bluuebunny/crossref_metadata_2025 huggingface dataset:
“Navigating the In-Between: A Cross-Cultural Researcher’s Fluid Positionality in West Africa”
Authors: Niati Noella Binda
Published: January 2024

This article explores the challenges and complexities of a cross cultural PhD student conducting research in West Africa. I discuss how I navigated, negotiated and blurred my insider/outsider experiences as a Congolese-American woman as I engaged with themes oscillating between power, legitimacy, language, gender, and my decolonial and social justice commitments. Reflexive research on Africans studying a secondary non-native African country is seldom discussed or researched. As such, I utilised an intersectional transnegritude theoretical framework to centre and complicate the shared transcolonial struggles and neocolonial realities of myself and my participants. I conclude by positing that, despite the challenges of doing transnational work, reflexively recognising our positionality lends to a liberatory and critical transnational exchange that encourages new approaches to knowledge production for social justice. This article contributes to ongoing discussions of insider/outsider research, positionality, decolonising research, and comparative case study to articulate and dearticulate power dynamics in neocolonial contexts.
Effect of bamboo powder on mechanical property of aluminum matrix composite reinforced with aluminum oxide, boron carbide and molybdenum disulfide
Authors: Haile Dejene , Mengesha Getinet Asrat , Sinha Devendra Kumar , Kebere Aschenaki Haileeyesus , Lemma Beshahwured Shimelis
Published: January 2024

Natural fiber composites offer a range of advantages, from biodegradability after the component’s lifespan little to no output of greenhouse gases and reduced pollution. These properties have made natural fiber composites popular in military, automotive, aerospace, and residential spaces. Bamboo Stem Ash Powder (BSAP) is one example of a commonly found natural fiber composite. This research looks into its effect on the physical and mechanical parameters when added to pure aluminum. The 0, 2.5, 5, 7.5, and 10 weight percent of BSAP were added in addition to the secondary reinforcements in the matrix. Parameters such as density, porosity, hardness, compressive strength, X-Ray Diffraction analysis results of BSAP/composite mixture, as well as Thermal Gravimetric Analysis (TGA) findings for the BSAP itself were all studied. The highest values of hardness 239.66 HV and compressive strength 308.32 MPa have been observed with 7.5 weight percent BSAP addition. It can be confirmed that these natural fiber composites can improve standard materials’ behavior when used correctly and can be potential candidates for many engineering applications.
Post-reflux swallow-induced peristaltic wave index: a new parameter for the identification of non-acid gastroesophageal reflux-related chronic cough
Authors: Sha Bingxian , Li Wanzhen , Bai Haodong , Zhang Tongyangzi , Wang Shengyuan , Wu Linyang , Shi Wenbo , Zhu Yiqing , Yu Li , Xu Xianghuai
Published: January 2024

Background:

The current available diagnostic criteria for gastroesophageal reflux-related chronic cough (GERC) dominated by non-acid reflux is imperfect. The post-reflux swallow-induced peristaltic wave index (PSPWI) is a parameter reflecting esophageal clearance function.

Objectives:

This study aims to investigate its diagnostic value for non-acid GERC.

Design:

This study sought to compare the diagnostic value of PSPWI in different types of GERC, particularly non-acid GERC, and explore the clinical significance of PSPWI in the diagnosis of non-acid GERC through diagnostic experiments.

Methods:

A retrospective analysis was performed based on 223 patients with suspected GERC who underwent multichannel intraluminal impedance-pH monitoring (MII-pH) in the outpatient clinic of our department from August 2016 to June 2021. Their clinical information, laboratory test results, and treatment responses were assessed and the underlying etiologies of chronic cough were categorized. The predictive value of the PSPWI in diagnosing different types of GERC, especially non-acid GERC, was analyzed and compared.

Results:

A total of 195 patients with chronic cough who met the inclusion criteria underwent MII-pH monitoring. 143 patients had a definitive diagnosis of GERC, including 98 with acid GERC and 45 with non-acid GERC. The diagnostic value of PSPWI alone was moderate for GERC with an area under the working curve (AUC) 0.760, but poor for non-acid GERC with an AUC of 0.569. However, PSPWI < 39.8% combining with acid exposure time (AET) ⩽ 6.2% demonstrated a moderate diagnostic value for non-acid GERC, with an AUC of 0.722. When PSPWI < 39.8% combined with a non-acid reflux ratio >68.75%, the diagnostic value for non-acid GERC was improved (AUCROC = 0.80 versus AUCROC = 0.722, p < 0.05), which was significantly superior to non-acid symptom index (AUCROC = 0.804 versus AUCROC = 0.550, p < 0.05) and non-acid symptom association probability (AUCROC = 0.804 versus AUCROC = 0.571, p < 0.05).

Conclusion:

PSPWI < 39.8% and AET ⩽ 6.2% have demonstrated good diagnostic value for non-acid GERC. The diagnostic value was further improved when combined with non-acid reflux ratio >68.75%.
Association between hiatal hernia and Barrett’s esophagus: an updated meta-analysis with trial sequential analysis
Authors: Ma Shaoze , Tong Zhenhua , He Yong , Zhang Yiyan , Guo Xiaozhong , Qi Xingshun
Published: January 2024

Background:

Barrett’s esophagus (BE) is a precursor of esophageal adenocarcinoma. It is critical to recognize the risk factors associated with BE.

Objectives:

The present meta-analysis aims to systematically estimate the association of hiatal hernia with the risk of BE.

Design:

A meta-analysis with trial sequential analysis.

Data sources and methods:

The PubMed, EMBASE, and Cochrane Library databases were searched. The pooled odds ratios (ORs) and adjusted ORs (aORs) with their 95% confidence intervals (CIs) were calculated for the combined estimation of unadjusted data and data adjusted for confounders, respectively. Heterogeneity was quantified using the Cochrane Q test and I² statistics. Subgroup, meta-regression, and leave-one-out sensitivity analyses were employed to explore the sources of heterogeneity.

Results:

Forty-seven studies with 131,517 participants were included. Based on the unadjusted data from 47 studies, hiatal hernia was significantly associated with an increased risk of any length BE (OR = 3.91, 95% CI = 3.31–4.62, p < 0.001). The heterogeneity was significant ( I² = 77%; p < 0.001) and the definition of controls ( p = 0.014) might be a potential contributor to heterogeneity. Based on the adjusted data from 14 studies, this positive association remained (aOR = 3.26, 95% CI = 2.44–4.35, p < 0.001). The heterogeneity was also significant ( I² = 65%; p < 0.001). Meta-analysis of seven studies demonstrated that hiatal hernia was significantly associated with an increased risk of long-segment BE (LSBE) (OR = 10.01, 95% CI = 4.16–24.06, p < 0.001). The heterogeneity was significant ( I² = 78%; p < 0.001). Meta-analysis of seven studies also demonstrated that hiatal hernia was significantly associated with an increased risk of short-segment BE (OR = 2.76, 95% CI = 2.05–3.71, p < 0.001). The heterogeneity was not significant ( I² = 30%; p = 0.201).

Conclusion:

Hiatal hernia should be a significant risk factor for BE, especially LSBE.

Registration:

PROSPERO registration number CRD42022367376.
Nomogram to predict the presence of PSMA-negative but FDG-positive lesion in castration-resistant prostate cancer: a multicenter cohort study
Authors: Pan Jian , Zhang Tingwei , Chen Shouzhen , Bu Ting , Zhao Jinou , Ni Xudong , Shi Benkang , Gan Hualei , Wei Yu , Wang Qifeng , Wang Beihe , Wu Junlong , Song Shaoli , Wang Feng , Liu Chang , Ye Dingwei , Zhu Yao
Published: January 2024

Background:

PSMA-negative but FDG-positive (PSMA−/FDG+) lesion in dual-tracer (68Ga-PSMA and 18F-FDG) positron emission tomography/computed tomography (PET/CT) is associated with an unfavorable response to Lutetium-177 (177Lu)-PSMA-617. This study sought to develop both radiomics and clinical models for the precise prediction of the presence of PSMA−/FDG+ lesions in patients with castration-resistant prostate cancer (CPRC).

Methods:

A cohort of 298 patients who underwent dual-tracer PET/CT with a less than 5-day interval was included. The evaluation of the prognostic performance of the radiomics model drew upon the survival data derived from 40 patients with CRPC treated with 177Lu-PSMA-617 in an external cohort. Two endpoints were evaluated: (a) prostate-specific antigen (PSA) response rate, defined as a reduction exceeding 50% from baseline and (b) overall survival (OS), measured from the initiation of 177Lu-PSMA-617 to death from any cause.

Results:

PSMA−/FDG+ lesions were identified in 56 (18.8%) CRPC patients. Both radiomics (area under the curve [AUC], 0.83) and clinical models (AUC, 0.78) demonstrated robust performance in PSMA−/FDG+ lesion prediction. Decision curve analysis revealed that the radiomics model yielded a net benefit over the ‘screen all’ strategy at a threshold probability of ⩾4%. At a 5% probability threshold, the radiomics model facilitated a 21% reduction in 18F-FDG PET/CT scans while only missing 2% of PSMA−/FDG+ cases. Patients with a low estimated score exhibited significantly prolonged OS (hazard ratio = 0.49, p = 0.029) and a higher PSA response rate (75% versus 35%, p = 0.011) compared to those with a high estimated score.

Conclusion:

This study successfully developed two models with accurate estimations of the risk associated with PSMA−/FDG+ lesions in CRPC patients. These models held potential utility in aiding the selection of candidates for 177Lu-PSMA-617 treatment and guiding 68Ga-PSMA PET/CT-directed radiotherapy.
Authentic leadership and motivation as moderators of the organizational politics–knowledge sharing relationship: A test amidst crisis
Authors: Arias Rodriguez Indira , Muniz Jorge , Munyon Timothy P
Published: January 2024

Organizational politics are recognized as a ubiquitous and negative threat to knowledge sharing in organizations, yet less research has examined the boundary conditions that affect this relationship, particularly in interdependent manufacturing contexts. This article aims to explore how authentic leadership, intrinsic motivation, and prosocial motivation bound the effects of organizational politics on the knowledge sharing activities of individuals and workgroups in the shop floor of the Brazilian automotive consortium during a political and economic crisis context (2015–2017). This crisis context was marked by presidential impeachment, high inflation, economic instability, and massive plant layoffs. We sampled 144 shop floor workers using a questionnaire-based survey and established scales, and employed multivariate regression analyses to test our hypotheses. Contrary to expectations, we found that organizational politics increase, rather than decrease, knowledge sharing of individuals and groups. Moderation analyses suggest that worker intrinsic motivation and prosocial motivation significantly moderate the positive relationships between organizational politics and knowledge sharing of individuals and groups, while authentic leadership had no significant effect on this relationship.

JEL CLASSIFICATION: D2: Production and Organizations
Requirements for Teaching Experience and Pedagogical Training Among Public Health PhD Programs
Authors: Seitz Christopher M. , Orsini Muhsin Michael
Published: January 2024

The purpose of this study was to determine how public health PhD students from each of the core disciplines of public health are trained in teaching. The websites of CEPH accredited PhD programs in the core disciplines of public health were searched for degree requirements that included teaching experience and/or pedagogical training. Of the 244 PhD programs included in this study, only 87 (35%) required teaching assistant experience. In terms of training, only 43 programs (17%) required doctoral students to be trained to teach, with just over half of those trainings being for-credit. The topics that were covered in the trainings were analyzed, with the three most common being: assessing student learning (e.g., assignments, rubrics, exams), designing a course syllabus, and implementing active learning strategies. In all, this study provided additional evidence for the need of doctoral public health programs to require PhD students to acquire more teaching experience and pedagogical knowledge.
Management of Multifocal Squamous Dysplasia: Role of Esophagectomy
Authors: Wong Ian Y. H. , Law Simon Y. K.
Published: January 2024

Squamous dysplasia precedes invasive squamous cell carcinoma of the esophagus, but there is limited evidence on its surgical management. The “field change effect” further complicates matters, causing multifocal or second primary neoplasms in the esophagus and upper aerodigestive tract. While endoscopic procedures are the primary treatment, surgical resection, either alone or in combination with endoscopy, must be considered given the extent of the disease and organ involvement. This chapter summarizes multifocal squamous dysplasia scenarios and highlights the role of esophagectomy or surgical resection.
Assessing the integrity of auditory sensory memory processing in CLN3 disease (Juvenile Neuronal Ceroid Lipofuscinosis (Batten disease)): an auditory evoked potential study of the duration-evoked mismatch negativity (MMN)
Authors: Brima Tufikameni , Freedman Edward G. , Prinsloo Kevin D. , Augustine Erika F. , Adams Heather R. , Wang Kuan Hong , Mink Jonathan W. , Shaw Luke H. , Mantel Emma P. , Foxe John J.
Published: January 2024

Background

We interrogated auditory sensory memory capabilities in individuals with CLN3 disease (juvenile neuronal ceroid lipofuscinosis), specifically for the feature of “duration” processing. Given decrements in auditory processing abilities associated with later-stage CLN3 disease, we hypothesized that the duration-evoked mismatch negativity (MMN) of the event related potential (ERP) would be a marker of progressively atypical cortical processing in this population, with potential applicability as a brain-based biomarker in clinical trials.

Methods

We employed three stimulation rates (fast: 450 ms, medium: 900 ms, slow: 1800 ms), allowing for assessment of the sustainability of the auditory sensory memory trace. The robustness of MMN directly relates to the rate at which the regularly occurring stimulus stream is presented. As presentation rate slows, robustness of the sensory memory trace diminishes. By manipulating presentation rate, the strength of the sensory memory trace is parametrically varied, providing greater sensitivity to detect auditory cortical dysfunction. A secondary hypothesis was that duration-evoked MMN abnormalities in CLN3 disease would be more severe at slower presentation rates, resulting from greater demand on the sensory memory system.

Results

Data from individuals with CLN3 disease (N = 21; range 6–28 years of age) showed robust MMN responses (i.e., intact auditory sensory memory processes) at the medium stimulation rate. However, at the fastest rate, MMN was significantly reduced, and at the slowest rate, MMN was not detectable in CLN3 disease relative to neurotypical controls (N = 41; ages 6–26 years).

Conclusions

Results reveal emerging insufficiencies in this critical auditory perceptual system in individuals with CLN3 disease.
SiO2–alginate–melittin nano-conjugates suppress the proliferation of ovarian cancer cells: a controlled release approach leveraging alginate lyase
Authors: Si Lihui , Yang Shuli , Lin Ruixin , Gu Shiyu , Yan Chuhan , Yan Jia
Published: January 2024

Background

Ovarian cancer treatment is challenged by resistance and off-target effects. Melittin shows promise against cancer but is limited by its instability and harmful cellular interactions. Our study introduces SiO2–alginate–melittin nano-conjugates (SAMNs), incorporating alginate lyase to enhance melittin's release and mitigate alginate drawbacks.

Methods

We combined melittin with alginate and mesoporous silica, using alginate lyase to control melittin release. Effects on SKOV3 ovarian cancer cells were evaluated via viability, invasion, migration assays, ROS levels, apoptosis-related proteins, and mitochondrial function tests.

Results

SAMNs extended melittin’s cell control, reducing proliferation, invasion, and migration compared to free melittin. Alginate lyase facilitated controlled melittin release, decreasing off-target cytotoxicity. The only melittin group showed severe mitochondrial impairment, while the SAMNs and lyase groups had moderated impacts, indicating a dose-dependent effect on mitochondrial health and cell uptake.

Conclusions

SAMNs, especially with alginate lyase, offer an effective strategy for ovarian cancer treatment, optimizing melittin delivery while minimizing adverse effects of alginate. This approach enhances the therapeutic potential of melittin in combating ovarian cancer.
Synthesis and characterization of silver nanoparticles loaded with carboplatin as a potential antimicrobial and cancer therapy
Authors: Tunç Tutku
Published: January 2024

In recent studies with silver nanoparticles, it has been reported that the use of nanoparticles in carrier drug systems increases tumor suppression and reduces drug-related side effects. At the same time, the combination of traditional medicine with nanotechnology provides the opportunity to develop new antimicrobial agents. The aim of this study was to determine the anticancer, antimicrobial activities and pro-apoptotic effects of silver nanoparticles (AgNPs), and carboplatin-loaded silver nanoparticles (AgNPs-Car). Characterization studies of the synthesized nanoparticles were carried out by DLS, EDX-STEM, and FTIR analysis. The antiproliferative and pro-apoptotic effects of these molecules were evaluated using XTT and Annexin V, respectively. MIC (Minimum Inhibitory Concentration) test was used to determine the antimicrobial activity. The anticancer activity of the AgNPs-Car was high in MCF-7 (human breast adenocarcinoma), A549 (human lung carcinoma), and C6 (brain glioma) cells. The cell group with the most effective selective cytotoxic activity was C6 cells. It was also shown that AgNPs-Car and AgNPs induced DNA fragmentation eventually increasing apoptosis of cells. The antimicrobial activity of AgNPs and AgNPs-Car was evaluated on Gram-positive and Gram-negative pathogenic microorganisms and yeast fungi. Among the nanomaterials that reached effective MIC values according to reference sources, AgNPs-Car achieved better results. As a result, AgNPs-Car was found to be very successful in targeting C6 glioma cells by facilitating cell entry of the drug. In addition, their anticancer activity on MCF-7 and A549 cells was high and their toxicity was low. Silver nanoparticles are preferred for creating a better drug carrier system because of their qualitative properties and effects. Therefore, it is an interesting field for research on targeting cancer cells and pathogenic microorganisms.
The predictive value of peripheral blood CD4 cells ATP concentration for immune-related adverse events in advanced non-small cell lung cancer patients
Authors: Hou Kailian , Ye Weipeng , Huang Qunfeng , Li Weiyi , Tan Zhiqiong , tao Na , yang Dongheng , Lin Haoxin , Deng Zihao , Xia Yuanyuan , Yu Guifang
Published: January 2024

Objective

Lung cancer with the highest incidence and mortality in the world. Immune checkpoint inhibitors (ICIs), can bring long-term survival benefits to patients, but also can bring immune-related adverse events (irAEs) in some patients during therapy. Therefore, the aim of this study was to investigate the predictive effect of peripheral blood WBC, NLR, sATPCD4 and nATPCD4 on irAEs in advanced non-small cell lung cancer (NSCLC).

Methods

Clinical data of 112 patients with advanced NSCLC who were treated with PD -1/PD -L1 inhibitor in the Fifth Affiliated Hospital of Guangzhou Medical University from December 15, 2019 to April 30, 2023 were retrospectively analyzed. These patients were divided into the irAEs group (n = 27) and non-irAEs group (n = 85). The clinical data of the two groups were compared. Receiver operating characteristic (ROC) curves were drawn to determine the threshold value of baseline peripheral blood parameters to predict the occurrence of irAEs. Multivariate logistic regression analysis was used to explore the relationship between peripheral blood markers and the incidence of irAEs.

Results

The patient characteristics have no significant difference between irAEs and non-irAEs group. But the baseline peripheral blood WBC, sATPCD4 and nATPCD4 of patients in the irAEs group were higher than those in the non-irAEs group (p < 0.05), and the NLR in irAEs group was similar to in the non-irAEs group (p = 0.639).Univariate analysis showed that high WBC, sATPCD4 and nATPCD4 may the risk factors for the occurrence of irAEs (p < 0.05). Multivariate logistic regression analysis showed that high sATPCD4 and nATPCD4 were independent risk factors for the occurrence of irAEs (p < 0.05). The best critical values of WBC, sATPCD4 and nATPCD4 before treatment for predicting the occurrence of irAEs were 8.165 × 109cells/L (AUC = 0.705) ,484.5 ng/mL (AUC = 0.777), and 156 ng/mL (AUC = 0.840), respectively.

Conclusions

sATPCD4 and nATPCD4 were independent risk factors for the occurrence of irAEs in advanced NSCLC patients. This discovery provides a new method to predict the occurrence of irAEs in patients. Based on the prediction results, corresponding treatment measures can be taken to reduce the incidence of adverse events.
Non-thermal plasma (NTP) treatment of Trigonella foenum-graecum L. seeds stimulates the sprout growth and the production of nutraceutical compounds
Authors: Motrescu Iuliana , Lungoci Constantin , Ciolan Mihai Alexandru , Jităreanu Gerard
Published: January 2024

The possibility to stimulate the production of some nutraceutical properties of fenugreek (Trigonella foenum-graecum L.) sprouts by non-thermal plasma (NTP) processing of the seeds in different conditions was studied. The non-thermal plasma used in this work was a surface dielectric barrier discharge. Two types of processing were performed: direct NTP treatment and NTP with a cover treatment, to simulate the processing of packaged seeds. For all treatments, the effect of pre-soaking of the seeds was studied as well. The analyses of the seeds after processing indicated an increase of the hydrophilicity of their surface for NTP direct treatment as resulted from the water contact angle measurements, which could be due to the strong etching evidenced by scanning electron microscopy imaging. A significant (p < 0.05) increase of the seedling growth, by up to 50%, was found especially for the pre-soaked seeds. These results were correlated with the increase of chlorophyll pigments concentrations, with higher concentrations in the case of NTP direct treatment than for the NTP with cover treatments. Direct NTP treatment for 30 s of dry seeds led to the highest increase of the flavonoid concentration of about three times compared to that obtained for untreated seeds. For the polyphenols and antioxidant activity, NTP with cover treatments proved to be better, with a significant increase, especially for 90 s treatment of the pre-soaked seeds. All the results indicate the possibility of tuning the nutraceutical properties of fenugreek sprouts by NTP treatment.
Circulating secretoneurin level reflects angiographic coronary collateralization in stable angina patients with chronic total occlusion
Authors: Wu Zhi Ming , Huang Ke , Dai Yang , Chen Shuai , Wang Xiao Qun , Yang Chen Die , Li Le Ying , Liu Jing Meng , Lu Lin , Zhang Rui Yan , Shen Wei Feng , Shen Ying , Ding Feng Hua
Published: January 2024

Objective

To investigate the association between circulating secretoneurin (SN) and angiographic coronary collateralization in stable angina patients with chronic coronary total occlusion (CTO).

Methods

SN concentrations in serum were measured in 641 stable angina patients with CTO by radioimmunoassay. The status of coronary collaterals from the contra-lateral vessel was visually estimated using the Rentrop grading system, and was categorized into poor (grade 0 or 1) or good (grade 2 or 3) collateralization.

Results

Serum SN levels were significantly higher in patients with good coronary collaterals compared to those with poor collaterals (175.23 ± 52.09 pmol/L vs. 143.29 ± 42.01 pmol/L, P < 0.001). Serum SN increased stepwise across Rentrop score 0 to 3 (P < 0.001), and increasing SN tertiles were associated with higher proportion of good coronary collateralization (OR, 1.907; 95% CI, 1.558 ~ 2.335, P < 0.001). After adjustment for confounding variables, serum SN (per tertile) remained an independent factor for predicting good coronary collaterals (OR, 1.870; 95% CI, 1.515 ~ 2.309; P < 0.001). Moreover, the diagnostic value of serum SN (per tertile) was consistent after stratifying patients based on gender, age, body mass index, hypertension, diabetes, history of smoking, severity of coronary artery disease and kidney function (OR: 1.511 ~ 2.680, P interaction ≥ 0.327).

Conclusion

Elevated circulating SN reflects good angiographic coronary collaterals in stable angina patients with CTO. The findings may provide insight into decision-making for these patients.
The impact of the time factors on the exercise-based cardiac rehabilitation outcomes of the patients with acute myocardial infarction after percutaneous coronary intervention: a systematic review and meta-analysis
Authors: Zhang Peiyu , Niu Chaofeng , Zhang Lijing , Lai Haixia , Liu Birong , Lv Diyang , Zhuang Rui , Liu Yong , Xiao Di , Ma Liyong , Li Meng
Published: January 2024

Background and objective

Cardiac rehabilitation (CR) has been demonstrated to improve outcomes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, the optimal CR initiation time and duration remain to be determined. This study aimed to explore the impact of the time factors on the CR outcomes in AMI patients who received PCI by the method of meta-regression analysis.

Methods

We searched five databases (PubMed, Embase, Cochrane Library, Web of Science and Google scholar) up to October 31, 2023. Meta-regression analysis was utilized to explore the impact of the time factors on the effect sizes. Subgroups with more than 3 studies were used for meta-regression analysis.

Results

Our analysis included 16 studies and a total of 1810 patients. The meta-regression analysis revealed that the initiation time and duration of CR had no significant impact on the occurrence of arrhythmia, coronary artery restenosis and angina pectoris. The initiation time and duration of CR also had no significant impact on the changes in left ventricular ejection fraction (LVEF, starting time: estimate = 0.160, p = 0.130; intervention time: estimate = 0.017, p = 0.149), left ventricular end-diastolic volume (LVEDV, starting time: estimate = − 0.191, p = 0.732; intervention time: estimate = − 0.033, p = 0.160), left ventricular end-systolic volume (LVESV, starting time: estimate = − 0.301, p = 0.464; intervention time: estimate = 0.015, p = 0.368) and 6-minute walk test (6MWT, starting time: estimate = − 0.108, p = 0.467; intervention time: estimate = 0.019, p = 0.116).

Conclusion

Implementation of CR following PCI in patients with AMI is beneficial. However, in AMI patients, there is no significant difference in the improvement of CR outcomes based on different CR starting times within 1 month after PCI or different durations of the CR programs. It indicates that it is feasible for patients with AMI to commence CR within 1 month after PCI and continue long-term CR, but the time factors which impact CR are intricate and further clinical research is still needed to determine the optimal initiation time and duration of CR.
Studying missingness in spinal cord injury data: challenges and impact of data imputation
Authors: Bourguignon Lucie , Lukas Louis P. , Guest James D. , Geisler Fred H. , Noonan Vanessa , Curt Armin , Brüningk Sarah C. , Jutzeler Catherine R.
Published: January 2024

Background

In the last decades, medical research fields studying rare conditions such as spinal cord injury (SCI) have made extensive efforts to collect large-scale data. However, most analysis methods rely on complete data. This is particularly troublesome when studying clinical data as they are prone to missingness. Often, researchers mitigate this problem by removing patients with missing data from the analyses. Less commonly, imputation methods to infer likely values are applied.

Objective

Our objective was to study how handling missing data influences the results reported, taking the example of SCI registries. We aimed to raise awareness on the effects of missing data and provide guidelines to be applied for future research projects, in SCI research and beyond.

Methods

Using the Sygen clinical trial data (n = 797), we analyzed the impact of the type of variable in which data is missing, the pattern according to which data is missing, and the imputation strategy (e.g. mean imputation, last observation carried forward, multiple imputation).

Results

Our simulations show that mean imputation may lead to results strongly deviating from the underlying expected results. For repeated measures missing at late stages (> = 6 months after injury in this simulation study), carrying the last observation forward seems the preferable option for the imputation. This simulation study could show that a one-size-fit-all imputation strategy falls short in SCI data sets.

Conclusions

Data-tailored imputation strategies are required (e.g., characterisation of the missingness pattern, last observation carried forward for repeated measures evolving to a plateau over time). Therefore, systematically reporting the extent, kind and decisions made regarding missing data will be essential to improve the interpretation, transparency, and reproducibility of the research presented.
The use and usefulness of point-of-care tests in patients with pharyngotonsillitis – an observational study in primary health care
Authors: Pallon Jon , Sundqvist Martin , Hedin Katarina
Published: January 2024

Background

Rapid antigen detection tests (RADT) for Group A streptococci (GAS) and point-of-care tests for C-reactive protein (CRP) are commonly used in patients with pharyngotonsillitis in Sweden and Denmark although CRP testing is not supported by guidelines. We aimed to describe (1) the proportion of patients tested with RADT and/or CRP, (2) the relation between test results and antibiotic prescribing, and (3) the association between CRP level and microbial aetiology.

Methods

We used a post-hoc-analysis of data collected in primary health care in a prospective aetiological study of 220 patients 15–45 years old diagnosed with pharyngotonsillitis. The outcomes of RADTs and CRP tests were related to antibiotic prescribing and microbial aetiology.

Results

A RADT was used in 94% of the patients. A CRP test was used in 50% of the patients but more commonly in those with a negative RADT (59%) than in those with a positive RADT (38%) (p = 0.005). Most (74%) CRP tests were used in patients with a negative RADT. Antibiotic prescribing differed greatly between patients with a positive RADT (96%) and patients with a negative RADT (17%) (p < 0.001). In patients with a negative RADT, there was a positive association between CRP value and antibiotic prescribing (OR 1.05; 95% CI 1.02–1.07;p < 0.001). Patients with CRP values ≤ 30 mg/l were seldomly prescribed antibiotics. Patients with GAS in culture had the highest median CRP (46 mg/l), which was higher than in patients without GAS (8 mg/l;p < 0.001). However, the positive predictive value for GAS never exceeded 0.60 (95% CI 0.31–0.83) at the investigated CRP levels.

Conclusions

The widespread use of tests is a major deviation from national guidelines. Most CRP tests were used in patients with a negative RADT, suggesting a belief in the added value of a CRP test, and the CRP result seemed to influence antibiotic prescribing. However, as an aetiological test, CRP is not useful for predicting GAS.
Improving patient experience for people prescribed medicines with a risk of dependence or withdrawal: co-designed solutions using experience based co-design
Authors: Seddon Jennifer , Friedrich Claire , Wadd Sarah , Dicks David , Scott Sion , Robinson Anthea , Walker Charlotte
Published: January 2024

Background

Significant concerns have been raised regarding how medications with a risk of dependence or withdrawal are managed and how care is experienced by patients. This study sought to co-design solutions to improve the experience of care for patients prescribed benzodiazepines, z-drugs, opioids for chronic non-cancer pain, gabapentinoids and antidepressants.

Method

Twenty patients and fifteen healthcare professionals from five different GP practices were recruited to take part. The study used Experience Based Co-Design. Patients and healthcare professionals completed semi-structured interviews and took part in feedback groups and co-design workshops to collaboratively identify priorities for improvement and to co-design solutions to improve the experience of care.

Results

Poor patient experience was common among people prescribed medications with a risk of dependence or withdrawal. Patients and healthcare professionals identified three main priority areas to improve the experience of care: (i) ensuring patients are provided with detailed information in relation to their medication, (ii) ensuring continuity of care for patients, and (iii) providing alternative treatment options to medication. Solutions to improve care were co-designed by patients and healthcare staff and implemented within participating GP practices to improve the experience of care.

Conclusion

Good patient experience is a key element of quality care. This study highlights that the provision of in-depth medication related information, continuity of care and alternative treatment to medication are important to patients prescribed medicines with a risk of dependence or withdrawal. Improving these aspects of care should be a priority for future improvement and delivery plans.
Core values of employed general practitioners in Germany – a qualitative study
Authors: Horn Leonie , Ullrich Charlotte , Boelter Leonie , Wensing Michel , Peters-Klimm Frank , Stengel Sandra
Published: January 2024

Background

“Core values” help to guide practice of health care delivery. The core values of general practice are described in the European definition of general practice by WONCA, e.g. a holistic, comprehensive and continuous care. They may be associated with the idea that the general practitioner is the owner of the practice rather than an employee.

Objectives

The objective was to examine the core values of employed GPs in their professional setting and their practical manifestation.

Methods

From April to May 2021, we conducted 17 semi-structured telephone-interviews with employed GPs in two districts in Baden-Wuerttemberg, Germany. The data were analysed using qualitative content analysis.

Results

We identified twelve core values, including values relevant to patient care and values relevant to the lives of employed GPs. Values with high relevance were job satisfaction, the professional distance from patients, collaboration and collegial exchange, comprehensive care, adequate consultation time and availability to patients. Values with heterogeneous relevance were continuity of care, waiting times and medical autonomy. The value “availability” of employed GPs to patients was associated with both patient care and personal life. The limited availability of employed GPs was accompanied by tensions between these two trends and other values.

Conclusion

The values of employed GPs are partly consistent with the current WONCA definition of general practice. There were also indications of new values. The increase in the proportion of employed GPs implies a need to reflect on the core values of general practice, taking into account factors on the part of employed GPs, patients, and practice organisation.
Validation of diagnoses of liver disorders in users of systemic azole antifungal medication in Sweden
Authors: Giunta Diego Hernan , Karlsson Pär , Younus Muhammad , Berglind Ina Anveden , Kieler Helle , Reutfors Johan
Published: January 2024

Background

Liver disorders are important adverse effects associated with antifungal drug treatment. However, the accuracy of Clinical International Classification of Diseases (ICD)-10 codes in identifying liver disorders for register based research is not well-established. This study aimed to determine the positive predictive value (PPV) of the ICD-10 codes for identifying patients with toxic liver disease, hepatic failure, and jaundice among patients with systemic antifungal treatment.

Methods

Data from the Swedish Prescribed Drug Register and the National Patient Register were utilized to identify adult patients who received systemic azole antifungal drugs and had a recorded diagnosis of toxic liver disease (K71.0, K71.1, K71.2, K71.6, K71.8, K71.9), hepatic failure (K72.0, K72.9), or jaundice (R17) between 2005 and 2016. The medical records of all included patients were reviewed. Prespecified criteria were used to re-evaluate and confirm each diagnosis, serving as the gold standard to calculate PPVs with 95% confidence intervals (95% CI) for each diagnostic group.

Results

Among the 115 included patients, 26 were diagnosed with toxic liver disease, 58 with hepatic failure, and 31 with jaundice. Toxic liver disease was confirmed in 14 out of 26 patients, yielding a PPV of 53.8% (95% CI 33.4–73.4%). Hepatic failure was confirmed in 26 out of 38 patients, resulting in a PPV of 62.1% (95% CI 48.4–74.5%). The highest PPV was found in jaundice, with 30 confirmed diagnoses out of 31, yielding a PPV of 96.8% (95% CI 83.3–99.9%).

Conclusion

Among patients who received azole antifungal treatment and were subsequently diagnosed with a liver disorder, the PPV for the diagnosis of jaundice was high, while the PPVs for toxic liver disease and hepatic failure were lower.
Community ambulation in older adults and people with OA – a model verification using Canadian Longitudinal Study on Aging (CLSA) data
Authors: Barclay Ruth , Liu Yixiu , Ripat Jacquie , Tate Robert , Nowicki Scott , Jiang Depeng , Webber Sandra C.
Published: January 2024

Background

There are health and well-being benefits of community ambulation; however, many older adults do not regularly walk outside of their home. Objectives were to estimate the associations between latent constructs related to community ambulation in older adults aged 65–85 (65+), and in adults with osteoarthritis (OA) aged 45–85.

Methods

Secondary data analysis of the comprehensive baseline and maintaining contact questionnaire data from the Canadian Longitudinal Study of Aging (CLSA) was completed. Based on a previous model of community ambulation post-stroke, structural equation modeling (SEM) was used to develop measurement and structural models for two groups: older adults 65+ and people with OA. Multi-group SEM was conducted to test measurement invariance across sex and age groups. Measurement models were developed for the following latent factors: ambulation (frequency of walking outside/week, hours walked/day, ability to walk without help, frequency and aids used in different settings); health perceptions (general health, pain frequency/intensity); timed functional mobility (gait speed, timed up-and-go, sit-to-stand, balance). Variables of depression, falls, age, sex, and fear of walking alone at night were covariates in the structural models.

Results

Data were used from 11,619 individuals in the 65+ group (mean age 73 years ±6, 49% female) and 5546 individuals in the OA group (mean age 67 ± 10, 60% female). The final 65+ model had a close fit with RMSEA (90% CI) = 0.018 (0.017, 0.019), CFI = 0.91, SRMR = 0.09. For the OA group, RMSEA (90% CI) = 0.021 (0.020, 0.023), CFI = 0.92, SRMR = 0.07. Health perceptions and timed functional mobility had a positive association with ambulation. Depression was associated with ambulation through negative associations with health perceptions and timed functional mobility. Multi-group SEM results reveal the measurement model was retained for males and females in the 65+ group, for males and females and for age groups (65+, < 65) in the OA group.

Conclusions

The community ambulation model post-stroke was verified with adults aged 65+ and for those with OA. The models of community ambulation can be used to frame and conceptualize community ambulation research and clinical interventions.
Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation
Authors: Adlbrecht Laura , Karrer Melanie , Helfenberger Nicole , Ziegler Eva , Zeller Adelheid
Published: January 2024

Background

Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital.

Methods

We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz’s content-structuring analysis scheme.

Results

We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups’ motivation and competence of managing change facilitated the implementation.

Conclusions

The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.
Post-transfusion severe headache in a patient with thalassemia with superficial siderosis of the central nervous system: a case report and literature review
Authors: Liu Xudong , Jiang Hongliang , Ren Lijie , Cao Liming
Published: January 2024

Background

Patients with severe thalassemia may experience adverse effects from transfusion such as fever, rash, and iron overload after long-term transfusion therapy. Severe headaches as a side effect of blood transfusion in patients with thalassemia are not commonly observed, especially when combined with superficial siderosis of the central nervous system, which is easily misdiagnosed and requires excessive examination and treatment.

Case Presentation

A 31-year-old woman was admitted with severe headache and vomiting over 3 days following blood transfusion. She was diagnosed with intermediate α-thalassemia at 2 years of age and had a history of irregular blood transfusions. Physical examination revealed horizontal nystagmus with no other abnormal neurological signs. Magnetic resonance (MR) imaging, MR venography, MR arteriography, and cerebrospinal fluid analysis were normal. However, susceptibility-weighted imaging showed abnormal signals in the bilateral and fourth ventricles. Initial antibiotics, antivirals, decompression of intracranial pressure, iron chelation, and symptomatic treatments were administered; subsequently, small intermittent blood transfusions were cautiously administered for severe anemia. The patient’s headache was gradually relieved, and she was discharged on day 9. At the 5-month follow-up, the patient’s headache recurred following another transfusion.

Conclusions

Severe post-transfusion headache in patients with thalassemia has not been fully recognized and is easily misdiagnosed, leading to excessive examination and treatment. Understanding the clinical features of transfusion-related headaches can help identify this complication, but the exact pathophysiological mechanism requires further research.
“We decided together”: a qualitative study about women with HIV navigating infant-feeding decisions with the father of their children
Authors: Kasadha Bakita , Tariq Shema , Freeman-Romilly Nell , Pope Catherine , Namiba Angelina , Nyatsanza Farai , Hinton Lisa , Rai Tanvi
Published: January 2024

Background

The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, United Kingdom (UK) guidelines encourage formula feeding, but breastfeeding can be supported under certain circumstances. Infant-feeding decisions often involve personal and social networks. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with the father of their children.

Methods

Semi-structured remote interviews were conducted with UK-based individuals with a confirmed HIV positive diagnosis who were pregnant or one-year postpartum, and two partners. Using purposive sampling, pregnant and postpartum participants were recruited through HIV NHS clinics and community-based organisations, and where possible, fathers were recruited via them. Data were analysed using thematic analysis and organised using NVivo 12.

Results

Of the 36 women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The key factors in women navigating HIV and infant-feeding discussions with respect to their baby’s father were the latter’s: (1) awareness of woman’s HIV status; (2) relationship with the woman; (3) confidence in infant-feeding decision; (4) support and opinion about woman’s infant-feeding intentions. Most women made a joint decision with biological fathers when in a long-term (> one year) relationship with them. Single women tended not to discuss their infant-feeding decision with the father of their child, often for safety reasons.

Conclusion

Women in ongoing relationships with the father of their child valued their support and opinions regarding infant-feeding. In contrast, single women chose not to involve the father for reasons of privacy and safety. Clinical teams and community-based organisations should support mothers in discussing infant-feeding decisions regardless of relationship status. When appropriate, they should also support discussions with their partners, but remain sensitive to circumstances where this may put women at risk.