bluuebunny/crossref_metadata_2025 huggingface dataset:
Within-person fluctuations over three years in depression, anxiety, fatigue, and health-related quality of life in multiple sclerosis
Authors: Marrie Ruth Ann , Bernstein Charles N , Dolovich Casandra , Bolton James M , Graff Lesley A , Hitchon Carol A , Lix Lisa M , Marriott James J , Fisk John D
Published: August 2023

Background:

Longitudinal studies of health-related quality of life (HRQoL) in multiple sclerosis (MS) are limited. Most have examined average changes within the population, rather than dynamic changes within individuals.

Objective:

To assess the between- and within-individual association between depression, anxiety, fatigue, cognition, physical functioning, and physical comorbidities and HRQoL.

Methods:

Adults with MS underwent physical and cognitive assessments and reported symptoms of fatigue (Daily Fatigue Impact Scale), depression and anxiety (Hospital Anxiety and Depression Scale (HADS)), and HRQoL (RAND-36) annually ( n = 4 visits). We evaluated associations of elevated symptoms of anxiety (HADS-A) and depression (HADS-D), fatigue, physical function (timed-walk and nine-hole peg test), cognitive function and comorbidity count with physical (PCS-36) and mental (MCS-36) HRQoL using multivariable linear models—estimating between-person and within-person effects.

Results:

Of 255 participants with MS enrolled, 81.6% were women. After adjustment, within-person increases in depression and fatigue were associated with decreases in physical HRQoL. Increases in depression, anxiety, and comorbidity count were associated with decreases in mental HRQoL.

Conclusions:

Within-person increases in symptoms of depression, anxiety and fatigue, and comorbidity count are associated with HRQoL decreases among adults with MS, highlighting the potential magnitude of individual benefit of intervention for these symptoms.
Mapuche entrepreneur women profiles and their trajectories in poverty alleviation programs
Authors: Daher Marianne , Campero María José , Rosati Antonia , Jaramillo Andrea
Published: August 2023

Entrepreneurship has become a prominent strategy for overcoming poverty, but few studies have identified the specificities of different entrepreneurial configurations in indigenous contexts. Thus, the aim of this study was to analyze positive effects and their relationship with participants’ profiles of entrepreneurial programs, from the experiences and meanings of Mapuche people (mostly women) in poverty and social vulnerability situation in rural and urban contexts. A qualitative study was conducted in rural and urban areas considering a total of 19 respondents. Results focus on woman experiences showing three types of Mapuche entrepreneur women profiles (fighter, submissive and reluctant) and their trajectories in entrepreneurship programs, considering their responses to their background, their relationship with the program and profile-specific positive effects.
Influence of the fruit waste fillers on the thermal, mechanical, and morphological properties of flax/epoxy composites
Authors: Chaudhary Sudhir , Gairola Sandeep , Sharma Hitesh
Published: August 2023

In the present research endeavor, the waste shells of pistachio and walnut have been used in the form of fillers to develop hybrid flax epoxy composites. The effect of hybridization on the developed composites was studied in terms of thermal, mechanical, and morphological properties. The properties like tensile strength, tensile modulus, flexural strength, flexural modulus, impact strength, and shore hardness were evaluated to ascertain the mechanical behavior. The thermogravimetric analysis of the composites was also performed in order to determine the thermal stability of the developed composites. The results revealed that pistachio shell filler-based flax/epoxy composites showed improved tensile strength and tensile modulus by over 73.26% and 42.53% in comparison to the control specimen. The walnut shell filler-based flax/epoxy composites also exhibited improved tensile strength and tensile modulus by 66.41% and 17.1% compared to the control specimen. Whereas, the hybrid filler-based flax/epoxy composites were found to be thermally more stable. The fractography of the developed composites was also studied using scanning electron microscope which revealed good filler distribution in the epoxy matrix.
Between redemption and affirmation: German identity in affective narratives of the ‘refugee crisis’
Authors: Armbruster Heidi
Published: August 2023

The German ‘refugee crisis’ produced formidable levels of civil society assistance, involving citizens and locations with no previous experience in refugee support. Grounded in research with citizen volunteers in a rural region in southern Germany conducted at a time when rightwing populism gained strength, this article explores how volunteers reflect on their relations with refugees while negotiating distinctly German identities. Scholarship on volunteering in refugee settings has looked at the emotional aspect of this work largely for its political import. This article expands attention to emotions in volunteering from a form of political practice on the ground to a practice of narrative reasoning. In a close reading of interview-derived narratives as affective practices the relevance of locality, identity and history for refugee reception comes to the fore. Deploying the notions of ‘redemptive’ and ‘affirmative’ Germanness the article shows how volunteers draw on specific historical trajectories to produce moral arguments about the support and incorporation of strangers. This article argues that volunteers’ affective involvement with history and locality needs unpacking if their relations of solidarity are to be understood.
Restoring Well-Being for Physicians Through Lifestyle Medicine
Authors: Lee Hannah , Going Michelle , Tivnan Valeria , Tollefson Michelle , Comander Amy , Frates Elizabeth
Published: August 2023

In the wake of the COVID-19 pandemic, physician burnout is a more relevant concern than ever. Pre-existing stressors in health care, such as poor work-life balance, perfectionism, and inadequate social support, have been exacerbated by uncertainty, increased risk exposure, and general anxiety. Burnout places not only physicians, but also patients, systems, and communities at risk. The promotion of physician well-being is critical to sustaining the health care system. Actions to reduce burnout and increase well-being can and should occur on multiple levels. Organizations and leaders must take steps to create a culture of support and respect for health care providers. Such steps may include improved time-off policies, destigmatizing the use of mental health services, and reducing administrative burden. Physician well-being may benefit from action on an individual level as well. The pillars of Lifestyle Medicine provide a framework for engaging in behaviors compatible with overall well-being, such as physical activity, social connection, and sleep. Lifestyle Medicine plays a key role in mitigating the impact of physician burnout, and will be essential to the success of the health care system moving forward.
Anesthetic management for lower extremity vascular bypass procedures: The impact of general or regional anesthesia on clinical outcomes
Authors: Schmidt André P. , Del Maschi Marine M. , Andrade Cristiano F.
Published: August 2023

Purpose

Postoperative complications after major surgery, especially vascular procedures, are associated with a significant increase in costs and mortality. Previous studies evaluating general anesthesia versus regional or neuraxial anesthesia for infrainguinal bypass have produced conflicting results. The main aim of the present study is to review current evidence on the application of regional or general anesthesia in patients undergoing infrainguinal bypass surgery and its potential favorable effects on postoperative outcomes.

Contents

Patients undergoing vascular surgery often have multiple comorbidities, and it is important to outline both benefits and risks of regional anesthesia techniques. Neuraxial anesthesia in vascular surgery allows overall avoidance of general anesthesia and does provide short-term benefits beyond analgesia. Previous observational studies suggest that neuraxial anesthesia for lower limb revascularization may reduce morbidity and length of stay. However, evidence of long-term benefits is lacking in most procedures and further work is still warranted.

Conclusions

Neuraxial anesthesia is usually an effective anesthesia technique for infrainguinal bypass surgery. Elderly patients and those with underlying respiratory problems may display some benefit from neuraxial anesthesia. Further evaluation within institutions should be performed to identify which patients would most benefit from regional techniques. Notably, systemic antithrombotic and anticoagulation therapy is common among this population and may affect anesthetic choices.
Effects of the discharge plan on the caregiving load of people with chronic disease: Quasi-experimental study
Authors: Carvajal Carrascal Gloria , Fuentes Ramírez Alejandra , Pulido Barragán Sandra Patricia , Guevara Lozano Maryory , Sánchez-Herrera Beatriz
Published: August 2023

Hospitalization due to non-transmissible chronic disease (NTCD) affects people and health institutions negatively. Healthcare systems need integral strategies to minimize this impact.

Objective

To determine the effect of an anticipated care plan, structured around hospital discharge (PC-AH-US), regarding the caregiving load of people with NTCD residing in Colombia, 2019–2021.

Method

This is a quasi-experimental study with pre- and post-intervention measurements. It includes 1170 participants who represented 585 chronic disease patient–caregiver pairs. We compared the PC-AH-US intervention, to the regular intervention.

Results

The PC-AH-US intervention group showed better results in all dimensions when compared to the regular intervention group: Awareness 8.7 (SD: 0.7) and 6.8 (SD: 1.7); Acknowledgement of their unique conditions 11.3 (SD: 1.0) and 9.4 (SD: 1.8); Capacity to fulfill care tasks 8.8 (SD: 0.7) and 7.5 (SD: 1.5); Wellbeing 11.4 (SD: 0.90) and 8.87 (SD: 2.3); Anticipation 5.88 (SD: 0.4) and 4.7 (SD: 1.1) and Support Network 11.4 (SD: 0.8) and 9.9 (SD: 2.5).

Conclusion

The PC-AH-US intervention group showed a statistically significant decrease in the caregiving load for people with NTCD ( p < 00). There were no significant institutional differences in readmissions or deaths. The PC-AH-US intervention backs institutional policies meant to care for people with NTCD.
Hong Kong's Networked Agitprop: Popular Nationalism in the Wake of the 2019 Anti-Extradition Protests
Authors: Ismangil Milan , Schneider Florian
Published: August 2023

Hong Kong's protest movements have created a repertoire of symbolism in artworks and artefacts that make statements about the political status of the city. This article analyses the protest art that emerged during the 2019 anti-extradition protests. We explore how actors produced a sense of “Hong Kong-ness” and distributed political meanings through networked agitprop: a form of strategic communication that links people and ideas together in both physical and digital contexts, through emotional appeals in the service of a grassroots political programme. By analysing examples of such agitprop, we show how the movement organically constructed networks of meaning to promote its ideas of people, nation, and even independence. However, we also find that the commitment to nationalist frames of reference ultimately prevents such art from re-imaging Hong Kong outside the confines of nations and that it even inadvertently reproduces the systems of power it ostensibly sets out to challenge.
Rare case of syringohydromyelia expansion after kyphotic cervical deformity correction in a patient with history of spinal coccidiomeningitis
Authors: Gassie Kelly , Rea Brittany , Zamore Robert , Alikhani Puya
Published: August 2023

Syringomyelia resulting from arachnoiditis due to disseminated coccidioidomycosis meningitis has been previously established in the literature. Worsening syringomyelia after kyphotic cervical deformity correction in a patient with spinal coccidioidomycosis, however, has not yet been reported. Herein we present an extremely rare case of disseminated coccidioidomycosis with cystic cervical lesions and an associated syrinx which, after undergoing cervical kyphotic deformity correction in the setting of iatrogenic loss of cervical lordosis, experienced acute syrinx expansion requiring urgent syringosubarachnoid shunt. To our understanding, this is the first case reported of such an event.
Hair repigmentation and regrowth in a dupilumab-treated paediatric patient with alopecia areata and atopic dermatitis: a case report
Authors: Yan Xin , Tayier Munire , Cheang Sin Tong , Liao Zhongmin , Dong Yi , Yang Yifeng , Ye Yanting , Zhang Xingqi
Published: August 2023

Alopecia areata (AA) is a chronic inflammatory disease mainly involving Th1 immunoreaction, but Th2 is also involved. A 9-year-old girl presented to our clinic with severe alopecia for 2 months and pruritus-related rashes for 8 years. She was diagnosed with AA and atopic dermatitis (AD), and the Severity of Alopecia Tool (SALT) score was 98. She used a 0.05% halometasone cream (occlusive dressing) topically applied overnight (6 days weekly) for 10 months. After 2 months of treatment, she had regrowth of both black and white hair. However, relapse occurred and she gradually lost all black terminal hair, but white terminal hair remained, with a SALT score of 70. Continuous topical occlusion resulted in white hair regrowth with a SALT score of 20 at the end of month 10. Dupilumab was initially prescribed as a 600-mg subcutaneous injection and maintained at 300 mg every 4 weeks thereafter. Hair repigmentation (10% of whole hair density) started, with black hair shaft appearing at the proximal end in parietal-occipital and occipital areas after three injections at week 12 of dupilumab therapy, with a SALT score of 10. After seven injections at week 28, the percentage of black hair shaft reached up to 90, and she regained her black hair and the pigmented section of hair shaft continued to grow longer at the rate of normal hair growth. Nevertheless, 4 months after termination of dupilumab therapy, the black terminal hair began to fall off, and white vellus hair gradually regrew on the scalp, with a SALT score of 80. Dupilumab induces hair regrowth and repigmentation of white terminal hair without disturbing the anagen phase of hair follicles. Therefore, melanocytes in AA may be a potential target of Th2-related factors. Persistent regrowth of white hair may be used as a signal of Th2 dominance in AA management.
Cost effectiveness of a telerehabilitation intervention vs home based care for adults with severe neurologic disability: A randomized clinical trial
Authors: Duruflé Aurélie , Le Meur Claire , Piette Patrice , Fraudet Bastien , Leblong Emilie , Gallien Philippe
Published: August 2023

Context

Several options are available for the care of neurological conditions including care delivered in rehabilitation centres, at home or remotely. While economic studies are available comparing centres and homes, very little economic data relates to mobile teams comparing face-to-face and remote care.

Objective

To conduct an economic study comparing face-to-face care at home and care delivered remotely (tele-rehabilitation).

Method

A randomised clinical study with two groups; a control group receiving home care and an experimental group receiving tele-rehabilitation. The primary outcome measure was the ICER (Incremental Cost Effectiveness Ratio).

Participants

Patients with severe neurological disabilities

Results

80 patients were enrolled in the study; 77 were analysed to calculate the ICER, which was positive and located in the SW quadrant. A bootstrap with 1000 replications was positioned at 72.8% in the SW quadrant.

Conclusion

Tele-rehabilitation is an acceptable alternative to the management of neurological patients at home. In the mildest cases, remote-rehabilitation may even be dominant. More extensive studies are needed to specify the indications.
Geopolitics in the infrastructural ideology of 5G
Authors: Maxigas  , ten Oever Niels
Published: August 2023

This paper explores how infrastructural ideologies function as tools in geopolitical struggles for dependence and independence between world powers. Meese et al. (2020) suggest that controversies around 5G stem from infrastructural anxieties best examined in the framework of geopolitics. We build on this work by analysing the emerging infrastructural ideology and sociotechnical imaginaries (Jasanoff and Kim, 2015) of 5G in light of the changing global division of labour. Sociotechnical imaginaries refer to the vision of technologies themselves, while ideologies refer to the totality of social relations, translating the objective reality of material conditions to subjective lived experience (Bory, 2020). The Western imaginaries around 5G infrastructures reflect, deflect, translate and sublimate the infrastructural anxieties tied to the development and deployment of new network paradigms by China as an emerging hegemon. The controversial nature, contradictory content and fragmented presentation of 5G is a necessary part of living through the trauma of lost historical agency on the part of Western superpowers. We engaged in code ethnography (Rosa, 2022) of GSM, internet and 5G technologies, as well as participant observation in the main standard-development organisations of the internet and 5G. Our methodological assumption, taken from world systems theory (Wallerstein, 2004), is that the character and content of imaginaries and their underpinning ideologies creatively translate the position of actors in the global division of labour. This paper contributes to the understanding of the role of media infrastructures in geopolitical power tussles and straddles the fields of materialist media studies, science and technology studies and international relations.
Prospective Associations Between Fear of Falling, Anxiety, Depression, and Pain and Functional Outcomes Following Surgery for Intertrochanteric Hip Fracture
Authors: Kalem Mahmut , Kocaoğlu Hakan , Duman Berker , Şahin Ercan , Yoğun Yener , Ovali Sancar A.
Published: August 2023

Objective

Fear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture.

Methods

This study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State–Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70.

Results

HHS score was significantly predicted at baseline by the full model [χ2 (7) = 18.18, P = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)].

Conclusions

In this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings.

Level of evidence

Prognostic level I.
Croatian Elementary School Teachers’ Maths Teaching Efficacy Beliefs: Knowledge Domains and Cross-Curricular Maths in the Post-Digital Era
Authors: Istenič Andreja , Simčič Blaž , Crnković Vedrana Mikulić , Volk Marina
Published: August 2023

This correlational study addressed two issues pertinent to developing mathematical competences for the 21st Century. Firstly, in a post-digital society, technology is recognized in teachers’ pedagogic and subject-specific knowledge domains. Secondly, cross-curricular teaching must be introduced to respond to societal requirements for maths knowledge application in diverse areas of life and work. Croatian educational reform recognized the importance of informatics and the integration of ICT across curricula supporting cross-curricular teaching. When reforming teaching, teaching efficacy beliefs inform change, and the study examined how technology pedagogy content knowledge (TPACK) contributes to teaching efficacy beliefs. Six hundred and six Croatian elementary school classroom teachers were surveyed for maths teaching efficacy beliefs (MTEBI) and self-assessment of their technology pedagogy content knowledge (TPACK). The study confirmed that the integration of technology knowledge in teachers’ pedagogical knowledge is, in addition to content knowledge, essential and predicts, with a large effect size ( f2 = 0.64), the MTEBI subscale math teaching efficacy (MTE), while isolated technology knowledge does not. In addition, there is a positive correlation between years of service and pedagogy content knowledge and a negative correlation between years of service and technology pedagogy knowledge and technology knowledge, however, with a small effect size.
Load-induced increase in muscle activity during 30° abduction in patients with rotator cuff tears and control subjects
Authors: Croci Eleonora , Warmuth Fabian , Baum Cornelia , Kovacs Balazs Krisztian , Nüesch Corina , Baumgartner Daniel , Müller Andreas Marc , Mündermann Annegret
Published: August 2023

Background

Rotator cuff muscles stabilise the glenohumeral joint and contribute to the initial abduction phase with other shoulder muscles. This study aimed to determine if the load-induced increase in shoulder muscle activity during a 30° abduction test is influenced by asymptomatic or symptomatic rotator cuff pathologies.

Materials and Methods

Twenty-five patients with unilateral rotator cuff tears (age, 64.3 ± 10.2 years), 25 older control subjects (55.4 ± 8.2 years) and 25 younger control subjects (26.1 ± 2.3 years) participated in this study. Participants performed a bilateral 30° arm abduction and adduction movement in the scapular plane with handheld weights (0–4 kg). Activity of the deltoid, infraspinatus, biceps brachii, pectoralis major, latissimus dorsi and upper trapezius muscles was analysed at maximum abduction angle after normalisation to maximum voluntary contraction. Shoulders were classified into rotator cuff tendinopathy, asymptomatic and symptomatic rotator cuff tears, and healthy based on magnetic resonance images. A linear mixed model (loads, shoulder types) with random effects (shoulder identification) was applied to the log-transformed muscle activities.

Results

Muscle activity increased with increasing load in all muscles and shoulder types (P < 0.001), and 1-kg increments in additional weights were significant (P < 0.001). Significant effects of rotator cuff pathologies were found for all muscles analysed (P < 0.05). In all muscles, activity was at least 20% higher in symptomatic rotator cuff tears than in healthy shoulders (P < 0.001). Symptomatic rotator cuff tears showed 20–32% higher posterior deltoid (P < 0.05) and 19–25% higher pectoralis major (P < 0.01) activity when compared with asymptomatic tears.

Conclusions

Rotator cuff pathologies are associated with greater relative activity of shoulder muscles, even with low levels of additional load. Therefore, the inclusion of loaded shoulder tests in the diagnosis and rehabilitation of rotator cuff pathologies can provide important insight into the functional status of shoulders and can be used to guide treatment decisions.

Level of evidence: Level 2.

Trial registration: Ethical approval was obtained from the regional ethics committee (Ethics Committee Northwest Switzerland EKNZ 2021-00182), and the study was registered at clinicaltrials.gov on 29 March 2021 (trial registration number NCT04819724, https://clinicaltrials.gov/ct2/show/NCT04819724).
Comparison of 6 DNA extraction methods for isolation of high yield of high molecular weight DNA suitable for shotgun metagenomics Nanopore sequencing to detect bacteria
Authors: Gand Mathieu , Bloemen Bram , Vanneste Kevin , Roosens Nancy H. C. , De Keersmaecker Sigrid C. J.
Published: August 2023

Background

Oxford Nanopore Technologies (ONT) offers an accessible platform for long-read sequencing, which improves the reconstruction of genomes and helps to resolve complex genomic contexts, especially in the case of metagenome analysis. To take the best advantage of long-read sequencing, DNA extraction methods must be able to isolate pure high molecular weight (HMW) DNA from complex metagenomics samples, without introducing any bias. New methods released on the market, and protocols developed at the research level, were specifically designed for this application and need to be assessed.

Results

In this study, with different bacterial cocktail mixes, analyzed as pure or spiked in a synthetic fecal matrix, we evaluated the performances of 6 DNA extraction methods using various cells lysis and purification techniques, from quick and easy, to more time-consuming and gentle protocols, including a portable method for on-site application. In addition to the comparison of the quality, quantity and purity of the extracted DNA, the performance obtained when doing Nanopore sequencing on a MinION flow cell was also tested. From the obtained results, the Quick-DNA HMW MagBead Kit (Zymo Research) was selected as producing the best yield of pure HMW DNA. Furthermore, this kit allowed an accurate detection, by Nanopore sequencing, of almost all the bacterial species present in a complex mock community.

Conclusion

Amongst the 6 tested methods, the Quick-DNA HMW MagBead Kit (Zymo Research) was considered as the most suitable for Nanopore sequencing and would be recommended for bacterial metagenomics studies using this technology.
SMC1A facilitates gastric cancer cell proliferation, migration, and invasion via promoting SNAIL activated EMT
Authors: Liu Yaling , Fang Xianrui , Wang Qianqian , Xiao Da , Zhou Ting , Kang Kuo , Peng Zhenyu , Ren Feng , Zhou Jingyu
Published: August 2023

Background

Structural maintenance of chromosomes protein 1 A (SMC1A) is a crucial subunit of the cohesion protein complex and plays a vital role in cell cycle regulation, genomic stability maintenance, chromosome dynamics. Recent studies demonstrated that SMC1A participates in tumorigenesis. This reseach aims to explore the role and the underlying mechanisms of SMC1A in gastric cancer (GC).

Materials and methods

RT-qPCR and western blot were used to examine the expression levels of SMC1A in GC tissues and cell lines. The role of SMC1A on GC cell proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) were analyzed. Furthermore,the mechanism of SMC1A action was investigated.

Results

SMC1A was highly expressed in GC tissues and cell lines. The high expression of SMC1A indicated the poor overall survival of GC patients from Kaplan-Meier Plotter. Enhancing the expression of SMC1A in AGS cells remarkably promoted cell proliferation in vitro and in vivo, migration and invasion, Conversely, knockdown of SMC1A in HGC27 cells inhibited cell proliferation, migration and invasion. Moreover, it’s observed that SMC1A promoted EMT and malignant cell behaviors via regulating SNAIL.

Conclusion

Our study revealed that SMC1A promotes EMT process by upregulating SNAIL, which contributes to gastric cancer cell proliferation, migration and invasion. Therefore, targeting SMC1A may be a potential strategy to improve GC therapy.
Exercise snacking to improve physical function in pre-frail older adult memory clinic patients: a 28-day pilot study
Authors: Western Max J. , Welsh Tomas , Keen Kristen , Bishop Vanessa , Perkin Oliver J.
Published: August 2023

Background

Finding innovative yet feasible ways of preventing physical and cognitive decline in those at risk is a critical global challenge, with exercise being championed as a key precursor to robust health in later life. Exercise snacking, here defined as short bouts of sporadic [muscle-strengthening] exercise, is one such strategy designed to overcome typical participation barriers observed in older adults. This study examined the acceptability of exercise snacking amongst pre-frail older adults and explored the efficacy of this approach in improving physical function.

Methods

In this single group design, 21 pre-frail outpatients with mild-cognitive impairment were recruited from a UK memory clinic. To be eligible, participants were aged ≥ 65-years who scored 3–8 (inclusive) on the short physical performance battery (SPPB) and were not regularly engaging in sport or exercise. Participants completed a 28-day, twice daily, exercise snacking intervention, consisting of five muscle-strengthening exercises, with the aim being to complete as many repetitions as possible of each exercise in a minute. Acceptability of the intervention was measured quantitatively and qualitatively using a survey and topic guide informed by the Theoretical Framework of Acceptability. Pre- and post-intervention physical function was measured using the SPPB, timed up-and-go (TUG), and 60s standing balance and sit-to-stand tests.

Results

Eighteen participants provided follow-up data and showed 85% adherence to the exercise snacking intervention, measured as the proportion of all sessions completed out of a possible 56. Participants rated the intervention as highly acceptable (4.6/5) suggesting it supported their self-efficacy (4.3/5) was enjoyable (4.1/5) and had a low burden (2.1/5). Qualitative findings suggested the ease of use, flexibility of the programme, and perceived effectiveness was important, and particularly useful for non-exercisers. Changes in SPPB score (8(1) vs. 9(3), p < 0.01), TUG (11.32(4.02) vs. 9.18(5.25) seconds, p < 0.01) and in the 60-second sit-to-stand test (17 ± 5 vs. 23 ± 7 repetitions, p < 0.01) were seen between baseline and follow-up.

Conclusions

Exercise snacking is an acceptable and potentially efficacious format of exercise for pre-frail memory clinic attendees who are at heightened risk of falling and frailty. Large scale randomised controlled trials are required to confirm whether exercise snacking is effective in the short and long term.

ClinicalTrials.gov registration

NCT05439252 (30/06/2022)
Effect of antimicrobial de-escalation strategy on 14-day mortality among intensive care unit patients: a retrospective propensity score-matched cohort study with inverse probability-of-treatment weighting
Authors: zhao Kai , zhang Zhengliang , liang Ying , wang Yan , cai Yan
Published: August 2023

Purpose

This study aimed to investigate the prevalence of antimicrobial de-escalation (ADE) strategy and assess its effect on 14-day mortality among intensive care unit patients.

Methods

A single-center retrospective cohort study was conducted on patients admitted to the intensive care unit (ICU) with infectious diseases between January 2018 and December 2020. Patients were stratified into three groups based on the initial treatment regimen within 5 days of antimicrobial administration: ADE, No Change, and Other Change. Confounders between groups were screened using one-way ANOVA and Chi-square analysis. Univariate and multivariate analyses were performed to identify risk factors for 14-day mortality. Potential confounders were balanced using propensity score inverse probability of treatment weighting (IPTW), followed by multivariate logistic regression analysis to evaluate the effect of ADE strategy on 14-day mortality.

Results

A total of 473 patients met the inclusion criteria, with 53 (11.2%) in the ADE group, 173 (36.6%) in the No Change group, and 247 (52.2%) in the Other Change group. The 14-day mortality rates in the three groups were 9.4%, 11.6%, and 21.9%, respectively. After IPTW, the adjusted odds ratio for 14-day mortality comparing No Change with ADE was 1.557 (95% CI 1.078–2.247, P = 0.0181) while comparing Other Change with ADE was 1.282(95% CI 0.884–1.873, P = 0.1874).

Conclusion

The prevalence of ADE strategy was low among intensive care unit patients. The ADE strategy demonstrated a protective effect or no adverse effect on 14-day mortality compared to the No Change or Other Change strategies, respectively. These findings provide evidence supporting the implementation of the ADE strategy in ICU patients.
Risk analysis of COVID-19 hospitalization and critical care by race and region in the United States: a cohort study
Authors: Jimbo Mitsuki , Saito Sakae , Uematsu Takayuki , Hanaki Hideaki , Otori Katsuya , Shibuya Kiyoshi , Ando Wataru
Published: August 2023

Background

This study aimed to identify the current risk factors for coronavirus disease 2019 severity and examine its association with medication use.

Methods

We used data from a large United States electronic health record database to conduct an anonymized cohort study of 171,491 patients with coronavirus disease 2019. The study was conducted from January 1, 2020, to August 27, 2021. Data on age, race, sex, history of diseases, and history of medication prescriptions were analyzed using the Cox proportional hazards model analysis to calculate hazard ratios for hospitalization and severe risk.

Results

Factors that increased the risk of hospitalization and critical care were age ≥ 65 years, male sex, type 2 diabetes, hypertension, interstitial pneumonia, and cardiovascular disease. In particular, age ≥ 65 years significantly increased the risk of hospitalization (hazard ratio, 2.81 [95% confidence interval, 2.58–3.07]; P < 0.001) and critical care (hazard ratio, 3.45 [2.88–4.14]; P < 0.001). In contrast, patients with hyperlipidemia had a reduced risk. However, patients with hyperlipidemia who were not taking statins had a significantly increased risk of hospitalization (hazard ratio, 1.24 [1.16–1.34]; P < 0.001). Sodium-glucose cotransporter-2 inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, glucocorticoids, and statins significantly reduced the risk of hospitalization and critical care. The risk of hospitalization and critical care increased in patients of all ethnicities with type 2 diabetes. The factors that significantly increased the risk of hospitalization in all regions were older age, hypertension, chronic obstructive pulmonary disease, and cardiovascular disease.

Conclusion

This study identified factors that increase or reduce the risk of severe coronavirus disease. The provision of appropriate drug treatment and modification of lifestyle-related risk factors may reduce coronavirus disease severity.
An interrupted time series analysis of trends in opioid-related emergency department visits from pre-COVID-19 pandemic to pandemic, from the Canadian Hospitals Injury Reporting and Prevention Program
Authors: Yao Xiaoquan , McFaull Steven R. , Champagne André S. , Thompson Wendy
Published: August 2023

Background

Opioid-related emergency department (ED) visits in Canada increased during the COVID-19 pandemic, but how trends in volume and case severity changed from pre-pandemic times through the pandemic is not known. Trends in ED visits related to specific types of opioids also remain unclear. Our objective was to describe pre-pandemic trends and how they changed with the onset of COVID-19 and thereafter.

Methods

Based on data from the Canadian Hospitals Injury Reporting and Prevention Program, we identified opioid-related ED visits and constructed a time series from March 12, 2018 through March 7, 2021—two pre-COVID periods and one COVID period. We used an interrupted time series (ITS) analysis to examine trends in volume and case severity. We compared medians and means of monthly counts and percentages of severe cases between the periods, by sex, age, and opioid type.

Results

Before the pandemic, there was an increasing trend in fentanyl-related visits for males, females and 25- to 64-year-olds, and a decreasing trend in heroin-related visits for males and 18- to 64-year-olds. Fentanyl-related visits for 18- to 24-year-olds showed an immediate increase at the start of the pandemic and a decreasing trend during the pandemic. Heroin-related visits for 12- to 17-year-olds had an immediate increase at the start of the pandemic; for 18- to 24-year-olds and 45- to 64-year-olds, the prior decreasing pre-pandemic trend ceased. For pooled opioid-related visits, no significant trend in the percentage of severe cases was observed throughout the entire study period.

Conclusion

This study shows that an ITS approach in trend analysis is a valuable supplement to comparisons of before and after measures (with or without controlling seasonal effects). The findings provide evidence on how ED presentations for opioid use evolved in Canada from 2018 to 2021. The results can inform policies designed to reduce opioid-related harm in the context of a public health emergency.
Metabolic syndrome and the likelihood of knee pain and functional disability: evidence from a large middle eastern population-based study
Authors: Ibrahim Talal , Ahmed Abdulaziz F , Nofal Mariam , Hegazy Abdelsalam , Ghomrawi Hassan M. K.
Published: August 2023

Objectives

Metabolic Syndrome (MetS) has been associated with knee osteoarthritis (KOA) in animal studies, but epidemiologic evidence of the association remains controversial. We investigated the association between MetS and knee pain and functional disability, the hallmarks of KOA, in a Middle Eastern population with high reported MetS rates.

Methods

A population-based study of adult individuals was conducted between 01/2016 and 03/2019. Data collected included age, sex, blood pressure, body mass index (BMI), waist circumference (WC), and comprehensive metabolic panel blood tests. Knee symptoms were assessed using The Western Ontario and McMaster Arthritis index (WOMAC) The Adult Treatment Panel III criteria was applied to determine if participants had MetS. Multivariable regression was used to determine the association of MetS, and its components, with the WOMAC total and subscale scores.

Results

Of 6,000 participants enrolled, 15.5% had MetS. The multivariate regression demonstrated that participants with MetS had significantly higher WOMAC total and subscale scores after adjusting for demographic variables; however, these associations were not significant after adjusting for BMI. Multivariate regression examining the association between MetS components and the WOMAC scores showed sex-based significant differences with WOMAC scores; however, the differences were not larger than the minimally clinical important differences.

Conclusions

This study demonstrated that after adjustment for BMI, neither MetS nor its individual parameters were associated with worse knee symptoms. As such, the association between MetS and worse knee symptoms requires further study.
Risk factors analysis for clinical symptoms of prenatally diagnosed choledochal cysts: a retrospective study
Authors: Yang Dan , Li Long , Diao Mei , Xie Xianghui , Ming Anxiao , Gao Ruyue , Tian Yu
Published: August 2023

Background

This study aimed to screen the impact factors for clinical symptoms of prenatally diagnosed choledochal cysts (CDCs), to warn about the occurrence of clinical symptoms and the timing of surgery.

Methods

Medical records of patients with prenatally diagnosed CDCs admitted to our hospital from April 2013 to April 2018 were retrospectively reviewed. Fetal hilar or abdominal cysts were found by prenatal ultrasonogram. All patients underwent laparoscopic cyst excision and hepaticojejunostomy in our center. Univariate analysis and multivariate logistic regression analysis were performed to screen the factors related to clinical symptoms intimately.

Results

Two hundred eighteen cases were included. One hundred thirty-four patients (134/218, 61.5%) presented clinical symptoms before surgery. The results of univariate analysis showed that patients with clinical symptoms had earlier time of prenatal diagnosis (P = 0.002), higher values of GGT, TBIL, DBIL (P < 0.001, P < 0.001, P < 0.001, respectively) and larger maximum diameter of cyst before surgery (P = 0.012). Multivariate logistic regression analysis suggested that the time of prenatal diagnosis (P = 0.001, OR = 0.898, 95% CI: 0.845 ~ 0.955) and the GGT value within one week of life (P = 0.028, OR = 1.002, 95% CI: 1.000 ~ 1.003) were independent influencing factors for symptoms.

Conclusions

For children with prenatally diagnosed CDCs, approximately 2/3 patients presented noticeable clinical symptoms before surgery. The time of prenatal diagnosis and the GGT value within 1 week of life were independent impact factors for the occurrence of clinical symptoms.
An ontology-based approach for harmonization and cross-cohort query of Alzheimer’s disease data resources
Authors: Hao Xubing , Li Xiaojin , Zhang Guo-Qiang , Tao Cui , Schulz Paul E. ,   The Alzheimer’s Disease Neuroimaging Initiative, Cui Licong
Published: August 2023

Background

In the United States, the National Alzheimer’s Coordinating Center (NACC) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI) are two major data sharing resources for Alzheimer’s Disease (AD) research. NACC and ADNI strive to make their data more FAIR (findable, interoperable, accessible and reusable) for the broader research community. However, there is limited work harmonizing and supporting cross-cohort interoperability of the two resources.

Method

In this paper, we leverage an ontology-based approach to harmonize data elements in the two resources and develop a web-based query system to search patient cohorts across the two resources. We first mapped data elements across NACC and ADNI, and performed value harmonization for the mapped data elements with inconsistent permissible values. Then we built an Alzheimer’s Disease Data Element Ontology (ADEO) to model the mapped data elements in NACC and ADNI. We further developed a prototype cross-cohort query system to search patient cohorts across NACC and ADNI.

Results

After manual review, we found 172 mappings between NACC and ADNI. These 172 mappings were further used to construct common concepts in ADEO. Our data element mapping and harmonization resulted in five files storing common concepts, variables in NACC and ADNI, mappings between variables and common concepts, permissible values of categorical type data elements, and coding inconsistency harmonization, respectively. Our cross-cohort query system consists of three core architectural elements: a web-based interface, an advanced query engine, and a backend MongoDB database.

Conclusions

In this work, ADEO has been specifically designed to facilitate data harmonization and cross-cohort query of NACC and ADNI data resources. Although our prototype cross-cohort query system was developed for exploring NACC and ADNI, its backend and frontend framework has been designed and implemented to be generally applicable to other domains for querying patient cohorts from multiple heterogeneous data sources.
Suspected clinical toxoplasmosis in a 12-week-old puppy in Singapore
Authors: Chen Audrey , Boulay Max , Chong Stacy , Ho Kelvin , Chan Amy , Ong Jasmine , Fernandez Charlene Judith , Chang Siow Foong , Yap Him Hoo
Published: August 2023

Background

Toxoplasma gondiiis traditionally known as a parasite of felids, with possible infection in intermediate hosts such as dogs and humans, and thus a disease of public health significance. Published data on the prevalence of toxoplasmosis in dogs and cats in Singapore is scanty, and this paper documents a suspect clinical case of toxoplasmosis in a free-roaming puppy trapped from an offshore island of Singapore.

Case presentation

A 12-week-old puppy presented with hindlimb weakness and sarcopenia, with rapidly progressing ascending paralysis and respiratory distress, one week after trapping. Toxoplasmosis was suspected after indirect fluorescence antibody testing (IFAT) revealed anti-T. gondiiantibodies. The puppy responded quickly to clindamycin treatment and was discharged from hospital after 10 days.

Conclusion

While rare and undocumented, veterinary clinicians in Singapore are advised to also include toxoplasmosis infection as a differential diagnosis in dogs presenting with similar clinical signs. This is especially so for dogs which have access to the outdoors.
Association of insulin use with LV remodeling and clinical outcomes in diabetic patients with heart failure and reduced ejection fraction: assessed by cardiac MRI
Authors: Shi Ke , Zhang Ge , Fu Hang , Huang Shan , Xu Hua-Yan , Gao Yue , Shi Rui , Yan Wei-Feng , Qian Wen-Lei , Li Yuan , Guo Ying-Kun , Yang Zhi-Gang
Published: August 2023

Background

Insulin is commonly used in type 2 diabetes mellitus (T2DM) to achieve glycemic control. However, recent evidence showed that insulin use is associated with poor outcomes in the context of heart failure (HF). Since heart failure with reduced ejection fraction (HFrEF) accounts for approximately 50% of cases in the general HF population, we aimed to evaluate the effect of insulin treatment on left ventricular (LV) remodeling and contractility abnormalities in a HFrEF cohort and assess whether insulin was a predictor of adverse outcomes in this entity.

Methods

A total of 377 HFrEF patients who underwent cardiac MRI were included and divided according to diabetes status and the need for insulin treatment. LV structural and functional indices, as well as systolic strains, were measured. The determinants of impaired myocardial strains were assessed using linear regression analysis. The associated endpoints were determined using a multivariable Cox proportional hazards model.

Results

T2DM patients on insulin displayed a higher indexed LV end-diastolic volume and LV mass than those with T2DM not on insulin or those without T2DM, despite similar LV ejection fractions, accompanied by a higher three-dimensional spherical index (P < 0.01). Worse longitudinal and circumferential peak systolic strain was shown to occur in T2DM patients on insulin (P < 0.01). Insulin treatment was independently associated with impaired magnitudes of systolic strain. The median follow-up duration was 32.4 months (IQR, 15.6–43.2 months). Insulin treatment remained consistently associated with poor outcomes after adjustment for established confounders, with an adjusted hazard ratio of 3.11; (95% CI, 1.45–6.87; P = 0.009) in the overall cohort and 2.16 (95% CI, 1.08–4.59; P = 0.030) in the diabetes cohort.

Conclusions

Insulin may further lead to adverse LV remodeling and contractile dysfunction in the context of HFrEF with T2DM. Considerable care should be taken when treating HFrEF patients with insulin.