bluuebunny/crossref_metadata_2025 huggingface dataset:
Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities
Authors: Ong-Artborirak Parichat , Seangpraw Katekaew , Boonyathee Sorawit , Auttama Nisarat , Winaiprasert Prakaipetch
Published: May 2023

Background

Properly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities.

Methods

A cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c).

Results

The mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%).

Conclusion

Diabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.
Time course of neuroinflammation after human stroke – a pilot study using co-registered PET and MRI
Authors: D’Anna Lucio , Searle Graham , Harvey Kirsten , Matthews Paul M. , Veltkamp Roland
Published: May 2023

Background

Microglial activation contributes to both inflammatory damage and repair in experimental ischemic stroke. However, because of the logistical challenges, there have been few clinical imaging studies directly describing inflammatory activation and its resolution after stroke. The purpose of our pilot study was to describe the spatio-temporal profile of brain inflammation after stroke using 18kD translocator protein (TSPO) positron emission tomography (PET) with magnetic resonance (MR) co-registration in the subacute and chronic stage after stroke.

Methods

Three patients underwent magnetic resonance imaging (MRI) and PET scans with TSPO ligand [11C]PBR28 15 ± 3 and 90 ± 7 days after an ischaemic stroke. Regions of interest (ROI) were defined on MRI images and applied to the dynamic PET data to derive regional time-activity curves. Regional uptake was quantified as standardised uptake values (SUV) over 60 to 90 min post-injection. ROI analysis was applied to identify binding in the infarct, and in frontal, temporal, parietal, and occipital lobes and cerebellum excluding the infarcted area.

Results

The mean age of participants was 56 ± 20.4 years and mean infarct volume was 17.9 ± 18.1 ml. [11C]PBR28 showed increased tracer signal in the infarcted area compared to non-infarcted areas of the brain in the subacute phase of stroke (Patient 1 SUV 1.81; Patient 2 SUV 1.15; Patient 3 SUV 1.64). [11C]PBR28 uptake returned to the level of non-infarcted areas at 90 days Patient 1 SUV 0.99; Patient 3 SUV 0.80). No additional upregulation was detected elsewhere at either time point.

Conclusions

The neuroinflammatory reaction after ischaemic stroke is limited in time and circumscribed in space suggesting that post-ischaemic inflammation is tightly controlled but regulatory mechanisms.
Pregnant woman awareness of obstetric danger signs in developing country: systematic review
Authors: Yunitasari Esti , Matos Filomena , Zulkarnain Hakim , Kumalasari Dewi Indah , Kusumaningrum Tiyas , Putri Tantya Edipeni , Yusuf Ah. , Astuti Nining Puji
Published: May 2023

Background

Mother's awareness of obstetric danger signs is the degree of a pregnant woman to fully utilize her knowledge of the signs and symptoms of complications of pregnancy, which helps the mother and family to seek medical help immediately. High maternal and infant mortality rates in developing countries are due to a combination of a lack of quality, resources and access to health services coupled with mother’s lack of awareness. The purpose of this study was to collect current empirical studies to describe the pregnant women awareness about the obstetric danger sign in developing country.

Method

This review employed the Prisma-ScR checklist. The articles searched in four electronic databases (Scopus, CINAHL, Science Direct, Google Scholar). Variables that used to search the articles (pregnant woman, knowledge, awareness, danger signs pregnancy). The Framework used to review is PICOS.

Result

The results of the article found 20 studies which met inclusion criteria. The determinants were high educational status, more pregnancy experience, more ANC visit, and labour in the health facility.

Conclusion

The level of awareness is low to medium, only some have fair awareness, in which related to determinant. The recommended effective strategy is to improve the ANC program by assess the risk of obstetric danger sign promptly, assess the barrier of health seeking related to the family support, i.e. the husband and the elderly. Additionally, use MCH handbook or mobile application to record the ANC visit and communicate with the family.
Clinical and laboratory features of SARS-CoV-2 variants across multiple rounds of pandemic waves in hospitalized children in an Iranian referral hospital
Authors: Mahmoudi Shima , Pourakbari Babak , Benvari Sepideh , Hosseinpour Sadeghi Reihaneh , Abdolsalehi Mohammad Reza , Shahbabaie Mohammad Ali , Jalali Fatemeh , Safari Fatemeh , Navaeian Amene , Mamishi Setareh
Published: May 2023

Background

Since the onset of the COVID-19 pandemic, SARS-CoV-2 has evolved into independent new forms, variants of concern (VOCs). While epidemiological data showed increased transmissibility of VOCs, their impact on clinical outcomes is less clear. This study aimed to investigate the differences between the clinical and laboratory features of children infected with VOCs.

Methods

This study included all cases with SARS-CoV-2-positive nasopharyngeal swabs obtained from patients referred to Children’s Medical Center (CMC), an Iranian referral hospital, between July 2021 and March 2022. The inclusion criteria for this study included all patients, regardless of age, who had a positive test anywhere in the hospital setting. Exclusion criteria for the study included those whose data was obtained from non-hospital outpatient settings, or referred from another hospital. The SARS-CoV-2 genome area encoding the S1 domain was amplified and sequenced. The type of variant in each sample was identified based on the mutations in the S1 gene. Demographic characteristics, clinical data, and laboratory findings were collected from the patient’s medical records.

Results

This study included 87 pediatric cases with confirmed COVID-19, with a median age of 3.5 years (IQR: 1-8.12). Data from sequencing reveals the type of variants as 5 (5.7%) alpha, 53 (60.9%) Delta, and 29 (33.3%) Omicron. The incidence of seizure was higher in patients with Alpha and Omicron infection compared to the Delta group. A higher incidence of diarrhea was reported in Alpha-infected patients, and a higher risk of disease severity, distress, and myalgia was associated with Delta infection.

Conclusion

Laboratory parameters did not mostly differ among the patients infected with Alpha, Delta, and Omicron. However, these variants may manifest different clinical features. Further studies with larger sample sizes are required to fully understand the clinical manifestations of each variant.
Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection
Authors: Ghimire Laxmi V , Chou Fu-Sheng , Aljohani Othman A. , Moon-Grady Anita J.
Published: May 2023

Background

COVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population.

Methods

We analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD.

Results

Out of 36,690 children admitted with a diagnosis of COVID-19 infection(ICD-10 code:U07.1 and B97.29) during calendar year 2020, 1240 (3.4%) had CHD. The risk of mortality in children with CHD was not significantly higher than those without CHD(1.2% vs. 0.8%, p = 0.50), with adjusted OR (aOR) of 1.7 (95% CI: 0.6–5.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.2 (95% CI: 1.8–9.9) and aOR of 5.0 (95% CI: 2.4–10.8), respectively. Similarly, respiratory failure [aOR = 2.0 (1.5–2.8)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 2.7 (1.4–5.2)] and invasive mechanical ventilation [aOR = 2.6 (1.6-4.0)], and acute kidney injury [aOR = 3.4 (2.2–5.4)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR: 2–11) vs. 3 days (IQR: 2–5), p = < 0.001].

Conclusions

Children with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They also had increased length of hospital stay and utilization of healthcare resources.
Understanding the spatial heterogeneity of COVID-19 vaccination uptake in England
Authors: Chen Huanfa , Cao Yanjia , Feng Lingru , Zhao Qunshan , Torres José Rafael Verduzco
Published: May 2023

Background

Mass vaccination has been a key strategy in effectively containing global COVID-19 pandemic that posed unprecedented social and economic challenges to many countries. However, vaccination rates vary across space and socio-economic factors, and are likely to depend on the accessibility to vaccination services, which is under-researched in literature. This study aims to empirically identify the spatially heterogeneous relationship between COVID-19 vaccination rates and socio-economic factors in England.

Methods

We investigated the percentage of over-18 fully vaccinated people at the small-area level across England up to 18 November 2021. We used multiscale geographically weighted regression (MGWR) to model the spatially heterogeneous relationship between vaccination rates and socio-economic determinants, including ethnic, age, economic, and accessibility factors.

Results

This study indicates that the selected MGWR model can explain 83.2% of the total variance of vaccination rates. The variables exhibiting a positive association with vaccination rates in most areas include proportion of population over 40, car ownership, average household income, and spatial accessibility to vaccination. In contrast, population under 40, less deprived population, and black or mixed ethnicity are negatively associated with the vaccination rates.

Conclusions

Our findings indicate the importance of improving the spatial accessibility to vaccinations in developing regions and among specific population groups in order to promote COVID-19 vaccination.
Dysglycemias in patients admitted to ICUs with severe acute respiratory syndrome due to COVID-19 versus other causes - a cohort study
Authors: Réa Rosângela Roginski , Bernardelli Rafaella Stradiotto , Kozesinski-Nakatani Amanda Christina , Olandoski Marcia , Martins-Junior Marcelo José , Oliveira Mirella Cristine , Réa-Neto Álvaro
Published: May 2023

Background

Dysglycemias have been associated with worse prognosis in critically ill patients with COVID-19, but data on the association of dysglycemia with COVID-19 in comparison with other forms of severe acute respiratory syndrome are lacking. This study aimed to compare the occurrence of different glycemic abnormalities in patients with severe acute respiratory syndrome and COVID-19 admitted to intensive care units versus glycemic abnormalities in patients with severe acute respiratory syndrome from other causes, to evaluate the adjusted attributable risk associated with COVID-19 and dysglycemia and to assess the influence of these dysglycemias on mortality.

Methods

We conducted a retrospective cohort of consecutive patients with severe acute respiratory syndrome and suspected COVID-19 hospitalized in intensive care units between March 11 and September 13, 2020, across eight hospitals in Curitiba-Brazil. The primary outcome was the influence of COVID-19 on the variation of the following parameters of dysglycemia: highest glucose level at admission, mean and highest glucose levels during ICU stay, mean glucose variability, percentage of days with hyperglycemia, and hypoglycemia during ICU stay. The secondary outcome was the influence of COVID-19 and each of the six parameters of dysglycemia on hospital mortality within 30 days from ICU admission.

Results

The sample consisted of 841 patients, of whom 703 with and 138 without COVID-19. Comparing patients with and without COVID-19, those with COVID-19 had significantly higher glucose peaks at admission (165 mg/dL vs. 146 mg/dL; p = 0.002) and during ICU stay (242 mg/dL vs. 187md/dL; p < 0.001); higher mean daily glucose (149.7 mg/dL vs. 132.6 mg/dL; p < 0.001); higher percentage of days with hyperglycemia during ICU stay (42.9% vs. 11.1%; p < 0.001); and greater mean glucose variability (28.1 mg/dL vs. 25.0 mg/dL; p = 0.013). However, these associations were no longer statistically significant after adjustment for Acute Physiology and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, and C-reactive protein level, corticosteroid use and nosocomial infection. Dysglycemia and COVID-19 were each independent risk factors for mortality. The occurrence of hypoglycemia (< 70 mg/dL) during ICU stay was not associated with COVID-19.

Conclusion

Patients with severe acute respiratory syndrome due to COVID-19 had higher mortality and more frequent dysglycemia than patients with severe acute respiratory syndrome due to other causes. However, this association did not seem to be directly related to the SARS-CoV-2 infection.
Screening and identification of key chromatin regulator biomarkers for ankylosing spondylitis and drug prediction: evidence from bioinformatics analysis
Authors: Wang Han , Jin Hongbo , Liu Zhiyang , Tan Chengju , Wei Lin , Fu Mingfen , Huang Yizhuan
Published: May 2023

Background

Ankylosing spondylitis (AS) is one of the most common immune-mediated arthritic diseases worldwide. Despite considerable efforts to elucidate its pathogenesis, the molecular mechanisms underlying AS are still not fully understood.

Methods

To identify candidate genes involved in AS progression, the researchers downloaded the microarray dataset GSE25101 from the Gene Expression Omnibus (GEO) database. They identified differentially expressed genes (DEGs) and functionally enriched them for analysis. They also constructed a protein–protein interaction network (PPI) using STRING and performed cytoHubba modular analysis, immune cell and immune function analysis, functional analysis and drug prediction.The results showed that DEGs were mainly associated with histone modifications, chromatin organisation, transcriptional coregulator activity, transcriptional co-activator activity, histone acetyltransferase complexes and protein acetyltransferase complexes.

Results

The researchers analysed the differences in expression between the CONTROL and TREAT groups in terms of immunity to determine their effect on TNF-α secretion. By obtaining hub genes, they predicted two therapeutic agents, AY 11–7082 and myricetin.

Conclusion

The DEGs, hub genes and predicted drugs identified in this study contribute to our understanding of the molecular mechanisms underlying the onset and progression of AS. They also provide candidate targets for the diagnosis and treatment of AS.
The effect of posterior tibial slope on anteroposterior stability in posterior cruciate retaining total knee arthroplasty
Authors: Ersin Mehmet , Demirel Mehmet , Civan Melih , Ekinci Mehmet , Akgül Turgut , Şen Cengiz
Published: May 2023

Background

It has been suggested that the posterior tibial slope (PTS) plays an important role in increasing the anteroposterior stability following total knee arthroplasty. Although the relationship between the PTS and the flexion range has been investigated many times, studies on the relationship between PTS and anterior-posterior stability are limited. The primary aim of this study was to investigate the relationship and effects of PTS on anteroposterior stability in posterior cruciate retainer total knee arthroplasty.

Methods

154 primary TKAs were identified retrospectively to analyze the any association between PTS and anteroposterior laxity following posterior cruciate-retaining total knee arthroplasty in the overall study populations. Anteroposterior displacement was measured at the final follow-up based on the following two procedures: KT-1000 arthrometer and sagittal drawer radiographic images. In addition, the relationship between PTS and functional scores-ROM was examined.

Results

There was no correlation between patients’ posterior tibial slope and postoperative VAS (r: -0.060, p:0.544), WOMAC (r:0.037, p:0.709), KSS (r: -0.073, p:0.455). In addition, there was no significant correlation between postoperative knee ROM and postoperative PTS (r:0.159, p:0.106). Moreover, no correlation was found between KT-1000 arthrometer and 20 degrees AP translation with PTS. There was a negative correlation between PTS and 70 degrees AP translation (r: -0.281, p:0.008).

Conclusions

This study aimed to clarify the association between instability and AP laxity in flexion of implanted knees, and to determine what degree of AP laxity results of instability. A fundamental finding of this study was that; the optimum TS angle to increase anterior-posterior stability after total knee arthroplasty is between ≥ 4 to < 6 degrees, we also proved that there is no relationship between stability and patient satisfaction.
Online education for prosthetics and orthotics students in the era of COVID-19 pandemic in Iran: challenges, opportunities, and recommendations
Authors: Jalali Maryam , Moradi Vahideh , Babaee Taher , Aminian Gholamreza , Mojgani Parviz , Shahabi Saeed
Published: May 2023

Introduction

With the advent of the COVID-19 pandemic, many higher education programs in Iran, including prosthetics and orthotics (P&O), had to shift to the online environment all at once. This unanticipated transition was challenging for the educational system. However, online education is superior in some aspects to conventional methods, and this situation may offer opportunities. This study was carried out from September 2021 to March 2022 to investigate the challenges and opportunities of online education in the P&O sector in Iran based on the opinions of students and faculty members. Relevant recommendations will also be discussed.

Methods

In this qualitative study, semi-structured interviews were conducted in both oral and written formats. Purposive and snowball sampling techniques were used to recruit undergraduate and postgraduate P&O students, as well as P&O faculty members, for this qualitative study. The data gathered from interviews with study participants were analyzed by thematic analysis.

Results

Based on the data analysis, many sub-themes of the three main themes were recognized: (1) challenges: technical, socioeconomic, environmental distractors, supervision and evaluation, workload, digital competence, interactions, motivation, sessions-related issues, class time, hands-on and clinical training; (2) opportunities: technological innovations, infrastructure development, flexible learning environment, student-centered learning, availability of contents, time and cost saving, high concentration, more self-confidence; (3) recommendations: technical infrastructure, team dynamics, hybrid courses, time management, awareness.

Conclusion

Online education of P&O during the era of the COVID-19 pandemic was accompanied by a series of challenges. Technical issues and the gravity of hands-on training in this field were significant challenges. This era, however, provided the opportunity to facilitate the establishment of needed infrastructure and support technological innovations for online education. Considering hybrid (mixed online and on-site) courses was recommended to improve the quality of learning.
Inhibition of discoidin domain receptor (DDR)-1 with nilotinib alters CSF miRNAs and is associated with reduced inflammation and vascular fibrosis in Alzheimer’s disease
Authors: Stevenson Max , Varghese Rency , Hebron Michaeline L. , Liu Xiaoguang , Ratliff Nick , Smith Amelia , Turner R. Scott , Moussa Charbel
Published: May 2023

Discoidin Domain Receptor (DDR)-1 is activated by collagen. Nilotinib is a tyrosine kinase inhibitor that is FDA-approved for leukemia and potently inhibits DDR-1. Individuals diagnosed with mild–moderate Alzheimer’s disease (AD) treated with nilotinib (versus placebo) for 12 months showed reduction of amyloid plaque and cerebrospinal fluid (CSF) amyloid, and attenuation of hippocampal volume loss. However, the mechanisms are unclear. Here, we explored unbiased next generation whole genome miRNA sequencing from AD patients CSF and miRNAs were matched with their corresponding mRNAs using gene ontology. Changes in CSF miRNAs were confirmed via measurement of CSF DDR1 activity and plasma levels of AD biomarkers. Approximately 1050 miRNAs are detected in the CSF but only 17 miRNAs are specifically altered between baseline and 12-month treatment with nilotinib versus placebo. Treatment with nilotinib significantly reduces collagen and DDR1 gene expression (upregulated in AD brain), in association with inhibition of CSF DDR1. Pro-inflammatory cytokines, including interleukins and chemokines are reduced along with caspase-3 gene expression. Specific genes that indicate vascular fibrosis, e.g., collagen, Transforming Growth Factors (TGFs) and Tissue Inhibitors of Metalloproteases (TIMPs) are altered by DDR1 inhibition with nilotinib. Specific changes in vesicular transport, including the neurotransmitters dopamine and acetylcholine, and autophagy genes, including ATGs, indicate facilitation of autophagic flux and cellular trafficking. Inhibition of DDR1 with nilotinib may be a safe and effective adjunct treatment strategy involving an oral drug that enters the CNS and adequately engages its target. DDR1 inhibition with nilotinib exhibits multi-modal effects not only on amyloid and tau clearance but also on anti-inflammatory markers that may reduce cerebrovascular fibrosis.
Smoking identified as preferred mode of opioid safe supply use; investigating correlates of smoking preference through a 2021 cross-sectional study in British Columbia
Authors: Kamal Ariba , Ferguson Max , Xavier Jessica C , Liu Lisa , Graham Brittany , Lock Kurt , Buxton Jane A.
Published: May 2023

Background

The increasing number of illicit drug toxicity deaths in British Columbia (BC) has led to calls for a regulated (pharmaceutical grade) supply of substances (“safe supply”). In order to inform safe supply recommendations, we aimed to identify why people currently smoke opioids and assess the preferred mode of consumption if people who use opioids were provided with opioid safe supply.

Methods

The BC Harm Reduction Client Survey (HRCS) is an annual survey that gathers information about people who use drugs' (PWUD) substance use characteristic with the goal of contributing to evidence-based policy. This study utilized data from the 2021 HRCS. The outcome variable was “prefer smoking opioid safe supply” (‘yes/no’). Explanatory variables included participants’ demographics, drug use, and overdose characteristics. Bivariate and hierarchical multivariable logistic regressions were conducted to identify factors associated with the outcome.

Results

Of 282 total participants who indicated a preference for a mode of consumption for opioid safe supply, 62.4% preferred a smokable option and 19.9% preferred to inject if provided with opioid safe supply. Variables significantly associated with the outcome (preferred smoking) included: being 19-29 years old (AOR=5.95, CI =1.93 – 18.31) compared to >50 years old, having witnessed an overdose in the last 6 months (AOR=2.26, CI=1.20 – 4.28), having smoked opioids in the last 3 days (AOR=6.35, CI=2.98 – 13.53) and having a preference to smoke stimulants safe supply (AOR=5.04, CI=2.53 – 10.07).

Conclusion

We found that over half of participants prefer smokable options when accessing opioid safe supply. Currently in BC, there are limited smokable opioid safe supply options as alternatives to the toxic street supply. To reduce overdose deaths, safe supply options should be expanded to accommodate PWUD that prefer smoking opioids.
The role of substance use treatment in reducing stigma after release from incarceration: A qualitative analysis
Authors: Moore Kelly E. , Wyatt Janan P. , Phillips Sarah , Burke Catherine , Bellamy Chyrell , McKee Sherry A.
Published: May 2023

Background

People with substance use disorders (SUD) who have been involved in the legal system often experience stigma upon reentry into the community after incarceration. Although substance use treatment can sometimes be a source of stigma, it may also reduce stigma by facilitating connections with providers, reducing distress, or helping people feel more integrated in their community. However, research has rarely examined the potential for treatment to reduce stigma.

Methods

This study examined stigma experiences and the degree to which substance use treatment reduced stigma among 24 people with SUDs who were receiving care in an outpatient treatment facility after release from incarceration. Qualitative interviews were conducted and analyzed using a content analysis approach.

Results

Participants reported negative self-judgements as well as perceiving negative judgments from the community upon reentry. With regard to stigma reduction, themes emerged around substance use treatment repairing strained family relationships and reducing participants’ self-stigma. Aspects of treatment that reportedly reduced stigma included the treatment facility having a nonjudgmental atmosphere, patients trusting the staff, and working with peer navigators who had lived experience of SUD and incarceration.

Conclusions

Results from this study suggest that substance use treatment has the potential to decrease the negative impacts of stigma upon release from incarceration, which continues to be a major barrier. Though more research on stigma reduction is needed, we suggest some preliminary considerations for treatment programs and providers.
Quantitative strong motion simulations at three locations in downtown Mashiki during the 2016 Kumamoto Earthquake (Mw 7.0) based on the nonlinear ground response analyses with soil liquefaction
Authors: Fukutake Kiyoshi , Yoshida Kazuhiro , Kawase Hiroshi , Nagashima Fumiaki , Sun Jikai
Published: May 2023

The mainshock of the 2016 Kumamoto Earthquake (Mw 7.0) caused extensive damage to buildings in downtown Mashiki, Kumamoto Prefecture, Japan. The heavy building damage in the area was associated with both strong ground motion and building response characteristics. Fortunately, there were two strong motion stations in the area and the observed records during the mainshock were distributed, showing peak ground velocities exceeding 100 cm/s on the surface. The level of shaking would be sufficient to make soft surface sediments nonlinear. To reproduce observed ground motions quantitatively, one-dimensional nonlinear effective-stress time-history analyses were conducted at three locations in downtown Mashiki. The input wave was employed as either the observed underground wave or simulated outcrop input motion based on the diffuse field theory. The main purpose of the study was twofold: to investigate the proper soil constitutive relationship and its nonlinear parameters based on the limited amount of in situ information, and to validate the method of input motion evaluation at the seismological bedrock level based on diffuse field theory. The nonlinear time history analyses using the on-site boring survey and the outcrop wave based on diffuse field theory showed that the waveform of the mainshock observed on the ground surface was explained with sufficient accuracy. In addition, the results of the effective stress analysis indicated that soil liquefaction might have occurred in the area with thick surface layers along the Akitsu River where the water table was considered to be quite shallow.

Graphical Abstract
Building low-cost simulators for invasive ultrasound-guided procedures using the V-model
Authors: Johnsson Vilma , Tolsgaard Martin Grønnebæk , Petersen Olav Bennike Bjørn , Svendsen Morten Bo Søndergaard
Published: May 2023

The use of medical simulators for training technical and diagnostic skills has rapidly increased over the past decade. Yet, most available medical simulators have not been developed based on a structured evaluation of their intended uses but rather out of expected commercial value. Moreover, educators often struggle to access simulators because of cost or because no simulators have been developed for a particular procedure. In this report, we introduce “the V-model” as a conceptual framework to illustrate how simulator development can be guided by the intended uses in an iterative fashion. Applying a needs-based conceptual framework when developing simulators is important to increase the accessibility and sustainability of simulation-based medical education. It will minimize the developmental barriers and costs, while at the same time improving educational outcomes. Two new simulators for invasive ultrasound-guided procedures are used as examples, the chorionic villus sampling model and the ultrasound-guided aspiration trainer. Our conceptual framework and the use cases can serve as a template for future simulator development and documentation hereof.
Crosstalk between the JAK2 and TGF-β1 signaling pathways in scleroderma-related interstitial lung disease targeted by baricitinib
Authors: Wang Dandan , Wei Yimei , Xu Lulu , Zhang Jie
Published: May 2023

Background and objective

Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by fibrosis and vascular lesions. Interstitial lung disease is an early complication of SSc and the main cause of death from SSc. Although baricitinib shows good efficacy in a variety of connective tissue diseases, its role in systemic sclerosis-related interstitial lung disease (SSc-ILD) is unclear. The objective of our study was to explore the effect and mechanism of baricitinib in SSc-ILD.

Methods

We explored crosstalk between the JAK2 and TGF-β1 pathways. In vivo experiments, SSc-ILD mice model were constructed by subcutaneous injection of PBS or bleomycin (7.5 mg/kg) and intragastric administration of 0.5% CMC-Na or baricitinib (5 mg/kg) once every two days. We used ELISA, qRT‒PCR, western blot and immunofluorescence staining to evaluate the degree of fibrosis. In vitro experiments, we used TGF-β1 and baricitinib to stimulate human fetal lung fibroblasts (HFLs) and assessed protein expression by western blot.

Results

The vivo experiments showed that baricitinib notably alleviated skin and lung fibrosis, decreased the concentration of pro-inflammatory factors and increased those of the anti-inflammatory factors. Baricitinib affected the expression of TGF-β1 and TβRI/II inhibitiing JAK2. In the vitro experiments, following the culture of HFLs with baricitinib or a STAT3 inhibitor for 48 h, the expression levels of TβRI/II decreased. Conversely, with successful inhibition of TGF-β receptors in HFLs, JAK2 protein expression decreased.

Conclusions

Baricitinib attenuated bleomycin-induced skin and lung fibrosis in SSc-ILD mice model by targeting JAK2 and regulating of the crosstalk between the JAK2 and TGF-β1 signaling pathways.
Reutilization of solid wastes to improve the hydromechanical and mechanical behaviors of soils — a state-of-the-art review
Authors: Liu Chih-Hsuan , Hung Ching
Published: May 2023

The rapid urbanization, industrialization, and population growth have led to a considerable rise in solid waste production, highlighting the need for efficient solid waste management and recycling methods. To address the challenge of solid waste production, an alternative solution is to repurpose it in geotechnical engineering. This offers promising benefits as solid waste exhibits various mechanisms that can improve soil's hydromechanical and mechanical behaviors. This review aims to comprehensively analyze the effects and potential application of various solid waste types to stabilize and reinforce soil. The impacts and research trends of industrial waste, such as fly ash, red mud, ground granulated blast-furnace slag, and construction and demolition waste, as well as agricultural and municipal solid wastes, including rice husk ash, press mud, used waste tires, and face masks, on soil properties were identified. The findings contribute to a better understanding of the potential of solid waste as a sustainable and cost-effective solution for improving soil quality, highlighting new research themes in this area. A wide range of innovative methods to stabilize and reinforce soil have also been proposed; however, ingenious and effective containment techniques, as well as addressing the potential impacts of climate change on stabilized and reinforced soils (SRS), still need to be developed for robust field applications. This state-of-the-art review offers useful insights into the reutilization of solid wastes as a promising alternative for improving the hydromechanical and mechanical behaviors of SRS.
Identifying Patterns and Barriers in OncotypeDX Recurrence Score Testing in Older Patients With Early-Stage, Estrogen Receptor–Positive Breast Cancer: Implications for Guidance and Reimbursement
Authors: Trapani Dario , Jin Qingchun , Block Caroline C. , Freedman Rachel A. , Lin Nancy U. , Tarantino Paolo , Mittendorf Elizabeth A. , King Tari A. , Lester Susan C. , Brock Jane E. , Tayob Nabihah , Bunnell Craig A. , Tolaney Sara M. , Burstein Harold J.
Published: May 2023

PURPOSE

To evaluate the clinical patterns of utilization of OncotypeDX Recurrence Score (RS) in early-stage, hormone receptor–positive, human epidermal growth factor receptor 2–negative breast cancer (BC) at an academic center with previously established internal reflex testing guidelines.

METHODS

RS testing in accordance with preexisting reflex criteria and predictors of utilization outside of reflex criteria were retrospectively analyzed for the years 2019-2021 in a quality improvement evaluation. Patients were grouped according to OncotypeDX testing within (cohort A) or outside (cohort B) of predefined criteria which included a cap at age older than 65 years.

RESULTS

Of 1,687 patients whose tumors had RS testing, 1,087 were in cohort A and 600 in cohort B. In cohort B, nearly half of patients were older than 65 years (n = 279; IQR, 67-72 years). For patients older than 65 years, those with RS testing were younger (median age: 69 v 73 years), with higher grade cancers (G2-3: 84.9% v 54.7%) and were more likely to be treated with chemotherapy (15.4% v 4.1%). Issues for implementation of RS testing in older patients were identified, including potential structural barriers related to the current policy on the reimbursements of genomic tests.

CONCLUSION

Internal guidelines may facilitate standardized utilization of the RS in early-BC. Our data suggest that clinicians preferred broader utilization of RS across the age spectrum, with therapeutically important consequences. Modifying the current policy for reimbursement of RS testing and in internal reflexive testing criteria for those older than 65 years is warranted.
Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement
Authors: Diaz-Thomas Alicia M , Golden Sherita Hill , Dabelea Dana M , Grimberg Adda , Magge Sheela N , Safer Joshua D , Shumer Daniel E , Stanford Fatima Cody
Published: May 2023

Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions—growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
Active Surveillance May Be the Best Initial Management for Papillary Thyroid Microcarcinoma
Authors: Ito Yasuhiro , Miyauchi Akira
Published: May 2023

Active surveillance for low-risk papillary thyroid microcarcinoma (PTMC; T1aN0MI) was initiated at Kuma Hospital (Kobe, Japan) in 1993, based on a proposal by Akira Miyauchi. Favorable outcomes of such surveillance have been reported. Our latest study revealed 5- and 10-year tumor enlargement rates (by ≥ 3 mm) of 3.0% and 5.5% and 5- and 10-year node metastasis appearance rates of 0.9% and 1.1%, respectively. The postoperative prognosis did not differ between patients who underwent immediate surgery and those who underwent conversion surgery after progression. These findings suggest that active surveillance may be the best initial management of PTMCs.
AI and machine learning ethics, law, diversity, and global impact
Authors: Drabiak Katherine , Kyzer Skylar , Nemov Valerie , El Naqa Issam
Published: May 2023

Artificial intelligence (AI) and its machine learning (ML) algorithms are offering new promise for personalized biomedicine and more cost-effective healthcare with impressive technical capability to mimic human cognitive capabilities. However, widespread application of this promising technology has been limited in the medical domain and expectations have been tampered by ethical challenges and concerns regarding patient privacy, legal responsibility, trustworthiness, and fairness. To balance technical innovation with ethical applications of AI/ML, developers must demonstrate the AI functions as intended and adopt strategies to minimize the risks for failure or bias. This review describes the new ethical challenges created by AI/ML for clinical care and identifies specific considerations for its practice in medicine. We provide an overview of regulatory and legal issues applicable in Europe and the United States, a description of technical aspects to consider, and present recommendations for trustworthy AI/ML that promote transparency, minimize risks of bias or error, and protect the patient well-being.
Nanopore-based RNA sequencing deciphers the formation, processing, and modification steps of rRNA intermediates in archaea
Authors: Grünberger Felix , Jüttner Michael , Knüppel Robert , Ferreira-Cerca Sébastien , Grohmann Dina
Published: May 2023

Ribosomal RNA (rRNA) maturation in archaea is a complex multistep process that requires well-defined endo- and exoribonuclease activities to generate fully mature linear rRNAs. However, technical challenges prevented detailed mapping of rRNA processing steps and a systematic analysis of rRNA maturation pathways across the tree of life. In this study, we used long-read (PCR)-cDNA and direct RNA nanopore-based sequencing to study rRNA maturation in three archaeal model organisms, namely the EuryarchaeaHaloferax volcaniiandPyrococcus furiosusand the CrenarchaeonSulfolobus acidocaldarius. Compared to standard short-read protocols, nanopore sequencing facilitates simultaneous readout of 5′- and 3′-positions, which is required for the classification of rRNA processing intermediates. More specifically, we (i) accurately detect and describe rRNA maturation stages by analysis of terminal read positions of cDNA reads and thereupon (ii) explore the stage-dependent installation of the KsgA-mediated dimethylations inH. volcaniiusing base-calling and signal characteristics of direct RNA reads. Due to the single-molecule sequencing capacity of nanopore sequencing, we could detect hitherto unknown intermediates with high confidence, revealing details about the maturation of archaea-specific circular rRNA intermediates. Taken together, our study delineates common principles and unique features of rRNA processing in euryarchaeal and crenarchaeal representatives, thereby significantly expanding our understanding of rRNA maturation pathways in archaea.
Minimizing amplification bias during reverse transcription for in vitro selections
Authors: Lucas Jordyn K. , Gruenke Paige R. , Burke Donald H.
Published: May 2023

Systematicevolution ofligands throughexponential enrichment (SELEX) is widely used to identify functional nucleic acids, such as aptamers and ribozymes. Ideally, selective pressure drives the enrichment of sequences that display the function of interest (binding, catalysis, etc.). However, amplification biases from reverse transcription can overwhelm this enrichment and leave some functional sequences at a disadvantage, with cumulative effects across multiple rounds of selection. Libraries that are designed to include structural scaffolds can improve selection outcomes by sampling sequence space more strategically, but they are also susceptible to such amplification biases, particularly during reverse transcription. Therefore, we tested five reverse transcriptases (RTs)—ImProm-II, Marathon RT (MaRT), TGIRT-III, SuperScript IV (SSIV), and BST 3.0 DNA polymerase (BST)—to determine which enzymes introduced the least bias. We directly compared cDNA yield and processivity for these enzymes on RNA templates with varying degrees of structure under various reaction conditions. In these analyses, BST exhibited excellent processivity, generated large quantities of the full-length cDNA product, displayed little bias among templates with varying structure and sequence, and performed well on long, highly structured viral RNAs. Additionally, six RNA libraries containing either strong, moderate, or no incorporated structural elements were pooled and competed head-to-head in six rounds of an amplification-only selection without external selective pressure using either SSIV, ImProm-II, or BST during reverse transcription. High-throughput sequencing established that BST maintained the most neutral enrichment values, indicating low interlibrary bias over the course of six rounds, relative to SSIV and ImProm-II, and it introduced minimal mutational bias.
A Time Series Analysis of Buddhist Painting Using Digital Image Data
Authors: Eom Tae Ho , Lee Hwa Soo
Published: May 2023

Damage to the painting cultural heritage is recognized through visual observation, photographic data, and conservation diagnosis records, and technology that accurately understands the degree of change over time can prevent damage and be effectively used for conservation treatment. In this study, a time series analysis was conducted to diagnose and compare the conservation status of the past and the present using the digital image of Hanging Painting of Bongjeongsa Temple, Andong (The Vulture Peak Assembly) with different filming times. Color information was analyzed using a digital image analysis program. The shape information and area of crease, exfoliation of painting layer, loss of background material and contamination were calculated using the Relief, Threshold Switching, Color Mapping in HSV space function. Based on the calculated data, the change pattern was confirmed by comparing the damage that occurred in the same area. Quantitative data such as the area of damage and the length of the object were used together to comprehensively compare and analyze the degree of improvement and change in damage that occurred throughout the work to evaluate the change over time.