bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical Thrombectomy in Pulmonary Embolism Associated with COVID-19: A “Clotography” Gallery
Authors: Balanescu Dinu V. , Kado Herman S. , Mertens Amy , Chand Rajat , Savin Michael , McNally Vicki , Bowers Terry R.
Published: August 2021

Venous thromboembolism from a “thrombotic storm”–like syndrome is a major cause of morbidity and mortality in patients with active or “recovered” COVID-19. Patients should be risk-stratified, optimally by a pulmonary embolism (PE) response team (PERT), and considered for escalation of care if found with intermediate or high-risk PE. We present a series of patients with COVID-19-associated PE and thrombotic storm with D-dimer >10 000 ng/mL who underwent successful mechanical thrombectomy for intermediate to high-risk PE. All patients had immediate improvement in hemodynamics and large amounts of thrombi were retrieved.
Joy in the Workplace: The Mayo Clinic Experience
Authors: Kelsey Elizabeth A.
Published: August 2021

The COVID-19 pandemic has changed dynamics in the healthcare setting, through social distancing guidelines and new protocols to promote safety for employees and patients. Although some find themselves more productive in this spread out or virtual environment, the social aspect of the work day has dramatically changed. Staying connected during the day or week comes with additional efforts to seek out opportunities to network and collaborate with colleagues with this work environment shift. Healthcare workers are already at high risk of occupational burnout. In addition, the COVID-19 pandemic has brought additional stressors to individuals outside of their workload compromising a balanced work–life integration. Consequently, personal well-being may become jeopardized due to physical, mental, and social constraints brought on by the pandemic. Mayo Clinic has implemented a joy in the workplace structure to support individual well-being and create space for healthcare workers to be energized in order to put the needs of the patient first and deliver excellent care. Joy at Mayo Clinic contributes to joy in the workplace, reduced burnout, and personal well-being.
Priorities for research during the Coronavirus SARS-CoV-2 (COVID-19) pandemic and beyond: a survey of nurses, midwives and health visitors in the United Kingdom
Authors: Manning Joseph C. , Bramley Louise , Coad Jane , Evans Catrin , Evans Kerry , Tinkler Linda , Cooper Joanne
Published: August 2021

Background

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a significant burden on global healthcare systems. Nurses, midwives and health visitors remain critical to the rapid responses and innovative solutions required. Their views, however, on priorities for research is mainly muted, necessitating greater clarity to inform research that benefits patients and families across the life course.

Aims

To identify priorities for research in relation to the COVID-19 pandemic and ‘beyond’, as recommended by nurses, midwives and health visitors across the four countries of the United Kingdom (UK).

Methods

A cross-sectional, web-based survey design was conducted (5th May-4th June 2020). In addition to the completion of demographic information, respondents identified up to three research areas important to their clinical care/practice in the context of COVID-19 and beyond. Data were imported for analysis into NVivo 12 (QSR International). Descriptive analysis was used to summarise the demographic variables. Free text responses were analysed using a semantic, inductive thematic analysis approach.

Results

In total 1,296 responses were received from a self-selected sample of predominantly of female, registered nurses of white British ethnicity, located in England and working for acute care providers, providing 3,444 research priority recommendations. Four higher-order themes emerged, (1) New and unknown frontiers; (2) Care and treatment solutions; (3) Healthcare leadership and inclusive workforce; and (4) Emotional and mental health impact.

Conclusions

At a time of significant global uncertainty, the collective voice of nursing, midwifery and health visiting is never more important to inform clinical research. Whilst generalisability is limited by the homogeneity of the sample, this is the first survey to elicit the priorities for research in relation to the COVID-19 pandemic and beyond from nurses, midwives and health visitors in the UK. Novel findings developed through a rigorous analytical approach illuminate areas that require both urgent and long-term attention and provide a platform to direct priority refinement, future research and the basis for evidence translation.
The Need to Improve Leadership to Address Poor Oral Health
Authors: Adenuga-Taiwo Olugbenga Adetokunbo , Batchelor Paul Anthony
Published: August 2021

The FDI World Dental Federation (FDI) has recently published their outline for shaping the future to improve oral health. In the document, several key features were identified including a need for a more collaborative approach across the differing health care sectors and the development of a responsive educational model. While such an approach is to be welcomed, a key element to ensure the realisation of the vision lies with developing leadership within the dental sector. This paper argues that central to this lies in the ability to inspire individuals and organisational excellence, to create and attain a shared vision, and to manage change to attain the organisation’s strategic ends and successful performance. Furthermore, if these goals are to be realised there is a requirement for educational developments at all levels of training that adheres to key principles including establishing a bond between all care workers to ensure that the determinants of poor oral health and its subsequent management are undertaken efficiently and are effective.
You Don’t Fool Me: On Scams, Scambaiting, Deception, and Epistemological Ambiguity at R/scambait on Reddit
Authors: Dynel Marta , Ross Andrew S.
Published: August 2021

With a focus on the online phenomena of scamming and scambaiting, this article explores users’ communicative activities on Reddit’s r/scambait subreddit. Drawing on a representative corpus viewed through grounded theory, we establish the basic categories of posts and then unpack those further to reveal the deceptive practices being undertaken by both scammers and scambaiters, as well as Redditors’ untruthfulness in their fabricated posts. The analysis reveals that the r/scambait subreddit exists as a site of humorous entertainment arising from various forms of deception. Scammers’ deceptive strategies are depicted as amusingly naïve and inefficient, while scambaiters’ deceptive messages targeted at scammers demonstrate great creativity and wittiness. In both cases, scammer-victims are disparaged for being immensely gullible or downright stupid; and Redditors earn online plaudits for submitting the most upvoted posts. Our significant finding is that posts such as those at r/scambait should never be taken at face value due to their inherent epistemological ambiguity, to which the users choose to remain oblivious or indifferent. Furthermore, on a general plane, this study indicates a potential shift in the emic understanding of the concept of “scambaiting” from a punitive measure and an educational instrument to a creative practice geared toward posters’ kudos and users’ joint humorous experience through “baitertainment” and “scamusement.”
Rapid Independent Health Literacy Assessment: A Pilot Study Among Native English-speaking and Low English Proficiency Patients
Authors: Hargiss John Blade , St. Jeor Jeffery D. , Horn Jennifer L. , Garrison Gregory M.
Published: August 2021

Objectives:

Health literacy is an individual’s capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. Failure to understand and correctly execute a plan of care often leads to poor health outcomes. Determining patient health literacy allows health care providers to tailor their plan of care instructions, increasing the probability of understanding, and adherence. Several validated health literacy tests have been developed to assess the health literacy of individuals and ethnic groups. However, because a proctor is required to administer these tests, their usefulness in clinical settings is limited. The issue of health literacy is especially relevant within minority groups. This research focused on producing a translatable assessment that can be administered quickly without a proctor.

Methods:

We developed a 15-question instrument (the RIHLA) in English using the Delphi method with a panel of bilingual experts and translated it into Spanish. Internal reliability was assessed using Cronbach’s alpha for 3 groups: Native English-speaking College students (NESC), Native English-speaking patients (NES), and Limited English Proficient Spanish-speaking patients (LEP). External validity was assessed using Pearson’s correlation coefficient to compare our instrument to a previously validated, proctored instrument measuring health literacy (the SAHL-E).

Results:

Four hundred fifteen subjects completed the RIHLA. Of these, 192 (46.3%) were NESC, 208 (50.1%) were NES, and 15 (3.6%) were LEP. The mean number of correct answers was 11.2, 11.6, and 8.3 respectively with the LEP group scoring lower ( P < .01). Cronbach’s alpha was >.70 for each group. Moderate correlation between the RIHLA and the previously validated instrument was present ( P < .01) with Pearson’s r = .47 (95% CI: 0.18-0.69).

Conclusion:

The RIHLA is a non-proctored assessment tool that may provide a measure of patients’ health literacy in multiple languages. Further studies with larger sample sizes are necessary to confirm the reliability, validity, and generalizability to a wider population.
Complex Repair of a Completely Fused Nullicuspid Aortic Valve Late in Adolescence
Authors: Meza James M. , Nellis Joseph R. , Rankin J. Scott , Wolsky Ryan M. , Badhwar Vinay , Hughes G. Chad , Turek Joseph W.
Published: August 2021

We report a case of an 18-year-old female who presented with severe aortic stenosis and insufficiency, eight years following resection of a subaortic membrane. On echocardiography, she was found to have a completely fused or nullicuspid valve, with three equal sinuses and three commissural fusions. Aortic valve repair included leaflet tricuspidization, three commissurotomies, trileaflet ring annuloplasty, and pericardial leaflet reconstruction. At one year follow-up, the patient is asymptomatic, with stable gradients.
Coping and Motivation for Change—An Interview Study of the Experience From Participation in an Educational Program for Patients With Medication-Overuse Headache
Authors: Mose Louise Schlosser , Bornhøft Jane Orry , Primdahl Jette , Gram Bibi
Published: August 2021

Patient educational programs (PEP) are recommended as part of the treatment for medication-overuse headache (MOH), however, knowledge of patients’ experiences when participating is sparse. This study explored how patients experienced participating in a PEP focusing on empowering coping strategies and motivation for behavioral changes. Eight individual semistructured interviews were conducted among patients suffering from MOH who had attended a PEP intervention in a randomized controlled trial. The PEP involved techniques from Motivational Interviewing as its communicative approach. Data collection, analysis, and interpretation were performed within a phenomenological-hermeneutic framework. Results showed that patients found the educational program relevant regarding coping with headache. Participants shifted from focusing on medication to include other ways to manage headache. Experiences regarding ambivalent feelings for behavioral change and feelings of stigmatization were key issues. Participation in this PEP helped the participants cope with headache in new ways relevant to their everyday lives and challenges. The individualized approach enabled by Motivational Interviewing was experienced as useful by the participants, as it actively involved them in the treatment.
Successful Psychological Strategies of Experienced Chronic Fatigue Patients: A Qualitative Study
Authors: Hall Katherine H , Amos Claire , Jaye Chrystal , Young Jessica
Published: August 2021

Trying to care for patients with medically unexplained symptoms (MUS) can lead to frustration and disappointment for both patients and health care professionals alike. Learning positive ways to assist patients avoids professionals collapsing into therapeutic nihilism. We sought to understand how people with such symptoms can live well despite (or even because of) their condition. Chronic fatigue was chosen as the exemplar symptom. Participants were invited to join the research if they, themselves, considered they were living well with this symptom. One-on-one interviews using an appreciative enquiry approach were performed and thematic analysis undertaken. Twelve participants were interviewed before data saturation occurred. The emotional stance or relationship a participant had with, and towards, their illness was the primary determinant underlying their interpretation of “living well.” Five major themes of this meta-theme were identified: (1) engaging with elusiveness, (2) befriending uncertainty, (3) reflecting on self, (4) living creatively, and (5) moving in stillness. Encouraging patients who are struggling with MUS to consider how they emotionally engage with their illness via these 5 positive dynamics may lead to better health outcomes for patients and happier, more fulfilled health care professionals.
Maryland’s Underage Sexting Case: Punishing Revenge Porn Victims?
Authors: Lalli Jaideep Singh
Published: August 2021

In 2019, the US State of Maryland’s highest court upheld the conviction of a 16-year-old minor for distributing her own ‘child pornography’ when she privately sent a clip of her performing a (completely legal) sexual act to a social media group of which only she and her two best friends were members. Considering that the child porn statute was never meant to prosecute legal and consensual sexting, this criminalization appears to be contra legem in light of the fact that the Court would not have regarded it as an offence if the girl was two years older (which does not make any difference to the legality of the sexual act since the age of sexual consent in Maryland is 16). The Court’s penalization of this act of sexting seems inappositely puritanical especially when it is noted that the convict was a victim of ‘revenge porn’ since one of the two friends leaked the clip in her school in an apparent act of revenge after their friendship ended. This paper analyses both the majority and dissenting opinions of this 2019 judgment to come to the conclusion that the majority ignores the true purport of the US Supreme Court decisions and wrongly invokes the doctrines for interpreting legislative intent to buttress its stance. As Maryland has criminalized acts of ‘revenge porn’, this article’s focus extends to examining how the Court’s failure of factoring in the effect of Maryland’s ‘revenge porn’ statute in discerning the legislative intent of the ‘child porn’ statute has produced an aberration of a statutory interpretation.
Placental 13C-DHA metabolism and relationship with maternal BMI, glycemia and birthweight
Authors: Watkins Oliver C. , Selvam Preben , Appukuttan Pillai Reshma , Cracknell-Hazra Victoria K. B. , Yong Hannah E. J. , Sharma Neha , Cazenave-Gassiot Amaury , Bendt Anne K. , Godfrey Keith M. , Lewis Rohan M. , Wenk Markus R. , Chan Shiao-Yng
Published: August 2021

Background

Fetal docosahexaenoic acid (DHA) supply relies on preferential transplacental transfer, which is regulated by placental DHA lipid metabolism. Maternal hyperglycemia and obesity associate with higher birthweight and fetal DHA insufficiency but the role of placental DHA metabolism is unclear.

Methods

Explants from 17 term placenta were incubated with 13C-labeled DHA for 48 h, at 5 or 10 mmol/L glucose treatment, and the production of 17 individual newly synthesized 13C-DHA labeled lipids quantified by liquid chromatography mass spectrometry.

Results

Maternal BMI positively associated with 13C-DHA-labeled diacylglycerols, triacylglycerols, lysophospholipids, phosphatidylcholine and phosphatidylethanolamine plasmalogens, while maternal fasting glycemia positively associated with five 13C-DHA triacylglycerols. In turn, 13C-DHA-labeled phospholipids and triacylglycerols positively associated with birthweight centile. In-vitro glucose treatment increased most 13C-DHA-lipids, but decreased 13C-DHA phosphatidylethanolamine plasmalogens. However, with increasing maternal BMI, the magnitude of the glucose treatment induced increase in 13C-DHA phosphatidylcholine and 13C-DHA lysophospholipids was curtailed, with further decline in 13C-DHA phosphatidylethanolamine plasmalogens. Conversely, with increasing birthweight centile glucose treatment induced increases in 13C-DHA triacylglycerols were exaggerated, while glucose treatment induced decreases in 13C-DHA phosphatidylethanolamine plasmalogens were diminished.

Conclusions

Maternal BMI and glycemia increased the production of different placental DHA lipids implying impact on different metabolic pathways. Glucose-induced elevation in placental DHA metabolism is moderated with higher maternal BMI. In turn, findings of associations between many DHA lipids with birthweight suggest that BMI and glycemia promote fetal growth partly through changes in placental DHA metabolism.
Association of CASC18/miR-20a-3p/TGFB2 ceRNA axis with occult lymph node metastasis in tongue squamous cell carcinoma
Authors: Zhou Bo , Zhou Yue , Liu Ying , Zhang Hailin , Mao Huangxing , Peng Mingjing , Xu Anji , Li Zan , Wang Hui , Tan Haolei , Ren Huayi , Zhou Xiao , Long Ying
Published: August 2021

Background

Tongue squamous cell carcinoma (TSCC) ranks as the most prevalent malignancy in the oral cavity. TSCC patients with occult lymph node metastasis (OLNM) are thought to be at risk of worse outcome. However, regulatory mechanisms underlying OLNM remain less investigated.

Methods

In the present study, CASC18/miR-20a-3p/TGFB2 axis was identified and evaluated by bioinformatic and qRT-PCR analyses. Effects of CASC18 knockdown on cell migration and invasion were determined by wound healing and transwell assays. Western blot, ELISA, RNA pulldown and luciferase reporter assays were performed for mechanism verification.

Results

CASC18 was identified up-regulating in TSCC tumours, and especially in those from patients with OLNM. Importantly, we found higher CASC18 expression was positively correlated with the presence of OLNM and worse outcome of TSCC patients. Furthermore, we demonstrated that CASC18 knockdown repressed cell migration and invasion through inhibiting epithelial-mesenchymal transition, which could be partly rescued by miR-20a-3p inhibitor. Regarding the molecular mechanism, we further confirmed that CASC18 functioned as a ceRNA to sponge miR-20a-3p to enhanceTGFB2 expression and secretion.

Conclusion

In conclusion, we have reported a novel CASC18/miR-20a-3p/TGFB2 ceRNA axis in OLNM of TSCC. Our findings will contribute to a deeper understanding of the molecular mechanism of OLNM in TSCC, and facilitate the development of diagnostic methods for assisting treatment decision-making.
The imaging evaluation of acetabular labral lesions
Authors: Liu Yuwei , Lu Wei , Ouyang Kan , Deng Zhenhan
Published: August 2021

The acetabular labrum is an important structure that contributes to hip joint stability and function. Diagnosing labral tears involves a comprehensive assessment of clinical symptoms, physical examinations, imaging examinations, and arthroscopic confirmation. As arthroscopy is an invasive surgery, adjuvant imaging of the acetabular labrum is increasingly imperative for orthopedists to diagnose and assess labral lesions prior to hip arthroscopy for surgical management. This article reviews the current imaging strategies for the evaluation of labrum lesions.
Porous Carbon Substrate Improving the Sensing Performance of Copper Nanoparticles Toward Glucose
Authors: Qu Zewen , Li Shi , Feng Wenshuai , Kan Shuting , Gao Xiaohui , Guo Aimin , Li Hongjian , Deng Lianwen , Huang Shengxiang , Zhao Yan , Chen Wei
Published: August 2021

An accurate sensor to rapidly determine the glucose concentration is of significant importance for the human body health, as diabetes has become a very high incidence around the world. In this work, copper nanoparticles accommodated in porous carbon substrates (Cu NP@PC), synthesized by calcinating the filter papers impregnated with copper ions at high temperature, were designed as the electrode active materials for electrochemical sensing of glucose. During the formation of porous carbon, the copper nanoparticles spontaneously accommodated into the formed voids and constituted the half-covered composites. For the electrochemical glucose oxidation, the prepared Cu NP@PC composites exhibit much superior catalytic activity with the current density of 0.31 mA/cm2 at the potential of 0.55 V in the presence of 0.2 mM glucose. Based on the high electrochemical oxidation activity, the present Cu NP@PC composites also exhibit a superior glucose sensing performance. The sensitivity is determined to be 84.5 μA /(mmol.L) with a linear range of 0.01 ~ 1.1 mM and a low detection limit (LOD) of 2.1 μmol/L. Compared to that of non-porous carbon supported copper nanoparticles (Cu NP/C), this can be reasonable by the improved mass transfer and strengthened synergistic effect between copper nanoparticles and porous carbon substrates.
Exploiting genomic synteny in Felidae: cross-species genome alignments and SNV discovery can aid conservation management
Authors: Samaha Georgina , Wade Claire M. , Mazrier Hamutal , Grueber Catherine E. , Haase Bianca
Published: August 2021

Background

While recent advances in genomics has enabled vast improvements in the quantification of genome-wide diversity and the identification of adaptive and deleterious alleles in model species, wildlife and non-model species have largely not reaped the same benefits. This has been attributed to the resources and infrastructure required to develop essential genomic datasets such as reference genomes. In the absence of a high-quality reference genome, cross-species alignments can provide reliable, cost-effective methods for single nucleotide variant (SNV) discovery. Here, we demonstrated the utility of cross-species genome alignment methods in gaining insights into population structure and functional genomic features in cheetah (Acinonyx jubatas), snow leopard (Panthera uncia) and Sumatran tiger (Panthera tigris sumatrae), relative to the domestic cat (Felis catus).

Results

Alignment of big cats to the domestic cat reference assembly yielded nearly complete sequence coverage of the reference genome. From this, 38,839,061 variants in cheetah, 15,504,143 in snow leopard and 13,414,953 in Sumatran tiger were discovered and annotated. This method was able to delineate population structure but limited in its ability to adequately detect rare variants. Enrichment analysis of fixed and species-specific SNVs revealed insights into adaptive traits, evolutionary history and the pathogenesis of heritable diseases.

Conclusions

The high degree of synteny among felid genomes enabled the successful application of the domestic cat reference in high-quality SNV detection. The datasets presented here provide a useful resource for future studies into population dynamics, evolutionary history and genetic and disease management of big cats. This cross-species method of variant discovery provides genomic context for identifying annotated gene regions essential to understanding adaptive and deleterious variants that can improve conservation outcomes.
Myocardial bridging of the left anterior descending coronary artery as a risk factor for atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy: a matched case–control study
Authors: Nie Changrong , Zhu Changsheng , Yang Qiulan , Xiao Minghu , Meng Yanhai , Wang Shuiyun
Published: August 2021

Background

Myocardial bridging (MB) is associated with various forms of arrhythmia. However, whether MB is a risk factor for atrial fibrillation (AF) in patients with hypertrophic obstructive cardiomyopathy (HOCM) remains unknown. This study aimed to identify the relationship between myocardial bridging of the left anterior descending coronary artery (MB-LAD) and AF in patients with HOCM.

Methods

We reviewed the medical records of 1925 patients diagnosed with HOCM at Fuwai Hospital from January 2012 to March 2019. Patients with coronary artery disease, a history of heart surgery, and those who had not been subjected to angiography were excluded. Finally, 105 patients with AF were included in this study. The control group was matched in a ratio of 3:1 based on age and gender.

Results

Forty-three patients were diagnosed with MB-LAD in this study. The presence of MB was significantly higher in patients with AF than in those without AF (19.0% vs. 7.3%; p = 0.001), although MB compression and MB length did not differ between the two groups. In conditional multivariate logistic analysis, MB (odds ratio [OR] 2.33; 95% confidence interval [CI] 1.08–5.01; p = 0.03), pulmonary arterial hypertension (OR 2.63; 95% CI 1.26–5.47; p = 0.01), hyperlipidemia (OR 1.83; 95% CI 1.12–3.00; p = 0.016), left atrial diameter (OR 1.09; 95% CI 1.05–1.13; p < 0.001), and interventricular septal thickness (OR 1.06; 95% CI 1.003–1.12; p = 0.037) were independent risk factors for AF in patients with HOCM.

Conclusions

The presence of MB is an independent risk factor for AF in patients with HOCM. The potential mechanistic link between MB and the development of AF warrants further investigation.
Acute liver failure in Still’s disease relapse during pregnancy: case report and discussion of a possible trigger role of DILI
Authors: Marrone Giuseppe , Galati Francesco , Biolato Marco , Oddy Christopher , De Carolis Sara , Zoli Angelo , Grieco Antonio
Published: August 2021

Background

Still's disease is a rare systemic inflammatory disease with frequent but generally mild liver involvement. The most common cause of acute liver failure in western countries is drug-induced liver injury, while it has rarely been reported in subjects suffering from Still’s disease.

Case presentation

We report a case of a young woman presenting with SD reactivation in pregnancy and acute liver failure after delivery with a possible triggering role of drug induced liver injury.

Conclusions

The prompt recognition of Still's disease reactivation allowed early introduction of steroid therapy and resolution of the clinical picture. We discuss potential factors precipitating ALF in this case, and implications for the diagnosis and management of such patients.
Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol
Authors: Tuot Sovannary , Teo Alvin Kuo Jing , Prem Kiesha , Chhoun Pheak , Pall Chamroen , Ung Mengieng , Ly Penh Sun , Jimba Masamine , Yi Siyan
Published: August 2021

Background

Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia.

Methods

We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective.

Discussion

This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response.

Trial registration

ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.
Confusion, cognitive impairment, and spinal cord compression caused by plasmacytoma: a case report
Authors: Axenhus Michael , Bogdanovic Nenad
Published: August 2021

Background

Plasmacytomas are rare tumors comprised of neoplastic monoclonal plasma cells and can be found anywhere in the body. Plasmacytomas that involve the nervous system can give rise to diffuse symptoms depending on their location. Patients with confusion or dementia might be difficult to neurologically assess in an acute setting and the subtle symptoms of neurological pathology caused by rare malignancies might go undiagnosed.

Case presentation

The patient is an 80 year old man presenting to the ER with walking difficulties, pain, and confusion. He underwent neurological evaluation for dementia and was eventually diagnosed with possible Alzheimer’s disease and a malignant plasmacytoma causing spinal cord compression. His CSF sample showed normal amyloid rate and very low Aβ. Following rehabilitation and oncological treatment, his walking ability and confusion improved.

Conclusion

This case is unique as we demonstrate that spinal cord compression by plasmacytoma can lead to abnormal CSF levels of several known pathology markers for Alzheimer’s disease and neuronal damage. We suggest that highly divergent amyloid CSF levels could be indicative of spinal pathologies affecting CSF circulation. We also suggest closer assessment of elderly confusion patients in ER settings by consultants specialized in neurological disorders.
An innovative intervention to improve respectful maternity care in three Districts in Ethiopia
Authors: Mengistu Birkety , Alemu Haregeweyni , Kassa Munir , Zelalem Meseret , Abate Mehiret , Bitewulign Befikadu , Mathewos Kedest , Njoku Kendra , Prose Neil S. , Magge Hema
Published: August 2021

Background

Mistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care.

As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions.

Methods

Facility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data.

Results

Significant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations.

Conclusion

This study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.
Neo-CheckRay: radiation therapy and adenosine pathway blockade to increase benefit of immuno-chemotherapy in early stage luminal B breast cancer, a randomized phase II trial
Authors: De Caluwé Alex , Buisseret Laurence , Poortmans Philip , Van Gestel Dirk , Salgado Roberto , Sotiriou Christos , Larsimont Denis , Paesmans Marianne , Craciun Ligia , Stylianos Drisis , Vandekerckhove Christophe , Reyal Fabien , Isabelle Veys , Eiger Daniel , Piccart Martine , Romano Emanuela , Ignatiadis Michail
Published: August 2021

Background

Residual breast cancer after neo-adjuvant chemotherapy (NACT) predicts disease outcome and is a surrogate for survival in aggressive breast cancer (BC) subtypes. Pathological complete response (pCR) rate, however, is lower for luminal B BC in comparison to the triple negative (TNBC) and HER2+ subtypes. The addition of immune checkpoint blockade (ICB) to NACT has the potential to increase pCR rate but is hampered by the lower immunogenicity of luminal B BC. Novel strategies are needed to stimulate the immune response and increase the response rate to ICB in luminal B BC.

Methods

The Neo-CheckRay trial is a randomized phase II trial investigating the impact of stereotactic body radiation therapy (SBRT) to the primary breast tumor in combination with an anti-CD73 (oleclumab) to increase response to anti PD-L1 (durvalumab) and NACT. The trial is designed as a three-arm study: NACT + SBRT +/− durvalumab +/− oleclumab. The result at surgery will be evaluated using the residual cancer burden (RCB) index as the primary endpoint. Six patients will be included in a safety run-in, followed by a randomized phase II trial that will include 136 evaluable patients in 3 arms. Inclusion is limited to luminal B breast cancers that are MammaPrint genomic high risk.

Discussion

combination of ICB with chemotherapy in luminal B BC might benefit from immune priming agents to increase the response rate. As none have been identified so far, this phase II trial will evaluate SBRT and oleclumab as potential immune priming candidates.

Trial registration

trial registered on ClinicalTrials.gov (NCT03875573) on March 14th, 2019.
Concentration levels of serum 25-Hydroxyvitamin-D and vitamin D deficiency among children and adolescents of India: a descriptive cross-sectional study
Authors: Mustafa Akif , Shekhar Chander
Published: August 2021

Background

Vitamin D is an essential micronutrient for the overall health and well-being of individuals. For strong musculoskeletal and neurological development of human body, vitamin D levels during childhood and adolescence have key importance. This is the first national-level study that analyzes the deficiency and concentration of serum 25-Hydroxyvitamin D [25(OH)D)] among Indian children and adolescents with respect to various demographic and socioeconomic characteristics.

Methods

Data of Comprehensive National Nutrition Survey (CNNS, 2016–18) was utilized for the present study. Vitamin D levels were assessed based on serum 25-hydroxyvitamin D concentration. Prevalence of vitamin D deficiency has been shown for the three age groups: 0–4 years (n = 12,764), 5–9 years (n = 13,482), 10–19 years (n = 13,065). Vitamin D deficiency was defined as: serum 25(OH)D < 12 ng/mL; and insufficiency as: 12 ng/ml ≤ 25(OH) < 20 ng/ml. 25(OH) D level higher than 20 ng/mL was accepted as adequate. Random slope multilevel logistic regression models were employed to assess the demographic and socioeconomic correlates of vitamin D deficiency.

Results

Mean serum 25(OH)D concentration level was found to be 19.51 ± 8.76, 17.73 ± 7.91, and 17.07 ± 8.16 ng/ml in age group 0–4 years, 5–9 years and 10–19 years respectively. 49.12% of the children aged 0–4 years were having insufficient level of vitamin D. Prevalence of vitamin D deficiency was comparatively higher among female adolescents (76.16%), adolescents living in rural region (67.48), Sikh individuals (0–4 years: 76.28%; 5–9 years: 90.26%; 10–19 years: 89.56%), and adolescents coming from rich households. North-Indian individuals were having substantially higher odds of vitamin D deficiency in all the three age groups.

Conclusion

The present study demonstrated that the prevalence of vitamin D deficiency is considerably high among children and adolescents of India. The study highlights high-risk group which require prompt policy interventions.
Impact of musculoskeletal disorders on healthy life expectancy in Japan
Authors: Ritsuno Yoshihiro , Kawado Miyuki , Morita Mitsuhiro , Yamada Harumoto , Kanaji Arihiko , Nakamura Masaya , Matsumoto Morio , Hashimoto Shuji , Fujita Nobuyuki
Published: August 2021

Background

Musculoskeletal disorders are a key cause of morbidity in elderly people. How musculoskeletal disorders relate to healthy life expectancy remain elusive. Hence, we aimed to estimate gains in healthy life expectancy from the elimination of musculoskeletal diseases and injuries by using recent national health statistics data in Japan.

Methods

Mortality data were taken from Japanese national life tables and death certificates in 2016. Information on medical diagnoses, injuries, and activity were obtained from the 2016 Comprehensive Survey of Living Conditions. We examined five disorders: rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture. The prevalence of limitations in activities of daily living (ADL) in the population after eliminating the disorder was estimated as the proportion of outpatients without the disorder and ADL limitations, inpatients without the disorder in hospitals and clinics, and people without the disorder who reside in long-term elderly care facilities.

Results

There were small gains in life expectancy from elimination of all selected musculoskeletal disorders (0.0–0.1 years). Elimination of rheumatoid arthritis, osteoporosis, and fracture slightly increased the expected years without activity limitation (0.1–0.4) and slightly decreased years with activity limitation (0.1–0.4 years). Meanwhile, elimination of arthrosis, low back pain, and arthrosis and low back pain moderately increased expected years without activity limitation (0.3–1.5 years) and decreased years with activity limitation (0.3–1.5 years). In addition, elimination of rheumatoid arthritis, arthrosis, low back pain, osteoporosis, and fracture decreased expected years with ADL limitations (0.0–0.8 years) and non-ADL limitations (0.0–0.3 years). A combination of arthrosis and low back pain showed a moderate decrease in expected years with both ADL limitations (0.7–1.1 years) and non-ADL limitations (0.3–0.4).

Conclusions

These findings provide clinical evidence that among the musculoskeletal disorders low back pain and arthrosis are the key factors for the elongation of healthy life expectancy.
A life-threatening case of pseudo-aldosteronism secondary to excessive liquorice ingestion
Authors: McHugh Joseph , Nagabathula Ramesh , Kyithar Ma Pyeh
Published: August 2021

Background

Liquorice is found in many food products, soft drinks, and herbal medicines. Liquorice ingestion is an uncommon cause of apparent mineralocorticoid excess or pseudo-aldosteronism. The mechanism involves the inhibition of 11-beta-hydroxysteroid dehydrogenase type-2 by the active ingredient called glycyrrhizin. This leads to the uninhibited activation of mineralocorticoid receptors by cortisol. Confectionary products that contain liquorice are readily available in many countries around the world.

Case presentation

We report a case of severe refractory hypokalaemia with hypertensive crisis and acute pulmonary oedema due to excessive liquorice consumption. A 79-year-old female presented to the emergency department following a road traffic accident. She described feeling weak and dizzy while driving before the collision. She attended her general practitioner (GP) several weeks earlier for fatigue and was being managed for hypokalaemia on oral potassium supplements. Investigations revealed hypertension (BP 180/69 mmHg), severe hypokalaemia (K 2.2 mmol/l), normal renal function, normal serum magnesium with metabolic alkalosis. Spot urinary potassium was 22 mmol/l. The patient denied taking medications including over-the-counter or herbal medication that can cause hypokalaemia. Hypokalaemia persisted despite aggressive intravenous (i.v.) and oral potassium replacement. She later developed a hypertensive crisis (BP 239/114 mmHg) with pulmonary oedema. She required admission to the intensive care unit and was managed with intravenous furosemide infusion and isosorbide dinitrate infusion. On further discussion, our patient admitted to struggling with nicotine cravings since quitting smoking two months earlier. She began eating an excessive amount of liquorice sweets to manage her cravings. Suppression of plasma renin and aldosterone supported the diagnosis of apparent mineralocorticoid excess secondary to excessive liquorice consumption. Her symptoms and hypokalaemia resolved after stopping liquorice intake.

Conclusions

This case highlights the life-threatening and refractory nature of hypokalaemia secondary to excessive liquorice consumption. This case also emphasizes the importance of comprehensive history taking including dietary habits. Increased awareness among the public is required regarding the potential health hazards of excessive liquorice consumption.
The role of 25-hydroxyvitamin-D3 and vitamin D receptor gene in human periodontal ligament fibroblasts as response to orthodontic compressive strain: an in vitro study
Authors: Küchler Erika Calvano , Schröder Agnes , Teodoro Vinicius Broska , Nazet Ute , Scariot Rafaela , Spanier Gerrit , Proff Peter , Kirschneck Christian
Published: August 2021

Background

This study aimed to investigate, if different physiological concentrations of vitamin D (25(OH)D3) and single nucleotide polymorphisms in vitamin D receptor (VDR) gene have an impact on gene expression in human periodontal ligament (hPDL) fibroblasts induced by simulated orthodontic compressive strain.

Methods

A pool of hPDL fibroblasts was treated in absence or presence of 25(OH)D3 in 3 different concentrations (10, 40 and 60 ng/ml). In order to evaluate the role of single nucleotide polymorphisms in the VDR gene, hPDL fibroblasts from 9 patients were used and treated in absence or presence of 40 ng/ml 25(OH)D3. Each experiment was performed with and without simulated orthodontic compressive strain. Real-time PCR was used for gene expression and allelic discrimination analysis. Relative expression of dehydrocholesterol reductase (DHCR7), Sec23 homolog A, amidohydrolase domain containing 1 (AMDHD1), vitamin D 25-hydroxylase (CYP2R1), Hydroxyvitamin D-1-α hydroxylase, receptor activator of nuclear factor-κB ligand (RANKL), osteoprotegerin (OPG), cyclooxygenase-2 (COX-2) and interleukin-6 (IL6) was assessed. Three single nucleotide polymorphisms in VDR were genotyped. Parametric or non-parametric tests were used with an alpha of 5%.

Results

RANKL, RANKL:OPG ratio, COX-2, IL-6, DHCR7, CYP2R1 and AMDHD1 were differentially expressed during simulated orthodontic compressive strain (p < 0.05). The RANKL:OPG ratio was downregulated by all concentrations (10 ng/ml, 40 ng/ml and 60 ng/ml) of 25(OH)D3 (mean = 0.96 ± 0.68, mean = 1.61 ± 0.66 and mean = 1.86 ± 0.78, respectively) in comparison to the control (mean 2.58 ± 1.16) (p < 0.05). CYP2R1 gene expression was statistically modulated by the different 25(OH)D3 concentrations applied (p = 0.008). Samples from individuals carrying the GG genotype in rs739837 presented lower VDR mRNA expression and samples from individuals carrying the CC genotype in rs7975232 presented higher VDR mRNA expression (p < 0.05).

Conclusions

Simulated orthodontic compressive strain and physiological concentrations of 25(OH)D3 seem to regulate the expression of orthodontic tooth movement and vitamin-D-related genes in periodontal ligament fibroblasts in the context of orthodontic compressive strain. Our study also suggests that single nucleotide polymorphisms in the VDR gene regulate VDR expression in periodontal ligament fibroblasts in the context of orthodontic compressive strain.
How do they learn: types and characteristics of medical and healthcare student engagement in a simulation-based learning environment
Authors: Wang Yashuang , Ji Yan
Published: August 2021

Background

Student engagement can predict successful learning outcomes and academic development. The expansion of simulation-based medical and healthcare education creates challenges for educators, as they must help students engage in a simulation-based learning environment. This research provides a reference for facilitators of simulation teaching and student learning in medical and health-related majors by providing a deep understanding of student engagement in a simulation-based learning environment.

Methods

We conducted semi-structured interviews with ten medical and healthcare students to explore their learning types and characteristics in a simulation-based learning environment. Thematic analysis was used to analyse the data.

Results

The interviews were thematically analysed to identify three types of student engagement in the simulation-based learning environment: reflective engagement, performance engagement, and interactive engagement. The analysis also identified eight sub-themes: active, persistent, and focused thinking engagement; self-directed-learning thinking engagement with the purpose of problem solving; active “voice” in class; strong emotional experience and disclosure; demonstration of professional leadership; interaction with realistic learning situations; support from teammates; and collegial facilitator-student interaction.

Conclusions

The student interview and thematic analysis methods can be used to study the richness of student engagement in simulation-based learning environments. This study finds that student engagement in a simulation-based learning environment is different from that in a traditional environment, as it places greater emphasis on performance engagement, which combines both thinking and physical engagement, as well as on interactive engagement as generated through interpersonal interactions. Therefore, we suggest expanding the learning space centring around “inquiry”, as it can help strengthen reflective communication and dialogue. It also facilitates imagination, stimulates empathy, and builds an interprofessional learning community. In this way, medical and healthcare students can learn through the two-way transmission of information and cultivate and reshape interpersonal relationships to improve engagement in a simulation-based learning environment.