bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of Machine Learning to Model Important Features of 30-day Readmissions following Surgery for Metastatic Spinal Column Tumors: The Influence of Frailty
Authors: Elsamadicy Aladine A. , Koo Andrew B. , Reeves Benjamin C. , Cross James L. , Hersh Andrew , Hengartner Astrid C. , Karhade Aditya V. , Pennington Zach , Akinduro Oluwaseun O. , Larry Lo Sheng-Fu , Gokaslan Ziya L. , Shin John H. , Mendel Ehud , Sciubba Daniel M.
Published: November 2022

Study Design

Retrospective cohort study

Objective

The aim of this study was to determine the relative importance and predicative power of the Hospital Frailty Risk Score (HFRS) on unplanned 30-day readmission after surgical intervention for metastatic spinal column tumors.

Methods

All adult patients undergoing surgery for metastatic spinal column tumor were identified in the Nationwide Readmission Database from the years 2016 to 2018. Patients were categorized into 3 cohorts based on the criteria of the HFRS: Low(<5), Intermediate(5-14.9), and High(≥ 15). Random Forest (RF) classification was used to construct predictive models for 30-day patient readmission. Model performance was examined using the area under the receiver operating curve (AUC), and the Mean Decrease Gini (MDG) metric was used to quantify and rank features by relative importance.

Results

There were 4346 patients included. The proportion of patients who required any readmission were higher among the Intermediate and High frailty cohorts when compared to the Low frailty cohort ( Low:33.9% vs. Intermediate:39.3% vs. High:39.2%, P < .001). An RF classifier was trained to predict 30-day readmission on all features (AUC = .60) and architecturally equivalent model trained using only ten features with highest MDG (AUC = .59). Both models found frailty to have the highest importance in predicting risk of readmission. On multivariate regression analysis, Intermediate frailty [ OR:1.32, CI(1.06,1.64), P = .012] was found to be an independent predictor of unplanned 30-day readmission.

Conclusion

Our study utilizes machine learning approaches and predictive modeling to identify frailty as a significant risk-factor that contributes to unplanned 30-day readmission after spine surgery for metastatic spinal column metastases.
Cardiac autonomic dysfunction and risk of incident stroke among adults with type 2 diabetes
Authors: Kaze Arnaud D , Yuyun Matthew F , Fonarow Gregg C , Echouffo-Tcheugui Justin B
Published: November 2022

Introduction:

There is a dearth of data on the association between cardiac autonomic neuropathy (CAN) with incident stroke among individuals with diabetes mellitus. We evaluated this association in a large sample of adults with type 2 diabetes.

Patients and methods:

Participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study without atherosclerotic cardiovascular disease at baseline were included. CAN was assessed at baseline by heart rate variability (HRV) indices and QT index (QTI) calculated from 10-s resting electrocardiograms. HRV was assessed using standard deviation of all normal-to-normal R-Rs intervals (SDNN) and root mean square of successive differences between normal-to-normal R-R intervals (rMSSD). CAN was defined based on several composite measures of SDNN, QTI, resting heart rate and peripheral neuropathy. We used Cox proportional hazards regression to generate hazard ratios (HR) and 95% confidence intervals (CI) for incident stroke in relation to CAN.

Results:

A total of 3493 participants (mean age 62.2 years, 44.5% women, 62.9% White) were included. Over a median follow-up of 5.0 years, 50 stroke cases occurred (incidence rate 3.0/1000 person-years [95% CI 2.2–3.9]). After adjusting for confounders, low HRV was associated with a higher risk of stroke (HR of 2.20 [95% CI 1.23–3.93] and 1.88 [95% CI 1.04–3.41] for low SDNN and rMSSD, respectively). Participants with CAN (defined as lowest quartile of SDNN and highest quartiles of QTI and heart rate) had a 5.7-fold greater risk of stroke (HR 5.70, 95% CI 2.49–13.08).

Discussion and conclusion:

CAN was independently associated with an increased risk of incident stroke in a large cohort of adults with type 2 diabetes.
Resolving impasses in policy translation: Shall we adjust the idea or the process?
Authors: Minkman Ellen
Published: November 2022

This study explains how contrasting perspectives on resolving impasses in policymaking exist among all relevant actors in a case of transferring Dutch flood management policy to Jakarta, Indonesia. It does so by introducing Q methodology as a novel method in policy transfer and policy mobility studies. International policy transfer requires a continuous, iterative process of policy translation where stagnation may occur following disruptions on the policy, polity or political dimension. This paper assumes that actors go through a process in which they assign meaning to transfer objects. Using Q methodology, two contrasting perspectives are identified in the case of transferring the ‘Dutch Delta Approach’ to Jakarta, Indonesia. One perspective emphasises the need for direct implementation, while the other advocates further modification of ideas. These contrasting perspectives cut through existing sender-receiver categorizations and prevent strategic alignment needed for a breakthrough. Furthermore, they suggest a lack of political leadership from Indonesia and potential conflict of interests of the Dutch government as policy sender as other causes for prolonged stagnation. Finally, I conclude that the outsourcing of strategy making and planning to consultants delimits the space for translation.
Constructing payments for ecosystem services hydrosocial territories through assemblage practices: China’s Xin’an river basin eco-compensation pilot
Authors: Sheng Jichuan , Han Xiao
Published: November 2022

This study employs the case of China’s Xin’an River Basin Eco-compensation Pilot to explore how the payments for ecosystem services (PES) can configure local water control arenas through various assemblage practices. The findings demonstrate that specific assemblage practices can construct a PES hydrosocial territory, which often reflects power struggles. We argue that the dynamic assemblage practices redefine the boundaries of the PES hydrosocial territory and trigger the reconfiguration of PES scalar territory. Finally, we draw attention to the critical role that state intervention plays in constructing China’s PES hydrosocial territory, reflecting China’s remarkable governance rationality and technology. Therefore, beyond the existing interpretation of PES hydrosocial territory, the analysis of the remaking of the Xin’an River Basin has promoted the study of hydropolitics to understand better the role of assemblage practices in PES hydrosocial territory.
Governing caterpillar fungus: Participatory conservation as state-making, territorialization, and dispossession in Dolpo, Nepal
Authors: Gurung Phurwa
Published: November 2022

Protected areas account for nearly a quarter of the total area of Nepal and over eighty percent of its Himalayan region. National parks—which are governed by top-down policies enforced through militarized infrastructures—have become a crucial avenue and site for the Nepali state to expand its authority and territorialize its peripheral spaces. But such state-forming effects of the park are obscured by the stated goals of biodiversity conservation which are often implemented through participatory conservation policies that claim to promote local participation and development. Through a case study of Shey Phoksundo National Park and the contested governance of caterpillar fungus in Dolpo, Northwest Nepal, this paper examines the role of participatory conservation in state-making, territorialization, and the dispossession of Indigenous peoples in the Himalayan borderlands. After a brief background on the relationship between Dolpopa and the Nepali state, I introduce state-making, territorialization, and dispossession as corollary processes that define the experiences of conservation for Dolpopa. I conceptualize state-making and territorialization as intertwined state efforts and strategies to systematize local spatial practices and reorder socio-natural relations in ways that justify state authority and establish state territory in Dolpopa spaces. I approach dispossession as an ongoing, relational process of domination and removal, particularly of Dolpopa's ability to access and govern their collective land including caterpillar fungus. In so doing, I neither reify the state as a monolith nor assume dispossession to be totalizing. Rather, I show how “the state” is constituted in moments by a range of actors, institutions, and processes; as well as how Dolpopa contest dispossession by asserting their claims to collective land both within and beyond state structures.
Iatrogenic Left Main Coronary Artery Dissection During Non-Left Main Intervention: A Case Series
Authors: Raj Ajay , Singh Ajay Pratap , Nath Ranjit Kumar
Published: November 2022

Iatrogenic left main coronary artery (LMCA) dissection is a rare complication of percutaneous coronary intervention (PCI), it is mainly attributed to the catheter-based manipulation during engagement of Ostia or during the intervention. LMCA dissections are very dynamic ranging from a small, stable, and localized tear to extensive dissection obstructing coronary branches and cardiac arrest. Without prompt intervention, it often is a fatal complication. In this case series, we report three cases of LMCA dissection and their management with intravascular ultrasound-guided PCI.
Emotional status does not alter exercise tolerance in patients with chronic obstructive pulmonary disease
Authors: Borak J , Chodosowska E , Matuszewski A , Zielinski J
Published: November 2022

Exercise tolerance in chronic obstructive pulmonary disease (COPD) patients has been shown to be related to airway limitation and dyspnoea, but little is known about the effects of an emotional status on physical performance. We examined 49 COPD patients with a wide spectrum of airway limitation severity and hypoxaemia. Exercise tolerance was evaluated using the Six-minute Walking Distance Test (6MWD), dyspnoea at rest and on exercise was measured using the visual analogue scale, and the emotional status was evaluated using the battery of psychological tests. The average 6MWD (mean+/-SD) was 355+/-112 m. In the majority of patients a fall in arterial blood oxygen saturation (Sa,O2) on exercise of >3% was found. The mean dyspnoea score of 21+/-19 at rest increased to 66+/-19 on exercise. All subjects demonstrated an increased level of anxiety. The majority also demonstrated elevated emotional tension, and half of the study group showed signs of depression. Step-wise multiple regression analysis with results of 6MWD as dependent and other studied variables as independent variables showed that exercise tolerance depended mainly on airway limitation. The forced expiratory volume in one second (FEV1) explained 24% of the variance. The forced vital capacity added a further 10%, and arterial blood carbon dioxide tension contributed 7%. The dyspnoea level on exercise added only 0.9%. All four variables explained 42% of the variance. There was no correlation between 6MWD and any of the variables characterizing the emotional status. We conclude that the emotional status of chronic obstructive pulmonary disease patients is characterized by an increased level of psychological tension, anxiety and depression, but these do not affect exercise tolerance as assessed by the six-minute walking distance test.
Motor-sparing peripatellar plexus block provides noninferior block duration and complete block area of the peripatellar region compared with femoral nerve block: a randomized, controlled, noninferiority study
Authors: Gong Wen-Yi , Li Chen-Guang , Zhang Jing-Yu , Liao Xiao-Hui , Zhu Cheng , Min Jie , Yue Xiao-Fang , Fan Kun
Published: November 2022

Background

Developing adequate regional anaesthesia for knee surgeries without affecting lower limb mobilization is crucial to perioperative analgesia. However, reports in this regard are limited. We proposed a technique for ultrasound-guided peripatellar plexus (PP) block. Compared with the femoral nerve (FN) block, we hypothesized that this technique would provide a noninferior block duration and a complete cutaneous sensory block in the peripatellar region without affecting lower limb mobilization. An investigation was conducted to verify our hypothesis in cadavers and volunteers.

Methods

The study was designed in two parts. First, eight cadaveric lower limbs were dissected to verify the feasibility of PP block after methylene blue injection under ultrasound. Second, using a noninferiority study design, 50 healthy volunteers were randomized to receive either a PP block (PP group) or an FN block (FN group). The primary outcome was the duration of peripatellar cutaneous sensory block, with the prespecified noninferiority margin of -3.08 h; the secondary outcome was the area of peripatellar cutaneous sensory block; in addition, the number of complete anaesthesias of the incision line for total knee arthroplasty and the Bromage score 30 min after block were recorded.

Results

The PP was successfully dyed, whereas the FN and saphenous nerve were unstained in all cadaveric limbs. The mean difference of the block duration between the two groups was − 1.24 (95% CI, -2.81 − 0.33) h, and the lower boundary of the two-sided 95% CI was higher than the prespecified noninferiority margin (Pnoninferiority= 0.023), confirming the noninferiority of our technique over FN block. The cutaneous sensory loss covered the entire peripatellar region in the PP group. PP block achieved complete anaesthesia of the incision line used for total knee arthroplasty and a Bromage score of 0 in 25 volunteers, which differed significantly from that of volunteers who underwent FN block.

Conclusion

Ultrasound-guided PP block is a feasible technique. Compared with FN block, PP block provides noninferior block duration and complete blocking of the peripatellar region without affecting lower limb mobilization.

Trial registration

This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2000041547, registration date 28/12/2020).
What we have learned from a patient with partial tracheal rupture caused by penetrating neck injuries: a case report
Authors: Tian Jun , Tao Xing , Quan Xiang , Zhang Sanmei
Published: November 2022

Background

Airway management of patients with direct airway trauma caused by penetrating neck injuries is always challenging. When a failed airway occurs and surgery access is difficult, it is crucial to find the optimal approach to save the life. We propose the concept “Cannot intubate, Cannot oxygenate, Difficult surgery access” to describe this emergency scenario.

Case presentation

We report a case of a 24-year-old woman who presented with partial tracheal rupture and pneumothorax caused by a knife stab injury to the neck. A "double setup" strategy, simultaneous preparation for orotracheal intubation and tracheotomy, was carried out before rapid sequence induction. A tracheotomy under local anesthesia or an awake intubation was not preferred in consideration that the patient had a high risk of being uncooperative owing to existing mental disease and potential smothering sensation during operation. During rapid sequence intubation, distal part of the tube penetrates the tear and creates a false lumen outside the trachea then a failed airway subsequently occurred. Rescue tracheotomy was successfully performed by an otolaryngology surgeon, with the help of limited ventilation using sequential bag–mask and laryngeal mask airway ventilation provided by an anesthesiologist, without severe sequelae.

Conclusions

The endotracheal tube have a risk of penetrating the tear outside the trachea in patient with partial tracheal rupture during orotracheal intubation, and once it occurs, proceeding directly to an emergency invasive airway access with optimizing oxygenation throughout procedure might increase the chance of success in rescuing the airway.
Association between violence and depression during pregnancy with perinatal outcomes: a moderated mediation analysis
Authors: Gómez Aristizábal Liliana Yanet , Confortin Susana Cararo , Batista Rosângela Fernandes Lucena , de Britto e Alves Maria Teresa Seabra Soares , Simões Vanda Maria Ferreira , da Silva Antônio Augusto Moura
Published: November 2022

Objective

To assess the direct, indirect, and total effects of violence during pregnancy on perinatal outcomes, and to evaluate the effect of violence as a moderator of the mediated relationship of depression with perinatal outcomes.

Methods

Data was collected from the prenatal study and follow-ups of the BRISA cohort, São Luís, Maranhão, Brazil. The perinatal outcomes investigated were: birth weight (BW), intrauterine growth restriction (IUGR) and gestational age (GA). Violence against women was evaluated using the World Health Organization Violence against Women instrument (Violence during pregnancy – regardless of the type of violence; Physical violence during pregnancy; Psychological violence during pregnancy). Depressive symptoms during pregnancy were evaluated as a mediating variable. Moderated mediation analysis was performed to estimate the effects of violence and depression on perinatal outcomes.

Results

Three types of violence analyzed by depression had an indirect effect in BW and GA. None of the types of violence showed an association with IUGR. All types of violence analyzed showed a moderated mediation effect with BW and GA. Only among women who experienced violence were birth weight and gestational age lower the higher the values of depressive symptoms.

Conclusion

Violence and depression are only associated with lower BW and GA when they occur simultaneously.
Prevalence of Her2-neu status and its clinicopathological association in newly diagnosed gastric cancer patients
Authors: Kattan Joseph , Karak Fady el , Farhat Fadi , Gerges Dany Abi , Mokaddem Walid , Chahine Georges , Khairallah Saad , Fakhruddin Najla , Makarem Jawad , Nasr Fadi
Published: November 2022

Background

This study aimed to report the prevalence of HER2-neu in newly diagnosed early or metastatic gastric cancer (GC) patients, to determine the percentage of patients achieving various IHC scores correlating with the ISH results and to establish a database for GC patients in Lebanon.

Methods

This was a national, multicenter, descriptive and cross-sectional study in patients with histologically confirmed early or metastatic GC newly diagnosed. All eligible patients underwent the IHC and ISH tests in a central laboratory. Demographics, medical history and histopathology data were collected.

Results

One hundred fifty-seven patients were included (mean age at diagnosis: 63 ± 14.1 years) during a 3.5 year period. The prevalence of HER2-neu over expression was 21% (95% CI: 15.3–27.4) using ICH and ISH. Agreement between IHC and ISH results was significantly substantial (kappa = 0.681;p-value < 0.001). Over expressed HER2-neu status was significantly associated with high ECOG performance status only.

Conclusions

The prevalence of HER2-neu over expression in newly diagnosed early or metastatic GC patients seemed to be high in Lebanon. The database generated allows to monitor trends in the epidemiology and management of GC.
Dietary intake of yogurt and cheese in children at age 1 year and sleep duration at age 1 and 3 years: the Japan Environment and Children’s Study
Authors: Inoue Mariko , Matsumura Kenta , Sugimori Narumi , Hamazaki Kei , Tsuchida Akiko , Inadera Hidekuni ,   The Japan Environment and Children’s Study (JECS) Group
Published: November 2022

Background

We previously reported that 1-year-old infants born to mothers who regularly consumed fermented food during pregnancy had a lower risk of sleep deprivation. However, it is not known if these positive effects are enhanced when infants themselves eat fermented foods or the long-term effects of such consumption. In this study, we examined the association between the frequency of fermented food intake during the child’s weaning period and sleep deprivation at age 1 and 3 years.

Methods

This birth cohort study used data from a nationwide, government-funded study called the Japan Environment and Children’s Study (JECS), covering 65,210 mother-child pairs. We examined the association between infants’ consumption of fermented foods at 1 year of age and sleep deprivation at 1 and 3 years of age.

Results

There was no association between yogurt or cheese intake and sleep duration at age 1; at age 3, there was no group difference, although a trend test showed that yogurt intake at age 1 was significantly associated with sleep duration at age 3. There was also no association between the frequency of cheese intake and inadequate sleep duration at age 3.

Conclusion

Frequency of children’s yogurt and cheese intake at age 1 was not associated with sleep duration at age 1 or 3. However, a trend test showed a significant association between the frequency of yogurt intake at age 1 and sleep duration at age 3.
Employees’ healthy eating and physical activity: the role of colleague encouragement and behaviour
Authors: van der Put Anne , Ellwardt Lea
Published: November 2022

Background:

Exercising and eating healthy are not just an individual choice, but influenced by family members, friends, or neighbours. Little is known, however, about colleagues, who are another important interpersonal influence. Many people spend many hours at work, surrounded by mostly the same colleagues, who could therefore significantly shape employees’ (un)healthy choices. We studied to what extent colleagues may play a part in one another’s eating and exercise behaviours by focusing on two pathways: colleagues can encourage a healthy lifestyle or act as role models whose behaviours can be observed and copied.

Methods:

We used the European Sustainable Workforce Survey, with data on 4345 employees in 402 teams in 113 organisations. We used network autocorrelation models, which resemble regression models, to study to what extent employee encouragement is related to fruit and vegetable consumption, and physical activity. Specific to this type of model is the inclusion of a network correlation parameter which allows for the outcome of an employee to be directly associated with the outcomes of their colleagues. In this way we tested whether colleagues’ behaviours were related to one another.

Results:

We found that employees were more likely to eat fruit and vegetables as well as engage in physical activity when their colleagues encourage a healthy lifestyle. Employees’ healthy eating behaviours were positively related to their colleagues’ fruit and vegetable consumption, while we found a negative correlation concerning physical activity.

Conclusion:

Overall, colleagues’ encouragement and own healthy behaviours have the potential to contribute to creating a culture of health in the workplace and support all employees in making healthy choices.
Gender-related factors associated with delayed diagnosis of tuberculosis in Eastern Europe and Central Asia
Authors: Turusbekova Nonna , Celan Cristina , Caraulan Liliana , Rucsineanu Oxana , Jibuti Mariam , Ibragimova Oxana , Saidova Nargis
Published: November 2022

Tuberculosis (TB), a preventable and treatable disease, yearly affects millions of people and takes more than a million lives. Recognizing the symptoms and obtaining the correct diagnosis are vital steps towards treatment and cure. How timely a person with TB gets diagnosed may be influenced by biological differences between the sexes, and factors that are linked to the person’s gender, in the context of the prevailing gender norms. According to our hypothesis, gender-related factors contribute to delays in the diagnosis of TB. We investigated four countries (Georgia, Kazakhstan, Republic of Moldova, and Tajikistan) of Eastern Europe and Central Asia (EECA) - a region with a high burden of drug-resistant TB, scarcity of gender-related TB information, and varying gender equality. Retrospective information was collected directly from the people with a history of TB - through in-depth interviews and focus group discussions. We did not find differences between genders in the way participants recognized TB symptoms. In three countries women de-prioritized seeking diagnosis because of their lack of access to finances, and household-related obligations. In all four countries, men, traditionally carrying the weight of economically supporting the family, tended to postpone TB diagnosis. In two countries women experienced stigma more often than men, and it was a deterrent factor to seeking healthcare. The role of gender in obtaining the correct diagnosis came forth only among the respondents from Georgia and to some extent from Kazakhstan. We conclude that there are barriers to health care seeking and TB diagnosis that affect differently women, men and gender-diverse persons in EECA Region.
Comparison of the effectiveness of anchoring needles and coils in localizing multiple nodules in the lung
Authors: Huang Ya-Yong , Wang Tao , Fu Yu-Fei , Shi Yi-Bing , Cao Wei , Hou Ju-Pan
Published: November 2022

Background

Recently, a new type of pulmonary nodule positioning needle has been adopted clinically. We aimed to evaluate the efficacy and safety of a new type of localization needles compared with coils for the simultaneous localization of multiple pulmonary nodules guided by computed tomography (CT) prior to video-assisted thoracoscopic surgery (VATS).

Materials and methods

From January 2021 to March 2022, 87 pulmonary nodules from 40 patients were localized using the new localization needle. From January 2020 to December 2020, 68 pulmonary nodules in 31 patients were localized using coils. The relative outcomes were compared.

Results

The success rate of pulmonary nodule localization in the needle group was 97.7% while that in the coil group was 98.5%. In the needle group, the time needed to locate the first nodule was significantly shorter than in the coil group (10.9 min vs. 17.2 min, P = 0.001). Moreover, the time needed per patient was also significantly shorter for the needle group compared with the coil group (23.7 min vs. 30 min, P = 0.017). The incidence of pneumothorax in the needle group was 25.0% vs. 12.9% in the coil group (P = 0.204). The rate of pulmonary hemorrhage in the needle group was 40.0% vs. 32.3% in the coil group (P = 0.502). The success rate of VATS wedge resection was 100% in both groups.

Conclusion

Both disposable pulmonary nodule localization needles and coils are safe and effective for CT-guided localization of multiple pulmonary nodules of the same stage prior to VATS. However, the use of needles is time-saving compared with the use of coils. The coil localization may exhibit better safety than needle localization.
Ovarian steroid cell tumors, not otherwise specified: analysis of nine cases with a literature review
Authors: Lin Mengyan , Bao Kechun , Lu Lingjia , Xu Shuhang , Liang Yun , Cheng Xiaodong , Wang Fenfen
Published: November 2022

Background

Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS), are rare, with few large studies. The purpose of this study was to analyze the clinical features, prognosis, and treatment choices for these patients of different age groups.

Methods

This was a retrospective study. We identified nine cases of ovarian steroid cell tumor, not otherwise specified, confirmed by post-operative histopathological examination, and analyzed clinical features, surgical procedures, and follow up outcomes. We also reviewed cases reports of ovarian steroid cell tumors, not otherwise specified.

Results

A total of nine cases were included. The age range was 9–68 years (mean, 41.89 ± 19.72 years). Clinical features included virilization, amenorrhea, abdominal pain, vaginal bleeding, isosexual precocious puberty, Cushing’s syndrome, and abnormal weight gain with elevated testosterone levels. The follow up interval ranged 5–53 months and no recurrence was observed.

Conclusion

Ovarian steroid cell tumors covered all age groups, with manifestations of androgen excess. Younger patients appeared to have a more favorable prognosis, which provided more opportunities for these patients to pursue treatment options that will preserve reproductive function.
The effect of complementary music intervention on the patients’ quality of life after septoplasty and rhinoplasty
Authors: Schell Angela , Wassmer Felix , Zaubitzer Lena , Kramer Benedikt , Sadick Haneen , Rotter Nicole , Häussler Daniel
Published: November 2022

Purpose:

Quality of life (QoL) assessment has emerged as an important evaluation tool for therapeutic treatments. The positive impact of complementary music interventions on QoL has been demonstrated in the literature, particularly in chronic and malignant diseases. However, its benefits during the perioperative period in head and neck patients have not been investigated thus far.

Methods:

Head and neck patients undergoing septoplasty and rhinoplasty were prospectively randomized and consecutively included in the trial. Passive music intervention (60 min per day) was applied to the intervention group. QoL was assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and the Functional Rhinoplasty Outcome Inventory 17 (FROI-17) questionnaire at three visits during the postoperative phase. Pain was measured using a visual analogue scale.

Results:

Forty-four patients were enrolled in the study. The NOSE score between the control group and the intervention group in the septoplasty arm differed significantly at visit #2 (p < 0.001) and visit #3 (p < 0.015). For the rhinoplasty study arm, significant differences in the FROI-17 score were also found at visit #2 and visit #3 (p = 0.04).

Conclusion:

Complementary music interventions can considerably improve patients’ QoL during the postoperative period. Furthermore, passive music interventions may be easily implemented in clinical practice as an additional cost-effective treatment with ubiquitous availability.
A comparative analysis of the impact of online, blended, and face-to-face learning on medical students’ clinical competency in the affective, cognitive, and psychomotor domains
Authors: Enoch L. C. , Abraham R. M. , Singaram V. S.
Published: November 2022

Background:

The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students’ clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.

Methods:

A non-random cross-sectional quasi-experimental study assessed third-year medical students’ knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.

Results:

Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group’s (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group’s affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.

Conclusion:

Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.
Evaluation of house staff candidates for program fit: a cohort-based controlled study
Authors: Lee Soo-Hoon , Phan Phillip H. , Desai Sanjay V.
Published: November 2022

Background

Medical school academic achievements do not necessarily predict house staff job performance. This study explores a selection mechanism that improves house staff-program fit that enhances the Accreditation Council for Graduate Medical Education Milestones performance ratings.

Objective

Traditionally, house staff were selected primarily on medical school academic performance. To improve residency performance outcomes, the Program designed a theory-driven selection tool to assess house staff candidates on their personal values and goals fit with Program values and goals. It was hypothesized cohort performance ratings will improve because of the intervention.

Methods

Prospective quasi-experimental cohort design with data from two house staff cohorts at a university-based categorical Internal Medicine Residency Program. The intervention cohort, comprising 45 house staff from 2016 to 2017, was selected using a Behaviorally Anchored Rating Scales (BARS) tool for program fit. The control cohort, comprising 44 house staff from the prior year, was selected using medical school academic achievement scores. House staff performance was evaluated using ACGME Milestones indicators. The mean scores for each category were compared between the intervention and control cohorts using Student’s t-tests with Bonferroni correction and Cohen’s d for effect size.

Results

The cohorts were no different in academic performance scores at time of Program entry. The intervention cohort outperformed the control cohort on all 6 dimensions of Milestones by end-PGY1 and 3 of 6 dimensions by mid-PGY3.

Conclusion

Selecting house staff based on compatibility with Residency Program values and objectives may yield higher job performance because trainees benefit more from a better fit with the training program.
The relationship between patient safety culture and patient safety competency with adverse events: a multicenter cross-sectional study
Authors: Hafezi Asal , Babaii Atye , Aghaie Bahman , Abbasinia Mohammad
Published: November 2022

Background

Patient safety culture and patient safety competency could be associated with adverse events (AEs). This study aimed to investigate the associations between nurses’ perceptions of patient safety culture, patient safety competency, and AEs.

Methods

A cross-sectional study was carried out among 338 nurses employed in three university hospitals in Qom, Iran between 17 August 2021 and 12 November 2021. Data were collected using three questionnaires: patient safety culture, patient safety competency, and AEs. Data were analyzed using SPSS-21 software. A multiple logistic regression model was used to analyze the data.

Results

The results of this study showed that medication errors were significantly associated with “frequency of events reported” (OR = 0.706, P = 0.012), “supervisor/manager expectations and actions promoting patient safety” (OR = 0.733, P = 0.048), and “management support for patient safety” (OR = 0.755, P = 0.012). Pressure ulcers were significantly associated with “supervisor/manager expectations and actions promoting patient safety” (OR = 0.729, P = 0.039), “handoffs and transition” (OR = 0.707, P = 0.034), and “comfort speaking up about patient safety” (OR = 0.614, P = 0.016). Falls were significantly associated with “teamwork within units” (OR = 0.735, P = 0.031), “feedback and communication about error” (OR = 0.756, P = 0.046), and “handoffs and transition” (OR = 0.660, P = 0.012). The use of restraints for ≥8 hr. was significantly associated with “management support for patient safety” (OR = 0.701, P = 0.021).

Conclusions

According to the results of this study, AEs are associated with some dimensions of patient safety culture and patient safety competency. Further research is needed to confirm these findings and identify interventions to reduce the occurrence of AEs.
Psoriasis and cardiovascular disease risk in European and East Asian populations: evidence from meta-analysis and Mendelian randomization analysis
Authors: Zhang Liming , Wang Yuxiang , Qiu Li , Wu Jian
Published: November 2022

Background

Psoriasis has been linked to cardiovascular disease (CVD), including coronary artery disease (CAD), myocardial infarction (MI), and heart failure (HF). However, available studies regarding this relationship have shown inconsistent results. Therefore, in this report, we performed a comprehensive review of the literature to assess the effects of psoriasis on risk of these CVDs.

Methods

A search of literature until 24 December 2021 was done in PubMed, the Cochrane Library, Web of Science, Google Scholar, and Embase. Within European and East Asian populations, meta-analyses of observational studies assessing correlations between psoriasis and various CVD risk factors were conducted. Mendelian randomization (MR) was then employed to assess the causative impact of genetic pre-disposition for psoriasis on these CVD risk factors.

Results

The results of the meta-analyses indicated that, in both the European and East Asian populations, psoriasis was significantly linked to an elevated risk in the incidence of CAD (RR = 1.51, 95% confidence interval (CI): 1.04–2.18, p = 0.028 and RR = 1.91, 95% CI: 1.62–2.25, p < 0.001) and MI (RR = 1.23, 95% CI: 1.04–1.46, p = 0.017 and RR = 2.17, 95% CI: 1.44–3.28, p < 0.001). A positive genetic relationship of psoriasis with CAD was found in European individuals (IVW OR:1.03; 95% CI: 1.01–1.06, p = 0.005) and in East Asian individuals (IVW OR:1.18; 95% CI: 1.03–1.32, p = 0.031). We also established that psoriasis was causally linked with an elevated risk of MI (IVW OR:1.05; 95% CI: 1.01–1.09, p = 0.026) in the European population as determined using an MR approach. Moreover, our MR results were congruent with the null findings from the meta-analysis assessing associations of psoriasis with HF risk.

Conclusions

This research work provides preliminary evidence that psoriasis and CVD have a common genetic origin and that targeted psoriasis treatment might improve cardiovascular outcomes. These results not only increase our knowledge of the genetic underpinnings linking a comorbidity of psoriasis with CVD but also suggests a novel approach for CVD prevention.
Pilot study on CHCF1 genotype in a pig challenge model for enterotoxigenic Escherichia coli F4ab/ac associated post-weaning diarrhea
Authors: Rydal Martin Peter , Gambino Michela , Jørgensen Claus Bøttcher , Poulsen Louise Ladefoged , Brøndsted Lone , Nielsen Jens Peter
Published: November 2022

Host genotype is important for enterotoxigenic E. coli (ETEC) susceptibility. We conducted two trials to evaluate the effect of CHCF1 genotype on incidence of ETEC diarrhea. In trial 1 (n = 15 pigs), pigs were inoculated with 108 CFU or 1010 CFU doses of an ETEC F4ac strain. In trial 2 (n = 33 pigs), pigs were inoculated with ETEC F4ab or F4ac. Across trials, all inoculated pigs that developed ETEC diarrhea were CHCF1 heterozygous susceptible (6/6). No inoculated CHCF1 homozygous resistant pigs developed ETEC diarrhea (0/26). Susceptibility towards ETEC F4ac/ab infection might correspond with CHCF1 genotype.
Qualitative inquiry into perceptions of HIV pre-exposure prophylaxis among people who inject drugs living with hepatitis C in Seattle, WA, USA
Authors: Barry Michael P. , Austin Elizabeth J. , Bhatraju Elenore P. , Glick Sara N. , Stekler Joanne D. , Tung Elyse L. , Hansen Ryan N. , Williams Emily C. , Gojic Alexander J. , Pickering Eleanor I. , Tsui Judith I.
Published: November 2022

Background

The incidence of HIV among persons who inject drugs (PWID) in the USA has been increasing since 2014, signaling the need to identify effective ways to engage PWID in HIV prevention services, namely pre-exposure prophylaxis (PrEP). Yet, the uptake of PrEP in this population is minimal compared to other populations at risk of HIV acquisition. In this work, we sought to explore knowledge, attitudes, and perspectives of PrEP acceptability among PWID.

Methods

In the context of a pilot study to explore the acceptability of pharmacy-based hepatitis C virus (HCV) treatment, we conducted semi-structured interviews (n = 24) and focus groups (n = 4, 16 participants) with people who were living with HCV and reported active injection drug use (≤ 90 days since last use). Participants were asked open-ended questions about their familiarity with and motivation to use PrEP. As part of a sub-analysis focused on PrEP, qualitative data were analyzed using a Rapid Assessment Process, where three coders used structured templates to summarize qualitative data and iteratively reviewed coded templates to identify themes. Participants also completed short quantitative questionnaires regarding drug use history and attitudes toward health concerns.

Results

Forty-seven percent of participants expressed having little or no concern regarding HIV acquisition. Targeted analyses focused on HIV prevention identified three themes, which help characterize behavioral determinants of nonadoption. First, knowledge of PrEP was limited among PWID and influenced by infrequent open community discussions around HIV risk. Second, PWID perceived sexual behaviors—but not injection drug use—as a motivator for HIV risk prevention. Finally, PWID identified many individual and environmental barriers that hinder PrEP uptake.

Conclusion

Among PWID, PrEP is rarely discussed and concerns about the feasibility of using daily PrEP are common. Taken with the prevalent perception that drug use is not a high risk for HIV acquisition, our findings point to opportunities for public health work to target PrEP education to PWID and to leverage other successful interventions for PWID as an opportunity to provide PrEP to this vulnerable population.
Evaluation of diurnal and postural intracranial pressure employing telemetric monitoring in idiopathic intracranial hypertension
Authors: Mitchell James L , Buckham Rebecca , Lyons Hannah , Walker Jessica K , Yiangou Andreas , Sassani Matilde , Thaller Mark , Grech Olivia , Alimajstorovic Zerin , Julher Marianne , Tsermoulas Georgios , Brock Kristian , Mollan Susan P , Sinclair Alexandra J
Published: November 2022

Objectives

Intracranial pressure (ICP) has been thought to vary diurnally. This study evaluates diurnal ICP measurements and quantifies changes in ICP occurring with changes in body posture in active idiopathic intracranial hypertension (IIH).

Methods

This prospective observational study utilized telemetric ICP monitoring in people with active IIH. Participants had the Raumedic p-Tel ICP intraparenchymal device (Raumedic, Hembrechts, Germany) surgically inserted. Changes in ICP in the supine position were evaluated. Then, the ICP was measured in the standing, sitting, supine, left lateral decubitus positions and with coughing and bending. Ultimately, changes in ICP over the course of 24 h were recorded. ISRCTN registration number 12678718.

Results

15 women were included, mean (standard deviation) age 29.5 (9.5) years, body mass index 38.1 (6.2) kg/m2, and baseline mean ICP of 21.2 (4.8) mmHg (equivalent to 28.8 (6.5) cmCSF). Mean ICP rose with the duration in the supine position 1.2 (3.3) mmHg over 5-minutes (p = 0.175), 3.5 (2.8) mmHg over 30-minutes (p = 0.0002) and by a further 2.1 (2.2) mmHg over 3 h (p = 0.042). Mean ICP decreased by 51% when moving from the supine position to standing (21.2 (4.8) mmHg to 10.3 (3.7) mmHg respectively, p = 0.0001). Mean ICP increased by 13% moving from supine to the left lateral decubitus position (21.2 (4.8) mmHg to 24.0 (3.8) mmHg, p = 0.028). There was no significant difference in ICP measurements at any point during the daytime, or between 5-minute standing or supine recordings and prolonged ambulatory daytime and end of night supine recordings respectively. ICP, following an initial drop, increased progressively in conjunction with lying supine position from 23:00 h to 07:00 h by 34% (5.2 (1.9) mmHg, p = 0.026).

Conclusion

This analysis demonstrated that ICP does not appear to have a diurnal variation in IIH, but varies by position and duration in the supine position. ICP rose at night whilst the patient was continuously supine. Furthermore, brief standing and supine ICP measures in the day predicted daytime prolonged ambulatory measures and end of night peak ICP respectively. This knowledge gives reassurance that ICP can be accurately measured and compared at any time of day in an ambulant IIH patient. These are useful findings to inform clinical measurements and in the interpretation of ICP analyses in IIH.

Trial registration

ISTCRN (12678718).
Transgenic animal models to explore and modulate the blood brain and blood retinal barriers of the CNS
Authors: Goncalves Andreia , Antonetti David A.
Published: November 2022

The unique environment of the brain and retina is tightly regulated by blood–brain barrier and the blood-retinal barrier, respectively, to ensure proper neuronal function. Endothelial cells within these tissues possess distinct properties that allow for controlled passage of solutes and fluids. Pericytes, glia cells and neurons signal to endothelial cells (ECs) to form and maintain the barriers and control blood flow, helping to create the neurovascular unit. This barrier is lost in a wide range of diseases affecting the central nervous system (CNS) and retina such as brain tumors, stroke, dementia, and in the eye, diabetic retinopathy, retinal vein occlusions and age-related macular degeneration to name prominent examples. Recent studies directly link barrier changes to promotion of disease pathology and degradation of neuronal function. Understanding how these barriers form and how to restore these barriers in disease provides an important point for therapeutic intervention. This review aims to describe the fundamentals of the blood-tissue barriers of the CNS and how the use of transgenic animal models led to our current understanding of the molecular framework of these barriers. The review also highlights examples of targeting barrier properties to protect neuronal function in disease states.