bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial Recanalization During Interhospital Transfer for Thrombectomy
Authors: Seners Pierre , Wouters Anke , Ter Schiphorst Adrien , Yuen Nicole , Mlynash Michael , Arquizan Caroline , Heit Jeremy J. , Kemp Stephanie , Christensen Soren , Sablot Denis , Wacongne Anne , Lalu Thibault , Costalat Vincent , Lansberg Maarten G. , Albers Gregory W.
Published: May 2024

BACKGROUND:

Patients with acute ischemic stroke harboring a large vessel occlusion admitted to nonendovascular-capable centers often require interhospital transfer for thrombectomy. We evaluated the incidence and predictors of arterial recanalization during transfer, as well as the relationship between interhospital recanalization and clinical outcomes.

METHODS:

We analyzed data from 2 cohorts of patients with an anterior circulation large vessel occlusion transferred for consideration of thrombectomy to a comprehensive center, with arterial imaging at the referring hospital and on comprehensive stroke center arrival. Interhospital recanalization was determined by comparison of the baseline and posttransfer arterial imaging and was defined as revised arterial occlusive lesion (rAOL) score 2b to 3. Pretransfer variables independently associated with interhospital recanalization were studied using multivariable logistic regression analysis.

RESULTS:

Of the 520 included patients (Montpellier, France, n=237; Stanford, United States, n=283), 111 (21%) experienced interhospital recanalization (partial [rAOL=2b] in 77% and complete [rAOL=3] in 23%). Pretransfer variables independently associated with recanalization were intravenous thrombolysis (adjusted odds ratio, 6.8 [95% CI, 4.0–11.6]), more distal occlusions (intracranial carotid occlusion as reference: adjusted odds ratio, 2.0 [95% CI, 0.9–4.5] for proximal first segment of the middle cerebral artery, 5.1 [95% CI, 2.3–11.5] for distal first segment of the middle cerebral artery, and 5.0 [95% CI, 2.1–11.8] for second segment of the middle cerebral artery), and smaller clot burden (clot burden score 0–4 as reference: adjusted odds ratio, 3.4 [95% CI, 1.5–7.6] for 5–7 and 5.6 [95% CI, 2.4–12.7] for 8–9). Recanalization on arrival at the comprehensive center was associated with less interhospital infarct growth (rAOL, 0–2a: 11.6 mL; rAOL, 2b: 2.2 mL; rAOL, 3: 0.6 mL;
P
trend
<0.001) and greater interhospital National Institutes of Health Stroke Scale score improvement (0 versus −5 versus −6;
P
trend
<0.001). Interhospital recanalization was associated with reduced 3-month disability (adjusted common odds ratio, 2.51 [95% CI, 1.68–3.77]) with greater benefit from complete than partial recanalization.

CONCLUSIONS:

Recanalization is frequently observed during interhospital transfer for thrombectomy and is strongly associated with favorable outcomes, even when partial. Broadening thrombolysis indications in primary centers, and developing therapies that increase recanalization during transfer, will likely improve clinical outcomes.
Emergency medical services in Armenia: national call trends and future directions
Authors: Arzoumanian Ani , Agopian Anya , Hovhannisyan Marine , Chekijian Sharon , Baghdassarian Aline
Published: May 2024

Background

Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods.

Results

For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%).

Conclusions

Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.
Genomic analysis of severe COVID-19 considering or not asthma comorbidity: GWAS insights from the BQC19 cohort
Authors: Amri Omayma , Madore Anne-Marie , Boucher-Lafleur Anne-Marie , Laprise Catherine
Published: May 2024

Background

The severity of COVID-19 is influenced by various factors including the presence of respiratory diseases. Studies have indicated a potential relationship between asthma and COVID-19 severity.

Objective

This study aimed to conduct a genome-wide association study (GWAS) to identify genetic and clinical variants associated with the severity of COVID-19, both among patients with and without asthma.

Methods

We analyzed data from 2131 samples sourced from the Biobanque québécoise de la COVID-19 (BQC19), with 1499 samples from patients who tested positive for COVID-19. Among these, 1110 exhibited mild-to-moderate symptoms, 389 had severe symptoms, and 58 had asthma. We conducted a comparative analysis of clinical data from individuals in these three groups and GWAS using a logistic regression model. Phenotypic data analysis resulted in the refined covariates integrated into logistic models for genetic studies.

Results

Considering a significance threshold of 1 × 10−6, seven genetic variants were associated with severe COVID-19. These variants were located proximal to five genes: sodium voltage-gated channel alpha subunit 1 (SCN10A), desmoplakin (DSP), RP1 axonemal microtubule associated (RP1), IGF like family member 1 (IGFL1), and docking protein 5 (DOK5). The GWAS comparing individuals with severe COVID-19 with asthma to those without asthma revealed four genetic variants in transmembrane protein with EGF like and two follistatin like domains 2 (TMEFF2) and huntingtin interacting protein-1 (HIP1) genes.

Conclusion

This study provides significant insights into the genetic profiles of patients with severe forms of the disease, whether accompanied by asthma or not. These findings enhance our comprehension of the genetic factors that affect COVID-19 severity.

Key messages

Seven genetic variants were associated with the severe form of COVID-19;

Four genetic variants were associated with the severe form of COVID-19 in individuals with comorbid asthma;

These findings help define the genetic component of the severe form of COVID-19 in relation to asthma as a comorbidity.
Identification of four mitochondria-related genes in sepsis based on RNA sequencing technology
Authors: ShilinLi  , Hu Yingchun
Published: May 2024

Objectives

The purpose of this study was to identify and analyze the mitochondrial genes associated with sepsis patients in order to elucidate the underlying mechanism of sepsis immunity and provide new ideas for the clinical treatment of sepsis.

Methods

The hospitalized cases of sepsis (n = 20) and systemic inflammatory response syndrome (SIRS) (n = 12) admitted to the Emergency Intensive Care Unit (EICU) of the Affiliated Hospital of Southwest Medical University from January 2019 to December 2019 were collected consecutively. RNA-seq was used to sequence the RNA (mRNA) of peripheral blood cells. Bioinformatics techniques were used to screen and identify differentially expressed RNAs, with an absolute value of fold change (FC) greater than or equal to 1.2 and a false discovery rate (FDR) less than 0.05. At the same time, mitochondrial genes were obtained from the MitoCarta 3.0 database. Differential genes were then intersected with mitochondrial genes. The resulting crossover genes were subjected to GO, KEGG, and PPI analysis. Subsequently, the GSE65682 dataset was downloaded from the GEO database for survival analysis to assess the prognostic value of core genes, and GSE67652 was downloaded for ROC curve analysis to validate the diagnostic value of core genes. Finally, the localization of core genes was clarified through 10X single-cell sequencing.

Results

The crossing of 314 sepsis differential genes and 1136 mitochondrial genes yielded 28 genes. GO and KEGG analysis showed that the crossover genes were mainly involved in the mitochondrion, mitochondrial matrix, and mitochondrial inner membrane. Survival analysis screened four genes that were significantly negatively associated with the prognosis of sepsis, namely FIS1, FKBP8, GLRX5, and GUK1. A comparison of peripheral blood RNA-seq results between the sepsis group and the SIRS group showed that the expression levels of these four genes were significantly decreased in the sepsis group compared to the SIRS group. ROC curve analysis based on GSE67652 indicates these four genes’ high sensitivity and specificity for sepsis detection. Additionally, single-cell RNA sequencing found that the core genes were mainly expressed in macrophages, T cells, and B cells.

Conclusions

Mitochondria-related genes (FIS1, FKBP8, GLRX5, GUK1) were underexpressed in the sepsis group, negatively correlated with survival, and mainly distributed in immune cells. This finding may guide studying the immune-related mechanisms of sepsis. This study protocol was reviewed by the Ethics Committee of the Affiliated Hospital of Southwest Medical University (ethics number: KY2018029), the clinical trial registration number is ChiCTR1900021261, and the registration date is February 4, 2019.
Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review
Authors: Mahura Melanie , Karle Brigitte , Sayers Louise , Dick-Smith Felicity , Elliott Rosalind
Published: May 2024

Background

In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this.

Aim

The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness.

Methods

In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global.

Results

From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries.

Conclusions

Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.
Clients’ expectations and experiences with providers of menstrual regulation: a qualitative study in Bangladesh
Authors: Ramirez Ana Maria , Tabassum Tanzila , Filippa Sofia , Katz Anna , Chowdhury Rezwana , Bercu Chiara , Baum Sarah E.
Published: May 2024

Background

Menstrual Regulation (MR) has been legal in Bangladesh since 1979 in an effort to reduce maternal mortality from unsafe abortion care. However, access to high-quality and patient-centered MR care remains a challenge. This analysis aimed to explore what clients know before going into care and the experience itself across a variety of service delivery sites where MR care is available.

Methods

We conducted 26 qualitative semi-structured interviews with MR clients who were recruited from three different service delivery sites in Dhaka, Bangladesh from January to March 2019. Interviews explored client expectations and beliefs about MR care, the experience of the care they received, and their perception of the quality of that care. We conducted a thematic content analysis using a priori and emergent codes.

Results

Clients overall lacked knowledge about MR care and held fears about the damage to their bodies after receiving care. Despite their fears, roughly half the clients held positive expectations about the care they would receive. Call center clients felt the most prepared by their provider about what to expect during their MR care. During counseling sessions, providers at in-facility locations reinforced the perception of risk of future fertility as a result of MR and commonly questioned clients on their need for MR services. Some even attempted to dissuade nulliparous women from getting the care. Clients received this type of questioning throughout their time at the facilities, not just from their medical providers. The majority of clients perceived their care as good and rationalized these comments from their providers as coming from a caring place. However, a handful of clients did report bad care and negative feelings about their interactions with providers and other clinical staff.

Conclusion

Providers and clinical staff can play a key role in shaping the experience of clients accessing MR care. Training on accurate knowledge about the safety and effectiveness of MR, and the importance of client communication could help improve client knowledge and person-centered quality of MR care.
Exploring the consent process among pregnant and breastfeeding women taking part in a maternal vaccine clinical trial in Kampala, Uganda: a qualitative study
Authors: Ssali Agnes , Namugumya Rita , Nalubega Phiona , Kyohere Mary , Seeley Janet , Doare Kirsty Le
Published: May 2024

Background

The involvement of pregnant women in vaccine clinical trials presents unique challenges for the informed consent process. We explored the expectations and experiences of the pregnant women, spouses/partners, health workers and stakeholders of the consent process during a Group B Streptococcus maternal vaccine trial.

Methods

We interviewed 56 participants including pregnant women taking part in the trial, women not in the trial, health workers handling the trial procedures, spouses, and community stakeholders. We conducted 13 in-depth interviews and focus group discussions with 23 women in the trial, in-depth interviews with 5 spouses, and 5 women not in the trial, key informant interviews with 5 health workers and 5 other stakeholders were undertaken.

Results

Decision-making by a pregnant woman to join a trial was done in consultation with spouse, parents, siblings, or trusted health workers. Written study information was appreciated by all but they suggested the use of audio and visual presentation to enhance understanding. Women stressed the need to ensure that their male partners received study information before their pregnant partners joined a clinical trial. Confidentiality in research was emphasised differently by individual participants; while some emphasised it for self, others were keen to protect their family members from being exposed, for allowing them to be involved in research. However, others wanted their community participation to be acknowledged.

Conclusion

We found that pregnant women make decisions to join a clinical trial after consulting with close family. Our findings suggest the need for an information strategy which informs not only the pregnant woman, but also her family about the research she is invited to engage in.
Sensory nerve conduction stimulus threshold measurements of the infraorbital nerve and its applicability as a diagnostic tool in horses with trigeminal-mediated headshaking
Authors: Nessler Jasmin Nicole , Delarocque Julien , Kloock Tanja , Twele Lara , Neudeck Stephan , Meyerhoff Nina , Riese Franziska , Cavalleri Jessica-M. V. , Tipold Andrea , Feige Karsten , Niebuhr Tobias
Published: May 2024

Background

To determine whether sensory nerve conduction stimulus threshold measurements of the infraorbital nerve are able to differentiate horses with idiopathic trigeminal-mediated headshaking (i-TMHS) from healthy horses and from horses with secondary trigeminal-mediated headshaking (s-TMHS). In a prospective trial, headshaking horses were examined using a standardized diagnostic protocol, including advanced diagnostics such as computed tomography and 3-Tesla-magnetic resonance imaging (MRI), to differentiate s-TMHS from i-TMHS. Clinically healthy horses served as controls. Within this process, patients underwent general anesthesia, and the minimal sensory nerve conduction stimulus threshold (SNCT) of the infraorbital nerve was measured using a bipolar concentric needle electrode. Sensory nerve action potentials (SNAP) were assessed in 2.5–5 mA intervals. Minimal SNCT as well as additional measurements were calculated.

Results

In 60 horses, SNAP could be recorded, of which 43 horses had i-TMHS, six had suspected s-TMHS, three horses had non-facial headshaking, and eight healthy horses served as controls. Controls had a minimal SNCT ≥ 15 mA, whereas 14/43 horses with i-TMHS and 2/6 horses with s-TMHS showed a minimal SNCT ≤ 10 mA. Minimal SNCT ≤ 10 mA showed 100% specificity to distinguish TMHS from controls, but the sensitivity was only 41%.

Conclusion

A minimal SNCT of the infraorbital nerve ≤ 10 mA was able to differentiate healthy horses from horses with TMHS. Nevertheless, a higher minimal SNCT did not exclude i-TMHS or s-TMHS and minimal SNCT does not distinguish s-TMHS from i-TMHS.
Quadrilateral plate classification program of acetabular fractures based on three-column classification: a three-dimensional fracture mapping study
Authors: Wang Ruihan , Jiang Songtao , Wang Wei , Yang Yingqiu , Zhang Lei , Wang Guoyou
Published: May 2024

Background

A new classification system for acetabular fractures has been proposed in recent years, which is called the 3-column classification. However, this system does not provide information regarding quadrilateral plate fractures. To address this issue, we utilized three-dimensional (3D) fracture line mapping and heat map to analyze the link between the 3-column classification and quadrilateral plate fractures.

Methods

We collected CT scan data from 177 patients who had been diagnosed with acetabular fractures. Additionally, we utilized a CT scan of a healthy adult to generate a standard acetabular model. We utilized the collected CT data of the fracture to create a 3D model and subsequently reduced it. We then matched each acetabular fracture model with the standard acetabular model and mapped all of the fracture lines to the standard model. 3D fracture lines and heat maps were created by overlapping all fracture lines. Fracture characteristics were then summarized using these maps.

Results

This study analyzed a total of 221 acetabular fractures. The most frequently observed fracture type, based on the three-column classification, was A1.2, which corresponds to fractures of the anterior column. In contrast, the least common type of fracture was A4, which represents fractures of the central wall. It was noted that quadrilateral plate fractures were frequently observed in fractures classified as type B and C according to the three-column classification.

Conclusions

Among the three-column classification, the QLP fractures are commonly observed in type B and C. It is important to carefully identify these fractures during the diagnostic process. Therefore, based on the three-column classification, we have amalgamated quadrilateral plate fractures and formulated a classification program for acetabular fractures.
Genetic variability of Aedes aegypti (Diptera: Culicidae) in El Salvador and Honduras: presence of a widespread haplotype and implications for mosquito control
Authors: Joyce A. L. , Moreno Miguel , Palomo Leonel , O’Connor Raul , Escobar Denis
Published: May 2024

Background

This study examined population genetics of Aedes aegypti in El Salvador and Honduras, two adjacent countries in Central America. Aedes aegypti is associated with yellow fever, dengue, chikungunya, and Zika. Each year, thousands of cases of dengue are typically reported in El Salvador and Honduras.

Methods

In El Salvador, collections were obtained from five Departments. In Honduras, samples were obtained from six municipalities in four Departments. Mitochondrial DNA cytochrome oxidase I (COI) was sequenced, and consensus sequences were combined with available sequences from El Salvador to determine haplotype number, haplotype diversity, nucleotide diversity, and Tajima’s D. A haplotype network was produced to examine the relationship between genotypes.

Results

In El Salvador, there were 17 haplotypes, while in Honduras there were 4 haplotypes. In both El Salvador and Honduras, Haplotype 1 is most abundant and widespread. In El Salvador, haplotype H2 was also widespread in 10 of 11 sampled municipalities, but it was not present in Honduras. The capital of El Salvador (San Salvador) and the eastern region of ES had the highest haplotype diversity of regions sampled.

Conclusions

Haplotype 1 and H2 each belong to different phylogenetic lineages of Ae. aegypti. The most geographically widespread haplotype (H1) may have been present the longest and could be a remnant from previous eradication programs. These data may contribute to future control programs for Ae. aegypti in the two countries.

Graphical Abstract
A comprehensive analysis of food insecurity in the drought–prone rural areas of Tigray
Authors: Gebre Tewelde , Abraha Zenebe , Zenebe Amanuel , Zeweld Woldegebrial
Published: May 2024

Background

The number of globally food-insecure people is increasing since 2017. Sub-Saharan Africa has the highest proportion of severely food-insecure people in the world. Tigray region of Ethiopia is one of the food-insecure regions, which, over the past many decades has been affected by recurrent food insecurities. In the drought–prone rural areas of Tigray, many people are living under the condition of chronic hunger. Proper food security studies are vital for proper intervention mechanisms. Yet, previous food security studies have rarely addressed the four pillars of food security: availability, access, utilization, and stability. In this study, all components are duly considered to assess the food insecurity status in the drought–prone rural areas of Tigray, Ethiopia. Of the 34 rural districts in Tigray, 363 households from three drought–prone rural districts were studied.

Results

Household Food Insecurity Access Scale and Food Insecurity Experience Scale were adapted to measure the food availability, access to food, and stability components of food security; and, Household Dietary Diversity Score (HDDS), Food Consumption Score (FCS), mid-upper arm circumference, and Bitot’s spot were used to analyze the food utilization aspect. Findings show that 68% of the studied community frequently ate less food than they felt they needed and 82.1% of the households have experienced hunger because of lack of food. The study rural districts were unconnected to road networks; hence, 87.9% of the elderly and 20.4% of the women and girls had no access to food markets. Regarding the food utilization, 81.5% of the studied households had poor FCS; and the average HDDS and FCS for the study areas were 2.47 and 18.9, respectively. The prevalence of Global acute malnutrition, severe acute malnutrition (SAM), and moderate acute malnutrition (MAM) for 6–59 months of age children in the study areas were 50.3, 4.2, and 46.1%, respectively. More notably, the prevalence of SAM for children from the food-insecure households was 21.2%. The prevalence of MAM for pregnant and lactating women (PLW) in the study areas was 59.5. Further, the prevalence of Bitot’s spot among 6–59 months of age children was 1.9%. On the other hand, all the rural households had anxiety about their future food demands.

Conclusion

The rural households living in the studied areas were critically food-insecure. All the measurements implied that the food insecurity situation in the study areas was unacceptably worrisome and life-threatening. This calls for an instant action to avert the occurrence of famine and starvation in the drought–prone rural areas of Tigray region. Thus, interventions should primarily target the vulnerable rural people and need to be planned based on attaining food availability first rather than concurrently addressing all components of food security. Further, due emphasis should be given to diversifying livelihood strategies of the vulnerable villagers.
Do you have AI dependency? The roles of academic self-efficacy, academic stress, and performance expectations on problematic AI usage behavior
Authors: Zhang Shunan , Zhao Xiangying , Zhou Tong , Kim Jang Hyun
Published: May 2024

Although previous studies have highlighted the problematic artificial intelligence (AI) usage behaviors in educational contexts, such as overreliance on AI, no study has explored the antecedents and potential consequences that contribute to this problem. Therefore, this study investigates the causes and consequences of AI dependency using ChatGPT as an example. Using the Interaction of the Person-Affect-Cognition-Execution (I-PACE) model, this study explores the internal associations between academic self-efficacy, academic stress, performance expectations, and AI dependency. It also identifies the negative consequences of AI dependency. Analysis of data from 300 university students revealed that the relationship between academic self-efficacy and AI dependency was mediated by academic stress and performance expectations. The top five negative effects of AI dependency include increased laziness, the spread of misinformation, a lower level of creativity, and reduced critical and independent thinking. The findings provide explanations and solutions to mitigate the negative effects of AI dependency.
Comparison of vascular risk profile and clinical outcomes among patients with central (branch) retinal artery occlusion versus amaurosis fugax
Authors: Diel Norma J. , Gerner Stefan T. , Doeppner Thorsten R. , Juenemann Martin , Maxhuni Toska , Frühwald Tobias , Worm Andre , Alhaj Omar Omar , Lytvynchuk Lyubomyr , Struffert Tobias , Bauer Pascal , Huttner Hagen B.
Published: May 2024

Background

Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF.

Methods

Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT.

Results

Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients.

Conclusion

The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes.
The Thai GoodWalk Index and the Thai Walkability Index: their application to urban regeneration exemplified by a historic riverside neighbourhood in Bangkok, Thailand
Authors: Serisakul Niramon , Guntamueanglee Adisak , Ovatvoravarunyou Thanaporn , Dechakaneewong Munchuchada , Navaraj Preechaya
Published: May 2024

The urban heritage regeneration strategy through walkability is widely accepted. However, in the context of a developing country, the tools to measure walkability, which are crucial for urban planning and development, still need to be improved. This article investigates ways to revitalise a run-down historic riverside area in Bangkok. It develops two indices, the Thai GoodWalk Index (TGWI) and the Thai Walkability Index (TWI). A hybrid of both indices is based on geospatial techniques and technology to optimise problem analysis processes, create problem-solving options, enhance spatial site selection decision capabilities, and assist urban planners in carrying out spatial scenario planning processes. It demonstrates how the GoodWalk Index has been employed to plan and prioritise urban development projects. This is exemplified by the Master Plan for the Regeneration of Kadeejeen-Klongsan, a historic riverside neighbourhood in Bangkok with limitations in density, functional mix of spaces, and access networks, especially in riverfront areas. The TGWI and TWI can be applied to the regeneration of other historic districts throughout Thailand.
Reimagining care: effectiveness of modifying an adolescent eating disorder intensive service
Authors: Hayes Ellen , Tweedy Nicola , Chapman Victoria
Published: May 2024

Aims and method

The COVID-19 pandemic prompted a surge in adolescent eating disorders and rapid changes in the delivery of intensive community treatments. This study investigates the modification from a group-based day programme to an intensive family treatment approach. A retrospective chart review was performed on data from 190 patients who accessed the intensive service for anorexia nervosa in the past 6 years. Outcomes from the traditional model were compared with the new intensive family model, namely length of admission, percentage median body mass index difference and transfers to in-patient services.

Results

There was a significant reduction in the length of intensive treatment (from 143.19 to 97.20 days). The number of transfers to specialist eating disorder in-patient services also significantly reduced, and is decreasing year on year.

Clinical implications

The findings hold particular relevance as intensive services for adolescent eating disorders continue to be established within health services, with no clear unified approach to treatment.
Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review
Authors: Bacorro Warren , Short Michala , Baldivia Kathleen , Mariano Jocelyn , Bautista Aida , Amparo Genalin , Tagayuna Irene , Jainar Carl Jay , Antonio Linda , Dancel Evelyn , Ortin Teresa Sy , Gonzalez Gil , Canlas Rodel
Published: May 2024

PURPOSE

Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology.

METHODS

We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines.

RESULTS

Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research.

CONCLUSION

Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.
Aerosol exposure analysis using mechanistically based modules
Authors: Μαμμή-Γαλάνη Ελένη
Published: May 2024

Ο στόχος της παρούσας διατριβής είναι η μελέτη της έκθεσης σε σωματίδια PM10 σε ατομική και πληθυσμιακή κλίμακα, μέσα από έναν συνδυασμό μετρήσεων, δοσιμετρικών μοντέλων και άλλων υπολογιστικών εργαλείων όπως τα Γεωγραφικά Συστήματα Πληροφοριών (GIS). Συγκεκριμένα, επιλέχθηκε η μέθοδος προσωπικής έκθεσης ώστε να υπολογιστεί η ημερήσια προσωπική δόση. Μετρήσεις PM10 πραγματοποιήθηκαν στην πόλη των Χανίων από κατοίκους και από μεταπτυχιακούς φοιτητές του Πολυτεχνείου Κρήτης, με τη χρήση ενός οργάνου μέτρησης προσωπικής έκθεσης κι ενός ημερολογίου καταγραφής δραστηριοτήτων. Ο σκοπός ήταν να διερευνηθεί η προσωπική έκθεση και η δόση των μελετούμενων υποκειμένων σε διαφορετικά μικροπεριβάλλοντα και να μελετηθεί η επίδραση των διαφορετικών δραστηριοτήτων και των εσωτερικών πηγών στην ανθρώπινη έκθεση. Επιπλέον, εφαρμόστηκε το μοντέλο έκθεσης και δόσης ExDoM2 και υπολογίστηκε η προσλαμβανόμενη δόση.Ακόμα, για τη διερεύνηση της έκθεσης σε εσωτερικές πηγές στο οικιακό περιβάλλον, επιλέχθηκε η δραστηριότητα της μαγειρικής, ως τη πιο σημαντική πηγή εσωτερικού χώρου και οι μετρήσεις πραγματοποιήθηκαν στο Πανεπιστήμιο του Μπέρμινγκχαμ (University of Birmingham). Τέσσερις διαφορετικοί τύποι μαγειρικής από διαφορετικές κουζίνες μελετήθηκαν (Κινέζικη, Αφρικανική, Ινδική και Δυτική) και αναλύθηκε η επίδρασής τους στην κατανομή μεγέθους των σωματιδίων. Επίσης, εκτιμήθηκε η ατομική δόση μετά από μία ώρα έκθεσης στους διαφορετικούς τύπους μαγειρικής καθώς και σε συγκεντρώσεις υποβάθρου. Στη συνέχεια, ερευνήθηκε η προσωπική έκθεση στο μετρό της Αθήνας, ένα μικροπεριβάλλον δημόσιου ενδιαφέροντος. Με στόχο τη μελέτη της έκθεσης τόσο των επιβατών όσο και των εργαζομένων στο μετρό, πραγματοποιήθηκαν δύο καμπάνιες μετρήσεων, εντός των τρένων και σε πολλές αποβάθρες. Το χρονικό βήμα που χρησιμοποιήθηκε στις μετρήσεις ήταν 1 δευτερόλεπτο και έτσι κατέστη εφικτή η μελέτη της επίδρασης του ανοίγματος των θυρών του τρένου στα επίπεδα συγκέντρωσης στο εσωτερικό τους. Ακόμη, έγινε εκτίμηση της εναποτιθέμενης δόσης σε δύο τύπους εργαζόμενων του μετρό καθώς και σε επιβάτες. Επιπροσθέτως, ερευνήθηκε η εναπόθεση βαρέων μετάλλων στο ανθρώπινο σώμα από την εισπνοή μετάλλων για τους κατοίκους πέντε Ευρωπαϊκών πόλεων. Το μοντέλο ExDoM σε συνδυασμό με ένα φαρμακοκινητικό μοντέλο PBPK χρησιμοποιήθηκαν για να προσδιοριστεί η δόση των μετάλλων σε σωματίδια στο ανθρώπινο σώμα. Το μοντέλο PBPK είναι ένας παράγοντας-κλειδί στην κατανόηση της εναπόθεσης μετάλλων στον ανθρώπινο σώμα, στην εκτίμηση της δόσης και των πιθανών επιπτώσεων στην υγεία. Τέλος, μελετήθηκε η έκθεση σε πληθυσμιακό επίπεδο με τη βοήθεια συνδυασμού διαθέσιμων μετρήσεων από σταθμούς μέτρησης σωματιδίων, δεδομένα απογραφής και τη μέθοδο παρεμβολής σε ένα Γεωγραφικό Σύστημα Πληροφοριών. Η αναλογία του πληθυσμού της Αθήνας που εκτίθεται σε διαφορετικές συγκεντρώσεις PM10 υπολογίστηκε για τέσσερα χρόνια, καθώς επίσης εξετάστηκε και η εποχική της διακύμανση.
Topical desiccating agent (DEBRICHEM): an accessible debridement option for removing biofilm in hard-to-heal wounds
Authors: Bhatt Priti , Sharpe Andrew , Staines Karen , Wallace Nicola , Withers Amy
Published: May 2024

It is now assumed that all hard-to-heal wounds contain biofilm. Debridement plays a key role in wound-bed preparation, as it can remove biofilm along with the devitalised tissue, potentially leaving a clean wound bed that is more likely to progress towards healing. The gold standard methods of debridement (surgical and sharp) are the least used, as they require specialist training and are often not readily available at the point of need. Most other methods can be used by generalists but are slower. They all need regular applications. The topical desiccating agent DEBRICHEM is an innovative alternative, as it is fast, effective and can be used in all clinical settings, as well as typically requiring only a single use. This article describes best practice for achieving optimal outcomes with its use.
Impact of Overjet Severity and Skeletal Divergence on the Perioral Soft Tissue Area
Authors:   Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Songkhla 90110, Thailand., Punyanirun Kulnipa , Charoemratrote Chairat ,   Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Songkhla 90110, Thailand.
Published: May 2024

Overjet (OJ) and skeletal divergence affect the perioral soft tissue. However, no previous study has investigated the combined effects on perioral soft tissue, which includes the upper lip (UL), lower lip (LL), and chin projection. We explored the impact of OJ severity and skeletal divergence on the perioral soft tissue. Lateral cephalograms of 133 untreated skeletal Class II adult patients were allocated into three categories according to the degree of skeletal divergence: hypodivergence (Hypo), normodivergence (Normo), and hyperdivergence (Hyper). Furthermore, OJ was classified as normal OJ (NOJ), moderately excessive OJ (MEOJ), and severely excessive OJ (SEOJ). A matrix of skeletal divergence and OJ variables produced the following groups: NOJ-Hypo, MEOJ-Hypo, SEOJ-Hypo, NOJ-Normo, MEOJ-Normo, SEOJ-Normo, NOJ-Hyper, MEOJ-Hyper, and SEOJ-Hyper. The skeletal, dental, and soft tissue parameters were measured. Statistical analyses showed that increased hyperdivergence and OJ severity corresponded with a more retruded mandibular perioral soft tissue (MPST), except for the Pog’ in the SEOJ-Hypo group, which was insignificantly more prominent than the MEOJ-Hypo group. Unlike the LL, the UL was similar among the groups. Multiple regression indicated that greater OJ and skeletal divergence significantly influenced MPST retrusion and increased vermilion lower lip thickness (VLLT) while independently affecting deeper mentolabial sulcus depth (MSD) and a more obtuse lip-chin-throat angle (P < 0.05). The effect of OJ was most significant at the LL and gradually decreased down to the chin; conversely, divergence increased downwards. The SEOJ-Hyper group displayed the greatest retruded MPST, thickest VLLT, and deepest MSD, which highlighted the combined effect of OJ and divergence.
OUTCOME AND COMPLICATIONS AFTER CHEILECTOMY FOR HALLUX RIGIDUS AT AN AVERAGE OF SIX YEARS
Authors: Sinan L. , Kokkinakis E. , Kumar C. Senthil
Published: May 2024

Introduction

Cheilectomy is a recommended procedure for the earlier stages of osteoarthritis of the 1st metatarsophalangeal joint. Although good improvement in symptoms have been reported in many studies, the long term performance of this procedure is not well understood. It is thought that a significant number of patients go onto have arthrodesis or joint replacement. We report on a large cohort of patients who received this procedure and report on the complications and mid-term outcome.

Methods

This is a retrospective study looking at all patients who underwent cheilectomy for hallux rigidus between November 2007 and August 2018. Departmental database was used to access patient details and outcome measures recorded include: postoperative wound infection, patient reported improvement in pain and the incidence of further surgical interventions like revision cheilectomy and conversion to arthrodesis and arthroplasty. X-rays were studied using PACS to stage the osteoarthritis (Hattrup and Johnson classification).

Results

A total of 240 feet in 220 patients (20 bilateral surgeries) were included in the study, there were 164 Females (75%) and 56 Males (25%), the median age was 55 years (range 22–90 years). Radiological assessment showed 89 Stage 1 arthritis(42%), 105 Stage 2 (50%), 17 Stage 3 (8%) and 9 patients were excluded due to unavailable X-rays. 5 patients (2%) had superficial wound infection. There were 16 further surgeries (7%) performed in this cohort, 12 arthrodesis (5%), 3 revision cheilectomy and 1conversion to arthroplasty. 157 patients were found to be pain-free at the latest post-operative visit (77%), 48 reported minimal pain (23%), 15 patients were excluded due to unavailable data.

Conclusion

Cheilectomy appears to produce good improvement in pain with a low complication rate. The rate of conversion to arthrodesis/arthroplasty is lower than in many reported studies.
CHARCOT NEUROARTHROPATHY: SURGICAL OUTCOMES FOLLOWING HIND- AND MIDFOOT RECONSTRUCTION. A MINIMUM 12-MONTH FOLLOW-UP FROM A TERTIARY HOSPITAL
Authors: Giddie J. , Phyo N. , Reichert I. , Ahluwalia R. , Kavarthapu V.
Published: May 2024

Background

Corrective fusion of a deformed / unstable Charcot neuroarthropathy (CN)of the midfoot and hindfoot is performed with the aim to prevent ulcers and maintain patient mobility.

Methods

Between October 2007 and July 2018, 103 CN mid and hind foot corrections in 95 patients were performed. There were 34 hind-foot, 38 mid-foot and 31 combined hind and mid-foot surgeries. 83 feet had single stage corrections, whereas 20 required a staged operation.

Results

Ninety-five patients were prospectively followed up. The mean patient age in our study was 57 years (21 – 85). Twenty-seven patients had type1 diabetes, 64 patients had type 2 and 4 patients had a neuropathy secondary to other conditions. Forty patients (42%) were offered a below knee amputation prior to attending our foot clinic. At a mean follow up of 56 months (12 – 140) we achieved 100% limb salvage with a 75% full bone fusion rate. There were 17 mortalities within our cohort at a mean period of 3 years. Ninety-seven percent (n=92) patients were mobilizing post-operatively in orthotic footwear. Fifty-two feet had pre-operative ulcers. Post-operatively 17 feet (16 patients) had persistent ulceration. Eight patients had ulcer resolution following further surgery and alteration of footwear, one patient has been listed for a below knee amputation for unstable non-union, whilst the remaining 7 patients have stable ulcers which are managed with dressings. Of the 26 feet (25 patients) with non-unions, 6 patients had revision fixation procedures whilst 8 patients required minor surgical procedures. The remaining 11 patients are stable non-unions who are asymptomatic and weight bearing. Other complications included a deep infection rate of 8% (n=7).

Conclusion

We demonstrated a 100% limb salvage rate and an 83% success rate in ulcer resolution. We recommend this be done with the support of the multi-disciplinary team.
EARLY OUTCOMES OF REVISION TOTAL ANKLE ARTHOPLASTY USING THE INBONE II AND INVISION SYSTEMS
Authors: Batten T. , Talbot N. , Sharpe I.
Published: May 2024

Revision options for a failed Total ankle arthroplasty (TAA) have historically been limited to complex hindfoot fusions, bespoke ankle arthroplasty revision or amputation. The patient outcomes of these procedures has been felt to be poor. The introduction of the INBONE-II and INVISION ankle arthroplasty revision systems has created a range of revision arthroplasty options, with the possibility of improved patient outcomes. We aim to report on the early results of 20 sequential revision TAA. All patients undergoing revision TAA with INBONE-II or INVISION had prospective collection of pre-operative and post-operative MOx-FQ and EQ-5D scores. Between September 2013 and June 2019 23 patients underwent revision TAA with mean time from implantation of 35 months (6 to 74). Those with greater than 1 year follow-up had scores included. Other outcomes included radiographic assessment for loosening and revision. 13 patients had INBONE-II and 10 INVISION. None required revision at the time of review. Pre-operative MOx-FQ averaged 40.6 (13.4 pain, 21 walking, 6.2 social). Post-operative MOx-FQ averaged 17.4 (6.2 pain, 8.1 walking, 3.1 social). Average EQ-5D improved from 8 to 6.6 and average EQ-VAS from 60 to 80. On radiograph review one patient had radiolucent lines around their INBONE-II stem evident at 1 year. This had not progressed by 4 years total follow-up. Another patient had uncoupling of part of the stem of her INBONE-II but had not required revision. This was attributed to surgeon error. Revision TAA using the INBONE-II and INVISION systems shows promising early results relating to loosening and revision and good maintained improvement in MOx-FQ and EQ-5D scores. This provides further evidence that patients with a failed TAA can safely have revision rather than having to commit to complex ankle/hindfoot fusion. This provides surgeons with flexibility particularly in those patients with other hindfoot arthritis or arthrodesis.