bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanism of reduced muscle atrophy via ketone body (D)-3-hydroxybutyrate
Authors: Chen Jin , Li Zihua , Zhang Yudian , Zhang Xu , Zhang Shujie , Liu Zonghan , Yuan Huimei , Pang Xiangsheng , Liu Yaxuan , Tao Wuchen , Chen Xiaoping , Zhang Peng , Chen Guo-Qiang
Published: June 2022

Background

Muscle atrophy is an increasingly global health problem affecting millions, there is a lack of clinical drugs or effective therapy. Excessive loss of muscle mass is the typical characteristic of muscle atrophy, manifesting as muscle weakness accompanied by impaired metabolism of protein and nucleotide. (D)-3-hydroxybutyrate (3HB), one of the main components of the ketone body, has been reported to be effective for the obvious hemodynamic effects in atrophic cardiomyocytes and exerts beneficial metabolic reprogramming effects in healthy muscle. This study aims to exploit how the 3HB exerts therapeutic effects for treating muscle atrophy induced by hindlimb unloaded mice.

Results

Anabolism/catabolism balance of muscle protein was maintained with 3HB via the Akt/FoxO3a and the mTOR/4E-BP1 pathways; protein homeostasis of 3HB regulation includes pathways of ubiquitin–proteasomal, autophagic-lysosomal, responses of unfolded-proteins, heat shock and anti-oxidation. Metabolomic analysis revealed the effect of 3HB decreased purine degradation and reduced the uric acid in atrophied muscles; enhanced utilization from glutamine to glutamate also provides evidence for the promotion of 3HB during the synthesis of proteins and nucleotides.

Conclusions

3HB significantly inhibits the loss of muscle weights, myofiber sizes and myofiber diameters in hindlimb unloaded mouse model; it facilitates positive balance of proteins and nucleotides with enhanced accumulation of glutamate and decreased uric acid in wasting muscles, revealing effectiveness for treating muscle atrophy.

Graphical Abstract
Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement
Authors: Puro Vincenzo , Coppola Nicola , Frasca Andrea , Gentile Ivan , Luzzaro Francesco , Peghetti Angela , Sganga Gabriele
Published: June 2022

Healthcare-associated infections (HAIs) represent a relevant problem for all healthcare facilities, because they involve both the care aspect and the economic management of the hospital. Most HAIs are preventable through effective Infection Prevention and Control (IPC) measures. Implementation and improvement of IPC programs are critical to reducing the impact of these infections and the spread of multi-resistant microorganisms. The purpose of this Expert Opinion statement was to provide a practical guide for healthcare organizations, physicians, and nursing staff on the optimal implementation of the core components of Infection Prevention and Control, as recommended by a board of specialists after in-depth discussion of the available evidence in this field. According to their independent suggestions and clinical experiences, as well as evidence-based practices and literature review, this document provides a practical bundle of organizational, structural, and professional requirements necessary to promote, through multimodal strategies, the improvement of the quality and safety of care with respect to infectious risk in order to protect the patient, facilities, and healthcare providers.
Examining resilience of individuals living with sickle cell disease in the COVID-19 pandemic
Authors: Buscetta Ashley J. , Abdallah Khadijah E. , Floyd K. Jameson , Wossenseged Faeben S. , Conn Corinne A. , Ramirez Hasmin C. , Bonham Vence L.
Published: June 2022

Background

The COVID-19 pandemic has impacted the physical and mental health of people worldwide including those living with genetic conditions. Sickle cell disease (SCD) is a hematologic chronic disease that causes multisystem damage and morbidity. Individuals living with SCD have had to continue managing their care for their chronic disease while following public health measures to protect against infection with COVID-19. Promoting resilience has been posited as being psychologically protective for those living with SCD. This study examines changes in resilience over time in a SCD population in the context of the COVID-19 pandemic.

Methods

Ninety-seven adults living with SCD completed two parent studies: (1) The INSIGHTS Study, a cross-sectional natural history study conducted from 2014–2019 and (2) The Living with SCD in COVID-19 Pandemic Study, an online survey conducted in 2020. Changes over time in resilience, perceived stress, emotional distress, and physical and mental health were analyzed in multivariable repeated measures model.

Results

Results showed that the psychological resilience of our study cohort had significantly decreased (0.19, p=0.01) over time. Resilience during the pandemic was associated with better mental health and physical health and lower perceived stress and emotional distress. In addition, results showed that marital status, education level, and employment were significantly associated with the psychological resilience of study participants.

Conclusion

Resilience declined during the COVID-19 pandemic but was still associated with better physical and mental health outcomes. Future studies should investigate the relationship between resilience and sociodemographic factors.
Development and validation of the Chinese version of the perceived partner responsiveness scale (C-PPRS)
Authors: Zhou Xinyi , Cai Yaochun , Huang Wanyi , Chen Qishan
Published: June 2022

Background

Perceived partner responsiveness (PPR) refers to the belief that the relational partner knows and is sensitive and supportive. Instead of translating the English version of the Perceived Partner Responsiveness Scale (PPRS) into Chinese, this study aimed to construct and analyze the psychometric properties of the Chinese version of the Perceived Partner Responsiveness Scale (C-PPRS). On the one hand, some words in the original scale are inappropriate for the Chinese due to cultural differences. On the other hand, we intended the scale to apply just to persons in romantic relationships, not to friends or roommates.

Method

We conducted two studies. In the first study, 441 participants who completed the C-PPRS were randomly divided into two samples for exploratory factor analysis and confirmatory factor analysis. Concurrent validity was assessed in a group of 224 participants who completed the C-PPRS and the Quality of Relationship Index in the second study.

Results

The results indicated that the four-factor model (understanding, intimacy, acceptance, and trust) was a feasible representation of the C-PPRS factor structure (χ2/df = 2.27, CFI = 0.94, TLI = 0.93, RMSEA = 0.08, SRMR = 0.05) and had robust internal consistency reliability (alpha = 0.90) and concurrent validity (moderately correlated with the Quality of Relationship Index, r = 0.66, p < 0.001).

Conclusion

PPR is a concept to understand the psychological manifestations of a person who believes that his or her partner is concerned with core characteristics of the self. The C-PPRS has good psychometric characteristics to evaluate such manifestations and can be applied to future intimacy research.
The inhibitory role of stigmasterol on tumor growth by inducing apoptosis in Balb/c mouse with spontaneous breast tumor (SMMT)
Authors: AmeliMojarad Mandana , AmeliMojarad Melika , Pourmahdian Alireza
Published: June 2022

Background

Breast cancer is one of the most common types of cancer in women worldwide. Anti-apoptotic activity of cancer cells is considered the main reason for drug resistance in BC which reduces the 5-year survival rate of patients and is still considered the main obstacle for cancer therapy. Stigmasterol (SS) is natural phytosterols compound in the plant which has been proved to play an important role to lower cholesterol and inducing anti-inflammatory, and anticancer properties.

Methods

In this, study, we aimed to evaluate the effect of SS on the expression of anti-apoptotic genes (Bcl-2 and BCL-XL), and also evaluate its effects on cell apoptosis and cell viability using MCF-7 cell line as well as evaluating its effect on tumor growth of spontaneous breast tumor (SMMT) in vivo.

Result

SS significantly decreased the expression of Bcl-2 and BCL-XL genes (*P < 0.05), induced apoptosis, and reduced cell proliferation in MCF-7 cell lines. Our in vivo study also indicated that SS could inhibit tumor size after treatment with (0, 10, 20 µM) compared to the normal control.

Conclusion

SS can be suggested as a potential agent in BC cancer treatment or as an adjuvant based on its ability to decrease the expression of Bcl-2 and BCL-XL genes and induce apoptosis.
Competence and autonomous motivation as motivational predictors of college students’ mathematics achievement: from the perspective of self-determination theory
Authors: Wang Cong , Cho Hyun Jin , Wiles Benjamin , Moss Jennifer D. , Bonem Emily M. , Li Qian , Lu Yaheng , Levesque-Bristol Chantal
Published: June 2022

Background

Applied Calculus courses serve hundreds of thousands of undergraduates as quantitative preparation and gatekeepers across diverse fields of study. The current study investigated how motivational factors are associated with students’ learning outcomes in Applied Calculus courses from the perspective of self-determination theory—a sound comprehensive motivation theory that has been supported by considerable research in psychology and education. In order to have a nuanced understanding of students’ motivation and learning in Applied Calculus courses, we used three different types of learning measures to investigate students’ mathematics achievement, including course grades, a standardized knowledge exam, and students’ perceived knowledge transferability.

Results

We tested the relationships between motivational factors and learning outcomes with a multi-semester sample of 3226 undergraduates from 188 Applied Calculus classrooms. To increase the precision of our analysis, we controlled for three demographic variables that are suggested to be relevant to mathematics achievement: gender, minority group status, and socioeconomic status. With a series of multilevel modeling analyses, the results reveal that: (1) competence satisfaction predicts college students’ mathematics achievement over and above the satisfaction of needs for autonomy and relatedness; and (2) autonomous motivation is a more powerful predictor of college students’ mathematics achievement than controlled motivation and amotivation. These findings are consistent across different types of learning outcomes.

Conclusions

Self-determination theory provides an effective framework for understanding college students’ motivation and learning in Applied Calculus courses. This study extends self-determination theory in the field of mathematics education and contributes to the dialogue on advancing undergraduate science, technology, engineering, and mathematics (STEM) education by providing evidence to understand how motivational factors are associated with students’ learning outcomes in undergraduate mathematics courses.
Sex-specific differences in cardiac function, inflammation and injury during early polymicrobial sepsis
Authors: Walker Sophie L. M. , Muthoo Chand , Sanchez Jenifer , Del Arroyo Ana Gutierrez , Ackland Gareth L.
Published: June 2022

Background

Sex differences in sepsis are underexplored and incompletely understood. Cardiac function in early sepsis is pivotal in determining survival; hyperdynamic left ventricular ejection fraction is associated with higher mortality. Female sex may be cardioprotective, but variable experimental findings have not controlled for hypovolaemia. Sex-specific local cardiac versus peripheral inflammation in causing cardiovascular dysfunction also remain unclear. We therefore examined whether there are sex-specific differences in cardiac function in early sepsis, controlling for volaemic status and sex-specific differences in the peripheral inflammatory response initiated by tumour necrosis factor (TNFα).

Methods

We used an experimental polymicrobial sepsis (faecal slurry) model titrated to minimise hypovolaemia as a confounding factor. We quantified cardiac function (transthoracic cardiac echocardiography) 1 week before, and 18 h after, sepsis. Cardiac injury (troponin I), inflammation and immune cell infiltration (flow cytometry) were quantified in naïve and septic female and male mice 18 h after sepsis. To evaluate the sex-specific influence of TNFα derived from peripheral leukocytes, we repeated the experiments in iRHOM2−/− mice that are unable to shed TNFα exclusively from circulating leucocytes.

Results

Serum troponin I increased to 1.39 ± 0.38 ng mL−1 (from undetectable levels in controls) 18 h after onset of normovolaemic sepsis to a similar extent in both sexes. Stroke volume in male mice increased by 8 µL [(3–13); p = 0.004], compared to individualised pre-sepsis values. By contrast, stroke volume remained at baseline levels in females [mean difference: 4 µL (− 1 to 9)]. Messenger RNA levels of markers for cardiac injury/inflammation after sepsis (real-time polymerase-chain reaction) were elevated in male wild-type mice compared to female wild types (n = 10/sex), with higher cardiac mRNA levels of atrial natriuretic peptide, inflammation (TNFα) and oxidative stress (superoxide dismutase-1), although serum troponin I values were similarly elevated. Flow cytometry analysis of cardiac tissue showed doubling of CD4 + leukocyte infiltration in male mice. Sex-specific cardiac physiologic differences were similar in iRHOM2−/− mice that are unable to shed TNFα exclusively from leucocytes.

Conclusions

In early normovolaemic polymicrobial sepsis, a relative hyperdynamic response develops in male mice. Myocardial stress/injury after early sepsis is limited in females, with less cardiac infiltration of CD4 + leukocytes but independent of shedding of TNFα from peripheral circulating leukocytes.
Stage IV anal canal squamous cell carcinoma with long-term survival: a case report
Authors: Sawai Katsuji , Goi Takanori , Tagai Noriyuki , Kurebayashi Hidetaka , Morikawa Mitsuhiro , Koneri Kenji , Tamaki Masato , Murakami Makoto , Hirono Yasuo , Maeda Hiroyuki
Published: June 2022

Background

Currently, no established standard treatment exists for metastatic anal squamous cell carcinoma. We report a case of complete response in a patient with stage IV anal squamous cell carcinoma after undergoing multidisciplinary treatment.

Case presentation

A 62-year-old woman visited a nearby doctor with a chief concern of severe pain associated with a firm mass in the anus. The patient was diagnosed with anal canal squamous cell carcinoma and liver metastases and referred to First Department of Surgery Faculty of Medicine University of Fukui for treatment. The patient received a TNM classification of T4N0M1 and stage IV. Rectal amputation was performed; however, postoperative complications hindered immediate anticancer therapy and the liver metastases exacerbated. Radiofrequency hyperthermia and systemic chemotherapy were performed 3 months postoperatively. A prominent reduction in the liver metastasis was observed. Lung metastases appeared during the course of systemic chemotherapy. Radiotherapy was performed to treat the lung lesion and resolved. Radiotherapy was also performed for liver metastasis. The lesion in the liver showed resolution after 54 months postoperatively, and treatment with the anticancer drug was discontinued. Ten-year follow-up findings suggested complete resolution of the lesion in response to the treatment protocol followed in this case. This long-term survival was achieved through a multidisciplinary treatment.

Conclusions

The present case suggests that multidisciplinary treatment approach is effective for resolving stage IV anal squamous cell carcinoma, and addition of new anticancer drug therapy may improve the overall prognosis of squamous cell carcinoma.
Laparoscopic repair and total gastrectomy for delayed traumatic diaphragmatic hernia complicated by intrathoracic gastric perforation with tension empyema: a case report
Authors: Kori Mayuko , Endo Hidetoshi , Yamamoto Kazuhiro , Awano Nobuyasu , Takehana Takuo
Published: June 2022

Background

Blunt traumatic diaphragmatic hernia (TDH) is a complication of blunt diaphragmatic injury. If missed, it could lead to critical presentations, such as incarceration or strangulation of the herniated intra-abdominal organs, and thus, early surgical repair is required. Methods of the operative approach against delayed TDH remain unclear. Even with the spread of the minimally invasive approach, laparotomy has been predominantly selected for cases with hemodynamic or gastrointestinal complaints. Literature on the use of laparoscopy for repair of such cases is limited, and no study has been conducted for those with intrathoracic gastric perforation.

Case presentation

A 55-year-old male patient with a history of multiple traumas presented with shock, followed by left hypochondrium pain and vomiting. The patient was admitted to the emergency department of our institution and diagnosed with delayed TDH complicated by intrathoracic gastric perforation, and tension empyema. Emergency surgery using laparoscopic approach was performed, despite unstable hemodynamics, considering orientation, exposure, and operativity compared with laparotomy. Repair of the diaphragm plus total gastrectomy was successfully performed by minimally invasive management. The patient made an uneventful recovery without recurrence after 8 months.

Conclusion

Unstable hemodynamic conditions and intrathoracic gastric perforation could not be contraindications to laparoscopic repair in treating delayed TDH.
Successful healing of non-healing surgical wound based on the release of platelet-derived growth factors from single donor allogeneic platelet-RICH plasma with one freeze-thaw cycle: a case report after a 1-year follow-up
Authors: Seco-Calvo Jesús , Vidán-Estévez Julia , Sánchez-Herráez Sergio
Published: June 2022

Background

Non-healing surgical wounds is a risk in certain patients. Recently, allogenic plasma-rich-platelet (PRP) is used such as regenerative treatment of different non-healing surgical wounds.

Purpose

We explore the potential role of using platelet-derived growth factors from single donor PRP, with a freeze-thaw process, for the treatment of surgical scar ulcer.

Methods

We have used a PRP preparation protocol that involved a single cycle of centrifugation at a mean speed of 2400–2800 rpm of donor blood taken with an apheresis machine.

Results

To our knowledge, this is the first study using the platelet-derived growth factors (PDGF) from single donor apheresis, with a freeze-thaw process. Four weeks after daily application of al-PRP, the ulcer progressed satisfactorily; at six weeks, the ulcer had healed.

Conclusion

We concluded that the healing of a surgical wound observed in our case, is promising and suggests that al-PRP might play a role in treating surgical scar ulcers. This must be confirmed in future studies.
Biological activity and genome composition of a Tunisian isolate of Spodoptera littoralis nucleopolyhedrovirus (SpliNPV-Tun2)
Authors: Ben Tiba Saoussen , Laarif Asma , Wennmann Jörg T. , Bouslama Thameur , Jehle Johannes A.
Published: June 2022

Background

The baculovirus Spodoptera littoralis nucleopolyhedrovirus (SpliNPV) is an entomopathogenic virus utilized as a biological control agent of the Egyptian cotton leaf worm, Spodoptera littoralis. Several studies have focused on the identification of different SpliNPV isolates from a biological and molecular point of view, but few of them conducted in-depth analyses of the genomic composition of these isolates.

Results

Identification of a novel isolate of SpliNPV, termed Tun2, which was purified from infected S. littoralis larvae from Tunisia was reported. This isolate was propagated in vivo and its median lethal concentration (LC50) was determined to be 1.5 × 104 occlusion bodies (OBs)/ml for third instar S. littoralis larvae at 7 days of post-infection. OB production in late fourth instar larvae was estimated to be at least 2.7 × 109 OBs/g larval weight. The completely sequenced genome of SpliNPV-Tun2 was 137,099 bp in length and contained 132 open reading frames (ORF). It showed a 98.2% nucleotide identity to the Egyptian isolate SpliMNPV-AN1956, with some striking differences; between both genomes, insertion and deletion mutations were noticed in 9 baculovirus core genes, and also in the highly conserved polyhedrin gene. The homologs of ORF 106 and ORF 107 of SpliNPV-AN1956 appeared to be fused to a single ORF 106 in SpliNPV-Tun2, similar to the homologous ORF 110 in SpltNPV-G2.

Conclusion

SpliNPV-Tun2 is proposed as a new variant of SpliNPV and a potential candidate for further evaluation as a biocontrol agent for S. littoralis and probably other Spodoptera species.
LGI-1 encephalopathy following ChAdOx1 nCov-19 vaccination
Authors: Garibashvili Tamara , Heckmann Josef Georg
Published: June 2022

A 71-year-old male patient was diagnosed with LGI1 encephalopathy 4 weeks following a first ChAdOx1 nCov-19 vaccination. Extensive work-up including analysis of CSF and PET examination did not reveal a tangible cause so that a vaccine-associated encephalopathy was considered as differential diagnosis. Under steroid treatment, the faciobrachial dystonic seizures subsided.
The prevalence and factors associated with anxiety symptoms among resident physicians in Oman: a cross-sectional study
Authors: AlJahwari Basim , AlKamli Ahmed , Al-Huseini Salim , Chan Moon Fai , AlMahroqi Badria , Al Saadoon Muna , Ambusaidi Aamal , Ganesh Aishwarya , Al-Adawi Samir
Published: June 2022

Background

Anxiety disorders are a significant factor associated with physician burnout and poor patient care, reported to have a significant frequency among the youth in the Middle East. However, to date, no study has explored the prevalence of anxiety among resident physicians in the Arabian Gulf country of Oman. This cross-sectional study, conducted among a random sample of residents affiliated with the Oman Medical Specialty Board, aimed to examine the frequency and factors associated with anxiety symptoms among them. Participants were asked to complete the General Anxiety Disorder Assessment (GAD-7) to assess anxiety, as well as a socio-demographic questionnaire.

Results

In a total of 251 residents, the prevalence of anxiety was 14.7% (GAD-7 cut-off score ≥ 10). More than 60% of the respondents were female (68.9%). The age breakdown ranged from 25 to 30 years old (66.5%) and the majority were married (64.9%). More than 70% of respondents attended at least 5 shifts in their weekly schedule and received at least 5 on-call shifts from the hospital per week. Logistic regression showed that residents with chronic disease were 2.5 times (95% CI 1.36–4.72, p = 0.003) more likely to have anxiety than those without them. Those residents who did not exercise were 2.1 times (95% CI 1.04–4.46, p = 0.038) more likely to have anxiety than those who exercise often or regularly. Residents who received 6 or more on-calls from the hospital were 2.6 times (95% CI 1.35–5.25, p = 0.005) more likely to have anxiety than those who received 5 or fewer on-calls in a month.

Conclusions

The factors seemingly responsible for anxiety symptoms in this sample of resident physicians are those that are typically associated with poor work-life balance and unhealthy lifestyles. Pending further scrutiny, these results could be used to lay the groundwork for the identification of those who will require more protracted help during their training in Oman and in other culturally similar Middle Eastern countries.
Factors influencing uptake of telemental health via videoconferencing at high and low adoption sites within the Department of Veterans Affairs during COVID-19: a qualitative study
Authors: Connolly Samantha L. , Sullivan Jennifer L. , Lindsay Jan A. , Shimada Stephanie L. , Heyworth Leonie , Weaver Kendra R. , Miller Christopher J.
Published: June 2022

Background

The coronavirus disease 2019 (COVID-19) pandemic dramatically increased the use of telemental health via videoconferencing (TMH-V). While TMH-V has been found to be effective and satisfactory to both patients and providers, little is known regarding factors that influence site-level uptake. We examined facilitators and barriers to TMH-V uptake at higher and lower adoption sites within the US Department of Veterans Affairs (VA).

Methods

We conducted twenty-four semi-structured qualitative interviews at four northeastern VA medical centers (two with higher TMH-V adoption and two with lower adoption). Six interviews were conducted per site (one member of mental health leadership, one facility telehealth coordinator/technician, and four mental health providers per site). We performed directed content analysis, guided by the Consolidated Framework for Implementation Research (CFIR), followed by a matrix rating process to rank the degree of influence of each of the 19 included CFIR constructs at the four sites. Positive overall influences, negative overall influences, and differentiators were then identified based on patterns in ratings across sites.

Results

Five CFIR constructs had positive overall influences across sites: Relative advantage, Patient needs and resources, Relative priority, Knowledge and beliefs, and Self-efficacy. Complexity had a negative overall influence across sites. Four constructs significantly differentiated between higher and lower adoption sites with regards to TMH-V use: Quality, Compatibility, Leadership engagement, and Champions.

Conclusions

Several positive overall influences on TMH-V uptake were identified across sites; respondents acknowledged multiple advantages of TMH-V (e.g., convenience), and providers’ attitudes towards TMH-V improved as they gained experience. In contrast, complexity was a negative overall influence; TMH-V platforms and processes must be simple and user friendly to promote use. The emergence of Quality, Leadership engagement, and Champions as differentiators speaks to the importance of educating frontline staff and leadership at lower adoption sites about the evidence base demonstrating that TMH-V is high-quality care. Compatibility also emerged as a differentiator; if TMH-V is not easily integrated into provider workflows, uptake will falter. Future work should draw from these findings to develop implementation strategies aiming to increase TMH-V uptake at lower adoption sites, thereby increasing access to high-quality mental health care.
Serum interleukin 38 (IL-38) as a new potential biomarker of pediatric asthma
Authors: Kamal Asmaa , Basanti Christine W. S. , Kaushty Mahmoud A. , Abdelmegeid Azza K.
Published: June 2022

Background

Bronchial asthma is considered the most prevalent chronic respiratory disease worldwide and is one of the main causes of hospitalization in the pediatric population. Serum interleukin 38 (IL-38) levels are elevated in several inflammatory and autoimmune diseases. However, its exact role in the pathogenesis of these diseases is unclear.

Objectives

To investigate the role of IL-38 as a potential biomarker in pediatric patients with bronchial asthma.

Methods

Serum IL-38 levels were measured in 73 pediatric patients with bronchial asthma (34 atopic and 39 non-atopic) and 30 age- and sex-matched healthy control subjects using enzyme-linked immunosorbent assay.

Results

Serum IL-38 levels were significantly higher in patients with bronchial asthma compared to the control group (p < 0.001). A significant negative correlation was found between serum IL-38 levels and both relative and absolute eosinophilic counts in the atopic group (R = −0.575, p < 0.001 and R = −0.474, p = 0.005, respectively).

Conclusion

IL-38 could be a useful prognostic and therapeutic biomarker of atopic asthma in pediatric patients.
Pedestrian-induced footbridge vibration response based on a simple beam analytical method
Authors: Feng Yuhao , Chen Deyi , Wang Zhenyu , Huang Shiping , He Yuejie
Published: June 2022

This article aims to study the quantitative calculation of pedestrian-induced footbridge vibration comfort. Firstly, the analytical expression for the vibration response was derived. In addition, the simplified formula of the vibration response under resonance condition was put forward. The proposed analytical solution was compared with the numerical solution and the experimental result. Secondly, the analytical method was used to calculate the acceleration response under different crowd densities. The peak acceleration distribution and cumulative probability were analyzed. Finally, the cumulative probability that exceeded the acceleration limit was proposed as the comfort evaluation index, and the improved annoyance rate model was used to verify the proposed evaluation method. The results demonstrate that the analytical method can efficiently calculate the dynamic response of footbridges. Errors between the analytical results and the experimental results are less than 6.2%. Vibration comfort is negatively correlated with crowd density and walking speed. Furthermore, the errors between the proposed discomfort probability values and the calculated annoyance rate results are within 6%.
Smoking and colorectal cancer survival in relation to tumor LINE-1 methylation levels: a prospective cohort study
Authors: Kishikawa Junko , Ugai Tomotaka , Fujiyoshi Kenji , Chen Yang , Haruki Koichiro , Liu Li , Arima Kota , Akimoto Naohiko , Hamada Tsuyoshi , Inamura Kentaro , Kosumi Keisuke , Twombly Tyler S. , Shi Shanshan , Lau Mai Chan , Du Chunxia , Li Peilong , Guo Chunguang , Väyrynen Juha P. , Väyrynen Sara A. , Gu Simeng , Song Mingyang , Zhang Xuehong , Dai Guanghai , Giannakis Marios , Drew David A. , Chan Andrew T. , Fuchs Charles S. , Meyerhardt Jeffrey A. , Nishihara Reiko , Nowak Jonathan A. , Ogino Shuji , Wu Kana
Published: June 2022

Background

Carcinogens in cigarette smoke may cause aberrant epigenomic changes. The hypomethylation of long interspersed nucleotide element-1 (LINE-1) in colorectal carcinoma has been associated with genomic instability and worse clinical outcome. We hypothesized that the association between smoking behavior and colorectal cancer mortality might be stronger in tumors with lower LINE-1 methylation levels.

Findings

To test our hypothesis, we examined the interaction of tumor LINE-1 methylation levels and smoking status at diagnosis using data of 1208 cases among 4420 incident colorectal cancer cases that were ascertained in two prospective cohort studies. We conducted multivariable Cox proportional hazards regression analyses, using inverse probability weighting with covariate data of the 4420 cases to control for potential confounders and selection bias due to data availability. The prognostic association of smoking status at diagnosis differed by tumor LINE-1 methylation levels (Pinteraction = 0.050 for overall mortality and 0.017 for colorectal cancer-specific mortality; with an alpha level of 0.005). In cases with <60% LINE-1 methylation, current smoking (vs. never smoking) was associated with worse overall mortality (multivariable hazard ratio, 1.80; 95% confidence interval, 1.19–2.73). In contrast, smoking status was not associated with mortality in cases with ≥60% LINE-1 methylation.

Conclusions

Our findings suggest that the association between smoking status and mortality is stronger in colorectal cancer patients with lower tumor LINE-1 methylation levels. These results warrant further investigation into an interactive role of smoking and aberrant DNA methylation in colorectal cancer progression.
Patient and Staff Perspectives on a Non-Restrictive Leave Protocol at Springbank Ward, Specialist Personality Disorder Unit
Authors: Yue Adelaide , Crawford Owen , Zimbron Jorge
Published: June 2022

Aims

Springbank Ward is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim was to gauge patient and staff satisfaction with the new protocol and investigate their views on the change.

Methods

Data were obtained through structured interviews with staff who assessed risk (nurses and psychiatrists) and patients. 9 patients and 8 members of staff were interviewed between 9–19 March 2021. Interviewees were presented with diagrams of both the new protocol and old risk assessment checklist and asked a series of questions, including: rating their satisfaction; any potential improvements; and whether they would prefer the previous or current protocol. Thematic analysis of interview answers was used to explore patient and staff perspectives. Two authors independently analysed the interview transcripts, before discussing any discrepancies to reach a unified set of themes, subthemes and codes.

Results

Both patients and staff gave the new protocol an average satisfaction rating of 4.1/5. Thematic analysis generated five themes: “taking ownership”, “autonomy Vs restriction”, “staff-patient interaction”, “staff expertise” and “protocol efficiency”. Most interviewees agreed that the new protocol supported patients in taking responsibility for their safety, helping to prepare for life in the community. The protocol was considered minimally restrictive and more efficient than the previous system. The importance of communication and trust between patients and staff, as well as the use of staff intuition in holistically assessing risk, was emphasised. Potential disadvantages included the perceived riskiness of reducing restrictions and difficulty seeking support early in the admission.

Conclusion

In general, the new protocol is rated highly by patients and staff and is considered to be minimally restrictive and more holistic, in line with the aims established by our previous evaluation. Our findings have implications regarding risk management for inpatients with EUPD.
Improving Education and Confidence for Junior Doctors Regarding Physical Health Matters on Psychiatry Wards: The Physical Health Huddle
Authors: Beyers Cornelia , Awais Onaiza , Stokes Sophie , Moholkar Rajesh , Packham Alice
Published: June 2022

Aims

The COVID-19 pandemic highlighted a greater need for multidisciplinary input for psychiatric patients with complex physical comorbidities at Reaside Forensic Medium Secure clinic. It was also felt that junior doctors would benefit from support in managing complex physical health matters as well as issues arising whilst on-call in order to improve morale and support their educational needs. We aimed to add to existing services by offering junior doctors a regular discussion group (Physical Health Huddle) to support with complex cases, share different perspectives on patient treatment and open conversation regarding issues arising whilst on-call. We further hoped to improve communication, provide education for junior trainees with limited experience of forensic psychiatry and support their involvement in patient care and multi-disciplinary meetings.

Methods

Junior doctors were invited to a monthly informal Huddle (in person and online) and supported to propose patients for discussion. A proforma was supplied to assist. The junior doctor presented the summary and following discussion we explored various ideas on how to manage the patient's physical health. Feedback was provided to the patient teams afterwards and short before and after questionnaires were used to monitor effectiveness and collect feedback.

Results

The result showed a significant increase in support felt and individual feedback highlighted the need to continue this effort. The Huddle therefore provided a safe reliable space to freely discuss concerns regarding the day-to day management or escalation of complex physical health issues on psychiatric wards as well as on-call.

Conclusion

The Huddle successfully created a sustainable, effective and interactive short learning session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and rolled out to a wider audience in the future to improve learning throughout the trust regarding physical health matters.
Achieving Autism Accreditation in Cat A Prison
Authors: Daly Rachel , Motherskill Kimbia
Published: June 2022

Aims

To ensure autististic prisoners are understood and receive necessary support in custodial environment.

Methods

1.

Prison healthcare staff and discipline staff jointly trained about autism and how it is best managed in prison setting.

2.

Promotion re-education aids for prisons visually and verbally.

3.

Prison staff as autistic champions.

4.

Accessible autistic spectrum lead in healthcare team to coordinate need.

Results

priority that prison becomes autism accredited by national autistic society in progress.

Conclusion

There is increase of prisoners with neurodevelopmental disorders and ensuring their needs met in prison and this is CAT A challenging prison environment.
Evaluating the Impact of a Simulation Based Training Course in Intellectual Disability Psychiatry and Autism Co-Delivered by Actors With Intellectual Disability
Authors: Rudra Sonya , Dave Rupal , Eady Nicole , Smith James , McNamara Eileen
Published: June 2022

Aims

Inequalities in health outcomes, and avoidable deaths, in people with intellectual disability has highlighted the need for improved training and education in Intellectual Disability and Autism. Simulation training facilitated by actors with intellectual disability has been shown to improve connection with people with intellectual disability (Attoe et al 2017). The aim of this project was to develop a simulation-based training course, focused on topics in mental health, intellectual disability and autism, to improve participant confidence in clinical knowledge and skills, as well as support leadership and professionalism training. Here we evaluate the impact of the training on participants’ confidence, and the longer-term effect on attitudes and working practice after attendance.

Methods

A novel simulation-based training course, directed at Specialty Trainees, was developed based on the Specialty Training in Learning Disability curriculum. The course was co-delivered by a person with intellectual disability. Participants who attended the simulation training completed general feedback, pre-course and post-course confidence questionnaires and attended a semi-structured group interview at 2 months. Questionnaire data weres analysed using descriptive and inferential statistics. Group interview data were analysed using open & axial coding, and thematic analysis of content. The project was approved by East London NHS Foundation Trust Governance and Ethics Committee for Studies and Evaluations.

Results

Eight psychiatrists participated in the training and completed the pre-course and post-course questionnaires. Independent t-test found significant increase in confidence for all scores from pre-course (M = 6.54, SE0.24) to post-course (M = 7.81, SE = 0.36), t= –2.93 p = 0.01. This included ratings of confidence in knowledge in areas such as mental health legislation, and improved confidence in skills such as communication with families of people with intellectual disability and difficult conversations with senior supervisors. In follow-up interviews we elucidated themes of the importance of supported, structured training opportunities with people with intellectual disability, and the value of connection with peers and supervisors.

Conclusion

Simulation based training in psychiatry, co-delivered with actors with intellectual disability, was reported to be an engaging and enjoyable form of learning. The evaluation suggests such training is effective in increasing trainee confidence in knowledge and skills at the time of training as well as resulting in a lasting change in attitudes after the training. We recommend such training be further developed and delivered at both postgraduate and undergraduate level.
Raising Concerns and Trainee Well-being: What Are the Issues?
Authors: Hasnaoui Sabrina , Ibbett Vicki , Navaratnarajah Sambavi , Harsh Rajendra , Pantall Shay-Anne , Scally Ruth
Published: June 2022

Aims

Raising concerns is an important part of being a doctor and part of the GMC ‘Good Medical Practice’ guidelines, however as a trainee it often comes with specific challenges. Historically trainees are often left feeling that their concerns are not taken seriously and there is no resolution to problems raised. Here we present the findings of a scoping exercise undertaken as part of a Quality Improvement project exploring these issues within a large mental health Trust.

Methods

Trainees across all training grades from Foundation doctors to higher trainees were invited to engage in virtual focus groups specific to their training programme. Contributions were analysed anonymously using a thematic analysis approach by two independent coders. Quantitative data were also gathered using an online survey to capture trainees who had been unable to attend a focus group.

Results

Key results included:

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A total of 6 focus groups were attended by more than 35 trainees, with high turnout particularly within Foundation trainees and CT1 doctors.

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Three key themes were identified from the qualitative data: difficulties with the process of raising concerns, fear of the consequences and challenging the culture of the organisation.

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It was noted that senior trainees felt more comfortable with the process of raising concerns compared with junior colleagues but were more apathetic about the impact of doing so.

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12 trainees completed the online survey. Of these, 6 (50%) reported having had patient safety concerns and 7 (58%) had had concerns about their training.

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The most common reported barriers to raising concerns were the impact on working relationships (67%), lack of support (50%) and fear of repercussions on their training (50%). 42% of respondents were unsure of how to raise concerns.

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Trainee suggestions for change included improved information for trainees and trainers about the process for raising concerns, sharing of feedback about concerns raised more widely and regular opportunity to meet with key stakeholders.

Conclusion

The majority of trainees had experienced concerns about either patient safety or training issues. It will be necessary to address the multiple barriers highlighted to enable trainees to feel more confident and able to raise concerns. Increasing awareness of escalation processes, improving the processes themselves and fostering a supportive environment which encourages and supports trainees to raise concerns will be important given the implications for patient safety and trainee well-being.
A Systematic Approach for the Interview of the Application to Psychiatry Specialty Training: The “I AM” Approach
Authors: Loo Jiann Lin
Published: June 2022

Aims

Job interviews are the platform for employers to identify suitable candidates for vacant posts, i.e. those who are able to demonstrate a certain set of competencies specified in the job description. In the recent psychiatry specialty training (ST) application process, candidates are required to propose a management plan for two complex scenarios. This interview can be stressful given the high-stakes nature of the outcome, i.e. the successful enrolment into a training programme of a preferred deanery. Candidates who are unable to have an organised approach to problem-solving will likely have an unfavourable result. To overcome this difficulty, a simplified “I AM” approach is being proposed to assist applicants to organise their thoughts during their ST application interview.

Methods

The “I AM” approach stands for “Issues, Assessments, and Management”, which is adapted from the “Handbook of Psychiatry: Surviving Consultation Viva Examination of Malaysian Conjoint Board”. The “Issues” are the problems identified in a scenario, “Assessments” are the investigation required to get a clearer picture of the problems, and “Management” is the action plan to solve the problems. This approach was piloted with five applicants of ST in psychiatry prior to their interview practices.

Results

For a complex clinical case scenario, the “I AM” approach can be put into the matrix of 3 × 3 tables together with a biopsychosocial model to ensure the issues in different domains are explored thoroughly. Further sub-classification into necessary subheadings, including ideas, concerns, and expectations from different parties, can be included in the assessment matrix. Lastly, a management plan using a multidisciplinary team and collaborative decision-making model with the patient and family can be proposed. For a complex managerial scenario, the seven pillars of the National Health Service's clinical governance model involving different stakeholders can be incorporated into the “I AM” approach to explore problem-solving strategies from different angles. Positive reactions had been received from all five trainees (Kirkpatrick's Evaluation Model Level One).

Conclusion

The “I AM” approach can be flexibly applied in different problem-solving scenarios and it works well with other models. The approach may be limited by inadequate information and a failure to prioritise. Further systematic evaluation of the effectiveness and generalisability of the “I AM” approach to other disciplines is required.