those with metastatic breast cancer; (3) care from metastatic breast care nurses (when available) was appreciated, valued and beneficial. Participants’ experiences differed in relation to ease of access to, amount of contact with, and level of care provided by breast care nurses. Contact and care ranged from little or none to comprehensive and ongoing. A key system-level challenge was that the diversity of diagnostic and treatment pathways for metastatic breast cancer meant that no systematic means existed to support routine or regular contact between breast care nurses and participants. Participants who did report having access to a specialised metastatic breast care nurse placed considerable value on the care received. For these participants, care from the breast care nurse extended and complemented care from the oncologist and included much needed psychosocial and practical support. For these participants, the breast care nurse assumed the role of key contact and care coordinator and was valued for their availability, accessibility and responsiveness. High levels of trust developed between patient and breast care nurse.

Conclusions

Findings indicate that there may be gaps and inequities in supportive care in Australia for people diagnosed with metastatic breast cancer, a finding that supports earlier reports of limited access to breast care nurses for people with metastatic breast cancer in Australia. The specialised metastatic breast care nurse could potentially play a key role in addressing the high level of unmet supportive care needs and improve continuity of care for these patients.
Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis
Authors: Bohle Leah F. , Abdallah Ally-Kebby , Galli Francesco , Canavan Robert , Molesworth Kate
Published: July 2022

Background

Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.

Methods

A situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014.

Results

Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.

Conclusions

Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.