bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of the process parameters on shoulderless friction stir processing on the tribological properties of polylactic acid/basalt composites
Authors: Arun Nallathambi , Prakash Muniyandi
Published: August 2023

The limitations of traditional metallic biomaterials motivated the development of polymer matrix composites to fabricate various biomedical implants. The wear resistance of the composites can be enhanced by modifying the surface properties, using a surface modification process to increase the components’ lifespan. Friction stir processing (FSP) is one of the best solid-state processing techniques for fabricating polymer composites. In the present study, a new, shoulderless tool has been developed to perform FSP to understand the process parameters’ influence to produce an effective processing zone. It may be called ‘Shoulderless Friction Stir Processing’. Therefore, for this research work, the tool rotational speeds of 500, 600 and 700 rpm and traverse speeds of 10, 15 and 20 mm/min have been selected as the process parameters to conduct the FSP on the developed basalt fibre-reinforced polylactic acid composite materials. The obtained result reveals that the tool rotational speed is the most influencing processing parameter, as it affects the surface of the composite. A high rotational speed leads to a high material removal rate, whereas a low rotational speed leads to the burning of the polymer. In addition, the specific wear rate (SWR) is also found to be minimal for the specimen processed at 600 rpm with 20 mm/min traverse speed compared to the other processing parameters.
Identification and characterization of stress degradation products of ibrutinib by LC-UV/PDA and LC-Q/TOF-MS studies
Authors: Mondal Bidisha , Bali Alka , Sharma Tanvi
Published: August 2023

The anticancer drug ibrutinib was subjected to stress degradation studies under the ICH-prescribed hydrolytic, photolytic, oxidative and thermal stress conditions, and its degradation behavior was studied. A significant degradation was noted for the drug under acidic/alkaline hydrolytic, acid/alkaline photolytic, and oxidative conditions. The UPLC-UV/PDA studies revealed the generation of six degradation products (I–VI), and these were adequately resolved from the drug under the developed chromatographic conditions over a Kinetex® C18 (100 mm×4.6 mm; 2.6 μm) column employing isocratic elution method. Detection wavelength was selected as 289 nm. The UPLC-UV/PDA method conditions were extrapolated to UPLC-MS/TOF studies. All the six degradation products were found to be ionized in the total ion chromatogram, and the products could be identified and characterized from their mass spectral data. The possible degradation route of ibrutinib leading to generation of various products was also postulated.
A narrative review and expert recommendations on the assessment of the clinical manifestations, follow-up, and management of post-OLT patients with ATTRv amyloidosis
Authors: Casasnovas Carlos , Lladó Laura , Borrachero Cristina , Pérez-Santamaría Patricia Valentina , Muñoz-Beamud Francisco , Losada-López Inés Asunción , Baliellas-Comellas Maria Carme , González-Moreno Juan
Published: August 2023

Orthotopic liver transplantation (OLT) was the first treatment able to modify the natural course of hereditary transthyretin (ATTRv) amyloidosis, which is a rare and fatal disorder caused by the accumulation of misfolded transthyretin (TTR) variants in different organs and tissues and which leads to a progressive and multisystem dysfunction. Because the liver is the main source of TTR, OLT dramatically reduces the production of the pathogenic TTR variant, which should prevent amyloid formation and halt disease progression. However, amyloidosis progression may occur after OLT due to wild-type TTR deposition, especially in the nerves and heart. In this review, we discuss the disease features influencing OLT outcomes and the clinical manifestations of ATTRv amyloidosis progression post-OLT to improve our understanding of disease worsening after OLT and optimize the follow-up and clinical management of these patients. By conducting a literature review on the PubMed database, we identified patient characteristics that have been associated with worse post-OLT outcomes, including late-onset V50M and non-V50M variants, age >40 years, long disease duration, advanced neuropathy and autonomic dysfunction, and malnutrition. Regarding post-OLT mortality, deaths occurring within the first year after OLT were mainly associated with fatal graft complications and infectious diseases, whereas cardiovascular-related deaths usually occurred later. Considering the diverse clinical manifestations of ATTRv amyloidosis progression post-OLT, including worsening neuropathy and/or cardiomyopathy, autonomic dysfunction, and oculoleptomeningeal involvement, we present advice on the most relevant tests for assessing disease progression post-OLT. Finally, we discuss the use of new therapies based on TTR stabilizers and TTR mRNA silencers for the treatment of ATTRv amyloidosis patients post-OLT.
A School Nurse’s Experience With Supraventricular Tachycardia
Authors: Howard Rachel N.
Published: August 2023

Students visit school health offices with a variety of complaints, and while some may be minor, others may be more pressing. The challenge for the school nurse is being able to differentiate between the two. This article features a case study of a fourth-grade elementary student who presented to the school nurse with a sudden onset of supraventricular tachycardia (SVT), a rapid cardiac arrhythmia that originates above the ventricles in the heart. The student’s complaint was a “racing heart,” and it was her first time experiencing a cardiac episode. It was also the school nurse’s first time encountering this chief complaint. The article will describe the student’s presentation to the health office, will discuss the school nurse’s assessments along with SVT management techniques, and will conclude with the student’s outcome and a sample individualized healthcare plan.
Are Academics Becoming More Confused Than Before? A Diachronic Study of Confusion Markers in Applied Linguistics Research Articles
Authors: Wang Qian
Published: August 2023

Research articles generate and disseminate disciplinary knowledge in a specific field of study. They are expected to be objective, faceless, and free from expressions of emotion. However, linguistic expressions of confusion that signal authors’ affective attitude toward the propositional information are not uncommon in research articles. To determine and describe the dynamic changes that occurred in the deployment of such expressions in communicating disciplinary knowledge, this study examined linguistically expressed confusion in a corpus of 160 research articles in applied linguistics that were published in two periods separated by 30 years. Drawing on a frame-based analytical approach, this study revealed that time of publication was a robust predictor of academic authors’ overall use of confusion markers and the presence of some subcategories across the four frame elements of the Confusion frame. This study sheds new light on the possibilities of applying frame semantics to academic discourse analysis. More importantly, it has pedagogical implications in terms of helping raise the awareness of novice writers about the necessity of acquiring a time-sensitive repertoire of discursive resources to convey an appropriate authorial identity for effective academic communication.
Exploring the Discourse of Debriefing Interactions: Areas for Improvement
Authors: Mohammad Abeer
Published: August 2023

Debriefing has been widely used as part of simulation-based education (SBE) to promote reflective thinking and prepare students for real clinical practice. This study examined a real debriefing transcript to identify its structure and gain insight into communication strategies used by the participants. The sample included an extended debriefing session in which a debriefer and undergraduate students, who participated in a critical care nursing simulation, engaged in a self-reflection phase. Adopting discourse analysis approaches, the analysis revealed how this interaction unfolds. The analysis also unveiled an asymmetric relationship during the debriefing that positioned the debriefer in a position of power and interactional dominance, and placed students in a passive role. Interactional features such as the use of open-ended questions, silent pauses, and informative feedback were identified as effective communication strategies to support the interaction; however, to achieve efficient self-debriefing, debriefers in this setting are encouraged to balance the use of questions to avoid restraining students from engaging and producing extended turns. Moreover, debriefers need to establish a safe environment that optimizes students’ involvement in self-reflection. This study recommends the use of other debriefing techniques to minimize the dominance of the debriefer during the interaction.
Modulation of human thrombopoietin receptor conformations uncouples JAK2 V617F-driven activation from cytokine-induced stimulation
Authors: Papadopoulos Nicolas , Pristavec Ajda , Nédélec Audrey , Levy Gabriel , Staerk Judith , Constantinescu Stefan N.
Published: August 2023

The thrombopoietin receptor (TpoR) plays a central role in myeloproliferative neoplasms (MPNs). Mutations in JAK2, calreticulin, or TpoR itself drive the constitutive activation of TpoR and uncontrolled proliferation and differentiation of hematopoietic stem cells and progenitors. The JAK2 V617F mutation is responsible for most MPNs, and all driver mutants induce pathologic TpoR activation. Existing therapeutic strategies have focused on JAK2 kinase inhibitors that are unable to differentiate between the mutated MPN clone and healthy cells. Surprisingly, the targeting of TpoR itself has remained poorly explored despite its central role in pathology. Here, we performed a comprehensive characterization of human TpoR activation under physiological and pathological conditions, focusing on the JAK2 V617F mutant. Using a system of controlled dimerization of the transmembrane and cytosolic domains of TpoR, we discovered that human TpoR (hTpoR) adopts different dimeric conformations upon Tpo-induced vs JAK2 V617F–mediated activation. We identified the amino acids and specific dimeric conformation of hTpoR responsible for activation in complex with JAK2 V617F and confirmed our findings in the full-length receptor context in hematopoietic cell lines and primary bone marrow cells. Remarkably, we found that the modulation of hTpoR conformations by point mutations allowed for specific inhibition of JAK2 V617F–driven activation without affecting Tpo-induced signaling. Our results demonstrate that modulation of the hTpoR conformation is a viable therapeutic strategy for JAK2 V617F–positive MPNs and set the path for novel drug development by identifying precise residues of hTpoR involved in JAK2 V617F–specific activation.
Anodal transcranial direct current stimulation over the right primary somatosensory cortex increases cough reflex sensitivity: a pilot randomised controlled crossover trial
Authors: Guo Liya , Wu Chunwei , Chen Chen , Zhang Bo , Wu Jian , Xie Ying , Gui Peijun
Published: August 2023

Background

The cough reflex is a protective reflex of the human body. Increases or decreases in cough reflex sensitivity may be related to chronic cough, aspiration pneumonia and other diseases. The right primary somatosensory cortex (RS1) is the main activation centre for the urge to cough. Here, we discuss the effects of transcranial direct current stimulation (tDCS) of RS1 on the cough reflex and urge to cough. In addition, we explored the role of the left dorsolateral prefrontal cortex (lDLPFC) in cough using tDCS.

Methods

24 healthy young adults completed this pilot randomised controlled crossover experiment. Each person was tested three times, receiving, in random order, anodal tDCS of RS1 or lDLPFC or sham stimulation. The current intensity was set to 2 mA, the stimulation time was 30 min and the interval between any two stimuli was ≥1 week. After each intervention, the citric acid cough challenge test was used immediately to assess the urge to cough and cough reflex sensitivity.

Results

The cough reflex thresholds, expressed as LogC2and LogC5, were significantly reduced after RS1 anodal stimulation compared to sham stimulation, accompanied by increased urge-to-cough sensitivity (urge-to-cough log–log slope 1.19±0.40 point·L·g−1versus0.92±0.33 point·L·g−1, p=0.001), but the threshold for the urge to cough did not change significantly. There were no significant changes in the urge to cough and cough reflex sensitivity after tDCS anodal lDLPFC stimulation.

Conclusion

Anodal tDCS stimulation of the RS1 can increase urge-to-cough sensitivity and reduce cough reflex threshold. The effects of tDCS on cough reflex, as well as the underlying mechanisms driving those effects, should be explored further.
Desmocollin-1 is associated with pro-metastatic phenotype of luminal A breast cancer cells and is modulated by parthenolide
Authors: Lapcik Petr , Sulc Petr , Janacova Lucia , Jilkova Katerina , Potesil David , Bouchalova Pavla , Müller Petr , Bouchal Pavel
Published: August 2023

Background

Desmocollin-1 (DSC1) is a desmosomal transmembrane glycoprotein that maintains cell-to-cell adhesion. DSC1 was previously associated with lymph node metastasis of luminal A breast tumors and was found to increase migration and invasion of MCF7 cells in vitro. Therefore, we focused on DSC1 role in cellular and molecular mechanisms in luminal A breast cancer and its possible therapeutic modulation.

Methods

Western blotting was used to select potential inhibitor decreasing DSC1 protein level in MCF7 cell line. Using atomic force microscopy we evaluated effect of DSC1 overexpression and modulation on cell morphology. The LC–MS/MS analysis of total proteome on Orbitrap Lumos and RNA-Seq analysis of total transcriptome on Illumina NextSeq 500 were performed to study the molecular mechanisms associated with DSC1. Pull-down analysis with LC–MS/MS detection was carried out to uncover DSC1 protein interactome in MCF7 cells.

Results

Analysis of DSC1 protein levels in response to selected inhibitors displays significant DSC1 downregulation (p-value ≤ 0.01) in MCF7 cells treated with NF-κB inhibitor parthenolide. Analysis of mechanic cell properties in response to DSC1 overexpression and parthenolide treatment using atomic force microscopy reveals that DSC1 overexpression reduces height of MCF7 cells and conversely, parthenolide decreases cell stiffness of MCF7 cells overexpressing DSC1. The LC–MS/MS total proteome analysis in data-independent acquisition mode shows a strong connection between DSC1 overexpression and increased levels of proteins LACRT and IGFBP5, increased expression of IGFBP5 is confirmed by RNA-Seq. Pathway analysis of proteomics data uncovers enrichment of proliferative MCM_BIOCARTA pathway including CDK2 and MCM2-7 after DSC1 overexpression. Parthenolide decreases expression of LACRT, IGFBP5 and MCM_BIOCARTA pathway specifically in DSC1 overexpressing cells. Pull-down assay identifies DSC1 interactions with cadherin family proteins including DSG2, CDH1, CDH3 and tyrosine kinase receptors HER2 and HER3; parthenolide modulates DSC1-HER3 interaction.

Conclusions

Our systems biology data indicate that DSC1 is connected to mechanisms of cell cycle regulation in luminal A breast cancer cells, and can be effectively modulated by parthenolide.

Graphical Abstract
Chromosome-level genome assembly of Babesia caballi reveals diversity of multigene families among Babesia species
Authors: Ochi Akihiro , Kidaka Taishi , Hakimi Hassan , Asada Masahito , Yamagishi Junya
Published: August 2023

Background

Babesia caballi is an intraerythrocytic parasite from the phylum Apicomplexa, capable of infecting equids and causing equine piroplasmosis. However, since there is limited genome information available on B. caballi, molecular mechanisms involved in host specificity and pathogenicity of this species have not been fully elucidated yet.

Results

Genomic DNA from a B. caballi subclone was purified and sequenced using both Illumina and Nanopore technologies. The resulting assembled sequence consisted of nine contigs with a size of 12.9 Mbp, rendering a total of 5,910 protein-coding genes. The phylogenetic tree of Apicomplexan species was reconstructed using 263 orthologous genes. We identified 481 ves1-like genes and named “ves1c”. In contrast, expansion of the major facilitator superfamily (mfs) observed in closely related B. bigemina and B. ovata species was not found in B. caballi. A set of repetitive units containing an open reading frame with a size of 297 bp was also identified.

Conclusions

We present a chromosome-level genome assembly of B. caballi. Our genomic data may contribute to estimating gene expansion events involving multigene families and exploring the evolution of species from this genus.
Occurrence of Acinetobacter baumannii genomic resistance islands (AbGRIs) in Acinetobacter baumannii strains belonging to global clone 2 obtained from COVID-19 patients
Authors: Naderi Ghazal , Asadian Mahla , Khaki Pegah Afarinesh , Salehi Mohammadreza , Abdollahi Alireza , Douraghi Masoumeh
Published: August 2023

Aim

The Acinetobacter baumannii genomic resistance islands (AbGRIs), which were characterized in the genome of the global clone 2 (GC2) A. baumannii contain resistance genes. Here, we aimed to determine the occurrence of AbGRIs in GC2 A. baumannii obtained from COVID-19 patients in a referral hospital in Tehran, Iran.

Methods

A total of 19 carbapenem-resistant A. baumannii (CRAB) isolates belonging to GC2 and sequence type 2 (ST2), including 17 from COVID-19 patients and two from the devices used in the ICU that the COVID-19 patients were admitted, were examined in this study. Antibiotic susceptibility testing was performed by the disk diffusion method. PCR and PCR mapping, followed by sequencing, were performed to characterize the structure of AbGRI resistance islands in the isolates tested.

Results

The AbGRI3 was the most frequent resistance island (RI) detected, present in all the 19 isolates, followed by AbGRI1 (15 isolates; 78.9%) and AbGRI2 (three isolates; 15.8%). Notably, AbGRIs were identified in one of the A. baumannii strains, which was isolated from a medical device used in the ICU where COVID-19 patients were admitted. Furthermore, new structures of AbGRI1 and AbGRI3 resistance islands were found in this study, which was the first report of these structures.

Conclusions

The present study provided evidence for the circulation of the GC2 A. baumannii strains harboring AbGRI resistance islands in a referral hospital in Tehran, Iran. It was found that resistance to several classes of antibiotics in the isolates collected from COVID-19 patients is associated with the resistance genes located within AbGRIs.
Hypnosis in the operating room: are anesthesiology teams interested and well-informed?
Authors: Zaccarini Sonia , Fernandez Aurore , Wolff Adriana , Magnusson Lennart , Rehberg-Klug Benno , Grape Sina , Schoettker Patrick , Berna Chantal
Published: August 2023

Background

Hypnosis can be a beneficial complementary anesthesia technique for a variety of surgical procedures. Despite favorable scientific evidence, hypnosis is still rarely used in the operating room. Obstacles to implementation could be a lack of interest or training, misconceptions, as well as limited knowledge amongst anesthesiology teams. Hence, this study aimed to assess the interest, training, beliefs, and knowledge about hypnosis in the operating room staff.

Design

A questionnaire with 21-items, based on a prior survey, was set up on an online platform. The medical and nursing anesthesiology staff of four Swiss academic and large regional hospitals (N = 754) were invited to participate anonymously through e-mails sent by their hierarchy. Results were analyzed quantitatively.

Results

Between June, 2020 and August, 2021 353 answers were collected (47% response rate). Most (92%) were aware that hypnosis needs specific training, with 14% trained. A large majority of the untrained staff wished to enroll for conversational hypnosis training. There was a strong agreement for hypnosis playing a role in anesthesia. Nevertheless, many of these professionals believed that hypnosis has a limited field of action (53%) or that it would be too time consuming (33%). The reduction of misconceptions was based more on exposure to hypnosis than on training.

Conclusion

Overall, anesthesia providers’ attitude was in favor of using hypnosis in the operating room. Misconceptions such as a prolongation of the procedure, alteration of consent, lack of acceptability for patients, and limited indications were identified as potential barriers. These deserve to be challenged through proper dissemination of the recent scientific literature and exposure to practice.
Predicting central lymph node metastasis in patients with papillary thyroid carcinoma based on ultrasound radiomic and morphological features analysis
Authors: Yan Xiang , Mou Xurong , Yang Yanan , Ren Jing , Zhou Xingxu , Huang Yifei , Yuan Hongmei
Published: August 2023

Objectives

To build a combined model based on the ultrasound radiomic and morphological features, and evaluate its diagnostic performance for preoperative prediction of central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC).

Method

A total of 295 eligible patients, who underwent preoperative ultrasound scan and were pathologically diagnosed with unifocal PTC were included at our hospital from October 2019 to July 2022. According to ultrasound scanners, patients were divided into the training set (115 with CLNM; 97 without CLNM) and validation set (45 with CLNM; 38 without CLNM). Ultrasound radiomic, morphological, and combined models were constructed using multivariate logistic regression. The diagnostic performance was assessed by the area under the curve (AUC) of the receiver operating characteristic curve, accuracy, sensitivity, and specificity.

Results

A combined model was built based on the morphology, boundary, length diameter, and radiomic score. The AUC was 0.960 (95% CI, 0.924–0.982) and 0.966 (95% CI, 0.901–0.993) in the training and validation set, respectively. Calibration curves showed good consistency between prediction and observation, and DCA demonstrated the clinical benefit of the combined model.

Conclusion

Based on ultrasound radiomic and morphological features, the combined model showed a good performance in predicting CLNM of patients with PTC preoperatively.
Impact of prematurity on long-stay paediatric intensive care unit admissions in England 2008-2018
Authors: van Hasselt Tim J. , Kanthimathinathan Hari Krishnan , Kothari Trishul , Plunkett Adrian , Gale Chris , Draper Elizabeth S. , Seaton Sarah E.
Published: August 2023

Background

Survival following extreme preterm birth has improved, potentially increasing the number of children with ongoing morbidity requiring intensive care in childhood. Previous single-centre studies have suggested that long-stay admissions in paediatric intensive care units (PICUs) are increasing.

We aimed to examine trends in long-stay admissions (≥28 days) to PICUs in England, outcomes for this group (including mortality and PICU readmission), and to determine the contribution of preterm-born children to the long-stay population, in children aged <2 years.

Methods

Data was obtained from the Paediatric Intensive Care Audit Network (PICANet) for all children <2 years admitted to National Health Service PICUs from 1/1/2008 to 31/12/2018 in England. We performed descriptive analysis of child characteristics and PICU outcomes.

Results

There were 99,057 admissions from 67,615 children. 2,693 children (4.0%) had 3,127 long-stays. Between 2008 and 2018 the annual number of long-stay admissions increased from 225 (2.7%) to 355 (4.0%), and the proportion of bed days in PICUs occupied by long-stay admissions increased from 24.2% to 33.2%.

Of children with long-stays, 33.5% were born preterm, 53.5% were born at term, and 13.1% had missing data for gestational age.

A considerable proportion of long-stay children required PICU readmission before two years of age (76.3% for preterm-born children). Observed mortality during any admission was also disproportionately greater for long-stay children (26.5% for term-born, 24.8% for preterm-born) than the overall rate (6.3%).

Conclusions

Long-stays accounted for an increasing proportion of PICU activity in England between 2008 and 2018. Children born preterm were over-represented in the long-stay population compared to the national preterm birth rate (8%).

These results have significant implications for future research into paediatric morbidity, and for planning future PICU service provision.
Changes in body mass index and behavioral health among adolescents in military families during the COVID-19 pandemic: a retrospective cohort study
Authors: Koehlmoos Tracey Pérez , Madsen Cathaleen , Banaag Amanda , Adirim Terry
Published: August 2023

Background

Widely published findings from the COVID-19 pandemic show adverse effects on body mass index (BMI) and behavioral health in both adults and children, due to factors such as illness, job loss, and limited opportunity for physical and social activity. This study investigated whether these adverse effects were mitigated in adolescents from military families, who are universally insured with consistent access to healthcare, and who generally have at least one parent who must adhere to physical and mental fitness as a condition of employment.

Methods

We conducted a cohort study using two groups of adolescents receiving care in the U.S. Military Health System during the COVID-19 pandemic; one for changes in Body Mass Index (BMI) and the second for changes in behavioral health diagnoses, using TRICARE claims data. Beneficiaries (160,037) ages 13 to 15 years in fiscal years 2017–2018, were followed up during October 2020 to June 2021.

Results

Among the BMI cohort, 44.32% of underweight adolescents moved to healthy weight, 28.48% from overweight to obese, and 3.7% from healthy weight to underweight. Prevalence of behavioral disorders showed an overall 29.01% percent increase during the study period, which included in mood (86.75%) and anxiety (86.49%) disorders, suicide ideation (42.69%), and suicide attempts (77.23%). Decreases in percent change were observed in conduct disorders (-15.93%) and ADD/ADHD (-8.61%).

Conclusions

Adolescents in military families experienced adverse health outcomes during the pandemic at approximately the same rates as those in non-military families, suggesting that universal insurance and military culture were not significantly mitigating factors. Obesity and underweight present significant opportunities to intervene in areas such as exercise and food access. Decreased conduct disorders and ADD/ADHD may reflect lower prevalence due to favorable home environment, or lower rates of diagnosis and referral; however, increased rates of anxiety, mood disorders, suicide ideation and attempt are especially concerning. Care should be taken to ensure that adolescents receive consistent opportunity for physical activity and social interaction, and those at risk for suicide should receive active monitoring and appropriate referral to behavioral healthcare providers.
Early tissue and healing responses after maxillary sinus augmentation using horizontal platelet rich fibrin bone blocks
Authors: Yu Shimin , BD Yinping Tian , BD Yan Wei , BD Mengge Feng , BMed Sensen Li , BMed Guoyong Tong , BMed Zhouqing Yu , Miron Richard J. , Zhang Yufeng , Yang Zaibo , Wang Yulan
Published: August 2023

Background

The effects of horizontal platelet-rich fibrin (H-PRF) bone block on the healing and immune response during sinus augmentation have not been fully investigated histologically at early time points.

Methods

Eighteenth male New Zealand white rabbits underwent bilateral sinus augmentation and were divided into two groups: deproteinized bovine bone mineral (DBBM) alone and H-PRF + DBBM (H-PRF bone block) group. Maxilla samples were collected at 3, 7 and 14 days post sinus augmentation procedures and analyzed using histological staining for the number of inflammatory cells, new blood vessels and evidence for early osteoclast bone turnover/remodeling. Furthermore, the effects of H-PRF bone blocks on the migration of osteoblasts and THP-1 macrophages were evaluated using a Transwell assay in vitro.

Results

A higher number of immune cells were found in the H-PRF bone block group at 3 and 7 days post-surgery when compared to the DBBM alone group,most notably in the regions close to the mucosal lining and bone plates. Furthermore, a significantly greater number of new blood vessel formations and early signs of osteoclast development were found in the H-PRF bone block group at 14 days. The in vitro transwell assay further confirmed that culture medium from H-PRF bone block markedly promote the migration of osteoblasts and THP-1 macrophages.

Conclusions

The findings from this study have shown that H-PRF bone block is capable of increasing early immune cell infiltration leading to the acceleration of neovascularization and speeding the process of bone metabolism in vivo following maxillary sinus grafting with DBBM.
Determinants of contraceptive continuation among women in sub-Saharan Africa
Authors: Budu Eugene , Okyere Joshua , Osei Mary Dansoah , Seidu Abdul-Aziz , Ahinkorah Bright Opoku
Published: August 2023

Background

Contraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes, like unintended pregnancies. Therefore, it is imperative to understand the factors that influence women’s decision to continue the use of contraceptives. The present study examined the determinants of contraceptive continuation among women in sub-Saharan Africa (SSA).

Methods

Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of twenty-four (24) countries in SSA. Descriptive and multivariable binary logistic regression analysis were conducted. Frequencies, percentanges, and an adjusted odds ratio with 95% confidence intervals were used to present the results.

Results

Compared to adolescents, adult women aged 45–49 years [aOR: 1.24; CI: 1.13–1.37] had higher odds of contraceptive continuation. The odds of contraceptive continuation were lower among those working [aOR: 0.96; CI: 0.93–0.98] compared to those not working. Also, the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed [aOR: 0.91; CI: 0.88–0.93]. Compared to women who used LARCs, women who used pills [aOR: 0.34; CI: 0.33–0.36], injectable [aOR: 0.42; CI: 0.40–0.43], other modern contraceptives [aOR: 0.72; CI: 0.68–0.75] or traditional methods [aOR: 0.50; CI: 0.478–0.523] were less likely to continue with their contraception. Women with one birth [aOR: 0.86; CI: 0.83–0.90] and those with 2 + births in the last five years [aOR: 0.54; CI: 0.512–0.56] reported lower odds of contraceptive continuation as compared to those with no births. Compared to women with no children living, those with 4 + children living had lower odds of contraceptive continuation [aOR: 0.62; CI: 0.57–0.67]. The study also found that the likelihood of contraceptive continuation was higher among those with secondary education [aOR: 1.08; CI: 1.04–1.12] as compared to those with no formal education. Contraceptive continuation was also higher among those who have information on choice [aOR: 3.91; CI: 3.82–4.01], and also higher among those who were undecided about having an additional child [aOR: 1.39; CI: 1.33–1.46]. Compared to West AfricaAngola, women from all other sub-regions were less likely to continue using contraceptives Comoros were more likely to continue with contraception [aOR: 1.49; CI: 1.24–1.78].

Conclusion

To improve contraceptive continuation among women of reproductive age, countries in SSA must invest heavily in advocacy and dissemination of family planning messages, and information of choice. Also, much commitment should be directed towards enhancing the use of long-acting reversible contraceptive use.
Virtual spaced-learning method, during COVID-19 for Pharm D students
Authors: Sharifdini Meysam , Evazalipour Mehdi , Hesari Zahra
Published: August 2023

Background

The coronavirus (COVID-19) outbreak basically changed teaching methods across the world, and learning was almost replaced by virtual learning during the pandemic. Also, the spacing effect is one of the most well-established phenomena in the science of learning. Using temporal intervals for re-exposing learners to information over time (spaced learning) leads to more effective retention of knowledge compared to having information presented at a single time (massed learning). Hence, we designed a virtual spaced learning method to reap the benefits of virtual learning and spaced learning concomitantly.

Methods/approach

An interventional semi- experimental survey among 66 Pharm D students was designed and implemented. Students were divided into two groups (spaced vs mass learning) in the national integrated virtual education platform (NAVID) as the matrix for teaching as well as evaluation. Classes were conducted in the following sequence: 1- answering the pre-test, 2- watching and listening to the educational content (separately for each group), 3- answering the post-test (n = 1). The pre/post-test consisted of 10 four-choice questions based on the Kirkpatrick Model extracted from the educational content.

Results/outcomes

Findings revealed that the average score was not significantly different between the post-tests of the spaced learning and mass learning (7.26 ± 2.26 vs 6.5 ± 2.5) methods utilizing the independent t- test (p ≥ 0.05).

Conclusions

Since no statistically significant improvement was observed in the virtual spaced learning group compared to the control group, it seems that clarifying the significant influence of the spaced learning strategy in pharmacy education requires longer period of study, or study on less complex or skill-based topics for further evaluation.
Factors associated with post-traumatic stress disorder in nurses after directly caring for COVID-19 patients: a cross-sectional study
Authors: Yoon Hyo-Jeong , Bae Soon Yeung , Baek Jihyun
Published: August 2023

Background

Nurses are particularly at risk of suffering from post-traumatic stress disorder (PTSD) owing to their overwhelming workload, risk of infection, and lack of knowledge about the coronavirus disease 2019 (COVID-19). PTSD negatively affects an individual’s health, work performance, and patient safety. This study aims to assess factors related to PTSD among nurses after providing direct care to COVID-19 patients.

Methods

This study is a secondary analysis aimed at identifying factors influencing PTSD among nurses who provided direct care to COVID-19 patients. Data from 168 nurses, collected between October and November 2020, were analyzed. The independent variables were personal, interpersonal, and organizational and COVID-19-related factors (experience of quarantine and direct care of COVID-19 patients), and the dependent variables were PTSD symptoms evaluated based on the PTSD Checklist-5. The nurses’ experience of direct care for COVID-19 patients in the designated COVID-19 isolation wards during the first wave of the pandemic (February 2020 to May 2020) was included.

Results

Among the nurses, 18.5% exhibited symptoms of PTSD. When providing direct care to a patient in the designated COVID-19 isolation ward, nurses witnessing the death of a patient (p = .001), low level of nurse staffing (p = .008), and inconvenience of electronic health records programs (p = .034) were associated with PTSD symptoms. The experience of quarantine owing to COVID-19 was also associated with PTSD symptoms (p = .034). Additionally, the higher the nurse managers’ ability, leadership, and support of nurses in the current ward, the higher the possibility of lowering nurses’ PTSD symptoms (p = .006).

Conclusions

Governments and hospitals should prepare and implement organizational intervention programs to improve nurse managers’ leadership, nurse staffing levels, and electronic health records programs. Additionally, because nurses who have witnessed the death of a COVID-19 patient or are self-isolating are vulnerable to PTSD, psychological support should be provided.
Severe falciparum malaria in pregnancy in Southeast Asia: a multi-centre retrospective cohort study
Authors: Saito Makoto , Phyo Aung Pyae , Chu Cindy , Proux Stephane , Rijken Marcus J. , Beau Candy , Win Htun Htun , Archasuksan Laypaw , Wiladphaingern Jacher , Phu Nguyen H. , Hien Tran T. , Day Nick P. , Dondorp Arjen M. , White Nicholas J. , Nosten François , McGready Rose
Published: August 2023

Background

Severe malaria in pregnancy causes maternal mortality, morbidity, and adverse foetal outcomes. The factors contributing to adverse maternal and foetal outcomes are not well defined. We aimed to identify the factors predicting higher maternal mortality and to describe the foetal mortality and morbidity associated with severe falciparum malaria in pregnancy.

Methods

A retrospective cohort study was conducted of severe falciparum malaria in pregnancy, as defined by the World Health Organization severe malaria criteria. The patients were managed prospectively by the Shoklo Malaria Research Unit (SMRU) on the Thailand-Myanmar border or were included in hospital-based clinical trials in six Southeast Asian countries. Fixed-effects multivariable penalised logistic regression was used for analysing maternal mortality.

Results

We included 213 (123 SMRU and 90 hospital-based) episodes of severe falciparum malaria in pregnancy managed between 1980 and 2020. The mean maternal age was 25.7 (SD 6.8) years, and the mean gestational age was 25.6 (SD 8.9) weeks. The overall maternal mortality was 12.2% (26/213). Coma (adjusted odds ratio [aOR], 7.18, 95% CI 2.01–25.57, p = 0.0002), hypotension (aOR 11.21, 95%CI 1.27–98.92, p = 0.03) and respiratory failure (aOR 4.98, 95%CI 1.13–22.01, p = 0.03) were associated with maternal mortality. Pregnant women with one or more of these three criteria had a mortality of 29.1% (25/86) (95%CI 19.5 to 38.7%) whereas there were no deaths in 88 pregnant women with hyperparasitaemia (> 10% parasitised erythrocytes) only or severe anaemia (haematocrit < 20%) only. In the SMRU prospective cohort, in which the pregnant women were followed up until delivery, the risks of foetal loss (23.3% by Kaplan–Meier estimator, 25/117) and small-for-gestational-age (38.3%, 23/60) after severe malaria were high. Maternal death, foetal loss and preterm birth occurred commonly within a week of diagnosis of severe malaria.

Conclusions

Vital organ dysfunction in pregnant women with severe malaria was associated with a very high maternal and foetal mortality whereas severe anaemia or hyperparasitaemia alone were not associated with poor prognosis, which may explain the variation of reported mortality from severe malaria in pregnancy. Access to antenatal care must be promoted to reduce barriers to early diagnosis and treatment of both malaria and anaemia.
Benefits of near-universal vaccination and treatment access to manage COVID-19 burden in the United States
Authors: Yang Fuhan , Tran Thu Nguyen-Anh , Howerton Emily , Boni Maciej F. , Servadio Joseph L.
Published: August 2023

Background

As we continue the fourth year of the COVID-19 epidemic, SARS-CoV-2 infections still cause high morbidity and mortality in the United States. During 2020–2022, COVID-19 was one of the leading causes of death in the United States and by far the leading cause among infectious diseases. Vaccination uptake remains low despite this being an effective burden reducing intervention. The development of COVID-19 therapeutics provides hope for mitigating severe clinical outcomes. This modeling study examines combined strategies of vaccination and treatment to reduce the burden of COVID-19 epidemics over the next decade.

Methods

We use a validated mathematical model to evaluate the reduction of incident cases, hospitalized cases, and deaths in the United States through 2033 under various levels of vaccination and treatment coverage. We assume that future seasonal transmission patterns for COVID-19 will be similar to those of influenza virus and account for the waning of infection-induced immunity and vaccine-induced immunity in a future with stable COVID-19 dynamics. Due to uncertainty in the duration of immunity following vaccination or infection, we consider three exponentially distributed waning rates, with means of 365 days (1 year), 548 days (1.5 years), and 730 days (2 years). We also consider treatment failure, including rebound frequency, as a possible treatment outcome.

Results

As expected, universal vaccination is projected to eliminate transmission and mortality. Under current treatment coverage (13.7%) and vaccination coverage (49%), averages of 81,000–164,600 annual reported deaths, depending on duration of immunity, are expected by the end of this decade. Annual mortality in the United States can be reduced below 50,000 per year with 52–80% annual vaccination coverage and below 10,000 annual deaths with 59–83% annual vaccination coverage, depending on duration of immunity. Universal treatment reduces hospitalizations by 88.6% and deaths by 93.1% under current vaccination coverage. A reduction in vaccination coverage requires a comparatively larger increase in treatment coverage in order for hospitalization and mortality levels to remain unchanged.

Conclusions

Adopting universal vaccination and universal treatment goals in the United States will likely lead to a COVID-19 mortality burden below 50,000 deaths per year, a burden comparable to that of influenza virus.
Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China
Authors: Henderson D. A. G , Donaghy E , Dozier M , Guthrie B , Huang H , Pickersgill M , Stewart E , Thompson A , Wang H. H. X , Mercer S. W
Published: August 2023

Background

Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key ‘components’, impacts of new models of care, and barriers and facilitators to PCT implementation.

Methods

We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed.

Results

A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with  < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes.

Conclusions

Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.
The triglyceride-glucose index is associated with atherosclerosis in patients with symptomatic coronary artery disease, regardless of diabetes mellitus and hyperlipidaemia
Authors: Li Jiao , Dong Zixian , Wu Hao , Liu Yue , Chen Yafang , Li Si , Zhang Yufan , Qi Xin , Wei Liping
Published: August 2023

Background

Diabetes and hyperlipidaemia are both risk factors for coronary artery disease, and both are associated with a high triglyceride-glucose index (TyG index). The TyG index has been presented as a marker of insulin resistance (IR). Its utility in predicting and detecting cardiovascular disease has been reported. However, few studies have found it to be a helpful marker of atherosclerosis in patients with symptomatic coronary artery disease (CAD). The purpose of this study was to demonstrate that the TyG index can serve as a valuable marker for predicting coronary and carotid atherosclerosis in symptomatic CAD patients, regardless of diabetes mellitus and hyperlipidaemia.

Methods

This study included 1516 patients with symptomatic CAD who underwent both coronary artery angiography and carotid Doppler ultrasound in the Department of Cardiology at Tianjin Union Medical Center from January 2016 to December 2022. The TyG index was determined using the Ln formula. The population was further grouped and analysed according to the presence or absence of diabetes and hyperlipidaemia. The Gensini score and carotid intima-media thickness were calculated or measured, and the patients were divided into four groups according to TyG index quartile to examine the relationship between the TyG index and coronary or carotid artery lesions in symptomatic CAD patients.

Results

In symptomatic CAD patients, the TyG index showed a significant positive correlation with both coronary lesions and carotid plaques. After adjusting for sex, age, smoking, BMI, hypertension, diabetes, and the use of antilipemic and antidiabetic agents, the risk of developing coronary lesions and carotid plaques increased across the baseline TyG index. Compared with the lowest quartile of the TyG index, the highest quartile (quartile 4) was associated with a greater incidence of coronary heart disease [OR = 2.55 (95% CI 1.61, 4.03)] and carotid atherosclerotic plaque [OR = 2.31 (95% CI 1.27, 4.20)] (P < 0.05). Furthermore, when compared to the fasting blood glucose (FBG) or triglyceride (TG) level, the TyG index had a greater area under the ROC curve for predicting coronary lesions and carotid plaques. The subgroup analysis demonstrated the TyG index to be an equally effective predictor of coronary and carotid artery disease, regardless of diabetes and hyperlipidaemia.

Conclusion

The TyG index is a useful marker for predicting coronary and carotid atherosclerosis in patients with symptomatic CAD, regardless of diabetes mellitus and hyperlipidaemia. The TyG index is of higher value for the identification of both coronary and carotid atherosclerotic plaques than the FBG or TG level alone.