bluuebunny/crossref_metadata_2025 huggingface dataset:
Fabrication of active whey Protein isolate/oleic acid emulsion based film as a promising bio-material for cheese packaging
Authors: Kashiri Mahboobeh , Maghsoudlou Yahya , Moayedi Ali
Published: May 2022

Emulsion is a colloidal dispersion for delivering natural antimicrobial, antioxidant, and bioactive compounds to improve the product's quality. The present study aimed to develop the active emulsion film based on whey protein isolate (WPI) by adding oleic acid (OA) (0, 10, and 20% w/w) and green tea extract (GTE) (0 and 0.5% w/v) for cheese packaging. Results showed that the opacity, flexibility, and water barrier properties of WPI hydrogel-based film were significantly increased by adding 10% OA. Active release from emulsion-based films was governed by pH and the nature of food model systems. The minimum release occurred in the acidic food model system. After 5 h exposure in the acid food model system, the obtained release from the active film containing OA 0, 10, and 20% was 52.39, 48.97, and 57.24% of incorporated GTE, respectively. The log reduction value (LRV) of active emulsion film against bacteria was significantly affected by the food model system. Moreover, packed lactic coagulated cheese delivered more phenolic compound of GTE than processed spread cheese. Korsmeyer-Peppas model and Weibull with lag were suggested as appropriate models to forecast the release kinetic of GTE.
A cross-sectional study on relationships between musical activities and quality of life in Japanese older adults
Authors: Mito Hiromichi , Kinjo Hikari
Published: May 2022

This study aimed to examine the association between musical activities and quality of life in older adults using a questionnaire survey. The questionnaire consisted of three parts: background variables, quality of life variables (measured from two aspects: appreciation of life and life-ability of the person), and musical activity variables (frequency of engagement in musical activities, perceived importance of musical activities, motivation for acquiring musical skills and knowledge, and self-efficacy regarding musical skills and knowledge). It was sent to 525 people aged 60 to 98 years who were enrolled in two Silver Human Resource Centers in Tokyo. We found a significant correlation between almost all the musical activity variables and the quality of life measures; the trend was consistent even after controlling for background variables. The results indicated that both the frequency of involvement in musical activities and the mindset toward musical skills and potency were associated with quality of life. The strength of this study is that the association between quality of life and various musical aspects—both frequency of participation and psychological aspects of musical activities—was explored within the same research design, which is the first to be carried out solely with older adults.
The impacts of domestic and global economic policy uncertainties on the hotel room demand: Evidence from Singapore
Authors: Lee Chew Ging , How Shi-Min
Published: May 2022

Applying cointegration analysis on the monthly data of Singapore, this research note examines the impacts of global economic policy uncertainty (GEPU) and domestic economic policy uncertainty (DEPU) on the hotel room demand. Although control variables, such as average room rates, industrial production index and international tourist arrivals, are used and the specific-to-general modelling is adopted, the results show that the standard diagnostic tests may be incapable of identifying possible model mis-specification. The main findings show that DEPU has a negative impact, but GEPU has a positive impact on the hotel room demand. DEPU is linked to the political instability of Singapore, which discourages international travellers to visit Singapore. GEPU enhances Singapore’s position as a stable business and financial hub in relation to others and thereby increases business travel.
Soft skills, stories, and self-reflection: Applied digital storytelling for self-branding
Authors: Henrickson Leah , Jephcote William , Comissiong Rhys
Published: May 2022

This paper documents an analytical autoethnographic approach to the development of a digital storytelling (DST) app for enhancing young adults’ employability prospects. Development is rooted in the classical DST approach proposed by StoryCenter Founding Director Joe Lambert. Blending theoretical consideration and empirical user testing (individual user observations and a co-creation workshops), we affirm the value of DST – and classical DST especially – for facilitating critical self-reflection and self-branding. By structuring discussion using Lambert’s seven steps of classical DST, we highlight how particular design decisions have promoted enjoyable and effective storytelling, recognizing both user preference and empirically demonstrated usage. This paper is the result of a positive interdisciplinary academic-industrial partnership.
Processes supporting effective skill-mix implementation in general practice: A qualitative study
Authors: Spooner Sharon , McDermott Imelda , Goff Mhorag , Hodgson Damian , McBride Anne , Checkland Katherine
Published: May 2022

Objectives

Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners.

Methods

Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings.

Results

The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients’ reported problem(s) and an understanding of practitioners’ capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process.

Conclusions

The processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices.
Autistic children who create imaginary companions: Evidence of social benefits
Authors: Davis Paige E , Slater Jessica , Marshall David , Robins Diana L
Published: May 2022

Past research shows that autistic children can and do create imaginary companions (ICs), and that these ICs resemble those that neurotypical children create. Neurotypical children creating ICs have been found to have significantly more developed theory of mind (ToM) and social understanding among other enhanced social cognitive skills. The study set out to determine if this finding applies to autistic children. Parents of 124 (38 female) autistic children, ages from 5 to –12 years old, completed questionnaires evaluating communication, social understanding, and social skills. Children with ICs had significantly higher ToM and social skills scores regardless of their communication abilities. Findings suggest that there is a variability in ToM and social skills in autistic children in reference to an IC play profile. Results are discussed in terms of direction of causality and lab-based investigations.

Lay abstract

Research on neurotypical children with imaginary friends has found that those with imaginary friends have better social skills and are more able to think about how other people’s minds work compared to children without imaginary friends. Research shows that some autistic children also create imaginary friends. This article is the first to look at whether or not autistic children with imaginary friends have stronger social skills and an improved ability to think about others’ minds than those without imaginary friends. We asked parents to report about their children aged 5 to 12. Finding almost half reported their child had an imaginary friend, a much larger number than previous research with younger children. Our findings also suggested that autistic children with imaginary friends were better able to understand others’ minds and had stronger social skills than their peers without imaginary friends. The children’s language ability did not influence this. The findings of this study add to the evidence that with respect to the creation imaginary friends and their potential benefits, the play profiles of autistic children are similar to the general population. It also provides more evidence that the understanding of others’ minds is not all or nothing in autism and gives reason for researchers to investigate whether the causes of these differences are the same or different for autistic children.
Vision-guided unmanned aerial system for rapid multiple-type damage detection and localization
Authors: Jiang Shang , Cheng Yuyao , Zhang Jian
Published: May 2022

Unmanned aerial systems (UASs) are increasingly applied for bridge inspection. A vision-guided UAS with a lightweight convolutional neural network is developed to detect and locate bridge cracks, spalling, and corrosion. The contributions are as follows: (1) To address the problem that traditional UASs are global positioning system (GPS) required while GPS signals under bridge bottom generally are weak. A vision-guided UAS is designed and applied, in which a stereo vision-inertial fusion method is used to provide position data instead of GPS and an ultrasonic ranger is applied to avoid obstacles. (2) Most of the deep learning-based damage detection methods are offline detection, which is unsuitable for UAS-based inspection because the endurance time is limited. To solve this problem, a lightweight end-to-end object detection network is proposed, by replacing the backbone of the original You Only Look Once v3 network with MobileNetv2, and the proposed network of much faster inference speed can be transplanted to the onboard computer of the designed UAS so that real-time edge computing can be performed during inspection. (3) A damage location method based on vision positioning data and simultaneous localization and mapping is also proposed to meet the urgent needs of locating damage in the whole structure. Finally, the proposed system is applied to inspect a long-span bridge to detect and locate the most common damages: crack, spalling, and corrosion with high accuracy and efficiency, which verified the practicability of the system.
Citizenship, self-efficacy and education: A conceptual review
Authors: Eidhof Bram , de Ruyter Doret
Published: May 2022

Primary and secondary schools across the world are expected to contribute to the citizenship development of their pupils. Most citizenship curricula focus on the acquisition of knowledge and the cultivation of skills and attitudes. Citizenship-related self-efficacy beliefs are often neglected in the literature on citizenship education, although they appear to play a crucial role in learning processes, among others as explanatory factors for the inequalities between students in different educational tracks. As such, studies on the development of citizenship-related self-efficacy beliefs have the potential to inform practice in a way that fosters greater equality of opportunity. However, as the literature on civic and political self-efficacy uses different dimensions and conceptualizations, this poses challenges to both the scientific accumulation of knowledge and translation to teaching practices. Here, we analyse the conceptual challenges and propose a framework for the study of self-efficacy in citizenship education research that incorporates social and political tasks of citizens and distinguishes the variety of communities in which citizens perform those tasks on two axes, namely formality and size. In doing so, we argue for fine-grained distinctions based on context instead of the all-encompassing notions of civic and political self-efficacy political theorists appear to prefer. We end by discussion two normative issues.
The Association of Cannabis Use Disorder with Acute Limb Ischemia and Critical Limb Ischemia
Authors: McGuinness Brandon , Goel Akash , Chen Jerry , Szalay David , Ladha Karim , Mittleman Murray A , Harlock John
Published: May 2022

Objectives

Heavy cannabis use has been associated with the development of acute myocardial infarction and stroke. The objective of this study was to determine if heavy, chronic cannabis use is associated with the development of acute limb ischemia (ALI) or critical limb ischemia (CLI).

Methods

We conducted a retrospective cohort study within the National Inpatient Sample (2006–2015). Patients without cannabis use disorder (CUD) were matched to patients with CUD in a 2:1 ratio using propensity scores. Our primary outcomes were incidence of ALI and CLI. Secondary outcomes included incidence of acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), frequency of open or endovascular interventions, length of stay, and total costs. Sensitivity analyses were performed with alternative models, including in the entire unmatched cohort with regression models utilizing survey weights to account for sampling methodology.

Results

We identified a cohort of 46,297 857 unmatched patients. Patients with CUD in the unmatched cohort were younger, with less cardiovascular risk factors, but higher rates of smoking and substance abuse. The matched cohort included 824,856 patients with CUD and 1,610,497 controls. Those with CUD had a higher incidence of ALI (OR 1.20 95% CI: 1.04-1.38 P=.016). Following multiple sensitivity analyses, there was no robust association between CLI and CUD. We observed no robust association of CUD with AMI, CMI, procedures performed, frequency of amputation, costs, or total length of stay.

Conclusions

Cannabis use disorder was associated with a significantly higher incidence of admission for acute limb ischemia. CUD was not associated with an increased risk of critical limb ischemia following sensitivity analysis. Given CUD is often seen in younger, less co-morbid patients it provides an important target for intervention in this population.
Bone Marrow Edema Injury Patterns in the Pediatric Knee: An MRI Study
Authors: Green Daniel W. , Hidalgo Perea Sofia , Kelly Anne M. , Potter Hollis G.
Published: May 2022

Background:

Symptomatic pediatric patients referred for magnetic resonance imaging (MRI) commonly present with traumatic bone marrow edema (BME) patterns.

Purpose:

We sought to associate discrete MRI patterns of BME with specific injury mechanisms in pediatric knee injuries to classify injury patterns by anatomical location of the BME. We aimed to group these into 6 patterns: patellar dislocation, extensor mechanism overload, hyperextension, single compartment impaction, ligament avulsion/translation, and direct contusion.

Methods:

We retrospectively reviewed 314 MRIs performed with a standard protocol on symptomatic patients aged 3 to 18 years at 1 institution. Our analysis included images, reports, and traumatic BME patterns. A musculoskeletal radiologist and orthopedic surgeon independently assigned 1 of the 6 injury patterns to each scan.

Results:

After exclusion criteria were applied to the 314 MRIs, 62 (19.7%) remained, 40 boys and 22 girls. The average age was of 12.2 years. The most frequent injury patterns were patellar dislocation (n = 22, 35%) and extensor mechanism overload (n = 14, 22%). κ value associated with pattern determination was .766, indicating substantial concordance. Bone marrow edema signal intensity on fat-suppressed sequences was classified as severe in 92% of cases.

Conclusions:

The strength of pediatric knee ligaments and tendons relative to epiphyseal bone may contribute to a high rate of BME injury patterns seen on MRI in symptomatic pediatric patients. We found that pediatric BME could be classified into 6 specific injury patterns, which might be useful to clinicians in recognizing mechanisms of injury. Further clinical studies are needed to assess the clinical differences in both short-term and long-term outcomes of the BME patterns described.
Ultrasound Assisted Extraction and Characterization of Bioactives From Verbascum thapsus Roots to Evaluate Their Antioxidant and Medicinal Potential
Authors: Shahbaz Fatima , Akhter Naheed , Shahid* Muhammad , Riaz Muhammad , Anjum Fozia , Hussain Fatma
Published: May 2022

Worldwide, Verbascum thapsus is used for the treatment of various ailments owing to the presence of bioactives of therapeutic potential. Current study was planned to extract bioactives from V thapsus roots using methanol and water as solvents under stimulated effect of ultrasonic waves and characterize them to evaluate their potential benefits. Proximate analysis explored the presence of significant contents of protein, fats, fiber, organic and inorganic minerals. Fourier transform infrared spectra and high-performance liquid chromatography chromatogram indicated the presence of different phytochemicals having antioxidant potential as evidenced by total phenolic contents, total flavonoids content and 2,2-diphenyl-1-picrylhydrazyl activity of both extracts. Both extracts displayed excellent antimicrobial potential against Staphylococcus aureus (S aureus) and Fusarium Solani (F solani). Aqueous and methanolic extracts exhibited higher inhibition of biofilm made by Bacillus subtilis (B subtilis) as 55.09 and 61.58%, respectively in comparison to biofilm of Escherichia coli ( E coli) as 48.11 and 36.51%, respectively. Methanol extract exhibited anti-amylase activity (IC50 5.26 ± .31 μg/mL) with an inhibition rate of 68.11% whereas IC50 of aqueous extract was 6.59 ± .53 μg/mL with an inhibition rate of 63.53%. Inhibitory potential against α-glucosidase (IC50 3.70 ± .94 ppm) was demonstrated by methanol extract in comparison to aqueous extract (IC50 7.58 ± .15). The study concluded that V thapsus roots have significant medicinal potential due to the presence of variety of bioactive molecules and can be used in pharmaceutical preparations.
Comparison of fluctuations and micro-vibration of the aerostatic bearing with the multi-hole integrated restrictor
Authors: Lu Zhiwei , Liu Xiyao , Liu Bo , Zhang Junan
Published: May 2022

In order to research the lubrication characteristics of various restrictors on the aerostatic bearing, an aerostatic bearing with the multi-hole integrated restrictor (MIR) was proposed in this paper. The gas film flow field at the orifice outlet of the MIR aerostatic bearing was numerically calculated and analyzed by using the numerical calculation method combined with the large eddy simulation and the over-relaxation iteration. The results showed that there was a pressure drop at the orifice outlet and the pressures were separated in the thickness direction of the gas film clearance, and the lubrication performance of the multi-hole integrated restrictor was better than that of the single-orifice restrictor. The fluctuation and micro-vibration of the flow field can be effectively reduced and suppressed by reasonably setting the parameter of the multi-hole integrated restrictor. It was proposed that the region near the orifice outlet of the MIR aerostatic bearing was divided into five regions to analyze and discuss the lubrication characteristics of the flow field, which provided a good means and method for further research the fluctuation and micro-vibration of the flow field at the orifice outlet.
Sex differences in long-term outcomes of patients with deep vein thrombosis
Authors: Chan Shin Mei , Brahmandam Anand , Valcarce-Aspegren Marcus , Zhuo Haoran , Zhang Yawei , Tonnessen Britt H , Lee Alfred I , Ochoa Chaar Cassius Iyad
Published: May 2022

Objective

Sex differences in short-term outcomes of patients with deep vein thrombosis (DVT) have been reported, but differences in long-term outcomes remain poorly characterized. This study aimed to evaluate sex differences in long-term mortality, venous thromboembolism (VTE)-related mortality, and bleeding-related mortality in patients with DVT at a tertiary care center.

Methods

A retrospective chart review from 2012 to 2018 of all consecutive patients diagnosed with DVT was performed. Patients were grouped by sex, and baseline characteristics and treatment modalities were compared. Long-term outcomes of recurrent VTE, bleeding, and related mortalities were analyzed. Multivariable regression analysis was performed to determine factors associated with overall mortality.

Results

A total of 1043 (female = 521 and male = 522) patients with DVT were captured in this study period. Female patients were older (64.7 vs 61.6 years old, p = 0.01) and less likely to be obese (68.2% vs. 71.1% , p = 0.04 ),but had a higher average Caprini score (6.73 vs 6.35, p = 0.04). There was no difference in anatomic extent of DVT, association with PE, and severity of PE between sexes. Most patients (80.5%) were treated with anticoagulation, with no differences in choice of anticoagulant or duration of anticoagulation between females and males. Male patients were more likely to undergo catheter-directed thrombolysis (CDT) for DVT (4.2% vs 1.7%, p = 0.02) and PE (2.7% vs 0.9%, p = 0.04). Female patients were more likely to receive systemic thrombolysis for PE (2.9% vs 1.1%, p = 0.05). After an average 2.3 years follow-up, there was significantly higher bleeding complications among females (22.2% vs 16.7%, p = 0.027). The overall mortality rate was 33.5% and not different between males and females. Females were more likely to experience VTE-related mortality compared to males (3.3% vs 0.6%, p = 0.002). On regression analysis, older age (OR = 1.04 [1.03–1.06]), cancer (OR = 7.64 [5.45–10.7]), and congestive heart failure (OR = 3.84 [2.15–6.86]) were independently associated with overall mortality.

Conclusions

In this study, there was no difference in overall long-term mortality between sexes for patients presenting with DVT. However, females had increased risk of long-term bleeding and VTE-related mortality compared to males.
Individual and situational influences on the propensity for unethical behavior in responses to organizational scenarios
Authors: Santalla-Banderali Zuleima , Malavé José
Published: May 2022

This article reports two studies evaluating the impact of moral intensity, work experience, and gender on the propensity (attitude, behavioral intention, and subjective norm) for unethical behavior of Venezuelan students and employees responding to different organizational scenarios, and controlling the effects of moral disengagement and empathy. One study singled out moral disengagement as a covariate, and the other did the same with empathy. In both studies, moral intensity, work experience, and gender acted as independent variables. Each study consisted of around 400 participants (totaling 801 participants in both studies): one-half were students without work experience and the other half were employees. For manipulating moral intensity, we used six scenarios describing ethically questionable situations. After reading each of the scenarios, participants answered the Multidimensional Ethics Scale to measure propensity for unethical behavior. After completing this phase, participants responded to the moral disengagement scale in Study 1 and the empathy scale in Study 2. This research did not find concluding, significant effects of moral intensity on the measures of the propensity for unethical behavior. Employees expressed higher intentions of acting unethically than students, though the effect was small (ε2 Study 1 = .016. ε2 Study 2 = .026). Gender had no significant effect on attitude and subjective norm; but, in behavioral intention, men's scores were significantly higher than women's in Study 1, but not in Study 2. Moral disengagement had a stronger effect than empathy on the propensity for unethical behavior (ε2 moral disengagement: attitude = .225, behavioral intention = .179, subjective norm = .159. ε2 empathy: attitude = .016, behavioral intention = .011, subjective norm = .010). The authors highlight the relevance of contrasting findings from less-developed countries with those from developed countries, commonly found in the literature, and suggest avenues for further research.
Feeling the music: The feel and sound of songs attenuate pain
Authors: Lad Dhillon , Wilkins Alex , Johnstone Emma , Vuong Quoc C
Published: May 2022

Background

Extensive research has demonstrated that music and touch can separately attenuate perceived pain intensity. However, little research has investigated how auditory and tactile stimulation can synergistically enhance pain attenuation by music. In the current study, we investigated whether tactile stimulation can enhance music-induced analgesia for noxious force stimulation on the fingertip.

Methods

We systematically applied force to 34 listeners’ fingertips to induce pain. We then compared the force measurement (in Newton) that gave rise to the same perceived moderate pain intensity when listeners were presented their self-selected liked or disliked song with auditory-only, tactile-only and auditory-tactile stimulation. Higher force indicated less perceived pain. The tactile stimulation were low-frequency modulations extracted from the songs and presented as vibrations on the wrist.

Results

The results showed a significant interaction between song preference and stimulation condition. Listeners had higher force measurements at the same moderate pain for their liked compared to disliked song only in the auditory-tactile condition. They also had higher force measurements for their liked song with auditory-tactile stimulation compared to the other remaining conditions except for the liked song with auditory-only stimulation.

Conclusions

The addition of tactile stimulation enhanced music-induced analgesia which reduced subjective pain intensity. The findings suggest that combined auditory and tactile stimulation may increase the affective content of self-selected preferred music, which may stimulate affective and motivation mechanisms which inhibit pain transmission.
Strategies for improving recruitment of pregnant women to clinical research: An evaluation of social media versus traditional offline methods
Authors: Cochrane Kelsey M , Hutcheon Jennifer A , Karakochuk Crystal D
Published: May 2022

Objectives

To evaluate the recruitment of pregnant women for a clinical trial in Vancouver, Canada, via social media versus offline methods and to explore optimization of social media campaigns.

Methods

Facebook was used to run nine social media campaigns (15 weeks total, CA$675). Offline methods were used concurrently over 64 weeks (printing costs: CA$300). The cost, rate of recruitment and conversion rate in each group was calculated. Performance metrics of social media campaigns (reach, impressions, clicks, inquiries, enrolments) were recorded. Linear regression was used to explore the association between metrics and dollars spent per campaign.

Results

In total, n = 481 inquiries were received: n = 51 (11%) via offline methods and n = 430 (89%) via social media. Enrolees (n = 60 total) included n = 24 (40%) and n = 36 (60%) via offline and social media methods, respectively. Gestational weeks upon inquiry (n = 251; mean ± SD) were not different among groups (offline: 13.3 ± 4.7; social media: 13.2 ± 5.6). Direct cost per enrolee was CA$13 and CA$19 via offline and social media methods, respectively (however, this does not include cost of labour). The rate of recruitment was approximately six times faster via social media. However, the conversion rate was higher via offline methods than social media (47% vs. 8%). The amount spent per campaign was significantly associated with improved clicks and inquiries, but not enrolments.

Conclusions

Social media was more efficient and effective than offline methods. We gained numerous insights for optimization of social media campaigns (dollars spent, attribution setting, photo testing, automatic optimization) to increase clicks and inquiries, however, this does not necessarily increase enrolments, which was more dependent on study-specific factors (e.g. time of year, study design).
Facilitators and Barriers of Reflective Learning in Postgraduate Medical Education: A Narrative Review
Authors: Gathu C
Published: May 2022

Background

Reflection in postgraduate medical education has been found to aid in the development of professional skills, improve clinical expertise, and problem solving with the aim of advancing lifelong learning skills and self-awareness, leading to good medical practice among postgraduate residents. Despite the evidenced benefits, reflection remains underused as a tool for teaching and learning, and few trainee physicians regularly engage in the process. Factors that affect the uptake of reflective learning in residency training have not yet been adequately explored.

Objective

The purpose of this review is to demonstrate the factors that influence the adoption of reflective learning for postgraduate students and their centrality to good clinical practice.

Methods

A review of the literature was performed using defined databases and the following search terms: ‘reflection’, ‘reflective learning’, ‘postgraduate medical education’, ‘barriers’ and ‘facilitators’. The search was limited to peer-reviewed published material in English between 2011 and 2020 and included research papers, reviews, and expert opinion pieces.

Results

Eleven relevant articles were included, which identified three main categories as facilitators and barriers to the adoption of reflective learning in postgraduate medical education. These included structure, assessment and relational factors. The structure of reflective practice is important, but it should not be too rigid. Assessments are paramount, but they should be multidimensional to accommodate the multicomponent nature of reflections. Relational factors such as motivation, coaching, and role modeling facilitate sustainable reflective practice.

Conclusions

This review suggests that the same factors that facilitate reflection can be a barrier if not used within the right epistemic. Educators should consider these factors to increase the acceptance and integration of reflective learning in curriculums by both teachers and learners.
A Possible Case of COVID-19 Booster Vaccine–Associated Rhabdomyolysis and Acute Kidney Injury
Authors: Unger Kendra , Ponte Charles D. , Anderson Dylan
Published: May 2022

Background: Nearly 10 billion doses of the various messenger ribonucleic acid (mRNA) and viral vector vaccines against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have been administered worldwide. Adverse drug reactions (ADRs) have been overwhelmingly mild to moderate in nature. Rare side effects have included myocarditis/pericarditis, thrombosis with thrombocytopenia syndrome (TTS), Guillain-Barré Syndrome (GBS), and death. However, vaccine-related ADR data are still being collected using a variety of reporting systems. Purpose: We will describe a case of suspected mRNA coronavirus disease 2019 (COVID-19) booster–related rhabdomyolysis in a woman who developed signs and symptoms 10 days after administration of the vaccine dose. With a Naranjo ADR probability score of 4, the vaccine was deemed to be a possible cause of our patient’s rhabdomyolysis. Methods: A search of the VAERS (Vaccine Adverse Event Reporting System) mined in November 2021 revealed 386 reported cases of COVID-19 vaccine–related rhabdomyolysis. However, system limitations make the utility of the information problematic. Conclusions: It is vitally important that clinicians, scientists, and patients are aware of rhabdomyolysis as a potential side effect of vaccination. Suspected vaccine-related ADRs should be promptly and accurately reported via VAERS or other surveillance systems to support the ongoing effort to ensure vaccine safety.
Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
Authors: Chauffard Aline , Bridevaux Pierre-Olivier , Carballo Sebastian , Prendki Virginie , Reny Jean-Luc , Stirnemann Jérôme , Garin Nicolas
Published: May 2022

Background

Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit.

Methods

This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity.

Results

Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2–6.2), heart failure (OR 2.6, 95% CI 1.1–6.1), absence of chest pain (OR 3.0, 95% CI 1.1–8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4–6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3–5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71–0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity.

Conclusion

Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects.

Trial registration: NCT00818610.
DNA methylation of miR-138 regulates cell proliferation and EMT in cervical cancer by targeting EZH2
Authors: Chen Rui , Gan Qiyu , Zhao Shuting , Zhang Dongrui , Wang Shunli , Yao Lili , Yuan Min , Cheng Jingxin
Published: May 2022

Background

Emerging evidence has identified miR-138 as a tumor suppressor that can suppress the proliferation of various cancers. Meanwhile, the cause of abnormal miR-138 expression in cervical cancer remains uncertain. This study clarified the mechanism by which miR-138 regulates proliferation, invasion, metastasis, and EMT in cervical cancer cells.

Results

miR-138 expression in human cervical cancer and adjacent normal tissue was measured using qPCR. SiHa and C33A cells were used to determine the function of miR-138 via miR-138 mimic or inhibitor transfection, followed by wound healing, Cell Counting Kit-8, flow cytometry, and Transwell assays. Epithelial and mesenchymal marker expression was analyzed using Western blotting. DNA methylation in the miR-138 promoter was examined using bisulfite sequencing PCR. The downstream target genes of miR-138 were identified via bioinformatics analysis and luciferase reporter assays. A tumor xenograft model was employed to validate DNA methylation-induced miR-138 downregulation and tumor growth inhibition in cervical cancer in vivo. miR-138 levels were significantly lower in cervical cancer tissues than in adjacent control tissues. Furthermore, lower miR-138 expression and higher CpG methylation in the miR-138 promoter were identified in lymph node-positive metastatic cervical cancer tumors versus that in non-metastatic tumor tissues. Upon miR-138 overexpression, cell proliferation, metastasis, invasion, and EMT were suppressed. miR-138 agomir transfection and demethylating drug treatment significantly inhibited cervical tumor growth and EMT in tumor xenograft models. DNA methylation inhibited miR-138 transcription, and enhancer of zeste homolog 2 (EZH2) downregulation mediated the tumor suppressor function of miR-138 in cervical cancer.

Conclusion

We demonstrated that miR-138 suppresses tumor progression by targeting EZH2 in cervical cancer and uncovered the role of DNA methylation in the miR-138 promoter in its downregulation. These findings demonstrated the potential of miR-138 to predict disease metastasis and/or function as a therapeutic target in cervical cancer.
Social alignment matters: Following pandemic guidelines is associated with better wellbeing
Authors: Tunçgenç Bahar , Newson Martha , Sulik Justin , Zhao Yi , Dezecache Guillaume , Deroy Ophelia , Zein Marwa El
Published: May 2022

Background

In response to the Covid-19 pandemic, most countries implemented physical distancing measures. Many mental health experts warned that through increasing social isolation and anxiety, these measures could negatively affect psychosocial wellbeing. However, socially aligning with others by adhering to these measures may also be beneficial for wellbeing.

Methods

We examined these two contrasting hypotheses using cross-national survey data (N = 6675) collected fortnightly from participants in 115 countries over 3 months at the beginning of the pandemic. Participants reported their wellbeing, perceptions of how vulnerable they were to Covid-19 (i.e., high risk of infection) and how much they, and others in their social circle and country, were adhering to the distancing measures.

Results

Linear mixed-effects models showed that being a woman, having lower educational attainment, living alone and perceived high vulnerability to Covid-19 were risk factors for poorer wellbeing. Being young (18–25) was associated with lower wellbeing, but longitudinal analyses showed that young people’s wellbeing improved over 3 months. In contrast to widespread views that physical distancing measures negatively affect wellbeing, results showed that following the guidelines was positively associated with wellbeing even for people in high-risk groups.

Conclusions

These findings provide an important counterpart to the idea that pandemic containment measures such as physical distancing negatively impacted wellbeing unequivocally. Despite the overall burden of the pandemic on psychosocial wellbeing, social alignment with others can still contribute to positive wellbeing. The pandemic has manifested our propensity to adapt to challenges, particularly highlighting how social alignment can forge resilience.
“Psychometric properties of the Norwegian foot function index revised short form”
Authors: Mørk Marianne , Hoksrud Aasne Fenne , Soberg Helene Lundgaard , Zucknick Manuela , Heide Marte , Groven Karen Synne , Røe Cecilie
Published: May 2022

Background

Foot disorders affect up to one quarter of the adult population. Plantar fasciopathy is a common cause of foot pain associated with decreased activity level and quality of life. Patient-reported outcome measures are important in assessing the burden of a condition as well as in research on the effects of interventions. The Foot Function Index revised short form (FFI-RS) is a region specific questionnaire frequently used in research. This study aimed to cross-culturally adapt the FFI-RS into Norwegian and to test its psychometric properties.

Methods

The FFI-RS was translated into Norwegian (FFI-RSN) following international guidelines. 139 patients with foot disorders (88% with plantar fasciopathy) were included at baseline to measure internal consistency, explorative factor analysis, construct validity and floor and ceiling effects. 54 patients were included after 1 week for test-retest reliability and smallest detectable change analyses. 100 patients were included for responsiveness and minimal important change at 3 months.

Results

Cronbach’s alpha for internal consistency was 0.97 and factor analysis supported the use of the total score of the FFI-RSN. Two out of three predefined hypotheses were confirmed by assessing the construct validity with Spearman’s correlation coefficient. Quadratic weighted Kappa for test-retest reliability showed 0.91 (95% CI 0.86–0.96) and the smallest detectable change was 6.5%. The minimal important change was 8.4% and the area under the receiver operating characteristic curve for responsiveness was 0.78 (95% CI 0.69–0.87). We found no floor or ceiling effects on the total score of the FFI-RSN.

Conclusions

The present study showed excellent reliability of the FFI-RSN and supports the use of the total score of the questionnaire. Furthermore, we found the FFI-RSN to have acceptable responsiveness in relation to change in general health. Smallest detectable change, minimal important change and responsiveness were presented as novel results of the total score of the FFI-RS. FFI-RSN can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy.

Trial registration

Clinical Trials.gov NCT04207164. Initial release 01.11.19.
Psychometric evaluation of the Ethical Caring Competency Scale in nursing
Authors: Katayama Harumi , Muramatsu Taeko , Aoki Yoshimi , Nagashima Eri
Published: May 2022

Background

An ethical competence list for nurses could guide educators and managers in the field of health care to both support the development of ethical conduct and improve the assessment of ethical competence in health care.

Aim

This study aimed to verify the reliability and validity of the Ethical Caring Competency Scale (ECCS) and to obtain suggestions for its use as an evaluation form in rubric format among a sample of Japanese nurses.

Research design

This research employed a descriptive and cross-sectional design.

Participants and research context

A self-administered questionnaire was distributed to 1157 nurses working in two hospitals in Japan. The contents of the survey were demographic data, a draft of the ECCS consisting of 22 competencies from four core competencies, questions regarding experience in learning about medical/nursing ethics, and the Work Motivation Measurement Scale for Nurses. Three levels of difficulty for the 22 items were established using relative comparisons of the mean scores within the four core competencies. Three groups, namely, an expert group, a middle group, and a beginner group, were categorized according to the quartiles of the total ECCS score.

Ethical considerations

This study was approved by the Clinical Research Ethics Committee of Hamamatsu University School of Medicine (Decision no. 18-267). The ethical principles of voluntary participation, anonymity, and confidentiality were considered.

Findings

A total of 962 valid responses were analyzed. The ECCS scores for the three levels of difficulty were significantly different from each other. Stability was confirmed by the test-retest of the total ECCS scores (r = .900, p < .0001). The total ECCS scores for the three groups showed significant differences in all pairs. The Cronbach’s α coefficient ranged from .72 to .89 for each core competency, and internal consistency was confirmed.

Conclusion

The reliability and validity of the ECCS as a scale were statistically verified, and we were able to obtain suggestions for its application as a form of evaluation in rubric format.
What are the health consequences associated with differences in medical malpractice liability laws? An instrumental variable analysis of surgery effects on health outcomes for proximal humeral facture across states with different liability rules
Authors: Chen Brian , Floyd Sarah , Jindal Dakshu , Chapman Cole , Brooks John
Published: May 2022

Background

States enacted tort reforms to lower medical malpractice liability, which are associated with higher surgery rates among Medicare patients with shoulder conditions. Surgery in this group often entails tradeoffs between improved health and increased risk of morbidity and mortality. We assessed whether differences in surgery rates across states with different liability rules are associated with surgical outcomes among Medicare patients with proximal humeral fracture.

Methods

We obtained data for 67,966 Medicare beneficiaries with a diagnosis of proximal humeral fracture in 2011. Outcome measures included adverse events, mortality, and treatment success rates, defined as surviving the treatment period with < $300 in shoulder-related expenditures. We used existing state-level tort reform rules as instruments for surgical treatment and separately as predictors to answer our research question, both for the full cohort and for stratified subgroups based on age and general health status measured by Charlson Comorbidity Index and Function-Related Indicators.

Results

We found a 0.32 percentage-point increase (p < 0.05) in treatment success and a 0.21 percentage-point increase (p < 0.01) in mortality for every 1 percentage-point increase in surgery rates among patients in states with lower liability risk. In subgroup analyses, mortality increased among more vulnerable patients, by 0.29 percentage-point (p < 0.01) for patients with Charlson Comorbidity Index >  = 2 and by 0.45 percentage-point (p < 0.01) among those patients with Function-Related Indicator scores >  = 2. On the other hand, treatment success increased in patients with lower Function-Related Index scores (< 2) by 0.54 percentage-point (p < 0.001). However, younger Medicare patients (< 80 years) experienced an increase in both mortality (0.28 percentage-point,p < 0.01) and treatment success (0.89 percentage-point,p < 0.01). The reduced-form estimates are consistent with our instrumental variable results.

Conclusions

A tradeoff exists between increased mortality risk and increased treatment success across states with different malpractice risk levels. These results varied across patient subgroups, with more vulnerable patients generally bearing the brunt of the increased mortality and less vulnerable patients enjoying increased success rates. These findings highlight the important risk-reward scenario associated with different liability environments, especially among patients with different health status.
Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible solutions
Authors: De Veer Anke J. E. , De Groot Kim , Verkaik Renate
Published: May 2022

Background

Home-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown.

Objective

To examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems.

Design

Qualitative descriptive research.

Setting

Communities across the Netherlands.

Participants

Twenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community.

Methods

Semi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed.

Results

Ten subthemes emerged that were clustered into three main themes: ‘dilemmas arise in choosing the right nursing care’; ‘cooperation and an integrated approach are often necessary, but lacking’; ‘home-care nurses have insufficient competencies’. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses.

Conclusions

Care for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.