bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of a 12-week yoga program on the CoP of military pilots before and after a flight emergency simulation using Biosignals Plux force platform
Authors: Santos Sara , Parraca José Alberto , Alegrete Joana , Cabo Carolina Alexandra , Melo Filipe , Fernandes Orlando
Published: September 2023

This study examined the effects of Ashtanga Vinyasa Yoga Supta on Center of Pressure (CoP) displacement in healthy student pilots, using the Biosignals Plux force platform, under the premise that yoga would lead to improvements in postural control responses. CoP response was analyzed by the Plux (Portugal) one-dimensional force platform. A total of 18 military pilots participated in this study. The pilots were in their Portuguese Air Force Academy course “Masters in Military Aeronautics: Aviator Pilot Specialist,” also called Tirocinium. Participants were randomly assigned to yoga classes (intervention group) or a waiting list (control group) and completed a flight emergency protocol in a flight simulator. CoP displacement was collected before and after all these maneuvers had been completed and both measures occurred before (baseline values) and after a 12-week yoga program. Although the differences observed between groups are not significant, after calculating the effect size, we can theorize that the intervention group maintains CoP displacement before and after flight and the control group has a higher CoP displacement after flight simulation. CoP information collected through noninvasive portable devices such as the Biosignals Plux force platform can relay important information quickly and easily. Knowing under what circumstances pilots are affected can then lead to development or enhancement of training strategies to improve those psychophysiological responses. In this study the effects, while not significant, are present, so it may be necessary to add more weeks of training to make the yoga program effective.
International GP exchanges: Opportunities, benefits, and challenges
Authors: Morris Dr Charlotte B. , Pettigrew Dr Luisa M.
Published: September 2023

The RCGP and its Junior International Committee have a long history of supporting early career GPs to undertake observational exchanges to experience international primary care systems first-hand. The benefits of international exchanges are wide-ranging and include allowing participants to develop collaborations, learn more about primary healthcare in the host country, reflect on that learning, and bring it back to their own practice. This article discusses the current opportunities for early career GPs and describes some of the existing evidence regarding the educational, personal and professional benefits, as well as challenges these may bring to participants, patients and the wider health system.
Androgenic anabolic steroid abuse
Authors: Robinson Dr Emilia , Haque Dr Raju , Eggink Dr Aline
Published: September 2023

Androgen anabolic steroid abuse is a broad term describing the use of structural derivatives of testosterone with the aim to increase body mass and muscle size, or to enhance athletic performance. These drugs are typically used in large doses, much higher than would be prescribed for the treatment of medical conditions. This use of steroids is illegal and can lead to multiple adverse effects including cardiovascular, hepatic, metabolic and psychological issues. Many patients abusing steroids will not typically disclose this information when presenting to their GP. This article aims to help raise awareness of signs and symptoms of abuse, as well as highlight the common long-term risks and discuss a GP’s role in managing these complex scenarios.
Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
Authors: Iolascon Giovanni , Liguori Sara , Paoletta Marco , Toro Giuseppe , Moretti Antimo
Published: September 2023

Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, such as bisphosphonates and denosumab, or osteoanabolic drugs, such as teriparatide and abaloparatide, has shown to be effective in reducing the risk of fracture in osteoporotic patients. In the context of the cellular and molecular mechanisms that regulate bone metabolism, the discovery of the Wnt signaling pathway and its role in bone tissue homeostasis has allowed the identification of sclerostin as an inhibitor of osteoblastic activity and simultaneously as a stimulator of osteoclastic activity. Therefore, the use of a monoclonal antibody, romosozumab, against this protein has been tested as a potential drug with a dual action, stimulating bone neo-apposition and inhibiting bone resorption. The efficacy of romosozumab has been demonstrated in numerous clinical trials against both placebo and other drugs commonly used in the treatment of patients affected by osteoporosis. The advantages of this drug lie above all in its rapid action which makes it particularly suitable in clinical situations where it is necessary to improve bone strength very quickly due to the imminent risk of fragility fracture. Clinical studies and guidelines suggest romosozumab as an initial drug in an ideal sequential approach from osteoanabolic to antiresorptive drugs. Some aspects of cardiovascular safety remain to be fully investigated, therefore its use in osteoporotic patients at high cardiovascular risk should be avoided until further data become available.
Complexifying quality in early childhood contexts through a theory of quality ecologies
Authors: Hunkin Elise , Grieshaber Susan
Published: September 2023

This paper makes a case for developing a theory of quality ecologies in early childhood education and care, and presents our initial thoughts around how that might be done, including how it might create a space for further thinking, research and discussion. First, the politicised, positivist nature of dominant contemporary interpretations of quality is discussed, including our case for theoretical experimentation and diversification. Then, we discuss existing applications of ecologies theory in education research and the opportunities it presents, followed by our thinking so far around how it can be applied to critical theorisations of quality ecologies. Last, we outline our research program and what we envisage can be accomplished by a theory of quality ecologies in early childhood education.
The Great Divide: Neither Fairness Nor Kindness Eliminates Moral Derogation of People With Opposing Political Beliefs
Authors: McGarry Phillip P. , Shteynberg Garriy , Hulsey Timothy L. , Heim Andrew S.
Published: September 2023

People increasingly view those with opposing political beliefs as less moral than those with shared political beliefs. Across two experiments, using a U.S. undergraduate sample ( n = 1,070) and a U.S. resident online sample through Prolific ( n = 402), we employed the Ultimatum Game (UG) to investigate whether acts of fairness, or even kindness, by persons with out-party political beliefs would mitigate moral derogation toward them. In neither experiment, did fairness or kindness by persons with opposite political beliefs moderate moral derogation. More extreme partisans engaged in even greater moral derogation of out-party (versus in-party) individuals, regardless of their acts of fairness or kindness. However, even self-identified moderate partisans engage in out-party moral derogation. The implications of these findings for political discourse and resolution for political conflict are discussed.
“I know my body better than anyone else”: a qualitative study of perspectives of people with lived experience on antimicrobial treatment decisions for injection drug use-associated infections
Authors: Eckland Amy , Kohut Michael , Stoddard Henry , Burris Deb , Chessa Frank , Sikka Monica K. , Solomon Daniel A. , Kershaw Colleen M. , Eaton Ellen F. , Hutchinson Rebecca , Friedmann Peter D. , Stopka Thomas J. , Fairfield Kathleen M. , Thakarar Kinna
Published: September 2023

Background:

People who inject drugs (PWID) are at risk for severe bacterial and fungal infections including skin and soft tissue infections, endocarditis, and osteomyelitis. PWID have high rates of self-directed discharge and are often not offered outpatient antimicrobial therapies, despite studies showing their efficacy and safety in PWID. This study fills a gap in knowledge of patient and community partner perspectives on treatment and discharge decision making for injection drug use (IDU)-associated infections.

Methods:

We conducted semi-structured interviews with patients ( n = 10) hospitalized with IDU-associated infections and community partners ( n = 6) in the Portland, Maine region. Community partners include peer support workers at syringe services programs (SSPs) and outreach specialists working with PWID. We transcribed and thematically analyzed interviews to explore perspectives on three domains: perspectives on long-term hospitalization, outpatient treatment options, and patient involvement in decision making.

Results:

Participants noted that stigma and inadequate pain management created poor hospitalization experiences that contributed to self-directed discharge. On the other hand, patients reported hospitalization provided opportunities to connect to substance use disorder (SUD) treatment and protect them from outside substance use triggers. Many patients expressed interest in outpatient antimicrobial treatment options conditional upon perceived efficacy of the treatment, perceived ability to complete treatment, and available resources and social support. Finally, both patients and community partners emphasized the importance of autonomy and inclusion in medical decision making. Although some participants acknowledged their SUD, withdrawal symptoms, or undertreated pain might interfere with decision making, they felt these medical conditions were not justification for health care professionals withholding treatment options. They recommended open communication to build trust and reduce harms.

Conclusion:

Patients with IDU-associated infections desire autonomy, respect, and patient-centered care from healthcare workers, and may self-discharge when needs or preferences are not met. Involving patients in treatment decisions and offering outpatient antimicrobial options may result in better outcomes. However, patient involvement in decision making may be complicated by many contextual factors unique to each patient, suggesting a need for shared decision making to meet the needs of hospitalized patients with IDU-associated infections.
Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda: a community-based cross-sectional study
Authors: Bongomin Felix , Kibone Winnie , Okot Jerom , Ouma Simple , Madraa Grace , Ojara Francis Williams , Musoke David , Pebolo Pebalo Francis
Published: September 2023

Background:

Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sex workers in Gulu, Uganda.

Methods:

In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3 months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p < 0.05 was considered statistically significant.

Results:

We enrolled 273 female sex workers with a median age of 27 (interquartile range: 24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with; regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p < 0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p = 0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI: 1.49–4.35, p < 0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p = 0.005), and use of postexposure prophylaxis (PEP) in the past 12 months (aPR: 0.31, 95% CI: 0.17–0.59, p < 0.001).

Conclusion:

Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.
Ecologies of Violence on Social Media: An Exploration of Practices, Contexts, and Grammars of Online Harm
Authors: Morales Esteban
Published: September 2023

Violence is an almost ubiquitous phenomenon in contemporary digital environments. In this context, there is a growing need to understand how violence is enacted and represented on social media. Drawing from a case study where Colombian young adults discussed the violence they interacted with on their everyday uses of digital platforms, this article explores how violence on social media is experienced and understood by users. Findings emphasize the need to look at violence on digital platforms as a multifaceted, fluid, overlapping, and interconnected phenomenon. In light of these results, I suggest framing current harmful practices as ecologies of violence. To better explore these ecologies, I outline three specific areas that highlight how violence is transformed on social media: practices, contexts, and grammars. Overall, this study emphasizes the need to recognize and address the complexity of violence in social media—a necessary step toward building cultures of peace in and outside of our digital environments.
Slippery lubricant-infused silica nanoparticulate film processing for anti-biofouling applications
Authors: Li Sip Yuen Yee , Jacobs Annabel , Morales Alejandra , Sun Mengdi , Roberson Luke B , Hummerick Mary E , Roy Herve , Kik Pieter , Zhai Lei
Published: September 2023

Microbial biofilm build-up in water distribution systems can pose a risk to human health and pipe material integrity. The impact is more devastating in space stations and to astronauts due to the isolation from necessary replacement parts and medical resources. As a result, there is a need for coatings to be implemented onto the inner region of the pipe to minimize the adherence and growth of biofilms. Lubricant-infused surfaces has been one such interesting material for anti-biofouling applications in which their slippery property promotes repellence to many liquids and thus prevents bacterial adherence. Textured and porous films are suitable substrate candidates to infuse and contain the lubricant. However, there is little investigation in utilizing a nanoparticulate thin film as the substrate material for lubricant infusion. A nanoparticulate film has high porosity within the structure which can promote greater lubricant infusion and retention. The implementation as a thin film structure aids to reduce material consumption and cost. In our study, we utilized a well-studied nanoporous thin film fabricated via layer-by-layer assembly of polycations and colloid silica and then calcination for greater stability. The film was further functionalized to promote fluorinated groups and improve affinity with a fluorinated lubricant. The pristine nanoporous film was characterized to determine its morphology, thickness, wettability, and porosity. The lubricant-infused film was then tested for its lubricant layer stability upon various washing conditions and its performance against bacterial biofilm adherence as a result of its slippery property. Overall, the modified silica nanoparticulate thin film demonstrated potential as a base substrate for lubricant-infused surface fabrication that repelled against ambient aqueous solvents and as an anti-biofouling coating that demonstrated low biofilm coverage and colony forming unit values. Further optimization to improve lubricant retention or incorporation of a secondary function can aid in developing better coatings for biofilm mitigation.
The Antifungal Potential of Cardamom-based DenteezTM Mouthwash Against Opportunistic Fungal Infections in the Oral Cavity
Authors: Tharakan Matthan , Kugaji Manohar , Bhat Kishore , Varkey Prashanth , Joshi Mayuri , Nanda Bhagyashree
Published: September 2023

Aim:

Oral candidiasis is a fungal infection of the oral cavity caused by Candida albicans. Currently used antifungal drugs fail to treat oropharyngeal candidiasis. Herbal remedies are found to be safe and effective to treat bleeding gums, halitosis, mouth ulcers, and reduce tooth decay. Cardamom is known to possess antimicrobial, antioxidant, and immunomodulatory activity. In an in vitro study, we aim to evaluate the antifungal potential of cardamom-based DenteezTM mouthwash against opportunistic fungal infections in the oral cavity.

Materials and Methods:

Five Candida species were included in the study: namely C. albicans, C. tropicalis, C. krusei, C. parapsilosis, and C. glabrata. Additionally, 54 clinical isolates obtained from oral cavity of healthy individuals and patients suffering from oral candidiasis were randomly selected and included. Various antifungal agents tested included fluconazole, itraconazole, ketoconazole, miconazole, and amphotericin B. Minimum inhibitory concentration (MIC) and time-kill assay were performed as per standard guidelines.

Results:

The MIC obtained for fluconazole against different Candida species was 1.25 µg/ml. The MIC of azole drugs was in the range of 0.312–0.62 µg/ml. The MIC of DenteezTM mouthwash was determined as 1.25%. The clinical isolates of Candida showed major resistance to fluconazole (75.9%) and absolute susceptibility to amphotericin B. DenteezTM was found effective in inhibiting 98.2% of the clinical isolates. DenteezTM mouthwash showed time-dependent inhibition of all Candida species.

Conclusion:

The mouthwash has comparable efficacy to that of other routinely used antifungal agents. DenteezTM can be effectively used to deal with oral candidiasis and antifungal resistance.
Evaluating Effects of Virtual Diabetes Group Visits in Community Health Centers During the COVID-19 Pandemic
Authors: Dinh Tracy , Staab Erin M , Nuñez Daisy , Zhu Mengqi , Wan Wen , Schaefer Cynthia T , Campbell Amanda , Quinn Michael , Baig Arshiya A
Published: September 2023

Diabetes is the seventh leading cause of death in the US. Diabetes group visits (GVs), which include group education and individual medical visits have been shown to improve clinical outcomes. However, few studies have evaluated virtual GVs. We conducted a single-arm pilot study to test the impact of virtual diabetes GVs in Midwestern community health centers (CHCs). Adult patients with diabetes participated in monthly virtual GVs for 6 months. Surveys and chart abstraction were used to assess patient-reported and clinical outcomes. Five CHCs implemented virtual GVs with 34 patients attending at least one session. Virtual GVs show promise as evidenced by these findings: (1) Patients had a nonsignificant decrease in A1C. (2) In the subgroup of patients with baseline A1C ≥ 9%, there was a significant decrease in A1C. (3) Patients had significant increases in diabetes knowledge and support as well as a decrease in diabetes distress. Future studies with a larger sample size and a control comparison group are needed to assess the impact of virtual GVs on patient outcomes.
Experiences of the Nursing Professionals Hospitalized by Covid-19 in Peru: Dawning Every Day Meant one More Chance to Live
Authors: Arévalo-Ipanaqué Janet Mercedes , Obando Zegarra Roxana , Cabanillas Chávez María Teresa
Published: September 2023

Introduction

Nursing professionals who contracted Covid-19 went from being caregivers to victims of the infection, and they knew first-hand how dangerous it could be. The impact on these health care professionals stayed with them even after their physical health recovered.

Objective

To understand the experiences of nursing professionals hospitalized with COVID-19, regarding their illness, hospitalization and care received.

Methods

Qualitative phenomenological study, with two in-depth interviews each with six nursing professionals who had representative cases from public hospitals in Lima, Peru, was chosen until theoretical saturation was achieved.

Results

Four main themes emerged from the transcripts of the 12 interviews conducted: self-assessment about the form of infection, identification and complications of the disease, feelings about the disease-hospitalization, and perception of the care received as a patient.

Conclusion

Being hospitalized as COVID-19 patients has been a difficult experience for nursing professionals, characterized by fear of dying; where the emotional support of their family and colleagues, as well as their spiritual strength, have allowed them to achieve their recovery, so they feel satisfied with the care received.
Effect of a Nurse-Led Intervention on Knowledge of the Modifiable Risk Behaviors of Cardiovascular Disease: A Randomized Controlled Trial
Authors: Okube Okubatsion Tekeste , Kimani Samuel T. , Mirie Waithira
Published: September 2023

Introduction

Cardiovascular disease (CVD) has disproportionately burdened the low- and middle-income countries where awareness and detection rates remain very low. Interventions directed to promote the community's awareness of CVD may help reduce the public's exposure to behavioral risk factors. However, the effectiveness of interventions implemented through a nurse on knowledge of the modifiable behavioral risk factors and preventive measures of CVD has not been determined in Kenya.

Objective

To establish the effect of a nurse-led intervention on knowledge of the modifiable risk behaviors of CVD in adults with metabolic syndrome (MetS) attending a mission-based hospital in Kenya.

Methods

A two-armed parallel-group randomized controlled trial design was conducted among 352 adults aged 18–64 years with MetS. The participants were recruited from a faith-based hospital in Nairobi, Kenya and randomly allocated to either a nurse-led lifestyle intervention or a control group. The intervention group received a comprehensive health education intervention using the World Health Organization (WHO) guideline recommendations for CVD control and prevention. Individuals in the control group were exposed to the usual CVD care according to hospital protocol. The duration of the intervention was 12 months. The primary outcome measure was a change in levels of knowledge on the modifiable risk factors and preventive measures of CVD. Outcome measures were assessed at baseline and at 15 months postintervention. Pre- and postintervention difference in the level of knowledge between the two groups was determined using the chi-square test of independence.

Results

The knowledge level of CVD risk factors and preventive measures was very low in both groups at baseline without significant difference. A significant improvement in the level of knowledge on CVD risk factors (78.2% vs. 30.4%, p < .001) and preventive measures (74.4% vs. 29.0%, p < .001) was observed in the intervention group relative to the control at the end-line.

Conclusions

The nurse-led lifestyle intervention significantly improved participants’ level of knowledge on CVD risk factors and preventive measures. It is highly recommended that nurses incorporate routine health education interventions for patients with cardio-metabolic abnormalities.
The quality of collaboration with child welfare scale (Q-CCW): Development and validation
Authors: Gau Jeff , Zilberstein Karen , Brown Adam , English Meme
Published: September 2023

Collaborations in child welfare are crucial for addressing complex needs and improving outcomes for children and their families. In this study we aimed to develop and validate the Quality of Collaboration with Child Welfare (Q-CCW) scale to assess working relationships between providers and child welfare workers. The scale was developed to assess four attributes of collaboration: quality of the working relationship, responsiveness, joint understanding, and communication. Following its construction, the scale was administered to a sample of 208 participants, including mental health clinicians, foster/kinship parents, and lawyers/evaluators. Exploratory factor analysis revealed a one-factor solution, indicating a unified construct of quality collaboration, that demonstrated reliability. The Q-CCW can facilitate the measurement and improvement of collaborations in child welfare, thereby contributing to enhanced service delivery and positive outcomes for children and families.
Sign language ideologies and deaf interpreters in Canada
Authors: Snoddon Kristin
Published: September 2023

This article reports preliminary survey and interview data from a 3-year study regarding language ideologies related to deaf interpreters (DIs). DIs are professional sign language interpreters who are deaf and who may work as part of a team with hearing sign language interpreters. Survey data provide a snapshot of current DI demographics and reflect that most DIs are Canadian-born and from a grandparent generation. This suggests that a precarious national sign language ecosystem currently exists in Canada. Data from an interview with one DI participant reveal how this participant, by virtue of his education in Canadian deaf schools and professional background, was positioned as a peer of other Canadian deaf professionals. Simultaneously, due to his immigrant background and accompanying lived experiences of language and multilayered repertoire, he was positioned in solidarity with deaf clients who were newcomers to Canada and multiply marginalised. This dual positioning and status enabled insights regarding dominant language ideologies among DIs and other deaf professionals.
Mindfulness-Based Teaching Competency Assessment: Comparing Self-Assessment With Expert Evaluation in the Veterans Administration – Compassionate Awareness Learning Module Program
Authors: Serpa J Greg , Shamblen Stephen R , Atwood Kathy , Sangpukdee Aree , Whitehead Alison , Wolf Christiane
Published: September 2023

Background

Meditation, including Mindfulness-Based Interventions (MBI), is a required Complementary and Integrative Health intervention at the US Department of Veterans Affairs (VA). Training VA clinicians to provide MBI at scale must address fidelity concerns and the assessment of clinician competency.

Objective

The psychometric properties of the Mindfulness-Based Intervention: Teaching Assessment Criteria (MBI:TAC), a widely used tool for assessing facilitator competence, continue to be explored. To support the dissemination of MBI, the utility of using the MBI:TAC for self-assessment for clinicians in a national training program was evaluated.

Methods

In a training cohort of VA clinicians (n = 39), participant self evaluations on 2 domains of the MBI:TAC are compared to the competency scores of 2 expert evaluators as based on the observations of a 10-minute exercise. Additionally, the inter-rater reliability between the 2 experts was explored.

Results

Intraclass Correlation for the 2 expert evaluators for Guiding Practice was significant ( ρ = .83, P = .003), but was not significant for Embodiment of Mindfulness (ρ = .34, P = .186). Self-evaluation scores were not significantly correlated to expert rater scores such that participants rate their level of competence higher than expert scores.

Conclusion

The MBI:TAC, while an essential tool in teacher training, may not produce accurate scores when used for self-assessment. Instruction from a senior teacher is needed for accurate scoring. Interrater reliability may be improved with enhanced domain operationalization and training. Implications for MBI training are explored.
The COVID-19 Pandemic and the Private Health Sector: Profiting without Socially Contributing
Authors: Kondilis Elias , Benos Alexis
Published: September 2023

The COVID-19 pandemic necessitated the mobilization of all available health care resources, including private, for-profit ones. The aim of this multiple methods study (combination of document and secondary data analysis) was to assess government regulations facilitating the private health sector's participation in the COVID-19 response in Greece. During the pandemic, the government made three successive increases in private providers’ reimbursement fees, provided additional financial incentives to private providers, and allocated €280 million of emergency funding for the private sector's involvement in the national COVID-19 response. In response, private hospitals made available on average 2.2% of their total bed capacity per epidemic wave for the treatment of COVID-19 patients and 1.7% of their total bed capacity for the treatment of non-COVID-19 patients transferred from National Health System (NHS) hospitals. In 2020 the five largest health care corporate groups maintained their revenues, while in 2021 they increased them by 18.7%—a striking comparison with the 9% recession experienced by the Greek economy in 2020 and its 8.4% recovery in 2021. In a time of an acute public health crisis, private health care providers responded to society's pressing health care needs by insulating their facilities from COVID-19 patients and NHS patient transfers, minimizing their social contribution and safeguarding their revenues and profits.
Variability of response spectra of single-path ground-motion record pairs
Authors: Hikita Tomoki , Tomozawa Yusuke
Published: September 2023

To improve the accuracy of seismic hazard analysis, understanding the uncertainty of the prediction of the ground-motion amplitude for a specific site owing to a specific source is important. In this study, the variability of the acceleration response spectra of single-path ground motion was evaluated using record pairs obtained from two earthquakes at the same site with the same magnitude, location, and focal mechanism, recorded by high-density strong-motion observation networks in Japan. The natural log standard deviations of the single-path ground motions varied with the period and were distributed in the range of approximately 0.3–0.5. Even if an empirical ground-motion prediction model that accurately models the characteristics of single-path ground motions could be developed, avoiding this variability in the prediction is difficult. The standard deviation of the within-event residuals was smaller at larger distances, and the period of the maximum standard deviation tended to increase as the earthquake magnitude increased. These features may be attributed to differences in the source characteristics of each earthquake. These findings will be useful for the development of advanced empirical ground-motion models and for improving the accuracy of seismic hazard analysis.
Follicular lymphoma evolves with a surmountable dependency on acquired glycosylation motifs in the B-cell receptor
Authors: Haebe Sarah , Day Grady , Czerwinski Debra K. , Sathe Anuja , Grimes Susan M. , Chen Tianqi , Long Steven R. , Martin Brock , Ozawa Michael G. , Ji Hanlee P. , Shree Tanaya , Levy Ronald
Published: September 2023

An early event in the genesis of follicular lymphoma (FL) is the acquisition of new glycosylation motifs in the B-cell receptor (BCR) due to gene rearrangement and/or somatic hypermutation. These N-linked glycosylation motifs (N-motifs) contain mannose-terminated glycans and can interact with lectins in the tumor microenvironment, activating the tumor BCR pathway. N-motifs are stable during FL evolution, suggesting that FL tumor cells are dependent on them for their survival. Here, we investigated the dynamics and potential impact of N-motif prevalence in FL at the single-cell level across distinct tumor sites and over time in 17 patients. Although most patients had acquired at least 1 N-motif as an early event, we also found (1) cases without N-motifs in the heavy or light chains at any tumor site or time point and (2) cases with discordant N-motif patterns across different tumor sites. Inferring phylogenetic trees of the patients with discordant patterns, we observed that both N-motif–positive and N-motif–negative tumor subclones could be selected and expanded during tumor evolution. Comparing N-motif–positive with N-motif–negative tumor cells within a patient revealed higher expression of genes involved in the BCR pathway and inflammatory response, whereas tumor cells without N-motifs had higher activity of pathways involved in energy metabolism. In conclusion, although acquired N-motifs likely support FL pathogenesis through antigen-independent BCR signaling in most patients with FL, N-motif–negative tumor cells can also be selected and expanded and may depend more heavily on altered metabolism for competitive survival.
Hemostasis without clot formation: how platelets guard the vasculature in inflammation, infection, and malignancy
Authors: Kaiser Rainer , Escaig Raphael , Nicolai Leo
Published: September 2023

Platelets are key vascular effectors in hemostasis, with activation signals leading to fast recruitment, aggregation, and clot formation. The canonical process of hemostasis is well-characterized and shares many similarities with pathological thrombus formation. However, platelets are also crucially involved in the maintenance of vascular integrity under both steady-state and inflammatory conditions by ensuring blood vessel homeostasis and preventing microbleeds. In these settings, platelets use distinct receptors, signaling pathways, and ensuing effector functions to carry out their deeds. Instead of simply forming clots, they mainly act as individual sentinels that swiftly adapt their behavior to the local microenvironment. In this review, we summarize previously recognized and more recent studies that have elucidated how anucleate, small platelets manage to maintain vascular integrity when faced with challenges of infection, sterile inflammation, and even malignancy. We dissect how platelets are recruited to the vascular wall, how they identify sites of injury, and how they prevent hemorrhage as single cells. Furthermore, we discuss mechanisms and consequences of platelets’ interaction with leukocytes and endothelial cells, the relevance of adhesion as well as signaling receptors, in particular immunoreceptor tyrosine–based activation motif receptors, and cross talk with the coagulation system. Finally, we outline how recent insights into inflammatory hemostasis and vascular integrity may aid in the development of novel therapeutic strategies to prevent hemorrhagic events and vascular dysfunction in patients who are critically ill.
Nine-year follow-up of lenalidomide plus rituximab as initial treatment for mantle cell lymphoma
Authors: Yamshon Samuel , Chen Gui Zhen , Gribbin Caitlin , Christos Paul , Shah Bijal , Schuster Stephen J. , Smith Sonali M. , Svoboda Jakub , Furman Richard R. , Leonard John P. , Martin Peter , Ruan Jia
Published: September 2023

Although chemoimmunotherapy is the current standard of care for initial treatment of mantle cell lymphoma (MCL), newer data suggest that there may be a role for a chemotherapy-free approach. We report the 9-year follow-up results of a multicenter, phase 2 study of lenalidomide plus rituximab (LR) as the initial treatment of MCL. The LR doublet is used as induction and maintenance until progression, with optional discontinuation after 3 years. We previously reported an overall response rate of 92% in evaluable patients, with 64% achieving a complete response. At a median follow-up of 103 months, 17 of 36 evaluable patients (47%) remain in remission. The 9-year progression-free survival and overall survival were 51% and 66%, respectively. During maintenance, hematologic adverse events included asymptomatic grade 3 or 4 cytopenia (42% neutropenia, 5% thrombocytopenia, and 3% anemia) and mostly grade 1 to 2 infections managed in the outpatient setting (50% upper respiratory infections, 21% urinary tract infections, 16% sinusitis, 16% cellulitis, and 13% pneumonia, with 5% requiring hospitalization). More patients developed grade 1 and 2 neuropathy during maintenance therapy (29%) than during induction therapy (8%). Twenty-one percent of patients developed secondary malignancies, including 5% with invasive malignancies, whereas the remainder were noninvasive skin cancers treated with local skin-directed therapy. Two patients permanently discontinued therapy because of concerns of immunosuppression during the COVID-19 pandemic. With long-term follow-up, LR continues to demonstrate prolonged, durable responses with manageable safety as initial induction therapy. This trial was registered at www.clinicaltrials.gov as #NCT01472562.
The fungal quorum-sensing molecule, farnesol, regulates the immune response of vaginal epithelial cells against Candida albicans
Authors: Li Ting , Liu Zhao-Hui , Fan Lin-Yuan , Zhang Zhan , Bai Hui-Hui , Wang Feng-Juan , Shang Chen-Guang , Zong Xiao-Nan , Liu Yong
Published: September 2023

Background

Farnesol is a Candida-secreted quorum-sensing molecule of great interest as a potential antifungal agent for serious and hardly curable infections—candidiasis, especially vulvovaginal candidiasis (VVC).

Methods

The effect of farnesol on cellular morphology and viability and evaluated the production of Th1 (IL-2), Th2 (IL-4), proinflammatory (IL-6), chemotactic (IL-8), and Th17 (IL-17) cytokines in the culture supernatants of vaginal epithelial cell line (VK2) were evaluated. Moreover, we tested the inhibitory effect of farnesol on C. albicans adhesion. Scanning electron microscopy was conducted to observe any VK2 cell ultrastructural changes.

Results

Only low concentrations (≤ 50 µmol/L) of farnesol did not affect the morphology and viability of the VK2 cells (P > 0.05). Farnesol reduced the adhesion of C. albicans to the VK2 cells. When treated with farnesol, statistical elevated levels of both IL-4 and IL-17 secreted by the infected VK2 cells were present in the culture supernatants (P < 0.05).

Conclusions

Farnesol acts as a stimulator to up-regulate the Th17-type innate immune response, as well as Th2-type humoral immunity following C. albicans infection. Further research is required to select the optimal therapeutic dose to develop efficacious and safe mucosal immune adjuvant for treating VVCs.
A comparative study of esketamine-dexmedetomidine and sufentanil-dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA): a randomized double-blind clinical trial
Authors: Lin Zhonglan , Li Shuxin , Zhou Yun , Lu Xinlei , Yang Bin , Yu Zhengwei , Cheng Yuan , Sun Jianliang
Published: September 2023

Objective

To observe and evaluate the effectiveness and safety of Esketamine or Sufentanil combined with Dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA) to provide a clinical basis for the optimization of sedation and analgesia in lung tumor PRFA protocols outside the operating room.

Methods

In this trial, 44 patients aged 37 to 84 undergoing lung tumor PRFA were enrolled and assigned to Group E (n = 22, Esketamine 0.2 mg/kg) or Group S (n = 22,Sufentanil 0.1 μg/kg ). Dexmedetomidine was infused intravenously as a sedative in both groups. The modified observer’s assessment of alertness and sedation scale (MOAAS), physical movement pain scale, intraoperative vital signs, anesthesia recovery time, radiologist and patient satisfaction rates, incidence of respiratory depression, and incidence of postoperative nausea and vomiting were recorded.

Results

Although there was no significant difference in the physical movement pain scale, blood oxygen saturation or incidence of perioperative adverse events between the two groups during ablation, the MOAAS, mean arterial pressure (MAP) and heart rate (HR) were higher in Group E than in Group S. The anesthesia recovery time was shorter in Group E than in Group S, and radiologist satisfaction was better in Group E than in Group S, but there was no significant difference between the two groups in terms of patient satisfaction.

Conclusion

Esketamine or Sufentanil combined with Dexmedetomidine is safe for lung tumor PRFA. However, in elderly patients with multiple underlying diseases, low-dose Esketamine combined with Dexmedetomidine has fewer hemodynamic effects on patients, milder respiratory depression, shorter recovery time, and better radiologist satisfaction because of its better controllability of sedation depth.

Trial registration

Chinese Clinical Trial Registry (Registration number#ChiCTR ChiCTR21000500 21); Date of Registration: 16/08/2021
Impact of a pediatric primary care health-coaching program on change in health-related quality of life in children with mental health problems: results of the PrimA-QuO cohort study
Authors: Loidl Verena , Hamacher Karina , Lang Martin , Laub Otto , Schwettmann Lars , Grill Eva
Published: September 2023

Mental health problems (MHP) have a considerable negative impact on health-related quality of life (HRQoL) in children and their families. A low threshold Health Coaching (HC) program has been introduced to bring MH services to primary care and strengthen the role of pediatricians. It comprised training concepts as a hands-on approach for pediatricians, standardization of diagnosis and treatment, and extended consultations. The aim of this study was to evaluate the potential effects of the HC on HRQoL in children with MHP and their parents.

We used data from the PrimA-QuO cohort study conducted in Bavaria, Germany from November 2018 until November 2019, with two assessments one year apart. We included children aged 17 years or younger with developmental disorder of speech and language, non-organic enuresis, head and abdominal pain, and conduct disorder. All included children were already part of the Starke Kids (SK) program, a more general preventive care program, which includes additional developmental check-ups for children enrolled in the program. In addition,  treatment according to the HC guidelines can be offered to children and adolescents with mental health problems, who are already enrolled in the SK program. These children form the intervention group; while all others (members of BKK and SK but not HC) served as controls. HRQoL in children was assessed using the KINDL questionnaire. Parental HRQoL was measured by the visual analogue scale. To analyze the effects of the intervention on children´s HRQoL over the 1-year follow-up period, we used linear mixed effects models.

We compared 342 children receiving HC with 767 control patients. We could not detect any effects of the HC on HRQoL in children and their parents. This may be attributed to the relatively high levels of children´s HRQoL at baseline, or because of highly motivated pediatricians for the controls because of the selection of only participant within the Starke Kids program. Generally, HRQoL was lower in older children (-0.42 points; 95% CI [-0.73; -0.11]) and in boys (-1.73 points; 95% CI [-3.11; -0.36]) when reported by proxy. Parental HRQoL improved significantly over time (2.59 points; 95% CI [1.29; 3.88]).

Although this study was not able to quantitatively verify the positive impact of this HC that had been reported by a qualitative study with parents and other stakeholders, and a cost-effectiveness study, the approach of the HC may still be valid and improve health care of children with MHP and should be evaluated in a more general population.
Systematic review on the management of term prelabour rupture of membranes
Authors: Ramirez-Montesinos Lucia , Downe Soo , Ramsden Annette
Published: September 2023

Introduction

Prelabour rupture of membranes at term affects approximately 10% of women during pregnancy, and it is often associated with a higher risk of infection than when the membranes are intact. In an attempt to control the risk of infection, two main approaches have been used most widely in clinical practice: induction of labour (IOL) soon after the rupture of membranes, also called active management (AM), and watchful waiting for the spontaneous onset of labour, also called expectant management (EM). In addition, previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis. However, the effect of vaginal examinations in the context of prelabour rupture of membranes have not been researched to the same extent.

Methods

This systematic review analyses and critiques the latest research on the management of term prelabour rupture of membranes, including the effect of vaginal examinations during labour, with a focus on the outcomes of both normal birth, and chorioamnionitis. Due to its complexity, three research questions were identified using the PICO diagram, and subsequently, the results from these searches were combined. The systematic review aimed to identify randomised controlled trials (RCTs) and observational studies that compared active vs expectant management, included number of vaginal examinations and had chorioamnionitis and/or normal birth as outcomes. The following databases were used: MEDLINE, EMBASE, Maternity and Infant care, LILACS, CINAHL and the Cochrane Central Register of Controlled trials. Quality was assessed using a tool developed especifically for this study that included questions from CASP and the Cochrane risk of bias tool. Due to the high degree of heterogeneity meta-analysis was not deemed appropriate. Therefore, simple narrative analysis was carried out.

Results

Thirty-two studies met the inclusion criteria, of which 27 were RCTs and 5 observational studies. The overall quality of the studies wasn’t high, 15 out of the 32 studies were deemed to be low quality and only 17 out of 32 studies were deemed to be of intermediate quality. The systematic review revealed that the management of term prelabour rupture of membranes continues to be controversial. Previous research has compared active management (Induction of labour shortly after the rupture of membrane) against expectant management (watchful waiting for the spontaneous onset of labour). Although previous studies have demonstrated that vaginal examinations increase the risk of chorioamnionitis, no prospective studies have included an intervention to reduce the number of vaginal examinations.

Conclusion

A RCT assessing the consequences of active management and expectant management as well as the effect of vaginal examinations during labour for term prelabour rupture of membranes is necessary.