bluuebunny/crossref_metadata_2025 huggingface dataset:
Phase 3 randomized trial of chemotherapy with or without oblimersen in older AML patients: CALGB 10201 (Alliance)
Authors: Walker Alison R. , Marcucci Guido , Yin Jun , Blum William , Stock Wendy , Kohlschmidt Jessica , Mrózek Krzysztof , Carroll Andrew J. , Eisfeld Ann-Kathrin , Wang Eunice S. , Jacobson Sawyer , Kolitz Jonathan E. , Thakuri Mohan , Sutamtewagul Grerk , Vij Ravi , Stuart Robert K. , Byrd John C. , Bloomfield Clara D. , Stone Richard M. , Larson Richard A.
Published: July 2021

Overexpression of B-cell leukemia/lymphoma 2 (BCL2) renders acute myeloid leukemia (AML) cells resistant to chemotherapy and has been associated with unfavorable outcomes. Oblimersen (G3139) is a phosphorothioate 18-mer antisense oligonucleotide directed against the first 6 BCL2 codons. In a phase 1 study of AML patients treated with G3139, cytarabine, and daunorubicin induction with cytarabine consolidation, no antisense-related toxicity was reported, and BCL2 downregulation occurred in patients achieving complete remission. In this phase 3 trial, untreated older AML patients were randomized to cytarabine (100 mg/m2 per day on days 4-10) and daunorubicin (60 mg/m2 per day on days 4-6) followed by cytarabine consolidation (2000 mg/m2 per day on days 4-8) with (arm A) or without (arm B) G3139 (7 mg/m2 per day on days 1-10 [induction] or days 1-8 [consolidation]). A total of 506 patients were enrolled. No differences in toxicity were observed between arms. Estimated overall survival (OS) at 1 year was 43% for arm A and 40% for arm B (1-sided log rank P = .13), with no differences in disease-free (DFS; P = .26) or event-free survival (P = .80). Subgroup analyses showed patients age <70 years in arm A had improved OS by 1 month vs those in arm B (P = .04), and patients with secondary AML in arm A had better DFS vs those in arm B (P = .04). We conclude that addition of G3139 to chemotherapy failed to improve outcomes of older AML patients. However, more effective means of inhibiting BCL2 are showing promising results in combination with chemotherapy in AML. This trial was registered at www.clinicaltrials.gov as #NCT00085124.
Epidemiological and genomic characteristics of Acinetobacter baumannii from different infection sites using comparative genomics
Authors: Bian Xingchen , Liu Xiaofen , Zhang Xuefei , Li Xin , Zhang Jing , Zheng Huajun , Song Sichao , Li Xiang , Feng Meiqing
Published: July 2021

Background

Acinetobacter baumanniiis a common nosocomial pathogen that poses a huge threat to global health. Owing to the severity ofA. baumanniiinfections, it became necessary to investigate the epidemiological characteristics ofA. baumanniiin Chinese hospitals and find the reasons for the high antibiotic resistance rate and mortality. This study aimed to investigate the epidemiologic and genetic characteristics ofA. baumanniiisolated from patients with hospital acquired pneumonia (HAP), bloodstream infection (BSI) and urinary tract infection (UTI) in China and uncover potential mechanisms for multi-drug resistance and virulence characteristics ofA. baumanniiisolates.

Results

All isolates were classified into two primary clades in core gene-based phylogenetic relationship. Clonal complex 208 (CC208) mainly consisted of ST195 (32 %) and ST208 (24.6 %). CC208 and non-CC208 isolates had carbapenem resistance rates of 96.2 and 9.1 %, respectively. Core genes were enriched in ‘Amino acid transport and metabolism’, ‘Translation’, ‘Energy production and conversion’, ‘Transcription’, ‘Inorganic ion transport and metabolism’ and ‘Cell wall/membrane/envelope synthesis’. Most isolates possessed virulence factors related to polysaccharide biosynthesis, capsular polysaccharide synthesis and motility. Eleven isolates belong to ST369 or ST191 (oxford scheme) all had the virulence factorcap8Eand it had a higher positive rate in UTI (35.3 %) than in BSI (18.9 %) and HAP (12.9 %). ABGRI1 antibiotic resistance islands were responsible for streptomycin, tetracycline and sulfonate resistance. TheblaOXA−23gene was the most probable cause for carbapenem resistance, although theblaOXA−66gene with nonsynonymous SNPs (F82L, I129L) was not.

Conclusions

A. baumanniiis a genomically variable pathogen that has the potential to cause a range of infectious diseases. There is high proportion of carbapenem resistance in isolates from all three infection sites (HAP, BSI and UTI), which can be attributed to theblaOXA−23gene. CC208 is the predominant clone inblaOXA−23-carryingA. baumanniithat should be monitored. Virulence factors involving bacteria motility and polysaccharide biosynthesis which are widespread in clinicalA. baumanniistrains deserve our attention.
Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study
Authors: Hernandez Alexandra L. , Karthik Rajiv , Sivasubramanian Murugesan , Raghavendran Anantharam , Lensing Shelly , Lee Jeannette Y. , Abraham Priya , Mathai Dilip , Palefsky Joel M.
Published: July 2021

Background

Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population.

Methods

We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history.

Results

The prevalence of oral HPV was 23.7% (95% CI: 19–29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4–6.9]) in multivariable analyses.

Conclusions

This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.
Magnetic resonance imaging-guided lumbar nerve root infiltrations: optimization of an in-house protocol
Authors: Scheffler Max , Guillemin Pauline Coralie , Lorton Orane , Maturana Enrique , Lauper Nicolas , Dominguez Dennis E. , Terraz Sylvain , Poletti Pierre-Alexandre , Salomir Rares , Boudabbous Sana
Published: July 2021

Background

For the treatment of radicular pain, nerve root infiltrations can be performed under MRI guidance in select, typically younger, patients where repeated CT exams are not desirable due to associated radiation risk, or potential allergic reactions to iodinated contrast medium.

Methods

Fifteen 3 T MRI-guided nerve root infiltrations were performed in 12 patients with a dedicated surface coil combined with the standard spine coil, using a breathhold PD sequence. The needle artifact on the MR images and the distance between the needle tip and the infiltrated nerve root were measured.

Results

The distance between the needle tip and the nerve root was 2.1 ± 1.4 mm. The visual artifact width, perpendicular to the needle long axis, was 2.1 ± 0.7 mm. No adverse events were reported.

Conclusion

This technical note describes the optimization of the procedure in a 3 T magnetic field, including reported procedure time and an assessment of targeting precision.
Myasthenia gravis associated with renal cell carcinoma: a paraneoplastic syndrome or just a coincidence
Authors: Zheng Yiming , Luo Jingjing , Jin Haiqiang , Liu Ran , Hao Hongjun , Gao Feng
Published: July 2021

Background

Myasthenia gravis (MG) can occur as a paraneoplastic phenomenon associated with thymoma. The association of MG with renal cell carcinoma (RCC) is not clear. Herein, we describe six cases of MG associated with RCC.

Methods

There were 283 patients diagnosed with MG admitted to our hospital from 2014 to 2019. Among them, 6 patients also had RCC. None of them had immune checkpoint inhibitor therapies. We performed a retrospective clinical data collection and follow-up studies of these 6 patients.

Results

These 6 patients with an average MG onset age of 61.3 ± 13.3 years, were all positive for anti-acetylcholine receptor antibodies. MG symptoms appeared after RCC resection in 3 cases. RCC was discovered after the onset of MG in 2 cases, and synchronously with MG in 1 case. After nephrectomy, the MG symptoms showed a stable complete remission in 1 case. Among them, four patients met the diagnostic criteria of possible paraneoplastic neurological syndromes.

Conclusions

Except for thymoma, patients with MG should pay attention to other tumors including RCC. MG may be a paraneoplastic syndrome of RCC, and further studies are needed to elucidate the relationship.
Depression and HIV associated neurocognitive disorders among HIV infected adults in rural southwestern Uganda: a cross-sectional quantitative study
Authors: Namagga Jane Kasozi , Rukundo Godfrey Zari , Niyonzima Vallence , Voss Joachim
Published: July 2021

Background

HIV-Associated Neurocognitive Disorder (HAND remains a pronounced consequence of HIV/AIDS despite improved life expectancies. This is often associated with several dysfunctions such as decrease of attention, mood alterations and psychomotor disturbances. Many factors, including age, gender, employment status, and psychiatric disorders, have been associated with HAND. Among the associated psychiatric disorders, depression is often more prevalent. It can influence not only quality of life, relationships and employment but also adherence to medical care. We assessed the prevalence of depression and its association with HAND among people living with HIV in rural Southwestern Uganda.

Methods

This was a cross-sectional study that used Beck Depression Inventory-1 and International HIV Dementia Scale to assess depression and HAND respectively. We defined depression with a score of > 10 and HAND with a cutoff score of ≤10. We conducted data analysis using STATA version 12, and Pearson Chi-square test and logistic regression to determine associations between depression and HAND. The level of statistical significance was set at p ≤ 0.05. Ethical approval and administrative clearance were obtained from relevant bodies.

Results

Of the 393 participants assessed for depression and HAND, 27% had depression and 58.3% screened positive for HAND. All levels of depression were more prevalent among female participants. We found a significant association between depression and HIV associated neurocognitive disorders (χ2 (3) = 9.0538 p = 0.029).

Conclusion

Our findings confirmed a high prevalence of depression in individuals with HAND which is a major component of the disease burden.
Feeling matters: perceived social support moderates the relationship between personal relative deprivation and depressive symptoms
Authors: Zhao Sibo , Peng Li
Published: July 2021

Background

Little research describes the mechanisms underlying depressive symptoms and personal relative deprivation in Chinese populations.

Methods

In this study, the respondents were (N = 914) residents of Beijing (17–59 years old) and robust multiple linear regressions were used to assess the main relationship between relative deprivation and depressive symptoms and social support as a potential moderator for that relationship.

Results

Individuals who reported higher personal relative deprivation had greater depressive symptoms than those who reported lower personal relative deprivation. Perceived social support buffered the relationship between depressive symptoms and personal relative deprivation.

Conclusions

The findings of this current study demonstrate the importance of relative deprivation for psychological strain and income in explaining how socioeconomic indices correlate with depressive symptoms. They also demonstrate the need to acknowledge the interaction of perceived social support and personal relative deprivation for influencing depression.
Factors influencing utilization and perception of health care: a qualitative study among traumatized Yazidi refugees in Germany
Authors: Tran Virginia M. , Fozouni Laila , Denkinger Jana K. , Rometsch Caroline , Junne Florian , Vinck Patrick , Pham Phuong
Published: July 2021

Background

Ensuring adequate utilization of healthcare services for displaced populations is critical, yet there are well-documented treatment gaps. Yazidi women captured by the Islamic State (IS) were subjected to extreme trauma and violence. This study aims to understand perceptions of healthcare providers and utilization of these services among women who experienced extreme trauma.

Methods

This is a qualitative study with voluntary participation offered to approximately 400 women resettled through the Special Quota Program. An empirical approach was used to collect data and a grounded theory approach was used for content analysis. Participants ranked their interactions with providers on a Likert scale. Posttraumatic stress disorder (PTSD) symptoms were assessed using the impact of event scale-revised questionnaire.

Results

A total of 116 Yazidi women participated in this study. The women experienced an average of 6.8 months of captivity by IS and 93% met criteria for probable PTSD. Eighty-three percent of the women interacted with a physician; 80% found this interaction helpful. Sixty-nine percent interacted with psychologists; 61% found this interaction helpful. Six themes emerged: “reminders of trauma” and “hopelessness” in relation to the traumatic experience; “immediate relief” and “healing through pharmaceutical treatment” in relation to provider interventions, and “support” and “cultural differences” in relation to interactions with providers.

Conclusions

There exist major barriers to care for Yazidi women who experienced extreme trauma, particularly in regards to psychiatric care. Perceptions of healthcare providers and perceived effectiveness of therapy are critical factors that must be taken into consideration to improve healthcare utilization and outcomes.
An innovative and integrated model for global outbreak response and research - a case study of the UK Public Health Rapid Support Team (UK-PHRST)
Authors: Raftery Philomena , Hossain Mazeda , Palmer Jennifer
Published: July 2021

Background

Despite considerable institutional experimentation at national and international levels in response to calls for global health security reform, there is little research on organisational models that address outbreak preparedness and response. Created in the aftermath of the 2013–16 West African Ebola epidemic, the United Kingdom’s Public Health Rapid Support Team (UK-PHRST) was designed to address critical gaps in outbreak response illuminated during the epidemic, while leveraging existing UK institutional strengths. The partnership between the government agency, Public Health England, and an academic consortium, led by the London School of Hygiene and Tropical Medicine, seeks to integrate outbreak response, operational research and capacity building. We explored the design, establishment and early experiences of the UK-PHRST as one of the first bodies of its kind globally, paying particular attention to governance decisions which enabled them to address their complex mission.

Methods

We conducted a qualitative case study using 19 in-depth interviews with individuals knowledgeable about the team’s design and implementation, review of organisational documents, and observations of meetings to analyse the UK-PHRST’s creation, establishment and initial 2 years of operations.

Results

According to key informants, adopting a triple mandate (response, research and capacity building) established the team as novel in the global epidemic response architecture. Key governance decisions recognised as vital to the model included: structuring the team as a government-academic collaboration which leveraged long-term and complementary UK investments in public health and the higher education sector; adopting a more complex, dual reporting and funding structure to maintain an ethos of institutional balance between lead organisations; supporting a multidisciplinary team of experts to respond early in outbreaks for optimal impact; prioritising and funding epidemic research to influence response policy and practice; and ensuring the team’s activities reinforced the existing global health architecture.

Conclusion

The UK-PHRST aims to enhance global outbreak response using an innovative and integrated model that capitalises on institutional strengths of the partnership. Insights suggest that despite adding complexity, integrating operational research through the government-academic collaboration contributed significant advantages. This promising model could be adopted and adapted by countries seeking to build similar outbreak response and research capacities.
Facility-level characteristics associated with family planning and child immunization services integration in urban areas of Nigeria: a longitudinal analysis
Authors: Sheahan Kate L. , Speizer Ilene S. , Orgill-Meyer Jennifer , Curtis Siân , Weinberger Morris , Paul John , Bennett Antonia V.
Published: July 2021

Background

Unmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria.

Methods

This study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics.

Results

Within intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores.

Conclusion

Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.
Body image perception and body composition in early adolescents: a longitudinal study of an Italian cohort
Authors: Toselli Stefania , Grigoletto Alessia , Zaccagni Luciana , Rinaldo Natascia , Badicu Georgian , Grosz Wilhelm Robert , Campa Francesco
Published: July 2021

Background

Adolescence is a sensitive period of life in which everyone faces physical and psychological changes. No longitudinal studies considering changes in body image perception and body composition in Italian adolescents have been carried out. The aims of this study were to evaluate the longitudinal change in body composition and weight status in a sample of Italian students of both sexes over the 3 years of middle school and to analyse the influence of these parameters on the perception and satisfaction of one’s own body image.

Methods

Sixty-four males and seventy females were followed longitudinally from 11 to 14. Age at first measurement was 11.8 ± 0.3 yrs. in males and 11.9 ± 0.3 yrs. in females, then the students were measured again after 1 year and 2 years. Anthropometric measurements were collected and body composition was assessed by skinfolds. Maturity status was detected by age at menarche in females and by estimated age at peak height velocity in males; sports practice was assessed by a questionnaire. Body Silhouette Charts were used to assess body image perception. The degree of body image dissatisfaction and improper perception of weight status were evaluated. Univariate and multivariate analyses were applied.

Results

Height, sitting height, leg length, and weight increments were higher in males than in females, and in both sexes the sitting height increment was higher than that of leg length. Skinfold thicknesses and percentage of body fat, showed a decrease in males and an increase in females over the 3 years. About 90% of the sample practiced sport during the 3 years. No significant variations in body image perception were observed among repeated measures but significantly differences were observed between sexes. Although the girls showed a lower incidence of overweight and obesity than boys, girls had a higher dissatisfaction than males. Males were less accurate in one’s perception of one’s own weight status.

Conclusions

The changes in body composition observed in the sample of the present study were in accordance with their maturity stage. An increase in parameters connected with adiposity is observed in females and a decrease in males. Body image perception did not seem to change with growth, but associations were found between body image perception and BMI and sex. Monitoring body image perception in young adolescents, especially in females and in overweight/obese subjects, is a priority to prevent nutritional disorders.
Rheological effects of hypertonic saline and sodium bicarbonate solutions on cystic fibrosis sputum in vitro
Authors: Budai-Szűcs Mária , Berkó Szilvia , Kovács Anita , Jaikumpun Pongsiri , Ambrus Rita , Halász Adrien , Szabó-Révész Piroska , Csányi Erzsébet , Zsembery Ákos
Published: July 2021

Background

Cystic fibrosis (CF) is a life-threatening multiorgan genetic disease, particularly affecting the lungs, where recurrent infections are the main cause of reduced life expectancy. In CF, mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) protein impair transepithelial electrolyte and water transport, resulting in airway dehydration, and a thickening of the mucus associated with abnormal viscoelastic properties. Our aim was to develop a rheological method to assess the effects of hypertonic saline (NaCl) and NaHCO3 on CF sputum viscoelasticity in vitro, and to identify the critical steps in sample preparation and in the rheological measurements.

Methods

Sputum samples were mixed with hypertonic salt solutions in vitro in a ratio of either 10:4 or 10:1. Distilled water was applied as a reference treatment. The rheological properties of sputum from CF patients, and the effects of these in vitro treatments, were studied with a rheometer at constant frequency and strain, followed by frequency sweep tests, where storage modulus (G′), loss modulus (G″) and loss factor were determined.

Results

We identified three distinct categories of sputum: (i) highly elastic (G′ > 100,000 Pa), (ii) elastic (100,000 Pa > G′ > 1000 Pa), and (iii) viscoelastic (G′ < 1000). At the higher additive ratio (10:4), all of the added solutions were found to significantly reduce the gel strength of the sputum, but the most pronounced changes were observed with NaHCO3 (p < 0.001). Samples with high elasticity exhibited the greatest changes while, for less elastic samples, a weakening of the gel structure was observed when they were treated with water or NaHCO3, but not with NaCl. For the viscoelastic samples, the additives did not cause significant changes in the parameters. When the lower additive ratio (10:1) was used, the mean values of the rheological parameters usually decreased, but the changes were not statistically significant.

Conclusion

Based on the rheological properties of the initial sputum samples, we can predict with some confidence the treatment efficacy of each of the alternative additives. The marked differences between the three categories suggest that it is advisable to evaluate each sample individually using a rheological approach such as that described here.
Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions
Authors: Johnson Christina E. , Keating Jennifer L. , Leech Michelle , Congdon Peter , Kent Fiona , Farlie Melanie K. , Molloy Elizabeth K.
Published: July 2021

Background

Face-to-face feedback plays an important role in health professionals’ workplace learning. The literature describes guiding principles regarding effective feedback but it is not clear how to enact these. We aimed to create a Feedback Quality Instrument (FQI), underpinned by a social constructivist perspective, to assist educators in collaborating with learners to support learner-centred feedback interactions. In earlier research, we developed a set of observable educator behaviours designed to promote beneficial learner outcomes, supported by published research and expert consensus. This research focused on analysing and refining this provisional instrument, to create the FQI ready-to-use.

Methods

We collected videos of authentic face-to-face feedback discussions, involving educators (senior clinicians) and learners (clinicians or students), during routine clinical practice across a major metropolitan hospital network. Quantitative and qualitative analyses of the video data were used to refine the provisional instrument. Raters administered the provisional instrument to systematically analyse educators’ feedback practice seen in the videos. This enabled usability testing and resulted in ratings data for psychometric analysis involving multifaceted Rasch model analysis and exploratory factor analysis. Parallel qualitative research of the video transcripts focused on two under-researched areas, psychological safety and evaluative judgement, to provide practical insights for item refinement. The provisional instrument was revised, using an iterative process, incorporating findings from usability testing, psychometric testing and parallel qualitative research and foundational research.

Results

Thirty-six videos involved diverse health professionals across medicine, nursing and physiotherapy. Administering the provisional instrument generated 174 data sets. Following refinements, the FQI contained 25 items, clustered into five domains characterising core concepts underpinning quality feedback:set the scene,analyse performance,plan improvements,foster learner agency, andfoster psychological safety.

Conclusions

The FQI describes practical, empirically-informed ways for educators to foster quality, learner-centred feedback discussions. The explicit descriptions offer guidance for educators and provide a foundation for the systematic analysis of the influence of specific educator behaviours on learner outcomes.
Development and web deployment of an automated neuroradiology MRI protocoling tool with natural language processing
Authors: Chillakuru Yeshwant Reddy , Munjal Shourya , Laguna Benjamin , Chen Timothy L. , Chaudhari Gunvant R. , Vu Thienkhai , Seo Youngho , Narvid Jared , Sohn Jae Ho
Published: July 2021

Background

A systematic approach to MRI protocol assignment is essential for the efficient delivery of safe patient care. Advances in natural language processing (NLP) allow for the development of accurate automated protocol assignment. We aim to develop, evaluate, and deploy an NLP model that automates protocol assignment, given the clinician indication text.

Methods

We collected 7139 spine MRI protocols (routine or contrast) and 990 head MRI protocols (routine brain, contrast brain, or other) from a single institution. Protocols were split into training (n = 4997 for spine MRI; n = 839 for head MRI), validation (n = 1071 for spine MRI, fivefold cross-validation used for head MRI), and test (n = 1071 for spine MRI; n = 151 for head MRI) sets. fastText and XGBoost were used to develop 2 NLP models to classify spine and head MRI protocols, respectively. A Flask-based web app was developed to be deployed via Heroku.

Results

The spine MRI model had an accuracy of 83.38% and a receiver operator characteristic area under the curve (ROC-AUC) of 0.8873. The head MRI model had an accuracy of 85.43% with a routine brain protocol ROC-AUC of 0.9463 and contrast brain protocol ROC-AUC of 0.9284. Cancer, infectious, and inflammatory related keywords were associated with contrast administration. Structural anatomic abnormalities and stroke/altered mental status were indicative of routine spine and brain MRI, respectively. Error analysis revealed increasing the sample size may improve performance for head MRI protocols. A web version of the model is provided for demonstration and deployment.

Conclusion

We developed and web-deployed two NLP models that accurately predict spine and head MRI protocol assignment, which could improve radiology workflow efficiency.
Psycho-social components determining the strategies of coping with stress in undergraduate Polish nursing students
Authors: Bodys-Cupak Iwona , Majda Anna , Kurowska Anna , Ziarko Ewa , Zalewska-Puchała Joanna
Published: July 2021

Background

In order for the nursing students to fully benefit from the clinical experience, it is necessary for them to be able to handle education-related stress. It is important to establish the importance of personal resources and social determinants, that influence coping strategies in stressful situations.

Methods

The cross-sectional study was conducted among 307 nursing students. The study research tools: Perceived Stress Scale (PSS-10), Life Orientation Test - Revised (LOT-R), Generalized Self-Efficacy Scale (GSES), Satisfaction With Life Scale (SWLS), Clinical Learning Environment Inventory (CLEI – 19), Brief COPE and the original questionnaire were used.

Results

Active strategies of coping with stress were used significantly more often by the respondents with a greater sense of self-efficacy, a greater sense of life satisfaction and disposable optimism. Avoidance strategies of coping with stress were used significantly more often by the respondents with low self-efficacy, low level of disposable optimism, low sense of life satisfaction, and not a lot of teacher support. The higher was the intensity of stress experienced by students, the more often they coped by avoidance behaviour or showing helplessness.

Conclusions

All the variables had a significant impact on coping with stress: the level of perceived stress, disposable optimism, sense of self-efficacy, sense of life satisfaction, as well as satisfaction with the stay in a hospital ward, support received from the teacher and the year of the study. The results of the research have allowed the identification of the needs in the field of strengthening the personal resources of nursing students. In the future, they may be useful for the development of educational programs.
Factors influencing nurses participation in the health policy-making process: a systematic review
Authors: Hajizadeh Alireza , Zamanzadeh Vahid , Kakemam Edris , Bahreini Rona , Khodayari-Zarnaq Rahim
Published: July 2021

Background

Nurses as the majority of the health care workforce help in the health systems strengthening. Nurses’ involvement in health policy making is clear; however, still few are involved in policy-making processes, even in the clinical context. The aim of the present systematic review was to identify factors influencing nurses participation in the health policy-making process.

Methods

The present systematic review was designed on studies conducted between 2000 and 2019. Four online databases including PubMed, EMBASE, SCOPUS and Science Direct were searched using comprehensive terms. Study selection, quality assessment, data extraction, and data analysis were independently done by two reviewers. Inclusion criteria included published studies in English language and between 2000 to 2019, participants such as nurses and the healthcare managers, mentioned influential factors, types of participants were included nurses and the healthcare managers, study designs and methods clearly defined. The methodological quality of included article was appraised using the checklists of CASP and MMAT. Finally the data were analyzed using content analysis.

Results

After quality assessment, 11 studies, according to inclusion criteria, were retrieved. Nine studies had a good, 2 a medium, and non-articles was poor methodological quality. Three main themes include nursing-related factors (4 sub- themes), management and organizational factors (8 sub-themes) and creating a positive work environment (3 sub-themes) identified as affecting factors on nurses participation in health policy.

Conclusion

Nurses can utilize this finding to develop empowering programs to play efficient roles and increase their participation in health policy making. Also, the extracted factors in this review can place nurses in suitable position and make them potential agents in changing the ways of policy-making. Further studies are required to survey the relation between these factors and nursing participation in health policy making.
Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions
Authors: Morciano Marcello , Checkland Katherine , Durand Mary Alison , Sutton Matt , Mays Nicholas
Published: July 2021

Background

Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. We evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies.

Methods

Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes.

Results

CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI:7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes.

Conclusions

Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.
Patients perspectives on drug shortages in six European hospital settings – a cross sectional study
Authors: Kuruc Poje Darija , Kifer Domagoj , Huys Isabelle , Miranda Joao , Jenzer Helena , Miljković Nenad , Hoppe-Tichy Torsten , Bochniarz Marcin , Frontini Roberto , Schwartz David G , Vujić-Aleksić Vesna , Nežić Lana , Rinaki Eleni , Tzimis Leonidas , Green Kim , Jovanić Jelena , Carić Bojana , Mandić Danijela , Vilić Katarina , Bochenek Tomasz , Bačić Vrca Vesna , Marušić Srećko
Published: July 2021

Background

It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages.

Methods

A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3).

Results

6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p < 0.001) while the fewest patients were in H-SE (1 %, N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional.

Conclusions

Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.
Innate antiviral defense demonstrates high energetic efficiency in a bony fish
Authors: Polinski Mark P. , Zhang Yangfan , Morrison Phillip R. , Marty Gary D. , Brauner Colin J. , Farrell Anthony P. , Garver Kyle A.
Published: July 2021

Background

Viruses can impose energetic demands on organisms they infect, in part by hosts mounting resistance. Recognizing that oxygen uptake reliably indicates steady-state energy consumption in all vertebrates, we comprehensively evaluated oxygen uptake and select transcriptomic messaging in sockeye salmon challenged with either a virulent rhabdovirus (IHNV) or a low-virulent reovirus (PRV). We tested three hypotheses relating to the energetic costs of viral resistance and tolerance in this vertebrate system: (1) mounting resistance incurs a metabolic cost or limitation, (2) induction of the innate antiviral interferon system compromises homeostasis, and (3) antiviral defenses are weakened by acute stress.

Results

IHNV infections either produced mortality within 1–4 weeks or the survivors cleared infections within 1–9 weeks. Transcription of three interferon-stimulated genes (ISGs) was strongly correlated with IHNV load but not respiratory performance. Instead, early IHNV resistance was associated with a mean 19% (95% CI = 7–31%; p = 0.003) reduction in standard metabolic rate. The stress of exhaustive exercise did not increase IHNV transcript loads, but elevated host inflammatory transcriptional signaling up to sevenfold. For PRV, sockeye tolerated high-load systemic PRV blood infections. ISG transcription was transiently induced at peak PRV loads without associated morbidity, microscopic lesions, or major changes in aerobic or anaerobic respiratory performance, but some individuals with high-load blood infections experienced a transient, minor reduction in hemoglobin concentration and increased duration of excess post-exercise oxygen consumption.

Conclusions

Contrary to our first hypothesis, effective resistance against life-threatening rhabdovirus infections or tolerance to high-load reovirus infections incurred minimal metabolic costs to salmon. Even robust systemic activation of the interferon system did not levy an allostatic load sufficient to compromise host homeostasis or respiratory performance, rejecting our second hypothesis that this ancient innate vertebrate antiviral defense is itself energetically expensive. Lastly, an acute stress experienced during testing did not weaken host antiviral defenses sufficiently to promote viral replication; however, a possibility for disease intensification contingent upon underlying inflammation was indicated. These data cumulatively demonstrate that fundamental innate vertebrate defense strategies against potentially life-threatening viral exposure impose limited putative costs on concurrent aerobic or energetic demands of the organism.
Diagnostic challenges in a CMMRD patient with a novel mutation in the PMS2 gene: a case report
Authors: Tan Shiqing , Wu Xiaoting , Wang Aoxue , Ying Li
Published: July 2021

Background

Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive condition, which is caused by biallelic mutations in mismatch repair genes: MSH2, MLH1, MSH6, and PMS2.

Case presentation

We reported a unique case of an 11-year-old Chinese girl with colorectal polyposis and café-au-lait macules who had no obvious family history of Lynch syndrome-associated tumors, followed by brain gliomas and colorectal carcinoma five years later. The diagnosis of CMMRD was based on gene sequencing analysis showing a homozygous deletion NM_00535.5:c.1577delA (p.Asp526fs) in exon 11 of the PMS2 gene. Although the patient underwent surgery and radiation therapy, and close surveillances including radiological, endoscopic and hematological screening have been recommended, she died of the exacerbation of neurological symptoms at the age of 18.

Conclusions

We identified a novel homozygous deletion in the PMS2 gene in a CMMRD patient with complex clinical features.
Weight change and risk of cardiovascular disease among adults with type 2 diabetes: more than 14 years of follow-up in the Tehran Lipid and Glucose Study
Authors: Moazzeni Seyyed Saeed , Hizomi Arani Reyhane , Deravi Niloofar , Hasheminia Mitra , Khalili Davood , Azizi Fereidoun , Hadaegh Farzad
Published: July 2021

Background

To examine the impact of weight change on incident cardiovascular disease and coronary heart disease (CVD/CHD) among an Iranian population with type 2 diabetes mellitus (T2DM).

Methods

The study population included 763 participants with T2DM aged ≥ 30 years without a history of CVD and cancer at baseline. Two weight measurements done at baseline and about 3 years later. Based on their weight change, they categorized into: > 5% loss, 3–5% loss, stable (± < 3%), 3–5% gain, > 5% gain. Participants were then followed for incident CVD/CHD annually up to 20 March 2018. Multivariable Cox proportional hazard models, adjusted for age, sex, body mass index, educational level, current smoking, glucose-lowering drug use, family history of CVD, hypertension, hypercholesterolemia, chronic kidney disease, and fasting plasma glucose (FPG) were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for incident CVD/CHD, considering stable weight as reference.

Results

After the weight change measurement, during a median follow-up of 14.4 years, 258 CVD and 214 CHD occurred. Over 5% weight gain was associated with reduced risks of CVD and CHD development by the HRs of 0.70 [95% CI 0.48–1.01; P-value: 0.058] and 0.61 [0.40–0.93], respectively, in multivariable analysis. After further adjustment for FPG change, the HRs of weight gain > 5% were attenuated to 0.75 [0.51–1.10; P-value: 0.138] and 0.66 [043–1.01; P-value: 0.053] for incident CVD and CHD, respectively. The effect of weight loss > 5% was in opposite direction among those older versus younger than 60 years; with suggestive increased risk (not statistically significant) of incident CHD/CVD for the older group. Moreover, weight gain > 5% significantly reduced the risk of CHD only among those older than 60 years (P-value for interaction < 0.2). Furthermore, weight gain > 5% had an association with lower risk of CVD and CHD among sulfonylurea users (0.56 [0.32–0.98] for CVD and 0.54 [0.29–0.99] for CHD).

Conclusions

Our results with a long-term follow-up showed that weight gain > 5% was associated with better CVD/CHD outcomes among Iranian participants with T2DM, especially older ones. Moreover, we did not find an unfavorable impact on incident CVD/CHD for sulfonylurea-induced weight gain.
Systematic identification of a panel of strong promoter regions from Listeria monocytogenes for fine-tuning gene expression
Authors: Ji Qianyu , Ma Junfei , Wang Shuying , Liu Qing
Published: July 2021

Background

Attenuated Listeria monocytogenes (Lm) has been widely used as a vaccine vector in the prevention and treatment of pathogen infection and tumor diseases. In addition, previous studies have proved that the attenuated Lm can protect zebrafish from Vibrio infections, indicating that the attenuated Lm has a good application prospect in the field of aquatic vaccines. However, the limitation mainly lies in the lack of a set of well-characterized natural promoters for the expression of target antigens in attenuated Lm.

Results

In our study, candidate strong promoters were identified through RNA-seq analysis, and characterized in Lm through enhanced green fluorescent protein (EGFP). Nine native promoters that showed stronger activities than that of the known strong promoter P36 under two tested temperatures (28 and 37 °C) were selected from the set, and P29 with the highest activity was 24-fold greater than P36. Furthermore, we demonstrated that P29 could initiate EGFP expression in ZF4 cells and zebrafish embryos.

Conclusions

This well-characterized promoter library can be used to fine-tune the expression of different proteins in Lm. The availability of a well-characterized promoter toolbox of Lm is essential for the analysis of yield increase for biotechnology applications.