bluuebunny/crossref_metadata_2025 huggingface dataset:
41-Year-Old Male with Sub-Acute Encephalopathy, Seizures, and End Stage Renal Disease: A Unifying Diagnosis and Response to Therapy
Authors: Wais Tameena , Ibarra Karen P. , Sudarshana Dattanand M. , Eswarappa Meghana , Park Meyeon , Gallagher Renata C. , Tsui Brian , Teixeira Stephanie , Josephson S. Andrew , Richie Megan
Published: August 2023

We describe a case of a 41-year-old male with a history of end-stage renal disease, hypertension, epilepsy, ischemic stroke, and traumatic brain injury transferred to our tertiary care center for subacute, progressive cognitive impairment. He was found to have disproportionate brain atrophy, focal seizures, and refractory hypertension. Given suspicion for an underlying genetic etiology, a genetic panel for progressive renal disease was sent, revealing two known pathogenic variants in a gene for a cobalamin metabolism disorder, Cobalamin C deficiency. He was started on targeted metabolic supplementation with subsequent improvement in his cognition. Our case highlights the crucial need to expand diagnostic workup to include genetic and metabolic causes in patients with neurologic disease, atypical features, relevant family history and multi-organ dysfunction.
Optimizing the pre-analytical phase for accurate HPV detection in skin disorders: insights from a cutaneous warts case study
Authors: Redzic Nina , Pereira A. Rita , Vanden Broeck Davy , Bogers Johannes P.
Published: August 2023

Background:

In previous years, several cutaneous disorders have been associated with human papillomavirus (HPV); however, the exact role of HPV remains largely unknown. The lack of optimization and standardization of the pre-analytical phase forms a major obstacle. The aim of this study was to develop an accurate/patient-friendly sampling method for skin disorders, with cutaneous warts as a case study.

Methods:

Various sample processing techniques, pre-treatment protocols and DNA extraction methods were evaluated. Several sampling methods were examined, that is, skin scrapings, swabs and a tape-based method. Quantification of DNA yield was achieved by beta-globin real-time polymerase chain reaction (qPCR), and a wart-associated HPV genotyping qPCR was used to determine the HPV prevalence.

Results:

All samples tested positive for beta-globin. Skin scrapings had significantly higher yield than both swab and tape-based methods ( p < 0.01), the latter two did not significantly differ from each other ( p > 0.05). No significant difference in DNA yield was found between cotton and flocked swabs ( p > 0.05). All swabs were HPV positive, and although there were some discrepancies in HPV prevalence between both swabs, an overall good strength of agreement was found [κ = 0.77, 95% CI (0.71–0.83)].

Conclusion:

Although skin scrapings produced the highest DNA yield, patient discomfort was an important limitation of this method. Considering that in combination with our optimized DNA extraction procedure, all samples gave valid results with the less invasive swab methods preferred. Standardization of the pre-analytical phase is the first step in establishing a link between HPV and specific skin disorders and may have significant downstream diagnostic as well as therapeutic implications.
Efficacy of Interventions in Reducing the Risks of Work-Related Musculoskeletal Disorders Among Healthcare Workers: A Systematic Review and Meta-Analysis
Authors: Abdul Halim Nur Shuhaidatul Sarmiza , Mohd Ripin Zaidi , Ridzwan Mohamad Ikhwan Zaini
Published: August 2023

Background:

Work-related musculoskeletal disorders (WMSDs) are prevalent among healthcare professionals, including nurses, therapists, doctors, and paramedics, due to the potential injuries incurred during patient transfer and handling. This review aimed to assess the effectiveness of existing interventions in reducing the risks of WMSDs in this population.

Methods:

Four databases including PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect were searched to identify randomized and nonrandomized controlled trials, as well as studies with pre-post design. Two reviewers independently extracted data and assessed the quality of the included studies using the Effective Public Health Practice Project criteria. A meta-analysis was performed to obtain quantitative results.

Results:

A total of 40 studies were included in the review. Among the interventions, motorized assistive devices showed the most significant relative reduction in WMSD risks ( p < .0000; standardized mean difference [ SMD] = −3.32, 95% confidence interval [CI] = [−4.53, −2.12]), followed by combined interventions of cognitive and exercise ( p < .0001; SMD = −0.62, 95% CI = [−0.91, −0.33]), combined intervention of cognitive and assistive device intervention ( p = .02; SMD = −0.77, 95% CI = [−1.42, −0.12]), nonmotorized assistive device ( p = .02; SMD = −0.63, 95% CI = [−1.15, −0.12]), cognitive intervention ( p < .0001; SMD = −0.62, 95% CI = [−0.91, −0.33]), and physical exercise ( p = .06; SMD = −0.16, 95% CI = [−0.32, 0.00]) intervention.

Conclusion:

The overall evidence indicates that interventions have a significant effect in reducing the risk of WMSDs among healthcare workers, with motorized assistive devices showing the most promising results. The findings from this review can provide valuable guidance for hospital administrators, policymakers, and other experts in implementing effective strategies to prevent WMSDs among healthcare professionals.
Tracing the Evolution of Alternative Care for Children in India in the Last Decade and the Way Forward
Authors: Kaur Maninder , Mehta Nilima , Adhikary Subhadeep , Viswanath Anamika
Published: August 2023

Alternative Care is a form of care provided to children by caregivers other than their birth parents. In India, the existing alternative care mechanisms include institutional care, foster care and kinship care. As a continuum of support for care experienced youth, there is a provision of aftercare in the country. Child Protection System and Alternative Care in India have become more structured with relevant laws and policies in place, which guide the service delivery mechanisms to rehabilitate children in vulnerable circumstances, and those separated from their birth parents. In the recent past, India has witnessed pertinent changes in the child protection space, reflected at both policy and practice levels, with a visible move towards family-based alternative care and a focus to prevent unnecessary separation of children from their families.

This paper intends to capture the landscape of alternative care and its evolution in India, drawing from the review of the legal and policy framework, existing literature, and detailed discussions with Civil Society Organisations(CSOs) and State functionaries. It brings out the role of stakeholders, good practices and challenges in implementing alternative care over the last decade, and provides recommendations for achieving a safe and nurturing family environment for children in vulnerable situations.
Implementation and Evaluation of a Longitudinal Flipped-Classroom Point-of-Care Ultrasound Curriculum at an Internal Medicine Residency Program
Authors: Elliott Brian P , Berglund Andrew J , Markert Ronald J , Burtson Kathryn M
Published: August 2023

BACKGROUND

Point-of-care ultrasound (POCUS) has extensive clinical utility in internal medicine, but formal and uniform curricula in internal medicine are lacking.

OBJECTIVE

To determine the effectiveness of a longitudinal, flipped-classroom, academic half-day curriculum on internal medicine resident confidence, utilization, and changes in clinical management.

METHODS

We implemented an asynchronous, flipped-classroom, academic half-day curriculum from November 2020 to November 2021 and conducted an evaluation with a prospective, before-after cohort study. Curriculum included 4 rotating sessions comprised of 20 to 30 min of image interpretation followed by 1.5 to 2 h of image acquisition. Confidence was rated via Likert scale. Utilization was reported via indicating never, 1 to 2, 3 to 4, 5 to 6, or >6 times per month (recorded as 1-5, respectively). Image interpretation was assessed via a 6-question, multiple-choice video assessment.

RESULTS

Nineteen of 99 potential residents (19%) completed a pre- and post-curriculum evaluation. Residents attended a median of 4 sessions. Confidence improved from 2.47 to 3.53 ( P = .002). Utilization did not improve overall (2.11-2.42, P = .22), but utilization of left ventricular function assessment (1.53-2.00, P = .046) and pulmonary assessment (1.53-2.00, P = .039) increased. The percentage of residents that had ever changed their clinical management by POCUS increased from 47% to 84% after implementation of the curriculum. Cardiac, pulmonary/pleural, volume assessment, and abdominal free fluid exams were reported as the most clinically useful.

CONCLUSION

Implementation of a longitudinal, academic half-day curriculum for POCUS resulted in improved confidence, increased POCUS utilization for the cardiac and pulmonary examination, and changes in clinical management based on POCUS.
Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa
Authors: Sosanya Mercy E. , Beamon Isaiah , Muhammad Raza , Freeland-Graves Jeanne H.
Published: August 2023

Background

In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

Methods

A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach’s alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test–retest reliability was assessed via intraclass correlations.

Results

The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach’s alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability.

Conclusion

The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.
Adaptation and validation of the chronic illness-related shame scale among patients with knee osteoarthritis in Singapore
Authors: Yeo Jia Ying , Lim Chien Joo , Tan Bryan Yijia
Published: August 2023

Background

Osteoarthritis (OA) of the knee is one of the most common and disabling conditions worldwide. A neglected aspect of knee OA is its psychosocial impact, such as shame. However, assessment tools to measure shame among patients diagnosed with knee OA are lacking. In this study, the psychometric properties of the Chronic Illness-related Shame Scale (CISS) were evaluated among knee OA patients in Singapore.

Methods

Adaptations were made to CISS for use among the knee OA population. An exploratory factor analysis (EFA) was performed to analyze the factor structure. Cronbach’s Alpha and corrected item-total correlations were used to evaluate the internal consistency. Spearman correlation coefficient was used to test the correlation between CISS and Patient Health Questionnaire-4 (PHQ-4) to determine the validity of the instrument.

Results

The EFA yielded a one-factor structure, with an eigenvalue of 4.78 explaining 68.25% of variance. Cronbach Alpha was 0.92, which indicated good internal consistency. The Spearman correlation revealed a significant correlation between CISS and PHQ-4.

Conclusions

The adapted CISS is a valid and reliable instrument to measure shame for knee OA patients. Both research and clinical settings can benefit from the use of the adapted CISS for assessing shame among knee OA patients.
Genome-wide identification and analysis of a cotton secretome reveals its role in resistance against Verticillium dahliae
Authors: Li Ran , Ma Xi-Yue , Zhang Ye-Jing , Zhang Yong-Jun , Zhu He , Shao Sheng-Nan , Zhang Dan-Dan , Klosterman Steven J. , Dai Xiao-Feng , Subbarao Krishna V. , Chen Jie-Yin
Published: August 2023

Background

The extracellular space between the cell wall and plasma membrane is a battlefield in plant-pathogen interactions. Within this space, the pathogen employs its secretome to attack the host in a variety of ways, including immunity manipulation. However, the role of the plant secretome is rarely studied for its role in disease resistance.

Results

Here, we examined the secretome of Verticillium wilt-resistant Gossypium hirsutum cultivar Zhongzhimian No.2 (ZZM2, encoding 95,327 predicted coding sequences) to determine its role in disease resistance against the wilt causal agent, Verticillium dahliae. Bioinformatics-driven analyses showed that the ZZM2 genome encodes 2085 secreted proteins and that these display disequilibrium in their distribution among the chromosomes. The cotton secretome displayed differences in the abundance of certain amino acid residues as compared to the remaining encoded proteins due to the localization of these putative proteins in the extracellular space. The secretome analysis revealed conservation for an allotetraploid genome, which nevertheless exhibited variation among orthologs and comparable unique genes between the two sub-genomes. Secretome annotation strongly suggested its involvement in extracellular stress responses (hydrolase activity, oxidoreductase activity, and extracellular region, etc.), thus contributing to resistance against the V. dahliae infection. Furthermore, the defense response genes (immunity marker NbHIN1, salicylic acid marker NbPR1, and jasmonic acid marker NbLOX4) were activated to varying degrees when Nicotina benthamiana leaves were agro-infiltrated with 28 randomly selected members, suggesting that the secretome plays an important role in the immunity response. Finally, gene silencing assays of 11 members from 13 selected candidates in ZZM2 displayed higher susceptibility to V. dahliae, suggesting that the secretome members confer the Verticillium wilt resistance in cotton.

Conclusions

Our data demonstrate that the cotton secretome plays an important role in Verticillium wilt resistance, facilitating the development of the resistance gene markers and increasing the understanding of the mechanisms regulating disease resistance.
Decreased TMIGD1 aggravates colitis and intestinal barrier dysfunction via the BANF1-NF-κB pathway in Crohn’s disease
Authors: Zhou Longyuan , Zhu Liguo , Wu Xiaomin , Hu Shixian , Zhang Shenghong , Ning Min , Yu Jun , Chen Minhu
Published: August 2023

Background

Disrupted intestinal epithelial barrier is one of the major causes of Crohn’s disease (CD). Novel molecular targets for intestinal epithelial barrier are essential to treatment of CD. Transmembrane and immunoglobulin domain-containing protein 1 (TMIGD1) is an adhesion molecule that regulates cell adhesion, migration, and enterocyte differentiation. However, the function and mechanism of TMIGD1 in CD and intestinal epithelial barrier has rarely been studied. Furthermore, the association between TMIGD1 and the clinical features of CD remains unclear.

Methods

Transcriptome analysis on colonic mucosa from CD patients and healthy individuals were performed to identify dysregulated genes. Multi-omics integration of the 1000IBD cohort including genomics, transcriptomics of intestinal biopsies, and serum proteomics identified the association between genes and characteristics of CD. Inflammation was assessed by cytokine production in cell lines, organoids and intestinal-specific Tmigd1 knockout (Tmigd1INT-KO) mice. Epithelial barrier integrity was evaluated by trans-epithelium electrical resistance (TEER), paracellular permeability, and apical junction complex (AJC) expression. Co-immunoprecipitation, GST pull-down assays, mass spectrometry, proteomics, and transcriptome analysis were used to explore downstream mechanisms.

Results

Multi-omics integration suggested that TMIGD1 was negatively associated with inflammatory characteristics of CD. TMIGD1 was downregulated in inflamed intestinal mucosa of patients with CD and mice colitis models. Tmigd1INT-KO mice were more susceptible to chemically induced colitis. In epithelial cell lines and colonic organoids, TMIGD1 knockdown caused impaired intestinal barrier integrity evidenced by increased paracellular permeability and reduced TEER and AJC expression. TMIGD1 knockdown in intestinal epithelial cells also induced pro-inflammatory cytokine production. Mechanistically, TMIGD1 directly interacted with cytoplasmic BAF nuclear assembly factor 1 (BANF1) to inhibit NF-κB activation. Exogenous expression of TMIGD1 and BANF1 restored intestinal barrier function and inhibited inflammation in vitro and in vivo. TMIGD1 expression predicted response to anti-TNF treatment in patients with CD.

Conclusions

Our study demonstrated that TMIGD1 maintained intestinal barrier integrity and inactivated inflammation, and was therefore a potential therapeutic target for CD.
Early neuro-rehabilitation in traumatic brain injury: the need for an African perspective
Authors: Buh Franklin Chu , Hutchinson Peter J. A. , Anwar Fahim
Published: August 2023

Background

Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 million individuals annually and being one of the leading causes of mortality. It has adverse consequences in terms of cognitive and physical functioning, which makes rehabilitation interventions an integral part of its management. Early neuro-rehabilitation guidelines for traumatic brain injury have not yet been developed and implemented in most of Africa especially Sub-Saharan Africa.

Body

We aimed with this Opinion to propose a collective reflection on the development and implementation of early neuro-rehabilitation guidelines as an integral part of the care in traumatic brain injury. The different aspects to be considered for reflection have been highlighted: Traumatic brain injury severity to be considered in early neuro-rehabilitation; who should be assessed and receive early neurorehabilitation, barriers to be considered for early neurorehabilitation; what early neurorehabilitation to be considered; the different phases involved in rehabilitation after mild, moderate, and severe TBI; and lastly, what perspective for the creation of neurorehabilitation teams. In conclusion, neuro-rehabilitation should start at the time of admission and should continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. However, mild TBI should also be considered for long-term follow-up in the community due to the fact that some mild traumatic brain injury patients might develop chronic cognitive problems or fatigue with time.

Conclusion

Neurorehabilitation should start at the time of admission and continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. There is a need to develop, agree on, and implement guidelines on early neuro-rehabilitation interventions for patients with moderate to severe traumatic brain injury in the African region, where disparities in care are common reality.
Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned
Authors: Bachfischer Andreas , Barbosa Martha Cecilia , Rojas Angel Alberto Riveras , Bechler Reinaldo , Schwienhorst-Stich Eva-Maria , Kasang Christa , Simmenroth Anne , Parisi Sandra
Published: August 2023

Background

Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities.

Methods

This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols.

Results

A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains.

Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5).

Conclusion

People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.
Managing household income and antiretroviral therapy adherence among people living with HIV in a low-income setting: a qualitative data from the HPTN 071 (PopART) trial in South Africa
Authors: Mcinziba Abenathi , Bock Peter , Hoddinott Graeme , Seeley Janet , Bond Virginia , Fidler Sarah , Viljoen Lario
Published: August 2023

Background

South Africa is reported to have the highest burden of HIV with an estimated 8.2 million people living with HIV (PLHIV) in 2021- despite adopting the World Health Organisation (WHO) universal HIV test and treat (UTT) recommendations in 2016. As of 2021, only an estimated 67% (5.5 million) of all PLHIV were accessing antiretroviral therapy (ART), as per recorded clinic appointments attendance. Studies in sub-Saharan Africa show that people living in low-income households experience multiple livelihood-related barriers to either accessing or adhering to HIV treatment including lack of resources to attend to facilities and food insecurity. We describe the interactions between managing household income and ART adherence for PLHIV in low-income urban and semi-urban settings in the Western Cape, South Africa.

Methods

We draw on qualitative data collected as part of the HPTN 071 (PopART) HIV prevention trial (2016 – 2018) to provide a detailed description of the interactions between household income and self-reported ART adherence (including accessing ART and the ability to consistently take ART as prescribed) for PLHIV in the Western Cape, South Africa. We included data from 21 PLHIV (10 men and 11 women aged between 18 and 70 years old) from 13 households. As part of the qualitative component, we submitted an amendment to the ethics to recruit and interview community members across age ranges. We purposefully sampled for diversity in terms of age, gender, and household composition.

Results

We found that the management of household income interacted with people’s experiences of accessing and adhering to ART in diverse ways. Participants reported that ART adherence was not a linear process as it was influenced by income stability, changing household composition, and other financial considerations. Participants reported that they did not have a fixed way of managing income and that subsequently caused inconsistency in their ART adherence. Participants reported that they experienced disruptions in ART access and adherence due to competing household priorities. These included difficulties balancing between accessing care and/or going to work, as well as struggling to cover HIV care-related costs above other basic needs.

Conclusion

Our analysis explored links between managing household income and ART adherence practices. We showed that these are complex and change over the course of treatment duration. We argued that mitigating negative impacts of income fluctuation and managing complex trade-offs in households be included in ART adherence support programmes.
Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma
Authors: Zhang Rui-Jun , Zhou Hong-Mei , Lu Hai-Yan , Yu Hong-Ping , Tang Wei-Zhong , Qiu Mo-Qin , Yan Liu-Ying , Long Mei-Ying , Su Ting-Shi , Xiang Bang-De , He Mei-Ling , Wang Xiao-Ting , Liang Shi-Xiong , Li Jian-Xu
Published: August 2023

Purpose

In this study, we aimed to compare the radiation-induced hepatic toxicity (RIHT) outcomes of radiotherapy (RT) plus antibodies against programmed cell death protein 1 (anti-PD1) versus RT alone in patients with hepatocellular carcinoma (HCC), evaluate prognostic factors of non-classic radiation-induced liver disease (ncRILD), and establish a nomogram for predicting the probability of ncRILD.

Patients and methods

Patients with unresectable HCC treated with RT and anti-PD1 (RT + PD1, n = 30) or RT alone (n = 66) were enrolled retrospectively. Patients (n = 30) in each group were placed in a matched cohort using propensity score matching (PSM). Treatment-related hepatotoxicity was evaluated and analyzed before and after PSM. The prognostic factors affecting ncRILD were identified by univariable logistic analysis and Spearman’s rank test in the matched cohort to generate a nomogram.

Results

There were no differences in RIHT except for increased aspartate aminotransferase (AST) ≥ grade 1 and increased total bilirubin ≥ grade 1 between the two groups before PSM. After PSM, AST ≥ grade 1 occurred more frequently in the RT + PD1 group (p = 0.020), and there were no significant differences in other hepatotoxicity metrics between the two groups. In the matched cohort, V25, tumor number, age, and prothrombin time (PT) were the optimal prognostic factors for ncRILD modeling. A nomogram revealed a good predictive performance (area under the curve = 0.82).

Conclusions

The incidence of RIHT in patients with HCC treated with RT + PD1 was acceptable and similar to that of RT treatment. The nomogram based on V25, tumor number, age, and PT robustly predicted the probability of ncRILD.
Patients’ and informal caregivers’ perspectives on self-management interventions for type 2 diabetes mellitus outcomes: a mixed-methods overview of 14 years of reviews
Authors: Niño-de-Guzman Quispe Ena , Bracchiglione Javier , Ballester Marta , Groene Oliver , Heijmans Monique , Martínez García Laura , Noordman Janneke , Orrego Carola , Rocha Claudio , Suñol Rosa , Alonso-Coello Pablo
Published: August 2023

Background

Self-management interventions (SMIs) are core components of high-quality care in type 2 diabetes mellitus (T2DM). We aimed to identify and summarise the scientific evidence exploring the perspectives of patients with T2DM and their informal caregivers on outcomes of SMIs, and the key themes to enhance T2DM patient-centred care.

Methods

We conducted a mixed-methods overview of reviews. We searched MEDLINE, CINAHL and PsycINFO, up to June 2021 for systematic reviews (SRs) exploring the perspectives of adults with T2DM and their informal caregivers, regarding self-management. Two reviewers conducted independently study selection, data extraction and quality assessment. We estimated the degree of overlap across SRs. We performed a qualitative analysis using a thematic synthesis approach.

Results

We identified 54 SRs, corresponding to 939 studies, with a slight overlap. Most SRs (47/54, 87%) were considered high quality. We developed summaries for 22 outcomes and identified six overarching themes: (1) diabetic identity; (2) accessing healthcare; (3) experience of care; (4) engagement with self-management; (5) outcomes awareness; and (6) challenges adhering to self-management. We found important variability in how patients with T2DM and their informal caregivers value critical outcomes influenced by the disease progression and several contextual factors.

Conclusions

Our findings represent what matters most to patients with T2DM and their informal caregivers regarding outcomes of SMIs. Our results can facilitate the development and evaluation of SMIs, and guide decision-making in diabetes care, including the formulation of decisions and recommendations.
Effects of nitrogen addition and drought on the relationship between nitrogen- and water-use efficiency in a temperate grassland
Authors: Hu Jiaxin , Ma Wang , Wang Zhengwen
Published: August 2023

Background

Nitrogen- and water-use efficiency (NUE and WUE) reflect the capacity of plants to take up and utilize resources in the environments. Although N deposition and drought are known to affect plant growth and persistence, it remains elusive how plants adjust NUE, WUE and their relationship to adapt to the concurrent N deposition and drought under the context of global change. We conducted a field experiment in a temperate grassland in Inner Mongolia, in which N addition (10 g m–2 yr−1), drought (reduced 66% precipitation during growing season) and their combination were manipulated, and we explored the responses of both instantaneous (NUEINST and WUEINST) and long-term (NUELT and WUELT) WUE and NUE for six common plant species (Leymus chinensis, Stipa baicalensis, Thermopsis lanceolata, Potentilla bifurca, Thalictrum squarrosum, Klasea centauroide).

Results

Across all the six species, NUEINST decreased and WUEINST increased with both N addition and drought; NUELT decreased with both N addition and drought, while WUELT decreased with N addition and increased with drought. A significant interactive effect between N addition and drought was detected, in that, drought weakened the negative effect of N addition on WUELT and NUELT, and N addition weakened the negative effect of drought on NUELT, but enhanced the positive effect of drought on WUELT. As a consequence, drought caused a trade-off between NUE and WUE, and N addition brought forth positive correlation between NUE and WUE. Meanwhile, the relationship between NUE and WUE varied among the species of different functional groups.

Conclusions

Our study demonstrated that NUE, WUE and their relationship play an important role in determining their responses and adaptability to changes in soil nitrogen and water availability induced by N deposition and drought. Our results shed light on the antagonistic, synergetic and neutral effects between nitrogen deposition and drought on resource use efficiency, and further clarified the different adaptability among species of different functional groups, which will conduce to a comprehensive understanding on the role of NUE and WUE in plant persistence and coexistence in grassland ecosystems.
Efficacy and safety of osimertinib for leptomeningeal metastases from EGFR-mutant non-small cell lung cancer: a pooled analysis
Authors: Wen Lei , Zhen Junjie , Shan Changguo , Lai Mingyao , Hong Weiping , Wang Hui , Ye Mingting , Yang Yanying , Li Shaoqun , Zhou Zhaoming , Zhou Jiangfen , Hu Qingjun , Li Juan , Tian Xuwei , Chen Longhua , Cai Linbo , Xie Zhanhong , Zhou Cheng
Published: August 2023

Background

The aim of this study was to evaluate the efficacy and safety of osimertinib for the treatment of leptomeningeal metastases (LM) from epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC).

Methods

We conducted a systematic review and meta-analysis to aggregate the clinical outcomes of patients with LM from EGFR-mutant NSCLC treated with osimertinib. A comprehensive literature search for published and unpublished studies was implemented in April 2021 of PubMed, EMBASE, the Cochrane Library, and several international conference databases, in accordance with the PRISMA guidelines. Meta-analysis of proportions was conducted to calculate the pooled rate of overall response rate (ORR), disease control rate (DCR), one-year overall survival (OS), and adverse events (AEs).

Results

A total of eleven studies (five prospective and six retrospective) including 353 patients were included. The majority of patients (346/353, 98.0%) received osimertinib as ≥ 2nd-line treatment for LM, either at a dosage of 80 mg (161/353, 45.6%) or 160 mg (191/353, 54.1%). The pooled rates of ORR and DCR were 42% (95% CI 24% to 59%) and 93% (95% CI 88% to 97%), respectively. The pooled one-year OS rate was 59% (95% CI 53% to 65%) in 233 patients from five studies. The highest incidence of AEs of all grades was rash (53%), followed by diarrhea (45%), paronychia (35%), decreased appetite (35%), and dry skin (27%), based on data from four studies.

Conclusions

Our study highlighted and confirmed the meaningful efficacy and a manageable safety profile of osimertinib for the treatment of LM from EGFR-mutant advanced NSCLC.
Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper
Authors: Brinkhof Lotte P. , Ridderinkhof K. Richard , Murre Jaap M. J. , Krugers Harm J. , de Wit Sanne
Published: August 2023

Background

Successful aging is often linked to individual’s ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems.

Methods

This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals.

Discussion

Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life.

Trial registration

Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz
An analysis of the prevalence and impact of obsessive-compulsive personality disorder on the course of obsessive-compulsive disorder
Authors: Żerdziński M. , Burdzik M. , Dębski P.
Published: August 2023

Introduction

Obsessive-compulsive disorder (OCD) is a disorder diagnosed on the basis of the presence of obsessions (persistently recurring, intrusive thoughts, images, impulses) and compulsions (compulsive and transiently satisfying actions performed in response to obsessions). A separate clinical phenomenon in the broadly understood anankastic spectrum is obsessive-compulsive disorder (OCPD). OCPD is characterized by scrupulousness, over-normative morality, perfectionism and an inability to make concessions in terms of cooperation. It is assumed that the incidence of OCPD in the course of OCD is 25-32% and it is a report with an unfavorable course and a more difficult therapeutic prognosis. It also means an early onset of OCD with a greater intensity of compulsions and a predominance of symptoms related to the sphere of purity, symmetry and gathering.

Objectives

The main aims of the study were as follows:

1. To assess the prevalence of OCPD in OCD patients.

2. To compare both groups of patients for the severity, level of insight, aggression, impulsiveness and affective symptoms.

3. To verify whether the presence of OCPD depend on factors such as age, gender, treatment duration and delay in starting treatment.

Methods

The study was conducted in a group of 78 patients diagnosed with and treated for OCD. The patients were divided into two groups: patients with OCD and OCPD (group 1, n=43) and patients with OCD without OCPD (group 2, n=35). The groups were subsequently compared for the severity of anankastic symptoms, the level of insight, aggression, impulsiveness and its components and affective symptoms (depression, mania). The following tools were used for the diagnosis: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression-Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Buss-Perry Aggression Questionnaire (BPAQ), Barratt Impulsiveness Scale (BIS-11), Brown Assessment of Beliefs Scale (BABS) and DSM 5 criteria for OCPD.

Results

Our results confirmed that OCPD is common in OCD and occurred in 55,12% of patients with OCD (n=43; m=21; f=22). The study shows that the presence of OCPD in the course of OCD negatively affects the severity of obsessive-compulsive symptoms, the level of insight, the level of aggression and impulsiveness, and affective disorders. Patients with OCPD obtained higher scores on the YBOCS, BABS, HDRS, and YMRS scales compared to patients with OCD without OCPD. The occurrence of OCPD in the study group did not depend on gender, duration of OCD treatment, or delay in starting it.

Conclusions

The occurrence of OCPD is common in OCD and can cause delay of treatment, worse course, greater intensity of egosyntonic symptoms, and thus worse insight. The presence of OCPD can lead to more hostility and more affective disorders. Screening for OCPD in patients with OCD should be an integral part of an OCD diagnostic process.

Disclosure of Interest

None Declared
Social stigma of people with mental disorders and attitude to psychiatric treatment in Polish society
Authors: Burdzik M.
Published: August 2023

Introduction

People with mental disorders (MD) may experience social stigma in various spheres of their lives. This phenomenon is based on negative social beliefs and hostile perceptions about mental disorders. Stigma may lead to social exclusion and discrimination (unjust treatment compared to people without MD). It may also result in resistance to using professional medical help (psychiatrist, psychotherapist) by people who experience symptoms of MD.

Objectives

The study aims to analyze the attitude of Polish society toward people with mental disorders and the attitude toward psychiatric treatment. The study investigates the correlation between the abovementioned attitudes and socioeconomic parameters of the respondents.

Methods

The study was conducted on a group of 1,230 respondents with the anonymous, authorial questionnaire disseminated by the CAWI technique. The questionnaire consisted of 10 single-choice questions concerned with the socioeconomic parameters of the respondents (age, place of residence, education, gender) and their attitudes toward mental health problems. The chi-square test and Kendall’s tau-b correlation coefficient (τb) were used to analyze the correlations between the above parameters (with p<0,05).

Results

Over 33% of respondents believes that people with MD are more aggressive than people who do not present this type of disorder. In turn, 16.4% of respondents admitted that they would feel uncomfortable in the presence of a person with mental disorders. There was no statistically significant correlation between the above beliefs and any socioeconomic parameter. Every tenth respondent would not hire a person with MD. Resistance to employment increased with the respondents’ age and level of education, whereas it decreased with the population of respondents’ domiciles. More than 17% of respondents would feel resistance to contacting with psychiatrist, and 4.1% of them already hide the fact of treatment from their family. The resistance to using psychiatric help was higher in villages and smaller towns than in bigger centers.

Conclusions

The study shows negative attitudes towards people with MD are still relatively frequent in Polish society. The stereotypical perception of this group of entities is generally not dependent on any analyzed socioeconomic parameter. Such correlations exist only in some areas (employment). Because of the negative perception of MD, some people who struggle with these problems do not use a psychiatrist’s professional help. In effect, these entities remain undiagnosed and untreated. Treatment delay may lead to exacerbating symptoms, prolong treatment time (including the necessity of hospitalization), and increase its cost. Reducing the stigma is necessary for counteracting discrimination against people with mental disorders and improving the mental health condition of Polish society. It requires educational activities and appropriate legal regulations.

Disclosure of Interest

None Declared
Localized magnetic states in a tilted Dirac cone system
Authors: Liu Fei-Yan , Zhang Shi-Jie , Zhang Yun , Ding Kai-He
Published: August 2023

We investigate the localized magnetic state in the tilted Dirac cone system, wherein a lattice staggered potential (LSP) is introduced to create a gap between the conduction and valence bands. Our findings reveal that the breaking of symmetry between the sublattices results in depletion of the magnetic region of the impurity for positive LSP values, while a sharp strip is formed for negative LSP values with an increase in the tilt of the Dirac cone. Interestingly, within the magnetic region, the magnetic moment of the impurity remains constant at 0.8 Bohr magneton irrespective of the sign of LSP. However, the magnetic susceptibility at the edge of the magnetic region displays inconsistent behavior for positive and negative LSP values. We also analyze in detail the variations in the magnetic region, magnetic moment, and magnetic susceptibility with LSP strength at a fixed tilt.
Intertextualité et histoire de la littérature
Authors: Siaflékis Ζ.Ι.
Published: August 2023

L’objet de cette étude est d’examiner dans quelles conditions l’intertextualité, sous ses multiples aspects, intra-textuels et extratextuels, pourrait devenir le support, en même temps qu’un lieu d’interrogation, de la formation et du cours de l’histoire de la littérature, dans la mesure où celle-ci se présente comme le phénomène qui englobe l’existence, la fonction, le sens et la durée de l’œuvre littéraire.L’étude est divisée en trois parties, dont chacune appréhende les problèmes po­sés par de différents points de vue. Ainsi dans la première, Reconnaissance et mé­moire l’accent est mis sur la fonction de ces deux situations; qui sont préalables a l’étude du phénomène intertextuel. La mémoire de la littérature aide le lecteur à reconnaître l’intertexte et à suivre le fil des significations. Dans la deuxième, Lec­ture et histoire de la littérature, l’analyse concerne le rôle de la lecture dans la for­mation du vaste ensemble que constitue l’histoire de la littérature. Dans le concept de lecture la fonction d’intertextualité est sous-entendue. Dans la troisième, L’in­ter­tex­tua­lité noyau de l’histoire de la littérature, l’on procède à une comparaison de la fonction de l’intertextualité, comme noyau de la structure du texte littéraire, et de la formation de l’histoire de la littérature, basée sur cette fonction- là du texte.Il apparaît que l’intertextualité, de par sa nature, se présente comme un instru­ment herméneutique, tout comme l’histoire de la littérature se veut un plan de connaissance et d’explication de la littérature elle-même. L’alternance de ces deux fonctions dans l’étude du texte littéraire et de son environnement nous offre un cadre d’appréhension et de compréhension du caractère complexe de la création littéraire.
Λογοτεχνικός και κινηματογραφικός αφηγητής: Προς τη σύγκλιση λόγου και εικόνας στην Κάθοδο των Εννιά
Authors: Μίγγα Νίκη
Published: August 2023

Narrateur littéraire et cinématographique:Vers la convergence de la parole et de l'image dans La Descente des NeufLa Guerre Civile Grecque a offert au récit historique une particulièrement dure version du drame humain, qui a été transporté dans un text emblématique et son adaptation au cinema. La Descente des Neuf de Thanassis Valtinos et le film de Christos Siopahas sont des exemples typiques de la rencontre des discours histo-riques, littéraires et cinématographiques. L'exploration de la convergence de la littérature et du cinéma acquiert un intérêt particulier lorsque le sujet touche à l'expérience traumatisante de la guerre, mettant en avant l'histoire comme l'inter-texte du récit littéraire et cinématographique.Le récit dans La descente des Neuf, reconstituant des traits du langage oral comme le dynamisme et la mobilité mais aussi sa dimension expérientielle, montre une forte affinité avec les récits autobiographiques populaires. La particu-larité du récit réside dans l'utilisation prudente de la focalisation comme facteur de production de sens. La narration de Valtinos était évidemment un grand défi pour Siopahas, qui a dû trouver des moyens de visualiser un discours qui bouge au bord de l'oralité. Les difficultés du projet se situent sur deux niveaux. L'une est liée à l'incapacité inhérente du cinéma à aborder la narration à la première per-sonne. Le second découle de la grande difficulté à intégrer l'image avec des traits purement linguistiques, afin de donner au récit un sens d'oralité.