bluuebunny/crossref_metadata_2025 huggingface dataset:
Coexistence of cryoglobulinemia and ANCA-associated vasculitis in a chronic brucellosis patient -a case report and literature review
Authors: Yang Xu , Jiao Congcong , Liu Xiaomei , Zhang Yongzhe , Zhou Hua , Wang Yanqiu
Published: May 2023

Background

The renal involvement of brucellosis is not common. Here we reported a rare case of chronic brucellosis accompanied by nephritic syndrome, acute kidney injury, the coexistence of cryoglobulinemia and antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV) superimposed on iliac aortic stent implantation. The diagnosis and treatment of the case are instructive.

Case presentation

A 49-year-old man with hypertension and iliac aortic stent implantation was admitted for unexplained renal failure with signs of nephritic syndrome, congestive heart failure, moderate anemia and livedoid change in the left sole with pain. His past history included chronic brucellosis and he just underwent the recurrence and completed the 6 weeks of antibiotics treatment. He demonstrated positive cytoplasmic/proteinase 3 ANCA, mixed type cryoglobulinemia and decreased C3. The kidney biopsy revealed endocapillary proliferative glomerulonephritis with a small amount of crescent formation. Immunofluorescence staining revealed only C3-positive staining. In accordance with clinical and laboratory findings, post-infective acute glomerulonephritis superimposed with AAV was diagnosed. The patient was treated with corticosteroids and antibiotics and sustained alleviation of renal function and brucellosis was achieved during the course of a 3-month follow-up.

Conclusions

Here we describe the diagnostic and treatment challenge in a patient with chronic brucellosis related glomerulonephritis accompanied by the coexistence of AAV and cryoglobulinemia. Renal biopsy confirmed the diagnosis of postinfectious acute glomerulonephritis overlapping with ANCA related crescentic glomerulonephritis, which was not ever reported in the literature. The patient showed a good response to steroid treatment which indicated the immunity-induced kidney injury. Meanwhile, it is essential to recognize and actively treat the coexisting brucellosis even when there are no clinical signs of the active stage of infection. This is the critical point for a salutary patient outcome for brucellosis associated renal complications.
Spatio-temporal distribution and influencing factors of norovirus outbreaks in Beijing, China from 2016 to 2020
Authors: Chen Yanwei , Liu Baiwei , Wang Yu , Zhang Yewu , Yan Hanqiu , Li Weihong , Shen Lingyu , Tian Yi , Jia Lei , Zhang Daitao , Yang Peng , Gao Zhiyong , Wang Quanyi
Published: May 2023

Background

Noroviruses are a leading cause of acute gastroenteritis (AGE) worldwide. The geographical characteristics of norovirus outbreaks in Beijing and their influencing factors remain unknown. This study aimed to explore the spatial distributions, geographical characteristics, and influencing factors of norovirus outbreaks in Beijing, China.

Methods

Epidemiological data and specimens were collected through the AGE outbreak surveillance system in all 16 districts of Beijing. Data on spatial distribution, geographical characteristics, and influencing factors of norovirus outbreaks were analyzed using descriptive statistics methods. We measured spatial, geographical clustering of high- or low-value deviance from random distribution using Z-scores and P-values as statistical significance measures with Global Moran’s I statistics and Getis-Ord Gi in ArcGIS. Linear regression and correlation methods were used to explore influencing factors.

Results

Between September 2016 and August 2020, 1,193 norovirus outbreaks were laboratory-confirmed. The number of outbreaks varied seasonally, typically peaking in spring (March to May) or winter (October to December). Outbreaks primarily occurred around central districts at the town level, and spatial autocorrelation was evident in both the entire study period and in individual years. Hotspots of norovirus outbreaks in Beijing were primarily found in contiguous areas between three central districts (Chaoyang, Haidian, Fengtai) and four suburban districts (Changping, Daxing, Fangshan, Tongzhou). The average population numbers, mean number of all schools, and mean number of kindergartens and primary schools for towns in central districts and hotspot areas were higher than those in suburban districts and non-hotspot areas respectively. Additionally, population numbers and densities of kindergartens and primary schools were influencing factors at the town level.

Conclusions

Hotspots of norovirus outbreaks in Beijing were in contiguous areas between central and suburban districts with high populations, and high kindergarten and primary school densities were the likely driving forces. Outbreak surveillance needs to focus on contiguous areas between central and suburban districts with increased monitoring, medical resources, and health education.
From disobedience to struggle for adaptation: ​​nursing students’ experiences of attending the clinical learning environment during Covid-19 pandemic
Authors: Jokar Zeinab , Torabizadeh Camellia , Rakhshan Mahnaz , Najafi Kalyani Majid
Published: May 2023

Background

The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic.

Methods

A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used.

Results

The data analysis led to emergence of two themes of “disobedience " and “struggle for adaptation”. The disobedience theme consists of two categories: “objection to attend CLE” and “patient marginalization”. The theme of struggle for adaptation includes two categories: “using support sources” and “applying problem-oriented strategies”.

Conclusion

At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.
Supporting US healthcare providers for successful vaccine communication
Authors: Pierz Amanda J , Rauh Lauren , Masoud Dima , Cruz Alanna Kate , Palmedo P. Christopher , Ratzan Scott C , Parker Ruth
Published: May 2023

Background

While many healthcare providers (HCPs) have navigated patients’ vaccine concerns and questions prior to the rollout of the COVID-19 vaccines, sentiments surrounding the COVID-19 vaccines have presented new and distinct challenges.

Objective

To understand the provider experience of counseling patients about COVID-19 vaccinations, aspects of the pandemic environment that impacted vaccine trust, and communication strategies providers found supportive of patient vaccine education.

Methods

7 focus groups of healthcare providers were conducted and recorded during December 2021 and January 2022, at the height of the Omicron wave in the United States. Recordings were transcribed, and iterative coding and analysis was applied.

Results

44 focus group participants representing 24 US states with the majority (80%) fully vaccinated at the time of data collection. Most participants were doctors (34%) or physician’s assistants and nurse practitioners (34%). The negative impact of COVID-19 misinformation on patient-provider communication at both intrapersonal and interpersonal levels as well as barriers and facilitators to patient vaccine uptake are reported. People or sources that play a role in health communication (“messengers”) and persuasive messages that impact behavior or attitudes towards vaccination (“messages”) are described. Providers expressed frustration in the need to continuously address vaccine misinformation in clinical appointments among patients who remained unvaccinated. Many providers found value in resources that provided up-to-date and evidence-based information as COVID-19 guidelines continued to change. Additionally, providers indicated that patient-facing materials designed to support vaccination education were not frequently available, but they were the most valuable to providers in a changing information environment.

Conclusions

While vaccine decision-making is complex and hinges on diverse factors such as health care access (i.e., convenience, expense) and individual knowledge, providers can play a major role in navigating these factors with their patients. But to strengthen provider vaccine communication and promote vaccine uptake, a comprehensive communication infrastructure must be sustained to support the patient-provider dyad. The findings provide recommendations to maintain an environment that facilitates effective provider-patient communication at the community, organizational and policy levels. There is a need for a unified multisectoral response to reinforce the recommendations in patient settings.
Can we predict who will benefit most from biologics in severe asthma? A post-hoc analysis of two phase 3 trials
Authors: Chen Wenjia , Reddel Helen K. , FitzGerald J Mark , Beasley Richard , Janson Christer , Sadatsafavi Mohsen
Published: May 2023

Background

Individualized prediction of treatment response may improve the value proposition of advanced treatment options in severe asthma. This study aimed to investigate the combined capacity of patient characteristics in predicting treatment response to mepolizumab in patients with severe asthma.

Methods

Patient-level data were pooled from two multinational phase 3 trials of mepolizumab in severe eosinophilic asthma. We fitted penalized regression models to quantify reductions in the rate of severe exacerbations and the 5-item Asthma Control Questionnaire (ACQ5) score. The capacity of 15 covariates towards predicting treatment response was quantified by the Gini index (measuring disparities in treatment benefit) as well as observed treatment benefit within the quintiles of predicted treatment benefit.

Results

There was marked variability in the ability of patient characteristics to predict treatment response; covariates explained greater heterogeneity in predicting treatment response to asthma control than to exacerbation frequency (Gini index 0.35 v. 0.24). Key predictors for treatment benefit for severe exacerbations included exacerbation history, blood eosinophil count, baseline ACQ5 score and age, and those for symptom control included blood eosinophil count and presence of nasal polyps. Overall, the average reduction in exacerbations was 0.90/year (95%CI, 0.87‒0.92) and average reduction in ACQ5 score was 0.18 (95% CI, 0.02‒0.35). Among the top 20% of patients for predicted treatment benefit, exacerbations were reduced by 2.23/year (95% CI, 2.03‒2.43) and ACQ5 score were reduced by 0.59 (95% CI, 0.19‒0.98). Among the bottom 20% of patients for predicted treatment benefit, exacerbations were reduced by 0.25/year (95% CI, 0.16‒0.34) and ACQ5 by -0.20 (95% CI, -0.51 to 0.11).

Conclusion

A precision medicine approach based on multiple patient characteristics can guide biologic therapy in severe asthma, especially in identifying patients who will not benefit as much from therapy. Patient characteristics had a greater capacity to predict treatment response to asthma control than to exacerbation.

Trial registration

ClinicalTrials.gov number, NCT01691521 (registered September 24, 2012) and NCT01000506 (registered October 23, 2009).
Malaria prevalence in Mauritania: a systematic review and meta-analysis
Authors: El Moustapha Inejih , Ouldabdallahi Moukah Mohamed , Ould Ahmedou Salem Mohamed Salem , Brahim Khyarhoum , Briolant Sébastien , Basco Leonardo , Ould Mohamed Salem Boukhary Ali
Published: May 2023

Background

Understanding malaria epidemiology is a critical step toward efficient malaria control and elimination. The objective of this meta-analysis was to derive robust estimates of malaria prevalence andPlasmodiumspecies from studies conducted in Mauritania and published since 2000.

Methods

The present review followed the PRISMA guidelines. Searches were conducted in various electronic databases such as PubMed, Web of Science, and Scopus. To obtain pooled prevalence of malaria, meta-analysis was performed using the DerSimonian-Laird random-effects model. Methodological quality of eligible prevalence studies was assessed using Joanna Briggs Institute tool. Inconsistency and heterogeneity between studies were quantified by the I2index and Cochran’s Q test. Publication bias was assessed with funnel plots and Egger’s regression tests.

Results

A total of 16 studies with a good individual methodological quality were included and analysed in this study. The overall random effects pooled prevalence of malaria infection (symptomatic and asymptomatic) across all included studies was 14.9% (95% confidence interval [95% CI]: 6.64, 25.80, I2 = 99.8%, P < 0.0001) by microscopy, 25.6% (95% CI: 8.74, 47.62, I2 = 99.6%, P < 0.0001) by PCR and 24.3% (95% CI: 12.05 to 39.14, I2 = 99.7%, P < 0.0001) by rapid diagnostic test. Using microscopy, the prevalence of asymptomatic malaria was 1.0% (95% CI: 0.00, 3.48) against 21.46% (95% CI: 11.03, 34.21) in symptomatic malaria. The overall prevalence ofPlasmodium falciparumandPlasmodium vivaxwas 51.14% and 37.55%, respectively. Subgroup analysis showed significant variation (P = 0.039) in the prevalence of malaria between asymptomatic and symptomatic cases.

Conclusion

Plasmodium falciparumandP. vivaxare widespread in Mauritania. Results of this meta-analysis implies that distinct intervention measures including accurate parasite-based diagnosis and appropriate treatment of confirmed malaria cases are critical for a successful malaria control and elimination programme in Mauritania.
Altering of the sprayed wall after indoor residual spraying and associated factors among households in Boricha district, Sidama regional state, Ethiopia, 2019: community-based cross-sectional study
Authors: Ibrahim Medina , Beyene Hunachew , Tolcha Alemu , Eskendir Habtamu , Assefa Abiyu Ayalew
Published: May 2023

Background

Indoor residual spraying (IRS) has been the main tool used to control malaria. Reducing the life span and the density of the vector mosquitoes are direct effects of IRS towards restricting malaria transmission. Residents must not wash or re-plaster walls after the spray application for at least 6 months to fight against malaria with IRS. This study sought to assess the alteration of the sprayed wall after the IRS operation and associated factors among households in the Boricha district.

Methods

Community-based cross-sectional study was conducted among 608 households selected using multi-stage sampling. A structured interviewer-administered questionnaire was used to collect data. Data were analysed by SPSS version 25. Both bivariable and multivariable logistic regression analysis was done. Finally, the strength of the association was measured based on AOR with 95% CI and statistical significance was declared at a p-value less than 0.05.

Result

From the total of 608 sprayed houses included in the study, 37.3% (95% CI: 33.41% – 41.15%) were found to have altered sprayed walls. The highest class of wealth index category (AOR = 2.50; 95% CI: 1.19, 5.16), low level of comprehensive knowledge about IRS (AOR = 6.08; 95% CI: 3.37, 10.94), did not get information within 2 weeks before spray (AOR = 2.09; 95% CI: 1.43, 3.05), absence of supervision after the spray operation (AOR = 1.77; 95% CI: 1.27, 2.73) and walking distance to nearest health facility (AOR = 2.39; 95% CI: 1.63, 3.35) remained significant factors of altering of the sprayed wall after IRS.

Conclusion

The prevalence of alteration was relatively high. The highest socio-economic status, poor knowledge about indoor residual spraying, lack of information about IRS within two weeks before spray, absence of supervision after IRS, and walking distance of more than 30 min to reach the nearest health post were the factors affecting the alteration status of the sprayed wall. Future efforts to focus on successive awareness creation activities should be done before and after IRS operation to the community by concerned bodies.
Cost of bladder cancer in Lebanon before and after the economic collapse: a probabilistic modeling study
Authors: Raad Elie , Helou Samar , Hage Karl , Daou Melissa , El Helou Elie
Published: May 2023

Background and objectives

Lebanon has one of the highest incidence rates of bladder cancer (BC) in the world. In 2019, Lebanon’s economy collapsed which majorly impacted healthcare costs and coverage. This study assesses the overall direct costs of urothelial BC in Lebanon, from the perspective of public and private third-party payers (TPP) and households, and evaluates the impact of the economic collapse on these costs.

Methods

This was a quantitative, incidence-based cost-of-illness study, conducted using a macro-costing approach. Costs of medical procedures were obtained from the records of various TPPs and the Ministry of Public Health. We modeled the clinical management processes for each stage of BC, and conducted probabilistic sensitivity analyses to estimate and compare the cost of each stage, pre-and post-collapse, and for each payer category.

Results

Before the collapse, the total annual cost of BC in Lebanon was estimated at LBP 19,676,494,000 (USD 13,117,662). Post-collapse, the total annual cost of BC in Lebanon increased by 768% and was estimated at LBP 170,727,187,000 (USD 7,422,921). TPP payments increased by 61% whereas out-of-pocket (OOP) payments increased by 2,745% resulting in a decrease in TPP coverage to only 17% of total costs.

Conclusion

Our study shows that BC in Lebanon constitutes a significant economic burden costing 0.32% of total health expenditures. The economic collapse induced an increase of 768% in the total annual cost, and a catastrophic increase in OOP payments.
CircRNAs: versatile players and new targets in organ fibrosis
Authors: Wei Lei , Liu Limin , Bai Ming , Ning Xiaoxuan , Sun Shiren
Published: May 2023

Organ fibrosis can occur in virtually all major organs with relentlessly progressive and irreversible progress, ultimately resulting in organ dysfunction and potentially death. Unfortunately, current clinical treatments cannot halt or reverse the progression of fibrosis to end-stage organ failure, and thus, advanced antifibrotic therapeutics are urgently needed. In recent years, a growing body of research has revealed that circular RNAs (circRNAs) play pivotal roles in the development and progression of organ fibrosis through highly diverse mechanisms of action. Thus, manipulating circRNAs has emerged as a promising strategy to mitigate fibrosis across different organ types. In this review, we systemically summarize the current state of knowledge about circRNA biological properties and the regulatory mechanisms of circRNAs. A comprehensive overview of major fibrotic signaling pathways and representative circRNAs that are known to modulate fibrotic signals are outlined. Then, we focus on the research progress of the versatile functional roles and underlying molecular mechanisms of circRNAs in various fibrotic diseases in different organs, including the heart, liver, lung, kidney and skin. Finally, we offer a glimpse into the prospects of circRNA-based interference and therapy, as well as their utilization as biomarkers in the diagnosis and prognosis of fibrotic diseases.
Mitochondria-derived vesicles and their potential roles in kidney stone disease
Authors: Chaiyarit Sakdithep , Thongboonkerd Visith
Published: May 2023

Recent evidence has shown significant roles of mitochondria-derived vesicles (MDVs) in mitochondrial quality control (MQC) system. Under mild stress condition, MDVs are formed to carry the malfunctioned mitochondrial components, such as mitochondrial DNA (mtDNA), peptides, proteins and lipids, to be eliminated to restore normal mitochondrial structure and functions. Under severe oxidative stress condition, mitochondrial dynamics (fission/fusion) and mitophagy are predominantly activated to rescue mitochondrial structure and functions. Additionally, MDVs generation can be also triggered as the major MQC machinery to cope with unhealthy mitochondria when mitophagy is unsuccessful for eliminating the damaged mitochondria or mitochondrial fission/fusion fail to recover the mitochondrial structure and functions. This review summarizes the current knowledge on MDVs and discuss their roles in physiologic and pathophysiologic conditions. In addition, the potential clinical relevance of MDVs in therapeutics and diagnostics of kidney stone disease (KSD) are emphasized.
Intimate partner violence victimization during pregnancy increases risk of postpartum depression among urban adolescent mothers in South Africa
Authors: Gebrekristos Luwam T. , Groves Allison K. , McNaughton Reyes Luz , Moodley Dhayendre , Beksinska Mags , Maman Suzanne
Published: May 2023

Background

It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study’s purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers.

Methods

Adolescent mothers (14–19 years) were recruited at a regional hospital’s maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6–9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates.

Results

Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6–9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97–2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06–2.49; p = 0.03).

Conclusions

Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers’ well-being and their baby’s health.
Can a powered knee-ankle prosthesis improve weight-bearing symmetry during stand-to-sit transitions in individuals with above-knee amputations?
Authors: Hunt Grace R. , Hood Sarah , Gabert Lukas , Lenzi Tommaso
Published: May 2023

Background

After above-knee amputation, the missing biological knee and ankle are replaced with passive prosthetic devices. Passive prostheses are able to dissipate limited amounts of energy using resistive damper systems during “negative energy” tasks like sit-down. However, passive prosthetic knees are not able to provide high levels of resistance at the end of the sit-down movement when the knee is flexed, and users need the most support. Consequently, users are forced to over-compensate with their upper body, residual hip, and intact leg, and/or sit down with a ballistic and uncontrolled movement. Powered prostheses have the potential to solve this problem. Powered prosthetic joints are controlled by motors, which can produce higher levels of resistance at a larger range of joint positions than passive damper systems. Therefore, powered prostheses have the potential to make sitting down more controlled and less difficult for above-knee amputees, improving their functional mobility.

Methods

Ten individuals with above-knee amputations sat down using their prescribed passive prosthesis and a research powered knee-ankle prosthesis. Subjects performed three sit-downs with each prosthesis while we recorded joint angles, forces, and muscle activity from the intact quadricep muscle. Our main outcome measures were weight-bearing symmetry and muscle effort of the intact quadricep muscle. We performed paired t-tests on these outcome measures to test for significant differences between passive and powered prostheses.

Results

We found that the average weight-bearing symmetry improved by 42.1% when subjects sat down with the powered prosthesis compared to their passive prostheses. This difference was significant (p = 0.0012), and every subject’s weight-bearing symmetry improved when using the powered prosthesis. Although the intact quadricep muscle contraction differed in shape, neither the integral nor the peak of the signal was significantly different between conditions (integral p > 0.01, peak p > 0.01).

Conclusions

In this study, we found that a powered knee-ankle prosthesis significantly improved weight-bearing symmetry during sit-down compared to passive prostheses. However, we did not observe a corresponding decrease in intact-limb muscle effort. These results indicate that powered prosthetic devices have the potential to improve balance during sit-down for individuals with above-knee amputation and provide insight for future development of powered prosthetics.
A study on atypical Kashin–Beck disease: an endemic ankle arthritis
Authors: Qi Fang , Cui Si-Lu , Zhang Bing , Li Hao-Nan , Yu Jun
Published: May 2023

Background

To study the epidemiological characteristics of atypical Kashin–Beck disease cases without characteristic hand lesions such as interphalangeal joint enlargement and brachydactyly and the characteristics of ankle joint lesions.

Methods

We investigated Kashin–Beck in the endemic villages in Heilongjiang Province. The patients were judged according to the “Diagnosis of Kashin–Beck Disease” (WS/T 207–2010). The severity of foot lesions was judged based on the changes of X-ray images. Residents of non-Kashin–Beck disease area were selected as normal controls in Jilin Province.

Results

A total of 119 residents over 40 years old were surveyed in a natural village in the non-endemic area. A total of 1190 residents over 40 years old were surveyed in 38 endemic areas of Kashin–Beck disease. A total of 710 patients with Kashin–Beck disease were detected, including 245 patients with grade I, 175 patients with grade II, 25 patients with grade III, and 265 atypical patients. Among all investigated patients, 92.0% (653/710) had ankle joint changes, and it was 80.0% (196/245) in grade I patients and 95.4% (167/175) in grade II. Varying degrees of ankle joint changes were found in both grade III and atypical patients. The grade of Kashin–Beck disease was correlated with the degree of ankle joint change (P < 0.001), and the correlation coefficientrs = 0.376. Atypical Kashin–Beck disease patients in mild and severe endemic area of Kashin–Beck disease were younger than those with typical Kashin–Beck disease.

Conclusions

We found a correlation between the degree of ankle joint change and the grade of Kashin–Beck disease. The higher the grade of Kashin–Beck disease, the more serious the change of the ankle joint.
Towards multiplexed immunofluorescence of 3D tissues
Authors: Cho Wonjin , Kim Sehun , Park Young-Gyun
Published: May 2023

Profiling molecular expression in situ allows the integration of biomolecular and cellular features, enabling an in-depth understanding of biological systems. Multiplexed immunofluorescence methods can visualize tens to hundreds of proteins from individual tissue samples, but their application is usually limited to thin tissue sections. Multiplexed immunofluorescence of thick tissues or intact organs will enable high-throughput profiling of cellular protein expression within 3D tissue architectures (e.g., blood vessels, neural projections, tumors), opening a new dimension in diverse biological research and medical applications. We will review current multiplexed immunofluorescence methods and discuss possible approaches and challenges to achieve 3D multiplexed immunofluorescence.
Research note reliability and validity of Japanese version of the trauma-informed care provider survey (TIC provider survey)
Authors: Kataoka Mayumi , Kotake Risa , Asaoka Hiroki , Miyamoto Yuki , Nishi Daisuke
Published: May 2023

Objective

Robust instruments to evaluate the ability of trauma-informed care among healthcare workers need to be developed, as this would help the implementation of trauma-informed care to prevent re-traumatization of patients. This study aims to assess the reliability and validity of the Japanese version of the Trauma-Informed Care (TIC) Provider Survey. A total of 794 healthcare workers were surveyed using a self-administered questionnaire, including the TIC Provider Survey, and six measures that were considered to be correlated with it. We calculated the Cronbach’s alpha coefficient to investigate the internal consistency of each category of the TIC Provider Survey (knowledge, opinions, self-rated competence, practices, and barriers). Spearman’s rank correlation coefficients were used to investigate the correlation between each category of the TIC Provider Survey, and other measures of construct validity.

Results

Cronbach’s alpha coefficients of each category of the TIC Provider Survey were 0.40 (Knowledge), 0.63 (Opinions), 0.92 (Self-rated competence), 0.93 (Practices), and 0.87 (Barriers). The Spearman’s rank correlation coefficients were small. We confirmed the reliability of the acceptable levels and examined the validity of modest or unacceptable levels of the Japanese version of the TIC provider survey among Japanese workers in a healthcare setting.
Predictors of resilience in healthcare workers during the COVID-19 pandemic: a longitudinal study comparing the first and second waves
Authors: Mendoza Bernal Irhomis , Sánchez-Teruel David , Robles-Bello María Auxiliadora , Sarhani-Robles Aziz , Sarhani-Robles Mariam
Published: May 2023

Few studies have investigated the effects of the pandemic caused by COVID-19 on health professionals, especially nurses, from the point of view of the protective factors of mental health. The aim of this study was to assess the level of resilience in healthcare workers, to determine whether there were differences between two moments of the pandemic. Applying a longitudinal study, participants (N = 590) from healthcare workers completed surveys in the first wave of the COVID-19 pandemic and the second wave. Socio-demographic and psychosocial variables such as resilience, emotional intelligence, optimism, self-efficacy, anxiety, and depression are used. There were differences between the two waves in all protective and risk variables except anxiety. In the first wave, there were three socio-demographic and psychosocial variables that explained 67.1% of the variance in resilience. In the first wave, three sociodemographic and psychosocial variables explained 67.1% of the variance in resilience in healthcare professionals. The enhancement of specific protective variables in healthcare professionals exposed to situations of high emotional stress can minimise the negative impact of the situation and promote more resilient responses in this professional group as a result.
Survivability of patients admitted for stroke in a primary stroke center, Penang, Malaysia: a retrospective 5-year study
Authors: Danial Monica , Izwani Mohdradzi Nurul Shahira , Khan Amer Hayat , Ch’ng Alan Swee Hock , Irene Looi
Published: May 2023

Background

Stroke is one of the most common noncommunicable diseases, with significant public health implications both globally and in Malaysia. The aim of this study was to evaluate post-stroke survivability as well as the major drug classes prescribed for hospitalized stroke patients.

Methods

A 5-year retrospective study was carried out on the survival of stroke patients admitted to Hospital Seberang Jaya, a main stroke center in the state of Penang, Malaysia. Patients admitted for stroke were first identified using the local stroke registry database, and their medical records were then accessed for data collection, which included demographic information, comorbid conditions, and medications prescribed during admission.

Results

The Kaplan-Meier overall survivability analysis performed indicated 50.5% survival for the duration of 10 days (p < 0.001) post-stroke. Ten-day survivability differences (p < 0.05) were observed for the categories of type of stroke (ischemic stroke (60.9%) and hemorrhagic stroke (14.1%)); stroke episodes (first (61.1%) and recurrent (39.6%)); anti-platelets (prescribed (46.2%) and not prescribed (41.5%)); statins (prescribed (68.7%) and not prescribed (28.1%)); anti-hypertensive (prescribed (65.4%) and not prescribed (45.9%)); and anti-infectives (prescribed (42.5%) and not prescribed (59.6%)) respectively. Higher risks of mortality were observed among patients with hemorrhagic stroke (HR: 10.61, p = 0.004); with 3 or more comorbidities (HR:6.60, p = 0.020); and not prescribed with statins and anti-diabetic. Patients prescribed anti-infectives, on the other hand, had a higher risk of mortality when compared to patients who did not receive anti-infectives (HR: 13.10, p = 0.019). The major drug classes prescribed for stroke patients were antiplatelet drugs (86.7%), statins (84.4%), and protein pump inhibitors (75.6%).

Conclusion

The findings of the study are intended to encourage more non-stroke hospitals in Malaysia to increase their efforts in treating stroke patients, as early treatment can help reduce the severity of the stroke. With the incorporation of evidence-based data, this study also contributes to local data for comparison and improves the implementation of regularly prescribed stroke medication.
Sharing space at the research table: exploring public and patient involvement in a methodology priority setting partnership
Authors: Burke Nikita N. , Stewart Derek , Tierney Theresa , Worrall Andrew , Smith Maureen , Elliott Jim , Beecher Claire , Devane Declan , Biesty Linda
Published: May 2023

Background

Public and patient involvement aims to improve research quality, relevance, and appropriateness. Despite an increasing evidence base on the influence of public involvement in health research, the role of involvement in methodology research (i.e. research that aims to enhance the quality and rigour of research) is less clear. Using a qualitative case study, we explored public involvement in a research priority-setting partnership in rapid review methodology (Priority III) to give practical insights to inform public involvement in priority-setting for future methodological research.

Methods

Participant observation, documentary analysis, interviews and focus groups were used to explore the processes of Priority III and identify the views and experiences of the participants of a steering group (n = 26) regarding public involvement in Priority III. We used a case study research design and conducted two focus groups with five public partners; one focus group with four researchers; and seven one-to-one interviews with researchers and public partners. Nine episodes of participant observation of meetings were conducted. All data were analysed using template analysis.

Results

The findings of this case study present three themes and six subthemes:

Theme 1

We all bring unique qualities to the table.

Subtheme 1.1—Coming from different perspectives towards shared-decision making;

Subtheme 1.2—Public partners bring pragmatism and grounding in reality;

Theme 2

We need support and space at the table.

Subtheme 2.1—Define and develop support needed for meaningful involvement;

Subtheme 2.2—Creating safe space to listen, challenge and learn;

Theme 3

We all benefit from working together.

Subtheme 3.1—Reciprocity in mutual learning and capacity building;

Subtheme 3.2—Relationships as partners in research, with a feeling of togetherness.

Communication and trust, as inclusive ways of working, underpinned the partnership approach to involvement.

Conclusions

This case study contributes to knowledge on public involvement in research by explaining the supportive strategies, spaces, attitudes and behaviours that enabled a productive working partnership to develop between a team of researchers and public partners in this research context.
Serum vitamin E levels in children with human immunodeficiency virus infection in Lagos Nigeria
Authors: Olibamoyo O. B. , Akintan P. E. , Adeniyi O. F. , Soriyan O. O.
Published: May 2023

Background

Vitamin E supplementation in many adult populations has been found to reduce the impact of oxidative stress from chronic diseases which include HIV infection. With paucity of data among the pediatric population, this study was conducted to determine the mean serum vitamin E levels and its associations with the immunologic status, the nutritional status and the use of highly active antiretroviral drugs (HAART) in children with HIV aged 6 weeks to 13 years.

Methods

Seventy HIV-infected children (35 HIV-infected on HAART, 35 HIV-infected HAART-naïve) and seventy age- and sex-matched HIV-uninfected children were recruited to the study. Social class, anthropometric measures, results of serum vitamin E (using HPLC), CD4 counts, and cholesterol levels were inputted into a pretested questionnaire.

Results

The median (IQR) serum vitamin E levels among the children with HIV was 2.54 (1.55–5.27) μmol/L which was higher than the controls 1.87 (1.63–2.88) μmol/L, p = 0.03.There was a positive correlation between serum vitamin E levels and immunological status using CD4% (r =  + 0.141, p = 0.53) and CD4 counts (r =  + 0.017, p = 0.91) among the children with HIV. There was no significant association between serum vitamin E levels and nutritional status. The vitamin E levels were higher in the HAART-exposed children compared to the HAART-naïve children but the difference was not significant p = 0.480 and p = 0.485 respectively.

Conclusion

The children with HIV had higher serum vitamin E levels. Further research is needed to investigate possible reasons and implications for this including the role of the vitamin E carrier protein in HIV management.
Η σχολική ένταξη παιδιών προερχόμενων από ειδικές πληθυσμιακά ομάδες μέσω παρεμβατικών δράσεων
Authors: Τσέλιου Ειρήνη
Published: May 2023

Η παρούσα εργασία μελετά το ζήτημα της ένταξης των ειδικών πληθυσμιακά ομάδων -και, πιο συγκεκριμένα, των παιδιών Ρομά, που αποτελούν και την ομάδα στόχο της μελέτης της- μέσω διαφόρων παρεμβάσεων που υλοποιούνται για τις ομάδες αυτές. Η βασική της υπόθεση είναι ότι οι πολιτικές παρεμβάσεις που εφαρμόζονται στο σχολείο, οι εκπαιδευτικές πολιτικές και πρακτικές που υλοποιούνται για τις παραπάνω ομάδες, καθώς και οι αντιλήψεις των στελεχών της εκπαίδευσης και των εκπαιδευτικών που εκπροσωπούν το σύστημα, επηρεάζουν τον βαθμό ένταξης των ειδικών πληθυσμιακά ομάδων και, ειδικότερα, τον βαθμό ένταξης των παιδιών Ρομά. Η εν λόγω διδακτορική διατριβή, διερευνά τις στάσεις και τις αντιλήψεις των λειτουργών της Εκπαίδευσης.Το πλαίσιο αυτής της ερευνητικής εργασίας που αφορά στην εκπαιδευτική έρευνα, στηρίχτηκε στις συνδυαστικές προσεγγίσεις που επεδίωξαν να συνθέσουν τα μακρο- και μικρο- θεωρητικο-αναλυτικά πλαίσια και πιο συγκεκριμένα το δίπολο δομής - δράσης. Γι’ αυτό και λαμβάνοντας υπόψη το υφιστάμενο κοινωνικό, πολιτικό, πολιτισμικό και εκπαιδευτικό πλαίσιο, χρησιμοποίησε το πλαίσιο της θεωρίας του Antony Giddens, ως βασικός οδηγός για τη μεθοδολογία της έρευνας που ακολούθησε, την ποιοτική έρευνα. Επίσης, το εργαλείο που επιλέχθηκε ως το πιο κατάλληλο είναι η ημιδομημένη συνέντευξη.Η έρευνα πραγματοποιήθηκε σε περιοχές με μαθητικούς πληθυσμούς Ρομά διαφορετικής δημογεωγραφίας, καθώς και σε περιοχές στις οποίες ισχύουν διαφορετικές κοινωνικοοικονομικές και πολιτισμικές συνθήκες της κοινότητας Ρομά. Το δείγμα αφορούσε σε συνεντεύξεις με 40 φυσικά πρόσωπα και πιο συγκεκριμένα με 3 Μέλη ΔΕΠ (Καθηγητές Πανεπιστημίων/Επιστημονικούς Υπευθύνους σε προγράμματα για την ένταξη και την εκπαίδευση των παιδιών Ρομά), 6 Διευθυντές Εκπαίδευσης, 8 Συντονιστές Εκπαιδευτικού Έργου, 10 Διευθυντές Σχολείων και 13 εκπαιδευτικούς.Έπειτα από την παράθεση των αποτελεσμάτων της έρευνας και των συμπερασμάτων προτείνεται, μία σειρά από μέτρα που συνάδουν καθώς και οι προτάσεις που θα μπορούσαν να διερευνηθούν περαιτέρω.
Δρομολόγια της ταυτότητας
Authors: Σίδερης Θωμάς
Published: May 2023

Το αντικείμενο της διατριβής είναι το ανυπεράσπιστο σώμα σε συνθήκες εκτοπισμού, εγκλωβισμού ή γενικά εγκλεισμού και οι χωρικές αναπαραστάσεις που παράγει και εναποθέτει στον χώρο στις συνθήκες αυτές. Ως ανυπεράσπιστο σώμα λογίζεται εδώ το σώμα που είναι ευάλωτο στη βία, στη φτώχεια, στην κοινωνική περιθωριοποίηση, το σώμα που βρίσκεται στη δίνη ανεξέλεγκτων καταστάσεων και δραματικών γεγονότων, το σώμα που εκτοπίζεται με στρατιωτική ή αστυνομική βία, κατόπιν εισαγγελικής παραγγελίας, κατόπιν ειδικών νομοθετημάτων. Υπό μία έννοια, το ανυπεράσπιστο σώμα είναι και αόρατο σώμα, ένα σώμα που έχει περάσει στη σφαίρα της αορατότητας και της μη ύπαρξης/ταυτοποίησης από κρατικές αρχές και επίσημους φορείς εξουσίας. Ως εκ τούτου, και οι θύλακες και τα καταφύγια που διαμένουν ή κατοικούν είναι και αυτά αόρατα, πίσω από το οικιστικό πλαίσιο, στο περιθώριο της κοινωνικής και οικονομικής ζωής, χωρικές οντότητες ενός κατακερματισμένου και θρυμματισμένου χώρου. Η έννοια του ανυπεράσπιστου σώματος όμως δεν πρέπει να μας οδηγεί σε αυθαίρετα συπεράσματα που υπακούουν στη ντετερμινιστική θεώρηση (Μπιτσάκης, 1975). Οι ανυπεράσπιστοι φτωχοδιάβολοι του Μεσοπολέμου θα αυτό-οργανωθούν, θα υπερασπιστούν την παράγκα, όντες ανυπεράσπιστοι, θα διεκδικήσουν συλλογικά τα αιτήματά τους με χαρακτηριστικότερο παράδειγμα την οργάνωση των ασθενών στο σανατόριο «Σωτηρία» και την αντίδραση του προσφυγικού πληθυσμού της Δραπετσώνας στη λεγόμενη «μάχη της παράγκας» το 1960.
Αξιολόγηση των επιπτώσεων στα μέσα μαζικής μεταφοράς λόγω των επικείμενων προσαρμοστικών - ρυθμιστικών μέτρων για την πρόληψη της κλιματικής αλλαγής
Authors: Κάτσαρης Βασίλειος
Published: May 2023

Πρόσφατα, το 2015 η Διάσκεψη στο Παρίσι για την Κλιματική Αλλαγή έθεσε ως στόχο τον περιορισμό της υπερθέρμανσης του πλανήτη σε λιγότερο από 1,5ο μέχρι το 2100. Τα περισσότερα κράτη, αν όχι όλα αποδέχθηκαν το στόχο ως προς τις αρχές του. Με δεδομένο ότι δεν υφίσταται μηχανισμός επιβολής κυρώσεων η επιβολή του δεν είναι καθόλου σίγουρη. H υποβάθμιση του περιβάλλοντος και συνεπακόλουθα η κλιματική αλλαγή αποτελούν υπαρξιακή απειλή. Οι αναμενόμενες κλιματικές αλλαγές επαναπροσδιορίζουν τον κόσμο και μεγιστοποιούν τους κινδύνους αστάθειας σε όλες τις μορφές.Τέτοιες μορφές αστάθειας μπορεί να οδηγήσουν σε αύξηση των πολεμικών συγκρούσεων, σε οικονομική ύφεση καθώς και σε μαζικές μετακινήσεις προσφύγων.Στον δικό μας μικρόκοσμο, στην Περιφέρεια Αττικής, των μακρόπνοων σχεδιασμών και των αντιαισθητικών πολεοδομικών αυθαιρεσιών μπορεί αυτή η ζοφερή απειλή να μετουσιωθεί σε μοχλό αναστροφής και αλλαγών στην πραγματικότητα των δημόσιων συγκοινωνιών του Λεκανοπεδίου; μπορεί η αναδιάταξη των δημόσιων συγκοινωνιών να απελευθερώσει ικανό δημόσιο χώρο για τον πολίτη που σήμερα του αποστερείται; μπορεί να αντιστραφεί η κυριαρχία της εξατομίκευσης και να επικρατήσει η συλλογικότητα; μπορεί το δημόσιο να νικήσει το ιδιωτικό;Ο χρόνος θα δείξει…
Εκτιμήσεις πυρήνων θερμότητας για ελλειπτικούς διαφορικούς τελεστές τέταρτης τάξης
Authors: Μπρανίκας Παναγιώτης-Χρήστος
Published: May 2023

Στην παρούσα διδακτορική διατριβή, με τίτλο «Εκτιμήσεις πυρήνων θερμότητας για ελλειπτικούς διαφορικούς τελεστές τέταρτης τάξης» θεωρούμε μία κατηγορία ομοιόμορφα ελλειπτικών τελεστών τέταρτης τάξης σε ένα χωρίο Ω⊂R^2 και μελετάμε τον σχετικό πυρήνα θερμότητας. Για τελεστές με συντελεστές L^∞ βρίσκουμε Γκαουσιανές εκτιμήσεις με τις βέλτιστες σταθερές, ενώ για τελεστές με σταθερούς συντελεστές βρίσκουμε ασυμπτωτικές εκτιμήσεις. Η καινοτομία αυτής της διατριβής είναι ότι το σχετικό σύμβολο δεν είναι ισχυρά κυρτό. Οι ασυμπτωτικές εκτιμήσεις εμφανίζουν μία συμπεριφορά που είναι ποιοτικά διαφορετική από αυτή της ισχυρά κυρτής περίπτωσης.Βρίσκουμε επίσης εκτιμήσεις του πυρήνα θερμότητας για μία κατηγορία μη ομοιόμορφα ελλειπτικών τελεστών τέταρτης τάξης στις δύο διαστάσεις. Σε αντίθεση με τα υπάρχοντα αποτελέσματα, οι τελεστές που μελετώνται έχουν σύμβολα που δεν είναι ισχυρά κυρτά. Αυτό παρουσιάζει ιδιαίτερες δυσκολίες καθώς είναι γνωστό ότι, σε αντίθεση με την ισχυρά κυρτή περίπτωση, δεν υπάρχει απόλυτη εκθετική σταθερά. Οι εκτιμήσεις μας περιλαμβάνουν σταθερές και αποστάσεις τύπου Finsler που επάγονται από το σύμβολο του τελεστή. Το κύριο αποτέλεσμα βασίζεται σε δύο γενικές υποθέσεις, μία ανισότητα Sobolev με βάρος και μία ανισότητα παρεμβολής με βάρος, οι οποίες σχετίζονται με την ιδιομορφία ή τον εκφυλισμό των συντελεστών.
Comparative analysis of postmortem cerebral ammonia level and Alzheimer type 2 astrocytes with intravital blood laboratory parameters of deceased patients with liver cirrhosis of varying degree
Authors: Shulyatnikova Tatyana , Tumanskiy Valeriy
Published: May 2023

Purpose - correlation analysis of the postmortem ammonia level and numbers of Alzheimer type 2 astrocytes in different parts of the brain with intravital laboratory blood parameters of deceased patients with liver cirrhosis of varying severity.

Material and methods. Autopsied brains of 90 patients with non-alcoholic liver cirrhosis (LC) of class A, B and C according to Child-Pugh formed 3 groups: «A» (n = 30), «B» (n = 30) and «C» (n = 30). Control group - 30 patients deceased from cardiovascular failure. Cortex, white matter, hippocampus, thalamus, striatum and cerebellum were histochemically (HC) studied with Nessler's reagent for ammonia level. Correlation analysis of ammonia expression, Alzheimer type 2 astrocytes (AA2) numbers and 14 intravital laboratory blood parameters was performed.

Results. HC method reveals region-dependent ammonia expression in the brain neuropil. The most significant correlations are observed in thalamus, striatum, cerebellum, and cortex between ammonia expression (ACUOD), AA2-astrocytosis, and lifetime values of total bilirubin (for Bil/ACUOD & /AA2 r = 0.31-0.97), AST (for AST/ACUOD & /AA2 r = 0.30-0.81), ALT (for ALT/ACUOD & /AA2 r = 0.30-0.78), leukocyte index of intoxication (for LII/ACUOD & /AA2 r = 0.34-0.76), albumin (for Alb/ACUOD & /AA2 r = -0.34 to -0.78), leukocytes (for Wbc/ACUOD & /AA2 r = 0.31-0.68), prothrombin index (for PI/ACUOD & /AA2 r = -0.31 to -0.45) and potassium (for K+/ACUOD & /AA2 r = -0.32 to -0.45), p <0.05.

Conclusion. During LC ammonia expression and AA2-astrocytosis in cerebellum, thalamus, striatum and cortex significantly correlate with each other, as well as with indicators of total bilirubin, AST, ALT, albumin, leukocytes, leukocyte index of intoxication, prothrombin index and blood potassium.