bluuebunny/crossref_metadata_2025 huggingface dataset:
Revascularization prevents amputation among patients with diabetic foot during the COVID-19 era
Authors: Lozano-Corona Rodrigo , Reyes-Monroy José A , Lara-González Viridiana , Anaya-Ayala Javier E , Dardik Alan , Hinojosa Carlos A
Published: March 2022

Objective

The COVID‐19 pandemic has led to significant changes in healthcare systems that impact the management of chronic diseases such as diabetic foot (DF). We hypothesized that lack of access to healthcare would increase the severity of disease and lead to worse outcomes.

Methods

The medical records of patients with DF were reviewed to determine demographic data and outcomes including wound healing, major amputation (MA), and death. Groups were divided into the pre–COVID-19 era (15 March 2019–15 March 2020) and the COVID-19 era (16 March 2020–16 March 2021); multivariable logistic analysis was performed to identify risk factors for MA.

Results

261 patients with DF were included, 163 in the pre–COVID-19 era and 98 during the COVID-19 era. Patients in the COVID-19 presented with increased cardiovascular disease (19 vs 7%, p = 0.01), increased mean HbA1C (9.1 ± 2.1 vs 8.2 ± 2.1, p = 0.008) and higher WIFI-IV stage (78 vs 53%, p ≤ 0.0001). Patients with DF in the COVID-19 era were more likely to require MA (41 vs 21%, p ≤ 0.0001). Revascularization (OR = 0.12; 95% CI, 0.038–0.38) was a protective factor to reduce MA.

Conclusions

MA among DF patients increased two-fold during the COVID-19 era. Revascularization avoids MA in diabetic patients even during the COVID-19 pandemic, suggesting that revascularization should be performed when possible.
Sampling-based unmanned aerial vehicle air traffic integration, path planning, and collision avoidance
Authors: Sababha Belal H , Al-mousa Amjed , Baniyounisse Remah , Bdour Jawad
Published: March 2022

Unmanned aircraft or drones as they are sometimes called are continuing to become part of more real-life applications. The integration of unmanned aerial vehicles in public airspace is becoming an important issue that should be addressed. As the number of unmanned aerial vehicles and their applications are largely increasing, air traffic with more unmanned aircraft has to be given more attention to prevent collisions and maintain safe skies. Unmanned aerial vehicle air traffic integration and regulation has become a priority to different regulatory agencies and has become of greater interest for many researchers all around the world. In this research, a sampling-based air traffic integration, path planning, and collision avoidance approach is presented. The proposed algorithm expands an existing 2D sampling-based approach. The original 2D approach deals with only two unmanned aircraft. Each of the two aircraft shares location information with a ground-based path planner computer, which would send back the avoidance waypoints after performing the 2D sampling. The algorithm proposed in this article can handle any number of drones in the 3D space by performing either 2D or 3D sampling. The proposed work shows a 10-fold enhancement in terms of the number of unmanned aerial vehicle collisions. The presented results also contribute to enabling a better understanding of what is expected of integrating more drones in dense skies.
Transforming through power: Teachers identity in schools
Authors: Narayanan Madhu
Published: March 2022

Schools are unique institutions where structural and cultural dynamics shape the actions of humans. Power is everywhere, and the structures of schools channel power in ways that shape the identities of teachers. Yet, teachers find ways to challenge existing dynamics and in their confrontations with power can create new ways of being. This study uses a grounded theory approach to analyze interviews and observations of seven New York City public school teachers. Emerging from their words and re-tellings is a picture of teaching as an act of self-creation within the rigid dynamics of schools. As teachers sought their own answers, they showcased a transformative growth, a “becoming,” to build new identities through their work with students and the community.
Competitive tendering for rail track capacity: The liberalization of railway services in Spain
Authors: Montero Juan J , Ramos Melero Rodolfo
Published: March 2022

Congestion in infrastructure capacity is a barrier to entry to markets under liberalization. The Spanish rail infrastructure manager, ADIF AV, has implemented an innovative model to reduce such a barrier. ADIF AV optimized capacity by defining the schedule with the most efficient use of tracks, building packages with such track capacity and putting them for tender. Three railway undertakings, the incumbent and two newcomers, will compete in the high-speed market, increasing at least 55% the number of services. This model can be exported to other countries reforming the rail sector.
“Leading to God’s Deepening Life”: Considerations of Saint Ignatius of Loyola as Spiritual Guide for Ongoing Transformation in Christ
Authors: Looker Catherine
Published: March 2022

This article seeks to explore the spiritual guidance of Saint Ignatius of Loyola as a worthy spiritual guide for our time as we consider some ways that we might seek to more clearly understand and authentically live out the call of Christ in our life journey. In this context of considering the work of Ignatius’ Spiritual Exercises as a viable tool for such interior conversion, it is necessary for the work of this article to take a closer look at some highlights of Ignatius’ own life journey in order to appropriately consider the significance of key sections of his Spiritual Exercises and the dynamics for Christian formation and transformation inherent in these selected texts. I seek to argue that any assessment of our spiritual maturity in Christ finds clear context in our everyday life experiences as Saint Ignatius so aptly demonstrates
Top cited articles in concussion: A bibliometric analysis of the state of the science
Authors: Sharma Bhanu , Lawrence David Wyndham
Published: March 2022

Objective

Citation analyses identify the most-cited publications in a given field, which aids in understanding areas of the literature that are well-developed and those where additional research is required. Our objective was to perform a citation analysis in concussion to understand the state of the science from a bibliometric perspective.

Design

We performed a keyword search for articles related to concussion in Harzing's Publish or Perish, which scrapes Google Scholar for citation metrics. This approach was used to identify the 50 articles with the most lifetime citations as well as the 50 articles with the highest citation rate.

Main outcome measures

Citations and citation rates.

Results

Per our citation analysis, we found that concussion guidelines are among the most cited publications (comprising ≥20% of each citation cohort), yet there is a dearth of widely cited clinical trials to inform them; only one randomized trial (studying the effects of rest following concussion) was included in our citation analysis. The majority of study designs (≥40% of each citation cohort) were cross-sectional. Concussion recovery and secondary complications of concussion were common study topics, with ≥20% of publications in each citation cohort focused on these issues. The publications included in our analysis were authored by 596 authors from only 12 countries, suggesting a lack of global representation in concussion research.

Conclusions

Existing reviews and consensus statements have called for additional, high-quality research in concussion; our citation analysis quantifies this need. Further, although concussion is a global problem with its incidence and burden increasing in the developing world, our citation analysis demonstrates that the most-cited and discussed articles in concussion are published by authors from only 12 countries. Going forward, to address the global problem that is concussion, a more global research perspective is called for.
The Prevalence of Economic Abuse Among Intimate Partners in Alberta
Authors: McKay White R. , Fjellner Devon
Published: March 2022

We examine the prevalence of economic abuse in all demographics. Previous research primarily considers female victims within heterosexual relationships characterized by other forms of intimate partner violence (“IPV”). Consequently, economic abuse may appear to be a less widespread societal issue than it is. Relying on theory that IPV is not a gendered phenomenon, we collected primary data of the prevalence of economic abuse in the Alberta general population and analyzed the influence of demographic variables on the likelihood of experiencing economic abuse. We surveyed 300 random adults in every demographic on what economically abusive behaviors they have experienced and used univariate and regression analysis to determine the effect of different demographic variables on those experiences. We found that 36% of all adults in the sample experienced economic abuse, with 17% experiencing severe economic abuse. Being male or female had no statistical impact on the likelihood of experiencing such abuse, and the effect of income is contrary to previous assumptions. Women are more vulnerable to Economic Control, a subtype of economic abuse. Economic abuse is a broader problem than research to date has considered. Though it is not a gendered phenomenon, different behaviors are more prevalent or severe for different genders. The prevalence of economic abuse in all demographics suggests that further awareness and advocacy is necessary to reduce its incidence. Additional research on a national level is needed to determine patterns and motivations for economic abuse and its correlations with other forms of IPV.
Contextual Factors Influencing Chinese Early Study Abroad Students’ Acculturation Experiences in Canada: An Exploratory Study
Authors: Jing Xiaoli , Peng Lisha , Dai Kun
Published: March 2022

In order to explore the contextual factors that may influence Chinese early study abroad students’ acculturation experiences in Canada, we conducted in-depth interviews with 20 Chinese early study abroad students and 6 Chinese parents. Using Oppedal and Toppelberg’s acculturation development model as the analytical framework, we identify six microsystem factors (parents, host family, custodian, overseas-study service agent, friends, and church), two mesosystem factors (parents-custodian relationship and custodian-host family relationship), three exosystem factors (social services, public safety, and immigration policies), one majority culture macro factor (multiculturalism), and the time dimension are related to Chinese early study abroad students’ acculturation experiences. In addition to these factors, locosystem factors such as geography, physical environment, and climate of the city in which they live are also important. Based on these findings, we advise all stakeholders to create a supportive and sustainable environment for Chinese early study abroad students to live in Canada.
“Still on the Fence”: A Mixed Methods Investigation of COVID-19 Vaccine Confidence Among Health Care Providers
Authors: Choi Kristen , Chang John , Luo Yi X. , Lewin Bruno , Munoz-Plaza Corrine , Bronstein David , Rondinelli June , Bruxvoort Katia
Published: March 2022

Background:

There is evidence of disparities in COVID-19 vaccine acceptance among health care providers. The purpose of this study was to examine confidence receiving and recommending COVID-19 vaccines by health care provider type and race/ethnicity.

Methods:

This mixed methods study involved a cross-sectional survey and qualitative, semi-structured interviews from March to May 2021 among a sample of physicians, advanced practice providers, nurses, and pharmacists. These workers were recruited through voluntary response sampling from an integrated health system in Southern California. The primary dependent variables were (a) confidence in vaccine safety, (b) confidence in vaccine effectiveness, and (c) intent to recommend the vaccine to others. The primary independent variables were health care provider type and race/ethnicity.

Findings:

A total of 2,948 providers completed the survey. Nurses relative to physicians were 15% less likely to perceive the COVID-19 vaccine to be safe (risk ratio [RR] = 0.85; 95% confidence interval [CI] = 0.83–0.87); 27% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.73; 95% CI = 0.69–0.76); and 11% less likely to recommend the vaccine to others (RR = 0.89; 95% CI = 0.87–0.91). Hispanic/Latinx providers were 10% less likely to perceive the vaccine to prevent COVID-19 (RR = 0.90; 95% CI = 0.83–0.98) relative to White providers. Qualitative themes included: No need for vaccine; distrusting vaccine research and roll-out; caretaking barriers; uncertainty and potential to change one’s mind; framing vaccine decisions around personal beliefs.

Conclusions & Application to Practice:

Health care workplaces should consider interventions to increase COVID-19 vaccination among their workers, including education and mandatory vaccination policies.
High BMP4 expression in low/intermediate risk BCP-ALL identifies children with poor outcomes
Authors: Fernández-Sevilla Lidia M. , Valencia Jaris , Ortiz-Sánchez Paula , Fraile-Ramos Alberto , Zuluaga Pilar , Jiménez Eva , Sacedón Rosa , Martínez-Sánchez María V. , Jazbec Janez , Debeljak Marusa , Fedders Birthe , Stanulla Martin , Schewe Denis , Cario Gunnar , Minguela Alfredo , Ramírez Manuel , Varas Alberto , Vicente Ángeles
Published: March 2022

Pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL) outcome has improved in the last decades, but leukemic relapses are still one of the main problems of this disease. Bone morphogenetic protein 4 (BMP4) was investigated as a new candidate biomarker with potential prognostic relevance, and its pathogenic role was assessed in the development of disease. A retrospective study was performed with 115 pediatric patients with BCP-ALL, and BMP4 expression was analyzed by quantitative reverse transcription polymerase chain reaction in leukemic blasts at the time of diagnosis. BMP4 mRNA expression levels in the third (upper) quartile were associated with a higher cumulative incidence of relapse as well as a worse 5-year event-free survival and central nervous system (CNS) involvement. Importantly, this association was also evident among children classified as having a nonhigh risk of relapse. A validation cohort of 236 patients with BCP-ALL supported these data. Furthermore, high BMP4 expression promoted engraftment and rapid disease progression in an NSG mouse xenograft model with CNS involvement. Pharmacological blockade of the canonical BMP signaling pathway significantly decreased CNS infiltration and consistently resulted in amelioration of clinical parameters, including neurological score. Mechanistically, BMP4 favored chemoresistance, enhanced adhesion and migration through brain vascular endothelial cells, and promoted a proinflammatory microenvironment and CNS angiogenesis. These data provide evidence that BMP4 expression levels in leukemic cells could be a useful biomarker to identify children with poor outcomes in the low-/intermediate-risk groups of BCP-ALL and that BMP4 could be a new therapeutic target to blockade leukemic CNS disease.
Divergent selection for natural antibodies in poultry in the presence of a major gene
Authors: Bovenhuis Henk , Berghof Tom V. L. , Visker Marleen H. P. W. , Arts Joop A. J. , Visscher Jeroen , van der Poel Jan J. , Parmentier Henk K.
Published: March 2022

Background

Natural antibodies (NAb) are antibodies that are present in a healthy individual without requiring previous exposure to an exogenous antigen. Selection for high NAb levels might contribute to improved general disease resistance. Our aim was to analyse the genetic background of NAb based on a divergent selection experiment in poultry, and in particular the effect of a polymorphism in the TLR1A gene.

Methods

The study population consisted of a base population from a commercial pure-bred elite white leghorn layer line and seven generations of birds from a High and Low selection line. Birds were selected for total KLH-binding NAb titer (IgTotal). An enzyme-linked immunosorbent assay was performed to determine NAb titers in blood plasma for IgTotal and the antibody isotypes IgM and IgG. NAb titers were available for 10,878 birds. Genotypes for a polymorphism in TLR1A were determined for chickens in generations 5, 6 and 7. The data were analysed using mixed linear animal models.

Results

The heritability estimate for IgM was 0.30 and higher than that for IgG and IgTotal (0.12). Maternal environmental effects explained 2 to 3% of the phenotypic variation in NAb. Selection for IgTotal resulted in a genetic difference between the High and Low line of 2.4 titer points (5.1 genetic standard deviation) in generation 7. For IgM, the selection response was asymmetrical and higher in the Low than the High line. The frequency of the TLR1A C allele was 0.45 in the base population and 0.66 and 0.04 in generation 7 of the High and Low line, respectively. The TLR1A polymorphism had large and significant effects on IgTotal and IgM. Estimated genotypic effects suggest full dominance of the TLR1A C allele. Significant TLR1A by generation interactions were detected for IgM and IgTotal.

Conclusions

The effect of a polymorphism in the TLR1A gene on IgTotal and IgM NAb was confirmed. Furthermore, we provide experimental verification of changes in allele frequencies at a major gene with dominant gene action on a quantitative trait that is subjected to mass selection. TLR1A by generation interactions indicate sensitivity to environmental factors.
Variation in terpenoids in leaves of Artemisia annua grown under different LED spectra resulting in diverse antimalarial activities against Plasmodium falciparum
Authors: Sankhuan Darunmas , Niramolyanun Gamolthip , Kangwanrangsan Niwat , Nakano Masaru , Supaibulwatana Kanyaratt
Published: March 2022

Background

Productivities of bioactive compounds in high-value herbs and medicinal plants are often compromised by uncontrollable environmental parameters. Recent advances in the development of plant factories with artificial lighting (PFAL) have led to improved qualitative and/or quantitative production of bioactive compounds in several medicinal plants. However, information concerning the effect of light qualities on plant pharmaceutical properties is limited. The influence of three different light-emitting diode (LED) spectra on leaf fresh weight (FW), bioactive compound production and bioactivity of Artemisia annua L. against the malarial parasite Plasmodium falciparum NF54 was investigated. Correlation between the A. annua metabolites and antimalarial activity of light-treated plant extracts were also determined.

Results

Artemisia annua plants grown under white and blue spectra that intersected at 445 nm exhibited higher leaf FW and increased amounts of artemisinin and artemisinic acid, with enhanced production of several terpenoids displaying a variety of pharmacological activities. Conversely, the red spectrum led to diminished production of bioactive compounds and a distinct metabolite profile compared with other wavelengths. Crude extracts obtained from white and blue spectral treatments exhibited 2 times higher anti-Plasmodium falciparum activity than those subjected to the red treatment. Highest bioactivity was 4 times greater than those obtained from greenhouse-grown plants. Hierarchical cluster analysis (HCA) revealed a strong correlation between levels of several terpenoids and antimalarial activity, suggesting that these compounds might be involved in increasing antimalarial activity.

Conclusions

Results demonstrated a strategy to overcome the limitation of A. annua cultivation in Bangkok, Thailand. A specific LED spectrum that operated in a PFAL system promoted the accumulation of some useful phytochemicals in A. annua, leading to increased antimalarial activity. Therefore, the application of PFAL with appropriate light spectra showed promise as an alternative method for industrial production of A. annua or other useful medicinal plants with minimal environmental influence.
The impact of iron store on red blood cell transfusion: a multicentre prospective cohort study in cardiac surgery
Authors: Gaudriot Baptiste , Oilleau Jean-Ferreol , Kerforne Thomas , Ecoffey Claude , Huet Olivier , Mansour Alexandre , Verhoye Jean-Philippe , Massart Nicolas , Nesseler Nicolas ,   for the AtlanRea Study Group, Gaudriot Baptiste , Oilleau Jean-Ferreol , Kerforne Thomas , Ecoffey Claude , Huet Olivier , Mansour Alexandre , Massart Nicolas , Nesseler Nicolas
Published: March 2022

Background

Anaemia is common prior to cardiac surgery and contributes to perioperative morbidity. Iron deficiency is the main cause of anaemia but its impact remains controversial in the surgical setting. We aimed to estimate the impact of iron deficiency on in-hospital perioperative red blood cell transfusion for patients undergoing elective and urgent cardiac surgery. Secondary objectives were to identify risk factors associated with in-hospital red blood cell transfusion.

Methods

We conducted a prospective multicentre observational study in three university hospitals performing cardiac surgery. We determined iron status prior to surgery and collected all transfusion data to compare iron-deficient and iron-replete patients during hospital stay. We performed a multivariable logistic regression to compare transfusion among groups.

Results

Five hundred and two patients were included. A trend of low haemoglobin levels associated with iron deficiency persisted until discharge. Red blood cell transfusion was significantly higher in the group of iron deficient patients during surgery (22% vs 13%, p = 0.017), however the incidence during the whole hospital stay was 31% in the iron-deficient group, not significantly different with the non-deficient group (26%, p = 0.28). Iron deficiency was not independently associated with in-hospital red blood cell transfusion (adjusted OR = 0.85 [0.53–1.36], p = 0.49).

Conclusions

In-hospital red blood cell transfusion was not significantly higher in iron-deficient patients and iron deficiency was not associated with in-hospital red blood cell transfusion in patients undergoing elective and urgent cardiac surgery. Iron deficiency was the main cause of anaemia and anaemia was a strong driver of red blood cell transfusion. Further studies should identify sub-population of iron-deficient patients which may benefit from preoperative iron deficiency management and explore the long-term impact of lower haemoglobin levels at discharge in the iron deficient population.
Clinical relevance of circulating angiogenic cells in patients with ischemic stroke
Authors: Rodríguez-Esparragón Francisco , Torres-Mata Laura B. , López-Fernández Juan Carlos , Cappiello Laura , González-Martín Jesús M. , Clavo Bernardino , Serna-Gómez Jaime A. , Estupiñán-Quintana Lidia , Torres-Ascensión Cristina , Villar Jesús
Published: March 2022

Background

Endothelial progenitor cells (EPCs) are circulating angiogenic cells with endothelial features associated with risk for stroke. We aimed to delve into their functional characteristics. EPCs were isolated and cultured from Ischemic Stroke (IS) patients and predictors of their variance evaluated.

Methods

This is a single-center observational study evaluating 187 consecutively hospitalized patients with IS. EPCs were isolated from blood samples. The number of circulating angiogenic cells (CACs), colony-forming units (CFU-ECs) and the emergence of late outgrowths endothelial cells (LOECs) were counted. We collected clinical variables and measured the stromal cell-derived factor 1 alpha (SDF1α) serum levels. We also examined the relative telomere length and the expression of osteogenic gene markers in CACs.

Results

CACs counts and CFU-ECs colony numbers were positively correlated (rho = 0.41, p < 0.001, n = 187). We found significant differences according to whether thrombolytic treatment was performed in the distribution of CFU-ECs (odds ratio (OR) = 2.5; 95% confidence interval (CI) 1.01–6.35; p = 0.042) and CACs (OR = 4.45; 95% IC 1.2–15.5; p = 0.012). The main determinants of CACs variation were the number of risks factors, thrombolysis treatment, arterial hypertension, LOECs occurrence, and the vascular endothelial growth factor expression, whereas CFU-ECs variations depended on hemoglobin content and the relative reduction in the National Institutes of Health Stroke Scale (NIHSS) criteria. The main predictors of LOECs appearance were thrombolysis and length of hospital stay.

Conclusions

Our study supports the relevance of patient risk factors and treatments in the analysis of the functional properties of EPCs.
Partial upper sternotomy for extensive arch repair in older acute type A aortic dissection patients
Authors: Qiu Zhihuang , Xiao Jun , Wu Qingsong , Chai Tianci , Zhang Li , Li Yumei , Chen Liangwan
Published: March 2022

Objectives

The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated.

Methods

Between January 2014 and December 2019, 222 older adult patients (≥ 65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time.

Results

Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 min, P < 0.001), cross-clamp time (44.0 vs. 61.0 min, P < 0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 min, P < 0.001) than the FS group. Left ventricle ejection fraction  < 50% (odds ratio [OR] 17.05; 95% confidence interval [CI] 1.87–155.63; P = 0.012) and malperfusion syndromes (OR 65.83; 95% CI 11.53–375.86; P < 0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR] 0.76; 95% CI 0.64–0.91; P = 0.003), when compared with the FS group.

Conclusions

The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.
Comparative analysis of the association between traditional and lipid-related obesity indicators and isolated systolic hypertension
Authors: Qian Jian Dong , Li Xiao Mei , Chen Dong Shui , Zhu Jian Qin , Liu Xing Zhen
Published: March 2022

Background

Obesity is a well-known modified risk factor for isolated systolic hypertension (ISH), but evidence is lacking regarding whether the combination of anthropometric and lipid indicators could strengthen their correlation with ISH. Therefore, we compared the association of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product index (LAP), and cardiometabolic index (CMI) with ISH.

Methods

A total of 106,248 adults who received routine health screening and did not have diastolic blood pressure ≥ 90 mmHg were recruited in this cross-sectional study. The associations between these indicators and ISH were evaluated using multivariate regression.

Results

Each standard deviation (SD) increase in traditional obesity indicators (especially WHR and WHtR) had significantly higher multivariate-adjusted odds ratios (ORs) than each SD increase in lipid-related obesity indicators. In addition, multivariate-adjusted ORs for ISH in the third (vs. the first) tertile of traditional obesity indicators were also significantly higher than those of lipid-related indicators. Moreover, traditional obesity indicators exhibited a higher area under the ROC curve for discriminating ISH than lipid-related obesity indicators.

Conclusions

Traditional obesity indicators were more strongly associated with ISH than lipid-related obesity indicators among Chinese adults.
The role of primary physician training in improving regional standardized management of diabetes: a pre-post intervention study
Authors: Liu Hanbing , Hou Huimin , Yang Mingfeng , Hou Yusheng , Shan Zhongyan , Cao Yanli
Published: March 2022

Background

Hierarchical diagnosis and treatment has been gradually implemented throughout the China. Primary physicians are the main force in primary-level medical and health services, which means that standardized training of primary-level doctors is indispensable.

Objectives

Evaluation of the effect of primary physician training on standardized management of diabetes, and comparison of the effects of different training models.

Method

The study selected 24 community health service centers from 4 cities in Liaoning Province, and consisted of two groups: primary physicians (n = 2083) who received training; and patients with diabetes (n = 585) in community health service centers. Short-term training effects on primary physicians were assessed through diabetes knowledge tests at baseline and at the end of training; the long-term effects of training on patients with diabetes were assessed by questionnaires at baseline and 1 year after training. The differences in training effects between different training models were compared. Complication screening results were also assessed.

Results

After training, the primary physicians’ knowledge of diabetes diagnosis and treatment improved (p < 0.05). The complication screening rate of local diabetes patients increased from 22.2% before training to 27.7% 1 year after training (p = 0.033). There were significant differences in the training effect between different training models (p = 0.038). The short-term intensive training group demonstrated the greatest training effect, primary physicians under this training model are more likely to conduct standardized screenings for patients (OR = 1.806, 95%CI 1.008–3.233), and the complication screening rate was the highest (37.6%).

Conclusion

This study shows that training of primary physicians is an effective way to improve the standardized management of diabetes, by improving the ability of primary physicians to manage diabetes in a standardized manner, so that patients in primary hospitals receive more comprehensive diagnosis and treatment services. Compared with scattered training throughout the year, short-term intensive training was found to be more effective.
Development and psychometric evaluation of the Physical Resilience Instrument for Older Adults (PRIFOR)
Authors: Hu Fang-Wen , Lin Cheng-Han , Yueh Fang-Ru , Lo Yu-Tai , Lin Chung-Ying
Published: March 2022

Background

Physical resilience is known to minimize the adverse outcomes of health stressors for older people. However, validated instruments that assess physical resilience in older adults are rare. Therefore, we aimed to validate the Physical Resilience Instrument for Older Adults (PRIFOR) to fill the literature gap.

Methods

Content analysis with content validity was first carried out to generate relevant items assessing physical resilience for older adults, and 19 items were developed. Psychometric evaluation of the 19 items was then tested on 200 older adults (mean [SD] age = 76.4 [6.6] years; 51.0% women) for item properties, factor structure, item fit, internal consistency, criterion-related validity, and known-group validity.

Results

All 19 items had satisfactory item properties, as they were normally distributed (skewness = -1.03 to 0.38; kurtosis = -1.05 to 0.32). However, two items were removed due to substantial ceiling effects. The retained 17 items were embedded in three factors as suggested by the exploratory factor analysis (EFA) results. All items except one had satisfactory item fit statistics in Rasch model; thus, the unidimensionality was supported for the three factors on 16 items. The retained 16 items showed promising properties in known-group validity, criterion-related validity, and internal consistency (α = 0.94).

Conclusions

The 16-item PRIFOR exhibits good psychometric properties. Using this instrument to measure physical resilience would be beneficial to identify factors that could protect older people from negative health consequence. With the use of the PRIFOR, intervention effects could also be evaluated. It is helpful to strengthen resilience and thereby facilitate successful aging.
What do Brazilian health professionals know about the frailty syndrome? A cross-sectional study
Authors: Mesquita Wesley dos Reis , Ricci Natalia Aquaroni
Published: March 2022

Background

The growing care demand for frail older adults and those at risk of frailty in primary health care (PHC) requires professionals trained in the subject to promote adequate care. This study aimed to analyze the self-reported, theoretical and practical knowledge of PHC professionals about the frailty syndrome.

Methods

This is an observational cross-sectional study with a sample of 485 Brazilian health professionals (bachelor’s degree) working in PHC with older adults. An electronic questionnaire was used to collect data on professional characteristics and self-reported, theoretical and practical knowledge concerning frailty phenotype. Agreement analysis between types of knowledge and multivariate logistic regression were performed to show the factors associated with knowledge about frailty.

Results

Theoretical knowledge showed the worse result, with 87.5% of the professionals describing the syndrome incorrectly. Roughly half the professionals self-reported (52.6%) very little/no knowledge concerning the syndrome and demonstrated low practical knowledge (55.1%) when identifying clinical cases. There were misconceptions about the syndrome, like it is natural from the aging process (83.3%) and is synonymous with disability and comorbidity (51.2%). The majority of the professionals were unaware of instruments for assessing frailty (77.9%) and the phenotype criteria (68.2%). No agreement was observed between the types of knowledge. Professionals specialized in or who had taken training courses in older adult health were 6.1 and 2.7-fold more likely, respectively, to self-reported some knowledge on the frailty syndrome.

Conclusions

PHC professionals presented little knowledge on the frailty syndrome. Most professionals were unaware of the frailty definition, its assessments for diagnosis and evidence for its treatment. The lack of knowledge on frailty could affect the care provided to older adults in primary care.
Efficacy and acceptability of using wearable activity trackers in older adults living in retirement communities: a mixed method study
Authors: Zhang Zhanjia , Giordani Bruno , Margulis Alayna , Chen Weiyun
Published: March 2022

Background

Wearable activity trackers hold the potential for enhancing health and fitness, but the use of wearable activity trackers has remained largely unexplored in older adults. The purpose of the current study was to examine the effectiveness and acceptability of wearable activity trackers for promoting physical activity (PA) in older adults living in retirement communities.

Methods

Forty older adult participants (mean age = 85.4 years) used a wearable activity tracker (Fitbit InspireHR) for 12 weeks. Participants were provided with personalized activity goals and weekly feedback of PA during the 12 weeks. The main outcomes were daily step counts collected at baseline and the end of the intervention, and participants’ experiences of using the wearable activity tracker assessed after the 12-week intervention through an 8-item questionnaire and individual interviews.

Results

Participants used the activity tracker on 97.5% of measured days and had an average increase of 900 steps/day (p < 0.001). The Acceptance questionnaire revealed that the wearable activity tracker was acceptable, useful, and easy to use. Participants found that wearable activity trackers helped improve self-awareness and motivation of PA but reported a few concerns regarding the comfort of wearing the activity trackers and the ease of reading visual feedback.

Conclusions

Wearable activity trackers lead to a small but significant increase of PA and are perceived as acceptable and useful in older adults. Given the rapidly growing older population, wearable activity trackers are promising tools that could be used in large-scale interventions to improve PA and health in older adults.

Trial registration

Registered on Clinicaltrials.gov # NCT05233813 (Registered on 10/02/2022).
The fine-scale associations between socioeconomic status, density, functionality, and spread of COVID-19 within a high-density city
Authors: Zhang Anshu , Shi Wenzhong , Tong Chengzhuo , Zhu Xiaosheng , Liu Yijia , Liu Zhewei , Yao Yepeng , Shi Zhicheng
Published: March 2022

Background

Motivated by the need for precise epidemic control and epidemic-resilient urban design, this study aims to reveal the joint and interactive associations between urban socioeconomic, density, connectivity, and functionality characteristics and the COVID-19 spread within a high-density city. Many studies have been made on the associations between urban characteristics and the COVID-19 spread, but there is a scarcity of such studies in the intra-city scale and as regards complex joint and interactive associations by using advanced machine learning approaches.

Methods

Differential-evolution-based association rule mining was used to investigate the joint and interactive associations between the urban characteristics and the spatiotemporal distribution of COVID-19 confirmed cases, at the neighborhood scale in Hong Kong. The associations were comparatively studied for the distribution of the cases in four waves of COVID-19 transmission: before Jun 2020 (wave 1 and 2), Jul–Oct 2020 (wave 3), and Nov 2020–Feb 2021 (wave 4), and for local and imported confirmed cases.

Results

The first two waves of COVID-19 were found mainly characterized by higher-socioeconomic-status (SES) imported cases. The third-wave outbreak concentrated in densely populated and usually lower-SES neighborhoods, showing a high risk of within-neighborhood virus transmissions jointly contributed by high density and unfavorable SES. Starting with a super-spread which considerably involved high-SES population, the fourth-wave outbreak showed a stronger link to cross-neighborhood transmissions driven by urban functionality. Then the outbreak diffused to lower-SES neighborhoods and interactively aggravated the within-neighborhood pandemic transmissions. Association was also found between a higher SES and a slightly longer waiting period (i.e., the period from symptom onset to diagnosis of symptomatic cases), which further indicated the potential contribution of higher-SES population to the pandemic transmission.

Conclusions

The results of this study may provide references to developing precise anti-pandemic measures for specific neighborhoods and virus transmission routes. The study also highlights the essentiality of reliving co-locating overcrowdedness and unfavorable SES for developing epidemic-resilient compact cities, and the higher obligation of higher-SES population to conform anti-pandemic policies.
Use of low-protein staple foods in the dietary management of patients with stage 3–4 chronic kidney disease: a prospective case-crossover study
Authors: Shi Junbao , Wang Yue , Wang Song , Lu Xinhong , Chen Xinxin , Zheng Danxia
Published: March 2022

Objective

Maintaining a low-protein diet (LPD) is important for patients with chronic kidney disease (CKD) to delay renal degradation and alleviate clinical symptoms. For most patients with CKD, it is difficult to maintain the necessary low level of dietary protein intake (DPI). To improve the current dietary management of CKD, we conducted an intervention study by administering low-protein staple foods (LPSF).

Design and methods

We conducted a prospective case-crossover study among 25 patients with stage 3–4 CKD. During the initial 12 weeks of the study, we instructed the patients regarding a standard LPD according to the recommendations of a renal dietitian. In the second stage of the study, we requested the patients taking low-protein rice or low-protein flour (250 g/d) as an LPSF diet instead of regular staple food daily, and followed these patients up for 12 weeks. We compared the DPI, dietary energy intake (DEI), normalized protein equivalent of total nitrogen appearance (nPNA), serum creatinine levels, and nutritional index between baseline and the end of the study.

Results

We found no change in dietary variables among the patients during the first 12 weeks of the LPD. After subjecting them to an LPSF diet, the corresponding variables showed a pronounced change. The patients’ DPI decreased from 0.88 ± 0.20 to 0.68 ± 0.14 g/kg/d (P < 0.01) and the nPNA value decreased from 0.99 ± 0.18 to 0.87 ± 0.19 g/kg/d (P < 0.01). The high biological value protein intake proportion increased from 42% (baseline) to 57% (P < 0.01) during the 24 weeks. No variation was found in the measured DEI (28.0 ± 5.8 vs 28.6 ± 5.4 kcal/kg/d), nutrition assessment, or renal function and serum creatinine levels.

Conclusion

Our prospective case-crossover study demonstrated that an LPSF diet can help patients with stage 3–4 CKD reduce DPI and nPNA values, improve the proportion of highly bioavailable proteins, ensure adequate calorie intake, and avoid malnutrition. An LPSF diet is an effective and simple therapy for patients with stage 3–4 CKD.
Low birth weight and its associated risk factors in a rural health district of Burkina Faso: a cross sectional study
Authors: Lingani Moussa , Zango Serge Henri , Valéa Innocent , Somé Georges , Sanou Maïmouna , Samadoulougou Sékou O. , Ouoba Serge , Rouamba Eli , Robert Annie , Dramaix Michèle , Donnen Philippe , Tinto Halidou
Published: March 2022

Background

Low birth weight (LBW) is a major factor of neonate mortality that particularly affects developing countries. However, the scarcity of data to support decision making to reduce LBW occurrence is a major obstacle in sub-Saharan Africa. The aim of this research was to determine the prevalence and associated factors of LBW at the Yako health district in a rural area of Burkina Faso.

Methods

A cross sectional survey was conducted at four peripheral health centers among mothers and their newly delivered babies. The mothers’ socio-demographic and obstetrical characteristics were collected by face-to-face interview or by review of antenatal care books. Maternal malaria was tested by standard microscopy and neonates’ birth weights were documented. Multivariate logistic regression was used to determine factors associated with LBW. A p-value < 0.05 was considered statistically significant.

Results

Of 600 neonates examined, the prevalence of low birth weight was 11.0%. Adjustment for socio-demographic characteristic, medical conditions, obstetrical history, malaria prevention measures by multivariate logistic regression found that being a primigravid mother (aOR = 1.8, [95% CI: 1.1–3.0]), the presence of malaria infection (aOR = 1.9, [95% CI: 1.1–3.5]), the uptake of less than three doses of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (IPTp-SP) (aOR = 2.2, [95% CI: 1.3–3.9]), the presence of maternal fever at the time of delivery (aOR = 2.8, [95% CI: 1.5–5.3]) and being a female neonate (aOR = 1.9, [95% CI: 1.1–3.3]) were independently associated with an increased risk of LBW occurrence. The number of antenatal visits performed by the mother during her pregnancy did not provide any direct protection for low birth weight.

Conclusion

The prevalence of LBW remained high in the study area. Maternal malaria, fever and low uptake of sulfadoxine-pyrimethamine doses were significantly associated with LBW and should be adequately addressed by public health interventions.
Expression of the preadipocyte marker ZFP423 is dysregulated between well-differentiated and dedifferentiated liposarcoma
Authors: Dang Thanh N. , Tiongco Rafael P. , Brown Loren M. , Taylor Jessica L. , Lyons John M. , Lau Frank H. , Floyd Z. Elizabeth
Published: March 2022

Background

Well-differentiated and dedifferentiated liposarcomas are rare soft tissue tumors originating in adipose tissue that share genetic abnormalities but have significantly different metastatic potential. Dedifferentiated liposarcoma (DDLPS) is highly aggressive and has an overall 5-year survival rate of 30% as compared to 90% for well-differentiated liposarcoma (WDLPS). This discrepancy may be connected to their potential to form adipocytes, where WDLPS is adipogenic but DDLPS is adipogenic-impaired. Normal adipogenesis requires Zinc Finger Protein 423 (ZFP423), a transcriptional coregulator of Perixosome Proliferator Activated Receptor gamma (PPARG2) mRNA expression that defines committed preadipocytes. Expression of ZFP423 in preadipocytes is promoted by Seven-In-Absentia Homolog 2 (SIAH2)-mediated degradation of Zinc Finger Protein 521 (ZFP521). This study investigated the potential role of ZFP423, SIAH2 and ZFP521 in the adipogenic potential of WDLPS and DDLPS.

Methods

Human WDLPS and DDLPS fresh and paraffin-embedded tissues were used to assess the gene and protein expression of proadipogenic regulators. In parallel, normal adipose tissue stromal cells along with WDLPS and DDLPS cell lines were cultured, genetically modified, and induced to undergo adipogenesis in vitro.

Results

Impaired adipogenic potential in DDLPS was associated with reduced ZFP423 protein levels in parallel with reduced PPARG2 expression, potentially involving regulation of ZFP521. SIAH2 protein levels did not define a clear distinction related to adipogenesis in these liposarcomas. However, in primary tumor specimens, SIAH2 mRNA was consistently upregulated in DDLPS compared to WDLPS when assayed by fluorescence in situ hybridization or real-time PCR.

Conclusions

These data provide novel insights into ZFP423 expression in adipogenic regulation between WDLPS and DDLPS adipocytic tumor development. The data also introduces SIAH2 mRNA levels as a possible molecular marker to distinguish between WDLPS and DDLPS.