bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance, Value, and Causal Impact
Authors: Kahane Guy
Published: August 2021

Many believe that because we are so small, we must be utterly insignificant on the cosmic scale. But whether this is so depends on what it takes to be important. On one view, what matters for importance is the difference to value that something makes. On this view, what determines our cosmic importance is not our size, but what else of value is out there. But a rival view also seems plausible: that importance requires sufficient causal impact on the relevant scale; since we have no such impact on the grand scale, that would entail our cosmic insignificance. I argue that despite appearances, causal impact is neither necessary nor sufficient for importance. All that matters is impact on value. Since parts can have non-causal impact on the value of the wholes that contain them, this means that we might have great impact on the grandest scale without ever leaving our little planet.
“I Counted Sun’s Faces” in the Short Recension of 2 Enoch
Authors: Navtanovich Liudmila
Published: August 2021

2 Enoch without any doubt is one of the most interesting and enigmatic texts of Slavonic Pseudepigrapha. Since the publication of the first fragments of it in the middle of the 19th century, there has been a protracted debate on all the questions concerning the history of the pseudepigraphon. And the “astronomical information” in it is possibly one of the most mysterious parts of 2 Enoch. The contents of the two main recensions are quite different in the chapter dealing with astronomical material. The paper studies the fragment, in which, in the short recension, it is literally said: “I [Enoch] counted Sun’s faces”.
Deagrarianization and Depeasantization: A Dynamic Process of Transformation in Rural China
Authors: Hu (呼占平) Zhanping
Published: August 2021

Centering on the terms of “deagrarianization” 去农化 and “depeasantization” 去小农化, this article aims to reinterpret socioeconomic changes in rural China from a theoretical and global perspective. Deagrarianization and depeasantization interwove to shape the dynamic process of rural transformation. Throughout the reform era, rural China underwent a transition from “deagrarianization without depeasantization” to “salient depeasantization.” In the end, deagrarianization led to a continual process of rural deterioration and at the same time turned rural China into a space of complexity. Depeasantization has been diversifying Chinese agriculture into multiple organizational forms. The mode of “part-time worker and part-time farmer” that emerged in the process of deagrarianization is gradually yielding to the specializing mode of “full-time farmer” or “full-time worker” during depeasantization. The strategy of rural revitalization should be adjusted dynamically on the basis of a recognition of these two interwoven processes.
New species of the genus Cenophengus LeConte 1881 (Coleoptera; Phengodidae) from Mexico and Guatemala
Authors: VEGA-BADILLO VIRIDIANA , ZARAGOZA-CABALLERO SANTIAGO , RÍOS-IBARRA JESSICA JAZMÍN
Published: August 2021

Six new species of the genus Cenophengus LeConte, 1881 are described. Five of these new species were collected in Mexico, in the states of Hidalgo (Cenophengus mboi sp. nov. and Cenophengus hnogamu̱i sp. nov.), Coahuila (Cenophengus kikapu sp. nov.) and San Luis Potosí (Cenophengus tupae sp. nov., Cenophengus mumui sp. nov.). An additional species was collected in Puerta Parada, Guatemala (Cenophengus xiinbali sp. nov.). The new taxa described in the present study increase to 27 the number of species assigned to Cenophengus.
The genus Alcochera Förster (Hymenoptera, Ichneumonidae, Ctenopelmatinae) in China with a key to world species
Authors: SUN SHU-PING , LI TAO , ZONG SHI-XIANG , SHENG MAO-LING
Published: August 2021

Two new species of Alcochera (Ichneumonidae, Ctenopelmatinae, Mesoleiini), Alcochera flavoclypeata Sheng & Sun, sp. nov. collected from Labagoumen Natural Reserve, Huairou, Beijing, and A. truncata Sheng & Sun, sp. nov. from Wugongshan Natural Reserve, are described and illustrated. An updated taxonomic key to world species of Alcochera is provided.
Retrieving accurate soil moisture over the Tibetan Plateau using multi-source remote sensing data assimilation with simultaneous state and parameter estimations
Authors: Chen Weijing , Huang Chunlin , Yang Zong-Liang , Zhang Ying
Published: August 2021

Data assimilation provides a practical way to improve the accuracy of soil moisture simulation by integrating a land surface model and satellite data. This study establishes a multi-source remote sensing data assimilation framework by incorporating a simultaneous state and parameter estimation method to acquire an accurate estimation of the soil moisture over the Tibetan Plateau. The brightness temperature of the Advanced Microwave Scanning Radiometer 2 (AMSR2) is directly assimilated into the coupled system of the Common Land Model (CoLM) and a microwave radiative transfer model (RTM) to improve the soil moisture simulation. The Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature product and the Beijing Normal University (BNU) leaf area index product are employed to not only improve the estimation of temperature and vegetation variables from the CoLM, but also provide more accurate background information for the RTM during the brightness temperature assimilation. In situ measurements from the Naqu network are used to evaluate the results. The model simulation showed an obvious underestimation of soil moisture and overestimation of soil temperature, which was alleviated by the assimilation experiments, particularly in the shallow soil layers. The estimated parameters also showed advantages in the soil moisture simulation when compared with the default parameters. The assimilation experiment presents promising results in the combination of model and multi-source remote sensing data for estimating soil moisture over the complex mountainous region in Tibet.
Assessment of Early Stage Glottic Cancer Depth of Resection After Transoral Laser Cordectomy
Authors: Cohen Jacob T. , Goldman Tal , Paker Miki , Fridman Eran
Published: August 2021

Objective

Surgeons generally determine depth of resection during transoral laser cordectomy by visual inspection of the surgical field. Our aim was to examine the correlation between early glottic cancer depth of resection as reported by surgeons in the operation report and depth of resection defined by pathology specimens, using various staining techniques intended to differentiate between the distinct vocal fold layers based on particular collagen deposition.

Study Design

Retrospective study.

Setting

A voice and swallowing clinic at a tertiary referral hospital.

Methods

We compared depth of cordectomy assessed intraoperatively by surgeons and by pathologists using Picrosirius red stain and collagen I immunohistochemistry stain in 32 patients who underwent transoral laser cordectomy for early glottic cancer.

Results

For type I, II, and III cordectomy, the respective proportions of patients were 14 (47%), 9 (30%), and 7 (23%) according to surgeons’ estimations; 2 (6%), 17 (55%), and 12 (39%) according to Picrosirius red stain; and 3 (11%), 12 (44%), and 12 (45%) according to immunohistochemistry for collagen I.

Conclusion

Surgeons’ reported depth of resection did not correlate with depth of resection established by either staining technique. Determining depth of resection necessitates special stains, which should help in the clinical assessment of cordectomy type.
Micro-Computed Tomography-Based Three-Dimensional Anatomical Structure of the Region Around the Pterygoid Hamulus
Authors: Zhao Jiuli , Ma Hengyuan , Wang Yongqian , Song Tao , Jiang Chanyuan , Wu Di , Yin Ningbei
Published: August 2021

Objective

Palatoplasty would involve the structures around the pterygoid hamulus. However, clinicians hold different opinions on the optimal approach for the muscles and palatine aponeurosis around the pterygoid hamulus. The absence of a consensus regarding this point can be attributed to the lack of investigations on the exact anatomy of this region. Therefore, we used micro-computed tomography to examine the anatomical structure of the region surrounding the pterygoid hamulus.

Design

Cadaveric specimens were stained with iodine–potassium iodide and scanned by micro-computed tomography to study the structures of the tissues, particularly the muscle fibers. We imported Digital Imaging and Communications in Medicine images to Mimics to reconstruct a 3-dimensional model and simplified the model.

Results

Three muscles were present around the pterygoid hamulus, namely the palatopharyngeus (PP), superior constrictor (SC), and tensor veli palatini (TVP). The hamulus connects these muscles as a key pivot. The TVP extended to the palatine aponeurosis, which bypassed the pterygoid hamulus, and linked the PP and SC. Some muscle fibers of the SC originated from the hamulus, the aponeurosis of which was wrapped around the hamulus. There was a distinct gap between the pterygoid hamulus and the palatine aponeurosis. This formed a pulley-like structure around the pterygoid hamulus.

Conclusions

Transection or fracture of the palatine aponeurosis or pterygoid hamulus, respectively, may have detrimental effects on the muscles around the pterygoid hamulus, which play essential roles in the velopharyngeal function and middle ear ventilation. Currently, cleft palate repair has limited treatment options with proven successful outcomes.
Analysis of treatment response about low-dose (0.01%) atropine eye-drops in myopic children
Authors: Jeon Gang Seok , Hong In Hwan , Lee Jang Hun , Song Tae Geun , Lee Tae Yeem , Han Jae Ryong
Published: August 2021

Introduction:

Myopia usually commences during primary school and progresses until the mean age of 16 years. Topical low-dose (0.01%) atropine eye-drop appears to be safe and efficacious for myopia control in children. However, in some cases, a higher concentration of atropine is required in some cases because low-dose atropine treatment is not effective.

Methods:

This is a retrospective study among young myopic children between 5 and 15 years with myopia progression > 0.50 D/year. We selected patients treated with low-dose atropine (0.01%) eye-drops for 12 months and conducted a comparative analysis of the group with good responder and poor responder. Patients were classified as good responders if spherical equivalent refractive error (SE) progression was ⩽ 0.50 D after 12 months of treatment and poor responders if SE progression > 0.50 D. The prognostic factors before and after treatment were analyzed in two groups.

Results:

A total of 68 eyes were included. Low-dose (0.01%) atropine eye-drops have a good treatment response in 54% of patients. In the good responder group ( n = 37), the mean rate of myopia progression after 12 months of treatment (0.36 ± 0.17 D) was significantly slower compared with the baseline progression ( p < 0.001). Good responders have smaller changes in axial length (AL) elongation and SE than poor responders ( p < 0.001). The only adverse event was temporary near vision difficulty (10%), photophobia (10%), and mild pupil dilation (30%).

Discussion:

The AL elongation is an important indicator for monitoring the treatment response. Children with a family history of myopia at a young age may not respond well to low-dose (0.01%) atropine eye-drops. In these cases, increasing the concentration of atropine eye-drops should be considered.
Parents’ experience of family-centred care in the post-anaesthetic care unit during non-clinical delays: A qualitative study
Authors: Taranto Jessica , Thornton Rebecca , Lima Sally , Redley Bernice
Published: August 2021

The qualitative exploratory descriptive study explored parents’ experience of family-centred care during delayed transfer from a paediatric post-anaesthetic care unit to an inpatient ward. Data were collected in a tertiary children’s hospital in Melbourne, Australia, using in-depth, semi-structured interviews. Participants ( n = 15) were parents of children ( n = 10, aged 6 months to 16 years) delayed in a Stage 1 post-anaesthetic care unit for longer than 30 min. Elements of the family-centred care framework guided thematic analysis, the core concepts of which are respect and dignity, information sharing, participation and collaboration. Respect and dignity was most often identified, expressed in three subthemes: (1) the caring behaviour of staff, (2) being present with their child and (3) a journey shared with other families. Information sharing was also common, illustrated through (1) being told information and (2) being heard. Participation, the third element of the framework, was infrequently identified by participants; however, parents of children under 6 years of age alluded to contributing to their child’s care. The final element, collaboration, was not identified in the study data. Only two of four elements of the family-centred care framework were common in parents’ experiences: respect and dignity, and information sharing. ‘Being with’ their child emerged as a central concern for parents’ perceptions of family-centred care.
The importance of health literacy for self-management: A scoping review of reviews
Authors: van der Gaag Marieke , Heijmans Monique , Spoiala Cristina , Rademakers Jany
Published: August 2021

Objectives

Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support.

Methods

We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010.

Results

A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients’ perspective described mainly medical management and the communication and navigation of the health care system.

Discussion

Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.
Digital Storytelling Enhancing Chinese Primary School Students’ Self-Efficacy in Mathematics Learning
Authors: Niemi Hannele , Niu Shuanghong Jenny
Published: August 2021

The aim of this study was to uncover how digital storytelling advances students’ self-efficacy in mathematics learning and what kinds of learning experiences contribute to self-efficacy. Four Chinese classes with 10- to 11-year-old students ( N = 121) participated in the project. The mathematics learning theme was geometry. Quantitative data was collected with questionnaires. The qualitative data was based on teachers’ and students’ interviews and observations. Both data sets showed that the students’ self-efficacy increased significantly during the project. The most important mediator was students’ perception of the meaningfulness of mathematics learning; digital storytelling enhanced the students’ ability to see mathematics learning as useful. They became more confident that they could learn mathematics and understand what they had learned. They also felt more confident in talking with their classmates about mathematical concepts. The role of self-efficacy was twofold: it supported students’ learning during the project and it increased due to meaningful mathematics learning experiences.
NOREC4DNA: using near-optimal rateless erasure codes for DNA storage
Authors: Schwarz Peter Michael , Freisleben Bernd
Published: August 2021

Background

DNA is a promising storage medium for high-density long-term digital data storage. Since DNA synthesis and sequencing are still relatively expensive tasks, the coding methods used to store digital data in DNA should correct errors and avoid unstable or error-prone DNA sequences. Near-optimal rateless erasure codes, also called fountain codes, are particularly interesting codes to realize high-capacity and low-error DNA storage systems, as shown by Erlich and Zielinski in their approach based on the Luby transform (LT) code. Since LT is the most basic fountain code, there is a large untapped potential for improvement in using near-optimal erasure codes for DNA storage.

Results

We present NOREC4DNA, a software framework to use, test, compare, and improve near-optimal rateless erasure codes (NORECs) for DNA storage systems. These codes can effectively be used to store digital information in DNA and cope with the restrictions of the DNA medium. Additionally, they can adapt to possible variable lengths of DNA strands and have nearly zero overhead. We describe the design and implementation of NOREC4DNA. Furthermore, we present experimental results demonstrating that NOREC4DNA can flexibly be used to evaluate the use of NORECs in DNA storage systems. In particular, we show that NORECs that apparently have not yet been used for DNA storage, such as Raptor and Online codes, can achieve significant improvements over LT codes that were used in previous work. NOREC4DNA is available on https://github.com/umr-ds/NOREC4DNA.

Conclusion

NOREC4DNA is a flexible and extensible software framework for using, evaluating, and comparing NORECs for DNA storage systems.
Classification of protein–protein association rates based on biophysical informatics
Authors: Dhusia Kalyani , Wu Yinghao
Published: August 2021

Background

Proteins form various complexes to carry out their versatile functions in cells. The dynamic properties of protein complex formation are mainly characterized by the association rates which measures how fast these complexes can be formed. It was experimentally observed that the association rates span an extremely wide range with over ten orders of magnitudes. Identification of association rates within this spectrum for specific protein complexes is therefore essential for us to understand their functional roles.

Results

To tackle this problem, we integrate physics-based coarse-grained simulations into a neural-network-based classification model to estimate the range of association rates for protein complexes in a large-scale benchmark set. The cross-validation results show that, when an optimal threshold was selected, we can reach the best performance with specificity, precision, sensitivity and overall accuracy all higher than 70%. The quality of our cross-validation data has also been testified by further statistical analysis. Additionally, given an independent testing set, we can successfully predict the group of association rates for eight protein complexes out of ten. Finally, the analysis of failed cases suggests the future implementation of conformational dynamics into simulation can further improve model.

Conclusions

In summary, this study demonstrated that a new modeling framework that combines biophysical simulations with bioinformatics approaches is able to identify protein–protein interactions with low association rates from those with higher association rates. This method thereby can serve as a useful addition to a collection of existing experimental approaches that measure biomolecular recognition.
Comparative study of Amsel’s criteria and Nugent scoring for diagnosis of bacterial vaginosis in a tertiary care hospital, Nepal
Authors: Bhujel Rajshree , Mishra Shyam Kumar , Yadav Santosh Kumar , Bista Kesang Diki , Parajuli Keshab
Published: August 2021

Background

The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel’s criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel’s criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system.

Methods

This was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were calculated, and each component of Amsel’s criteria was compared to the Nugent scoring system.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent’s scoring system.

Conclusions

Amsel’s criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel’s criteria shows good match with Nugent’s score.
Longitudinal changes in the inferior cerebellar peduncle and lower limb motor recovery following subcortical infarction
Authors: Liu Gang , Guo Yaomin , Dang Chao , Peng Kangqiang , Tan Shuangquan , Xie Chuanmiao , Xing Shihui , Zeng Jinsheng
Published: August 2021

Background

The cerebellum receives afferent signals from spinocerebellar pathways regulating lower limb movements. However, the longitudinal changes in the spinocerebellar pathway in the early stage of unilateral supratentorial stroke and their potential clinical significance have received little attention.

Methods

Diffusion tensor imaging and Fugl-Meyer assessment of lower limb were performed 1, 4, and 12 weeks after onset in 33 patients with acute subcortical infarction involving the supratentorial areas, and in 33 healthy subjects. We evaluated group differences in diffusion metrics in the bilateral inferior cerebellar peduncle (ICP) and analyzed the correlation between ICP diffusion metrics and changes to the Fugl-Meyer scores of the affected lower limb within 12 weeks after stroke.

Results

Significantly decreased fractional anisotropy and increased mean diffusivity were found in the contralesional ICP at week 12 after stroke compared to controls (all P < 0.01) and those at week 1 (all P < 0.05). There were significant fractional anisotropy decreases in the ipsilesional ICP at week 4 (P = 0.008) and week 12 (P = 0.004) compared to controls. Both fractional anisotropy (rs = 0.416, P = 0.025) and mean diffusivity (rs = -0.507, P = 0.005) changes in the contralesional ICP correlated with changes in Fugl-Meyer scores of the affected lower limb in all patients.

Conclusions

Bilateral ICP degeneration occurs in the early phase of supratentorial stroke, and diffusion metric values of the contralesional ICP are useful indicators of affected lower limb function after supratentorial stroke.
Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique
Authors: Siraj Shahul Hameed Mohamed , Lional Karuna Mary , Tan Kok Hian , Wright Ann
Published: August 2021

Background

To investigate whether the existing surgical technique for uterine closure at repeat lower segment Caesarean section (LSCS) can be modified to achieve adequate residual myometrial thickness (RMT) to ensure scar integrity and reduce complications in future pregnancy.

Methods

Women with a significant scar defect at repeat LSCS had the anterior uterine wall closed by a single experienced obstetrician with a technique focused on recognition, mobilisation and apposition of the retracted myometrial edges at the boundary of the defect. This was aimed at anatomical restoration of the lower segment. The RMT at the scar area was assessed by postnatal pelvic ultrasound scan at three months.

Results

Thirty women with a history of at least one previous CS, incidentally found to have a large defect at operation underwent the technique with prior consent. A postnatal scan showed a mean residual myometrial thickness of 8.4 mm (SD ±1.3 mm; range 5.6–11.0 mm). The average operating time was 91 mins and the average blood loss 728 ml. Two women who underwent the repair have gone on to have a further uneventful CS.

Conclusion

This modified technique resulted in scan evidence of an RMT indicative of uterine wall stability postnatally and offers the potential for reducing the risk of rupture and placenta accreta spectrum (PAS) in future pregnancy.
Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial
Authors: Subsoontorn Pattika , Lekprasert Varinee , Waleeprakhon Punjaporn , Ittasakul Pichai , Laopuangsak Atchaporn , Limpoon Suwimon
Published: August 2021

Background

Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time.

Methods

Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded.

Results

The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups.

Conclusions

Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration.

Trial registration

TCTR20170715003, registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.
Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression
Authors: Matizirofa Lyness , Chikobvu Delson
Published: August 2021

Background

In South Africa (SA), stroke is the second highest cause of mortality and disability. Apart from being the main killer and cause of disability, stroke is an expensive disease to live with. Stroke costs include death and medical costs. Little is known about the stroke burden, particularly the stroke direct costs in SA. Identification of stroke costs predictors using appropriate statistical methods can help formulate appropriate health programs and policies aimed at reducing the stroke burden. Analysis of stroke costs have in the main, concentrated on mean regression, yet modelling with quantile regression (QR) is more appropriate than using mean regression. This is because the QR provides flexibility to analyse the stroke costs predictors corresponding to quantiles of interest. This study aims to estimate stroke direct costs, identify and quantify its predictors through QR analysis.

Methods

Hospital-based data from 35,730 stroke cases were retrieved from selected private and public hospitals between January 2014 and December 2018. The model used, QR provides richer information about the predictors on costs. The prevalence-based approach was used to estimate the total stroke costs. Thus, stroke direct costs were estimated by taking into account the costs of all stroke patients admitted during the study period. QR analysis was used to assess the effect of each predictor on stroke costs distribution. Quantiles of stroke direct costs, with a focus on predictors, were modelled and the impact of predictors determined. QR plots of slopes were developed to visually examine the impact of the predictors across selected quantiles.

Results

Of the 35,730 stroke cases, 22,183 were diabetic. The estimated total direct costs over five years were R7.3 trillion, with R2.6 billion from inpatient care. The economic stroke burden was found to increase in people with hypertension, heart problems, and diabetes. The age group 55–75 years had a bigger effect on costs distribution at the lower than upper quantiles.

Conclusions

The identified predictors can be used to raise awareness on modifiable predictors and promote campaigns for healthy dietary choices. Modelling costs predictors using multivariate QR models could be beneficial for addressing the stroke burden in SA.
Barriers and facilitators to the use of e-health by older adults: a scoping review
Authors: Wilson Jessica , Heinsch Milena , Betts David , Booth Debbie , Kay-Lambkin Frances
Published: August 2021

Background

Limited attention has been paid to how and why older adults choose to engage with technology-facilitated health care (e-health), and the factors that impact on this. This scoping review sought to address this gap.

Methods

Databases were searched for papers reporting on the use of e-health services by older adults, defined as being aged 60 years or older, with specific reference to barriers and facilitators to e-health use.

Result

14 papers were included and synthesised into five thematic categories and related subthemes. Results are discussed with reference to the Unified Theory of Acceptance and Use of Technology2. The most prevalent barriers to e-health engagement were a lack of self-efficacy, knowledge, support, functionality, and information provision about the benefits of e-health for older adults. Key facilitators were active engagement of the target end users in the design and delivery of e-health programs, support for overcoming concerns privacy and enhancing self-efficacy in the use of technology, and integration of e-health programs across health services to accommodate the multi-morbidity with which older adults typically present.

Conclusion

E-health offers a potential solution to overcome the barriers faced by older adults to access timely, effective, and acceptable health care for physical and mental health. However, unless the barriers and facilitators identified in this review are addressed, this potential will not be realised.
Randomized, placebo controlled, double blinded pilot superiority phase 2 trial to evaluate the effect of curcumin in moderate to severe asthmatics
Authors: Quan Michele , Alismail Abdullah , Daher Noha , Cleland Derrick , Chavan Sonia , Tan Laren D.
Published: August 2021

Background

Curcumin, a derivative of the spice turmeric, has been adopted by Eastern medicine for centuries as an adjunct to treat several medical conditions (e.g., anorexia and arthritis) because of its well-established anti-inflammatory properties. Studies have shown that the use of curcumin in mice models has led to reduction in several inflammatory markers as well as key inflammatory pathway enzymes. As a result, studies in Western medicine have developed to determine if this recognized benefit can be utilized for patients with inflammatory lung diseases, such as asthma. This study will seek to better understand if curcumin can be used as an adjunctive therapy for improving asthma control of patients with moderate to severe asthma; a finding we hope will allow for a more affordable treatment.

Methods

This study will utilize a randomized, placebo controlled, double blinded pilot superiority phase 2 trial at an outpatient pulmonary clinic in Southern California, USA. Subjects will be receiving Curcumin 1500 mg or matching placebo by mouth twice daily for the study period of 12 weeks. Subjects will be randomized to either a placebo or intervention Curcumin. Subjects will have 6 clinic visits: screening visit, a baseline visit, monthly clinic visits (weeks 4, 8, and 12), at weeks 4, 8, and a follow-up clinic visit or phone-call (week 16). Changes in asthma control test scores, number of days missed from school/work, FEV1 (% predicted), FEV1/FVC ratio, FVC (% predicted), blood eosinophil count, blood total IgE, and FeNO levels will be compared by group over time.

Discussion

The therapeutic effects of curcumin have been studied on a limited basis in asthmatics and has shown mixed results thus far. Our study hopes to further establish the benefits of curcumin, however, there are potential issues that may arise from our study design that we will address within this paper. Moreover, the onset of the COVID-19 pandemic has resulted in safety concerns that have delayed initiation of our study. This study will contribute to existing literature on curcumin’s role in reducing lung inflammation as it presents in asthmatics as well as patients suffering from COVID-19.

Trial registration

This study protocol has been approved by the Institutional Review Board at Loma Linda University Health, (NCT04353310). IND# 145101 Registered April 20th, 2020. https://clinicaltrials.gov/ct2/show/NCT04353310.
Lumbar spine fusion outcomes using a cellular bone allograft with lineage-committed bone-forming cells in 96 patients
Authors: Elgafy Hossein , Wetzell Bradley , Gillette Marshall , Semaan Hassan , Rowland Andrea , Balboa Christopher A. , Mierzwa Thomas A. , McLean Julie B. , Dorsch Kimberly , Moore Mark A.
Published: August 2021

Background

Instrumented posterior lumbar fusion (IPLF) with and without transforaminal interbody fusion (TLIF) is a common treatment for low back pain when conservative interventions have failed. Certain patient comorbidities and lifestyle risk factors, such as obesity and smoking, are known to negatively affect these procedures. An advanced cellular bone allograft (CBA) with viable osteogenic cells (V-CBA) has demonstrated high fusion rates, but the rates for patients with severe and/or multiple comorbidities remain understudied. The purpose of this study was to assess fusion outcomes in patients undergoing IPLF/TLIF using V-CBA with baseline comorbidities and lifestyle risk factors known to negatively affect bone fusion.

Methods

This was a retrospective study of de-identified data from consecutive patients at an academic medical center who underwent IPLF procedures with or without TLIF, and with V-CBA. Baseline patient and procedure characteristics were assessed. Radiological outcomes included fusion rates per the Lenke scale. Patient-reported clinical outcomes were evaluated via the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain. Operating room (OR) times and intraoperative blood loss rates were also assessed.

Results

Data from 96 patients were assessed with a total of 222 levels treated overall (mean: 2.3 levels) and a median follow-up time of 16 months (range: 6 to 45 months). Successful fusion (Lenke A or B) was reported for 88 of 96 patients (91.7%) overall, including in all IPLF-only patients. Of 22 patients with diabetes in the IPLF+TLIF group, fusion was reported in 20 patients (90.9%). In IPLF+TLIF patients currently using tobacco (n = 19), fusion was reported in 16 patients (84.3%), while in those with a history of tobacco use (n = 53), fusion was observed in 48 patients (90.6%). Successful fusion was reported in all 6 patients overall with previous pseudarthrosis at the same level. Mean postoperative ODI and VAS scores were significantly reduced versus preoperative ratings.

Conclusion

The results of this study suggest that V-CBA consistently yields successful fusion and significant decreases in patient-reported ODI and VAS, despite patient comorbidities and lifestyle risk factors that are known to negatively affect such bony healing.
What impact does medicines shortages have on patients? A qualitative study exploring patients’ experience and views of healthcare professionals
Authors: Atif Muhammad , Sehar Azka , Malik Iram , Mushtaq Irem , Ahmad Nafees , Babar Zaheer-Ud-Din
Published: August 2021

Background

The shortage of medicines represents a complex global phenomenon that triggers patient care and safety issues. The study was undertaken to explore the impact of medicines shortages on patients in Pakistan. The study also identified barriers which hinder the solutions of medicines shortages issue.

Methods

A qualitative study design was adopted and the data was collected in stages between July and September 2019using an in-depth interview approach. The purposive and convenient sampling strategy was used to recruit the study participants. Sample size was limited by using the saturation point criteria. All interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

Results

A total of 35 stakeholders including 13 physicians, 12 pharmacists and 10 patients participated in the study. The findings of the study were classified into five key themes and seven subthemes. The five themes included, ‘impact of medicine shortages on patients’, ‘patients’ practices in response to medicine shortages’, ‘influence of medicines shortages on medical practice or pharmaceutical business’, ‘barriers to solutions for medicines shortages’, and ‘suggestions to assuage the impact of medicine shortages.’This study showed that the medicine shortages had significant clinical and financial impact on patients. Patients’ opted for a number of risk-prone practices to avoid treatment disruption during shortages. An array of pharmaceutical market, medicines quality and patient related factors refrain physicians to switch from brand name medicine to generics and lead to ineffective management of medicines shortages. Promotion of generic prescription, implementation of punitive policies and proper patient consultation was advised to assuage the impact of medicine shortages on patients.

Conclusion

The adverse clinical, economic and humanistic impact affirmed in this study demand the introduction of risk-management strategies for medicines shortages in hospital and community settings in accordance with the international standards. Promotion of effective patient counselling by the healthcare professionals to deter risk-prone practices associated with medicines shortages is mandatory.
Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study
Authors: Sami Ramin , Salehi Kobra , Hashemi Marzieh , Atashi Vajihe
Published: August 2021

Background

The complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD.

Methods

This qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis.

Results

The barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients’ and families’ lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients’ frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care.

Conclusion

PR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.
Does supportive supervision intervention improve community health worker knowledge and practices for community management of childhood diarrhea and pneumonia? Lessons for scale-up from Nigraan and Nigraan Plus trials in Pakistan
Authors: Aftab Wafa , Piryani Suneel , Rabbani Fauziah
Published: August 2021

Background

Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan’s Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.

Methods

The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.

Results

LHSs’ practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers’ (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs’ skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs’ performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).

Conclusion

Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn.

Trial registration Both trials are registered with the ‘Australian New Zealand Clinical Trials Registry’. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381.
Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial
Authors: Holst Anna , Labori Frida , Björkelund Cecilia , Hange Dominique , Svenningsson Irene , Petersson Eva-Lisa , Westman Jeanette , Möller Christina , Svensson Mikael
Published: August 2021

Objectives

To study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective.

Methods

Cost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs).

Results

At the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3).

Limitations

A limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients.

Conclusions

A care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective.

Trial registration details: The trial was registered in ClinicalTrials.com (https://clinicaltrials.gov/ct2/show/NCT02378272) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014.
Medical expenditure for lung cancer in China: a multicenter, hospital-based retrospective survey
Authors: Zhang Xin , Shi Ju-Fang , Liu Guo-Xiang , Ren Jian-Song , Guo Lan-Wei , Huang Wei-Dong , Shi Lin-Mei , Ma Yi , Huang Hui-Yao , Bai Ya-Na , Liao Xian-Zhen , Mao A-Yan , Sun Xiao-Jie , Zhu Xin-Yu , Zhou Qi , Gong Ji-Yong , Zhou Jin-Yi , Liu Yu-Qin , Mai Ling , Song Bing-Bing , Zhu Lin , Xing Xiao-Jing , Du Ling-Bin , Qi Xiao , Sun Xiao-Hua , Wu Shou-Ling , Ren Ying , Cao Rong , Lan Li , Lou Pei-An , Zhang Kai , He Jie , Dai Min
Published: August 2021

Background

Lung cancer is the most prevalent cancer, and the leading cause of cancer-related deaths in China. The aim of this study was to estimate the direct medical expenditure incurred for lung cancer care and analyze the trend therein for the period 2002–2011 using nationally representative data in China

Methods

This study was based on 10-year, multicenter retrospective expenditure data collected from hospital records, covering 15,437 lung cancer patients from 13 provinces diagnosed during the period 2002–2011. All expenditure data were adjusted to 2011 to eliminate the effects of inflation using China’s annual consumer price index.

Results

The direct medical expenditure for lung cancer care (in 2011) was 39,015 CNY (US$6,041) per case, with an annual growth rate of 7.55% from 2002 to 2011. Drug costs were the highest proportionally in the total medical expenditure (54.27%), followed by treatment expenditure (14.32%) and surgical expenditure (8.10%). Medical expenditures for the disease varied based on region, hospital level, type, and stage.

Conclusion

The medical expenditure for lung cancer care is substantial in China. Drug costs and laboratory test are the main factors increasing medical costs.