bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular air embolism during percutaneous nephrolithotomy without pneumopyelogram: a case report of successful rescue
Authors: Zhang Junlong , He Hongle , Mo Chengqiang , Chen Zhenhua , Jiang Shuangjian
Published: June 2022

Vascular air embolism (VAE) is a rare complication of percutaneous nephrolithotomy. Paradoxical air embolization resulting from VAE may be more likely to occur in patients with an atrial-septal defect, such as patent foramen ovale. Here, the case of a female patient with VAE that occurred during percutaneous nephrolithotomy is presented. Although the patient was diagnosed with patent foramen ovale, she recovered well without any severe paradoxical air embolization symptoms. To our knowledge, this is the first report of VAE with paradoxical air embolization that occurred in a patient with patent foramen ovale during percutaneous nephrolithotomy that was conducted without pneumopyelography.
Natural killer cell activity as a biomarker for the diagnosis of lung cancer in high-risk patients
Authors: Borg Morten , Wen Sara Witting Christensen , Hansen Torben Frøstrup , Jakobsen Anders , Andersen Rikke Fredslund , Hilberg Ole , Weinreich Ulla Møller , Nederby Line
Published: June 2022

Objective

Natural killer (NK) cells play an essential role in the immune response against cancer. However, immune escape mechanisms may cause inferior NK cell activity (NKA) in patients with cancer. This prospective study examined the relationship between NKA and lung cancer in a high-risk cohort.

Methods

In a cohort study, 250 participants referred by their general practitioner for suspicion of lung cancer were included. Before clinical investigation, blood was collected into NK Vue tubes, and the level of interferon gamma after 24 hours served as a surrogate marker for NKA.

Results

Among 250 patients, 79 were diagnosed with lung cancer. No difference in NKA was found between patients with lung cancer and control participants in which lung cancer was ruled out (median 226 pg/mL vs. 450 pg/mL). However, there was a significant difference in NKA between patients with late-stage lung cancer and controls (median 161 pg/mL vs. 450 pg/mL). A linear regression model showed that NKA was not influenced by age, sex or smoking status.

Conclusions

The significantly lower NKA in patients with late-stage lung cancer warrants further investigation combining NKA with other biomarkers and examining the potential role of NKA as a marker of disseminated disease.
Tuning the bandgap and absorption behaviour of the newly-fabricated Ultrahigh Molecular weight Polyethylene Oxide- Polyvinyl Alcohol/ Graphene Oxide hybrid nanocomposites
Authors: Aldulaimi Nisreen R , Al-Bermany Ehssan
Published: June 2022

Graphene nanosheets are promising nanofillers to the tunable structure, properties of materials, and optical bandgap. This search focuses on investigating the new nanocomposites of Ultra-high molecular weight polyethylene oxide (UHMWPEO) with different loading ratios of polyvinyl alcohol (PVA) reinforced with graphene oxide (GO) by applying the modified solution-sonication-casting method. Fourier-transform infrared spectroscopy (FTIR) shows strong interfacial interaction between the blended polymers and GO nanosheets in the nanocomposites. X-Ray diffraction (XRD) reveals a significant shifting in the PEO and reduction in the crystallinity. Optical microscopy (OM) images exhibit fine homogeneity of the polymer in the matrix with excellent dispersal of GO in nanocomposites as supported by scanning electron microscopy (SEM). Attractively, the samples with a higher ratio of UHMWPEO exhibit better optical behavior, and great improvements were presented after the contribution of GO. UV-visible spectroscopy has characterized the absorption, absorption coefficient, real and imaginary, bandgap, and other parameters. The allowed bandgap was significantly enhanced by reducing up to 80%, whereas the forbidden bandgap was improved by up to 160% of the nanocomposites. Additionally, nanocomposites exhibited significant adsorption of radiation-ray, especially after the contribution of GO. The findings are promising as various applications could come to the fore: radiation protection, spectroscopy devices, and other applications.
The Experiences of Female IBS Patients Concerning Physical Activity as Treatment Modality: A Qualitative Study
Authors: Groenendijk Daan W. , Witteman Ben J. , Mulder Bob C.
Published: June 2022

The purpose of this study is to investigate the patient’s perspective on physical activity as treatment modality for irritable bowel syndrome (IBS). An interpretive phenomenological analysis (IPA) approach was used to examine the experiences of IBS patients with physical activity, through in-depth interviews with 11 female IBS patients. Experiences with physical activity varied substantially among patients. Patients attributed negative experiences with physical activity to embarrassment, anxiety, inability, and symptom deterioration. Positive experiences with physical activity were attributed to symptom relief and improvements in overall health. Accordingly, patients discussed how they considered the application of physical activity in respect of IBS. Disease activity and the timing, type, and intensity of physical activities all could alter a patient’s response to physical activity. Physical activity seems to relieve complaints in most scenarios; however, a personal approach is required to tailor physical activity to the needs of each patient.
Lost in Translation: Neurotrophins Biology and Function in the Neurovascular Unit
Authors: Mirzahosseini Golnoush , Adam Justin Mark , Nasoohi Sanaz , El-Remessy Azza B. , Ishrat Tauheed
Published: June 2022

The neurovascular unit (NVU) refers to the functional building unit of the brain and the retina, where neurons, glia, and microvasculature orchestrate to meet the demand of the retina’s and brain’s function. Neurotrophins (NTs) are structural families of secreted proteins and are known for exerting neurotrophic effects on neuronal differentiation, survival, neurite outgrowth, synaptic formation, and plasticity. NTs include several molecules, such as nerve growth factor, brain-derived neurotrophic factor, NT-3, NT-4, and their precursors. Furthermore, NTs are involved in signaling pathways such as inflammation, apoptosis, and angiogenesis in a nonneuronal cell type. Interestingly, NTs and the precursors can bind and activate the p75 neurotrophin receptor (p75NTR) at low and high affinity. Mature NTs bind their cognate tropomyosin/tyrosine-regulated kinase receptors, crucial for maintenance and neuronal development in the brain and retina axis. Activation of p75NTR results in neuronal apoptosis and cell death, while tropomysin receptor kinase upregulation contributes to differentiation and cell growth. Recent findings indicate that modulation of NTs and their receptors contribute to neurovascular dysfunction in the NVU. Several chronic metabolic and acute ischemic diseases affect the NVU, including diabetic and ischemic retinopathy for the retina, as well as stroke, acute encephalitis, and traumatic brain injury for the brain. This work aims to review the current evidence through published literature studying the impact of NTs and their receptors, including the p75NTR receptor, on the injured and healthy brain-retina axis.
Downregulation of DNMT3A Attenuates the Warburg Effect, Proliferation, and Invasion via Promoting the Inhibition of miR-603 on HK2 in Ovarian Cancer
Authors: Lu Jiaojiao , Zhen Shuai , Tuo Xiaoqian , Chang Shixue , Yang Xiling , zhou Yuanyuan , Chen Wei , Zhao Le , Li Xu
Published: June 2022

Background: Ovarian cancer is a highly malignant gynecological cancer. Aerobic glycolysis is one of the features of cancer cell metabolism. Studying the molecular modulation of the Warburg effect in ovarian cancer is significantly valuable for understanding the progression mechanism of ovarian cancer. Materials and Methods: The expression level and prognostic significance of DNMT3A were analyzed using public databases. DNMT3A was overexpressed by plasmid transfection, and DNMT3A was interfered with specific siRNAs transfection. miR-603 was overexpressed by mimic transfection or inhibited by inhibitor transfection. The expression of the molecules was detected by qPCR or western blotting. CCK-8 and transwell assays were used to determine the cell proliferation, migration, and invasion abilities of ovarian cancer. Results: We found that the DNMT3A protein level was higher in ovarian cancer tissues than in normal ovary tissues, but the mRNA level had no significant difference in ovarian cancer tissues and normal ovary tissues. The higher the RNA level of DNMT3A, the poorer prognosis of patients. DNMT3A knocking down impeded the Warburg effect, cell proliferation, migration, and invasion of ovarian cancer cells. Further investigations discovered that DNMT3A promoted ovarian cancer cell malignancy via silencing miR-603. Conclusion: We found that patients who overexpressed DNMT3A showed a poor prognosis. DNMT3A was found to promote the Warburg effect, cell proliferation, migration, and invasion of ovarian cancer by inhibiting the expression of miR-603. As a result, the research revealed that DNMT3A/miR-603/HK2 axis contributed to the Warburg effect of ovarian cancer and DNMT3A may be a potential therapeutic target for ovarian cancer.
Analysis of “Accuracy of a Seventh-Generation Continuous Glucose Monitoring System in Children and Adolescents With Type 1 Diabetes”
Authors: Thabit Hood
Published: June 2022

In an article in the Journal of Diabetes Science and Technology, Laffell et al examined the accuracy and performance of a seventh-generation “G7” continuous glucose monitor (CGM) system in participants with type 1 diabetes aged 2 to 17 years. The study had notable points which increase the generalizability of the authors’ findings to usual clinical practice, such as accuracy assessment across a wide range of glycemia in the arm and abdominal area, at variable rates of change and time periods (beginning and end of sensor wear). However, accuracy measurements in the younger cohort (2-6 years old) were relatively few. Overall and per-sensor accuracy assessments using standard accuracy metrics were consistently high. The authors also highlighted the enhanced features of the G7 system compared to earlier generation systems, which support better usability.
Respect for service users’ human rights, job satisfaction, and wellbeing are higher in mental health workers than in other health workers: A study in Italy at time of the Covid pandemic
Authors: Carta Mauro Giovanni , Moro Maria Francesca , Sancassiani Federica , Ganassi Ruben , Melis Paola , Perra Alessandra , D’Oca Silvia , Atzeni Michela , Velluzzi Fernanda , Ferreli Caterina , Atzori Laura , Gonzalez Cesar Ivan Aviles , Serrentino Maria Roberta , Angermeyer Matthias Claus , Cossu Giulia
Published: June 2022

Background:

This study aimed to evaluate the respect for users’ rights, job satisfaction, and well-being between mental health workers (MHWs) compared to non-mental health care workers (nMHWs) from the same Italian region.

Methods:

The sample was recruited from community mental health and non-mental health outpatient centers in Sardinia. Participants fulfilled the WellBeing at work and respect for human-rights questionnaire (WWRR). The sample included 240 MHWs and 154 nMHWs.

Results:

MHWs were more satisfied with their work and workplace compared to nMHWs. MHWs had stronger beliefs that users were satisfied with the care received, and both workers and users’ human rights were respected in their workplace. MHWs reported to need more rehabilitation therapists and psychologists in their services, while nMHWs needed more nurses and professionals for users’ personal care. Italian MHWs are more satisfied with their work and workplace, and more convinced that users are satisfied with the care received and that users’ and staff human rights are respected in their workplaces, compared to nMHWs.

Conclusions:

The historic link between the community mental health network and other support networks in Italy and the consequent perception of proximity to the citizens of the care network may be the reason for this optimal situation of Italian MHWs.
Evaluation of the durable effects of corrective exercises on the postural alignment and stability in hyperkyphotic elderly with a history of falls
Authors: Sedaghati Parisa , Ahmadabadi Somayeh , Goudarzian Maryam
Published: June 2022

Background

This study aimed to investigate the durability of the effects of corrective exercises on the postural alignment and stability of hyperkyphotic elderly with a history of falls. Balance disturbance and recurrent falls are directly related to changes in the alignment of physical posture and function of the elderly, and effective methods with durable effects on improving the postural stability of the elderly have always been under the attention of researchers.

Methods

This study was a randomized clinical trial, and the statistical population included the elderly referred to neurology clinics. According to the research inclusion criteria (hyperkyphotic elderly with a history of falls during the last six months), 30 elderly aged 60 to 75 years old were purposefully selected and randomly divided into two groups of corrective exercises and control. The experimental group performed an exercise program based on the Alexander posture correction technique. Both groups were evaluated with forward head angle, kyphosis, the timed up and go test, postural stability, and fear of falling tests in three phases. Data analysis was conducted using SPSS 21 software and the MANCOVA test and repeated-measures analysis of variance.

Results

Data analysis showed significant improvements in the variables of forward head (p = 0.007), kyphosis(p = .001), balance(p = 0.002), postural stability(p = 0.001), and fear of falling(p = 0.001) in the experimental group. Post-test comparisons between the experimental and control groups showed significant differences in all variables except for kyphosis(p > .05), and follow-up analysis also revealed significant differences in all variables, except for the variables of forward head and kyphosis(p > .05).

Conclusions

Although the effects of corrective exercises in the elderly decreased regarding spinal alignment after three months, more lasting effects were seen in functional balance, postural stability, and fear of falling, suggesting this strategy as a stimulus for more mobility and a lower risk of falling in the elderly. Therefore, when using corrective exercises, it is possible to apply these exercises for a longer period of time to achieve more durable outcomes, especially regarding spinal alignment.

Trial registration

This research was registered in the Iranian Registry of Clinical Trials (IRCT2016081529373N1, Date of registration: 19/04/2017).
Prevalence of potentially inappropriate medications among old people with major neurocognitive disorder in 2012 and 2017
Authors: Rangfast Iris , Sönnerstam Eva , Gustafsson Maria
Published: June 2022

Background

The increased risk of adverse drug reactions due to age-related altered pharmacokinetics and pharmacodynamics is a challenge when prescribing medications to older people, and especially among older people with major neurocognitive disorder who are particularly sensitive to drug effects. The aim of this study was to investigate the use of potential inappropriate medications (PIMs) in 2012 and 2017 among old people with major neurocognitive disorder. A secondary aim was to investigate factors associated with PIM use.

Methods

This register-study was based on the Swedish registry for cognitive/dementia disorders and the Swedish prescribed drug register. Criteria from the National Board of Health and Welfare were used to identify PIMs between 1 July–31 December 2012 and 1 July-–31 December 2017 among people ≥ 65 years. Drug use was defined as one or more filled prescriptions during each timeframe.

Results

The total use of PIMs declined significantly between 2012 (28.7%) and 2017 (21.7%). All PIMs and PIM groups declined between these years, except for antipsychotic drugs, which increased from 11.6% to 12.3%. The results from the multiple regression model found that PIM use was associated with younger age (OR: 0.97 CI: 0.96–0.97), a lower Mini Mental State Examination score (OR: 0.99 CI: 0.99–1.00), the use of multi-dispensed drugs (OR: 2.05 CI: 1.93–2.18), and compared to Alzheimer’s disease, with the subtypes dementia with Lewy bodies and Parkinson’s disease dementia (OR: 1.57 CI: 1.40–1.75), frontotemporal dementia (OR: 1.29 CI: 1.08–1.54) and vascular dementia (OR: 1.10 CI: 1.03–1.16).

Conclusions

Overall, the use of PIMs decreased between the years 2012 and 2017. The increase of antipsychotic drugs and the association between PIM use and multi-dispensed drugs warrant concern.
Early predictors of functional outcome in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Authors: de Winkel Jordi , Cras Tim Y. , Dammers Ruben , van Doormaal Pieter-Jan , van der Jagt Mathieu , Dippel Diederik W. J. , Lingsma Hester F. , Roozenbeek Bob
Published: June 2022

Background

Patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH) often receive delayed or no aneurysm treatment, although recent studies suggest that functional outcome following early aneurysm treatment has improved. We aimed to systematically review and meta-analyze early predictors of functional outcome in poor-grade aSAH patients. 

Methods

We included studies investigating the association of early predictors and functional outcome in adult patients with confirmed poor-grade aSAH, defined as World Federation of Neurological Surgeons (WFNS) grade or Hunt and Hess (H–H) grade IV-V. Studies had to use multivariable regression analysis to estimate independent predictor effects of favorable functional outcome measured with the Glasgow Outcome Scale or modified Rankin Scale. We calculated pooled adjusted odds ratios (aOR) and 95% confidence intervals (CI) with random effects models. 

Results

We included 27 studies with 3287 patients. The likelihood of favorable outcome increased with WFNS grade or H–H grade IV versus V (aOR 2.9, 95% CI 1.9–4.3), presence of clinical improvement before aneurysm treatment (aOR 3.3, 95% CI 2.0–5.3), and intact pupillary light reflex (aOR 2.9, 95% CI 1.6–5.1), and decreased with older age (aOR 0.7, 95% CI 0.5–1.0, per decade), increasing modified Fisher grade (aOR 0.4, 95% CI 0.3–0.5, per grade), and presence of intracerebral hematoma on admission imaging (aOR 0.4, 95% CI 0.2–0.8).

Conclusions

We present a summary of early predictors of functional outcome in poor-grade aSAH patients that can help to discriminate between patients with favorable and with unfavorable prognosis and may aid in selecting patients for early aneurysm treatment.
Association between gait features assessed by artificial intelligent system and cognitive function decline in patients with silent cerebrovascular disease: study protocol of a multicenter prospective cohort study (ACCURATE-2)
Authors: Tang Yan-min , Fei Bei-ni , Li Xin , Zhao Jin , Zhang Wei , Qin Guo-you , Hu Min , Ding Jing , Wang Xin
Published: June 2022

Background

Gait disturbances may appear prior to cognitive dysfunction in the early stage of silent cerebrovascular disease (SCD). Subtle changes in gait characteristics may provide an early warning of later cognitive decline. Our team has proposed a vision-based artificial intelligent gait analyzer for the rapid detection of spatiotemporal parameters and walking pattern based on videos of the Timed Up and Go (TUG) test. The primary objective of this study is to investigate the relationship between gait features assessed by our artificial intelligent gait analyzer and cognitive function changes in patients with SCD.

Methods

This will be a multicenter prospective cohort study involving a total of 14 hospitals from Shanghai and Guizhou. One thousand and six hundred patients with SCD aged 60–85 years will be consecutively recruited. Eligible patients will undergo the intelligent gait assessment and neuropsychological evaluation at baseline and at 1-year follow-up. The intelligent gait analyzer will divide participant into normal gait group and abnormal gait group according to their walking performance in the TUG videos at baseline. All participants will be naturally observed during 1-year follow-up period. Primary outcome are the changes in Mini-Mental State Examination (MMSE) score. Secondary outcomes include the changes in intelligent gait spatiotemporal parameters (step length, gait speed, step frequency, step width, standing up time, and turning back time), the changes in scores on other neuropsychological tests (Montreal Cognitive Assessment, the Stroop Color Word Test, and Digit Span Test), falls events, and cerebrovascular events. We hypothesize that both groups will show a decline in MMSE score, but the decrease of MMSE score in the abnormal gait group will be more significant.

Conclusion

This study will be the first to explore the relationship between gait features assessed by an artificial intelligent gait analyzer and cognitive decline in patients with SCD. It will demonstrate whether subtle gait abnormalities detected by the artificial intelligent gait analyzer can act as a cognitive-related marker for patients with SCD.

Trial registration

This trial was registered at ClinicalTrials.gov (NCT04456348; 2 July 2020).
Depression, anxiety, and academic performance in COVID-19: a cross-sectional study
Authors: Barbosa-Camacho Francisco José , Romero-Limón Olaya Moramay , Ibarrola-Peña Juan Carlos , Almanza-Mena Yolanda Lorelei , Pintor-Belmontes Kevin Josué , Sánchez-López Verónica Alexandra , Chejfec-Ciociano Jonathan Matías , Guzmán-Ramírez Bertha Georgina , Sapién-Fernández José Héctor , Guzmán-Ruvalcaba Mario Jesús , Nájar-Hinojosa Rodrigo , Ochoa-Rodriguez Itzel , Cueto-Valadez Tania Abigail , Cueto-Valadez Andrea Estefanía , Fuentes-Orozco Clotilde , Cortés-Flores Ana Olivia , Miranda-Ackerman Roberto Carlos , Cervantes-Cardona Guillermo Alonso , Cervantes-Guevara Gabino , González-Ojeda Alejandro
Published: June 2022

Depression and anxiety are common after months of social isolation, and they can have a negative impact on anyone's quality of life if they are not treated promptly and appropriately. The aim of this study was to determine if the change to online modality courses and the presence of depression or anxiety symptoms during the COVID-19 pandemic was associated with a difference in the college student’s academic achievement. This study was a cross-sectional survey in which we used the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Also, we examined the students' perceptions of their academic performance using the Academic Self-Concept Scale (ASCS). A total of 610 students responded to the survey. The average score on the Academic Self-Concept Scale was 2.76 ± 0.35, the students presented a risk of 61.5% for possible depressive disorder and 52.1% for possible generalized anxiety disorder. The intensity of depression and anxiety symptoms had a significant effect on Academic Self-Concept Scale scores (p < 0.001 and p < 0.05, respectively). The findings indicate that the COVID-19 pandemic has had a direct effect on students' mental health and academic performance.
A risk measurement tool for targeted HIV prevention measures amongst young pregnant and lactating women in South Africa
Authors: Ramraj Trisha , Abdelatif Nada , Chirinda Witness , Abdullah Fareed , Kindra Gurpreet , Goga Ameena
Published: June 2022

Background

We aimed to develop and validate a tool to identify which pregnant/lactating young South African women (≤ 24 years) are at risk of HIV infection.

Methods

Data from three national South African Prevention of Mother-to-Child Transmission (PMTCT) evaluations were used to internally validate three HIV acquisition risk models for young postpartum women. We used univariate and multivariable logistic regression analysis to determine which risk factors were significant. Model coefficients were rounded and stratified into risk groups and the area under the receiver operating curve (AUROC) was computed. Models were developed to determine which risk factors provided the most predictive accuracy whilst remining clinically meaningful.

Results

Data from 9 456 adult and 4 658 young pregnant and lactating women were included in the development and validation data sets, respectively. The optimal model included the following risk factors: age (20–24 years old), informal house structure, two or more pregnancies, mothers who had knowledge of when they received their last HIV test result, no knowledge of the infant’s father’s HIV status, no knowledge of breastfeeding as a mode of MTCT and knowledge of PMTCT programme. The mean AUROC was 0.71 and 0.72 in the development and validation datasets respectively. The optimum cut off score was ≥ 27, having 84% sensitivity, 44% specificity, and identifying 44% of high-risk women eligible for PrEP.

Conclusion

The optimal model to be used as a possible risk scoring tool to allow for early identification of those pregnant/lactating women most at-risk of HIV acquisition included both statistically as well as clinically meaningful risk factors. A field-based study is needed to test and validate the effectiveness of this targeted approach.
“Your status cannot hinder you”: the importance of resilience among adolescents engaged in HIV care in Kenya
Authors: Adams Casey , Kiruki Millicent , Karuga Robinson , Otiso Lilian , Graham Susan M. , Beima-Sofie Kristin M.
Published: June 2022

Background

Approximately 40% of the 110,000 adolescents living with HIV (ALHIV) in Kenya have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers that impact ART adherence. This study aimed to identify key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers.

Methods

Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care. 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews were conducted with ALHIV (n = 12). Focus group discussions were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents receiving HIV services in community settings (AIC) irrespective of HIV status (n = 3). Interviews and focus groups were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience.

Results

While AIC primarily focused on adherence barriers and stigma, ALHIV and, to some extent, peer leaders, also identified resilience factors that helped overcome stigma. Four major themes emerged: 1) knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy; 2) disclosure to others strengthens support systems for ALHIV; 3) medication-taking strategies and strategic disclosure can overcome adherence challenges in school; and 4) a supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a conceptual stigma/resilience model depicting how resilience moderates negative effects of stigma among ALHIV.

Conclusions

This study demonstrates the positive effects of ALHIV resilience on ART adherence and illuminates how stigma impacts ALHIV differently depending on their resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV.
How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach
Authors: Olateju Adetoun , Peters Michael A. , Osaghae Ikponmwosa , Alonge Olakunle
Published: June 2022

Background

Improving service delivery is a key strategy for achieving service coverage, one of the two components of universal health coverage (UHC). As one of the largest global public health initiatives, individuals involved with the Global Polio Eradication Initiative (GPEI) have learned many important lessons about service delivery. We identified contributors and challenges to delivering health services at national and subnational levels using experiences from the GPEI. We described strategies used to strengthen service delivery and draw lessons that could be applicable to achieving UHC.

Methods

Online cross-sectional surveys based on the Consolidated Framework for Implementation Research (CFIR) domains and socioecological model were conducted from 2018–2019. Data were analyzed using an embedded mixed methods approach. Frequencies of the contributors and challenges to service delivery by levels of involvement were estimated. Chi-square tests of independence were used to assess unadjusted associations among categorical outcome variables. Logistic regressions were used to examine the association between respondent characteristics and contributors to successful implementation or implementation challenges. Horizontal analysis of free text responses by CFIR domain was done to contextualize the quantitative results.

Results

Three thousand nine hundred fifty-five people responded to the online survey which generated 3,659 valid responses. Among these, 887 (24.2%) reported involvement in service delivery at the global, national, or subnational level with more than 90% involved at subnational levels. The main internal contributor of strengthened service delivery was the process of conducting activities (48%); working in frontline role had higher odds of identifying the process of conducting activities as the main internal contributor (AOR: 1.22, p = 0.687). The main external contributor was the social environment (42.5%); having 10–14 years of polio program implementation was significantly associated with identifying the social environment as the main external contributor to strengthened service delivery (AOR: 1.61, p = 0.038). The most frequent implementation challenge was the external environment (56%); working in Eastern Mediterranean region was almost 4 times more likely to identify the external environment as the major challenge in service delivery strengthening (AOR:3.59, p < 0.001).

Conclusion

Priority actions to improve service delivery include: adopt strategies to systematically reach hard-to-reach populations, expand disease-focused programs to support broader primary healthcare priorities, maximize community outreach strategies to reach broader age groups, build community trust in health workers and develop multisectoral leadership for collaboration. Achieving UHC is contingent on strengthened subnational service delivery.
Evaluation of sparing the pronator quadratus for volar plating of distal radius fractures: a retrospective clinical study
Authors: Huang Xiaoxia , Jia Qiyu , Li Huaqiang , Kerem Erxat , Peng Cong , Kong Weiqi , Tusunniyazi Maimaitiaili , Hamiti Yimurang , Feng Dongwei , Zhao Yan
Published: June 2022

Background

The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.

Aim

The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.

Methods

Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated.

Results

All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.

Conclusion

The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.
Healthcare workers’ perceptions of how eHealth applications can support self-care for patients undergoing planned major surgery
Authors: Granath Anna , Eriksson Kerstin , Wikström Lotta
Published: June 2022

Background

In planned major surgery the duration of inpatient hospital care during the last decade has decreased because of a combination of different perioperative interventions. It is expected that patients can manage the needed pre- and postoperative self-care to a large extent on their own. This entails challenges to healthcare system to deliver appropriate information to patients in a safe and efficient manner. The aim of this study was therefore to describe healthcare workers’ perceptions of how eHealth applications can support patients’ self-care in relation to planned major surgery.

Methods

Semi-structured interviews were performed with sixteen healthcare workers from different disciplines. The interviews were transcribed and analysed using the phenomenography approach.

Results

Healthcare workers perceived both positive aspects and challenges with eHealth applications for self-care. eHealth applications can work as an information source, affect patients’ understanding of self-care, improve patients’ participation in self-care, streamline communication with healthcare professionals and improve patient safety during the pre- and postoperative period. The challenges included perceptions of that eHealth applications may have negative impact on personal interaction in care. eHealth applications may not be useful to all patients because of lack of equipment or knowledge and may increase patients’ suffering if physical visits are replaced by digital solutions.

Conclusions

This study improves our understanding of healthcare workers’ perceptions of how the use of self-care eHealth applications can support patients in performing pre- and postoperative self-care for major surgery. Access to appropriate and personalized information and instructions can improve patients’ understanding of self-care and enhance the participation and safety of those who can afford and handle digital tools. All these aspects must be considered in future digital development of eHealth applications to guarantee a person-centered care.
Efficacy and safety of the biosimilar denosumab candidate (Arylia) compared to the reference product (Prolia®) in postmenopausal osteoporosis: a phase III, randomized, two-armed, double-blind, parallel, active-controlled, and noninferiority clinical trial
Authors: Jamshidi Ahmadreza , Vojdanian Mahdi , Soroush Mohsen , Akbarian Mahmoud , Aghaei Mehrdad , Hajiabbasi Asghar , Mirfeizi Zahra , Khabbazi Alireza , Alishiri Gholamhosein , Haghighi Anousheh , Salimzadeh Ahmad , Karimzadeh Hadi , Shirani Fatemeh , Fard Mohammad Reza Hatef , Nazarinia MohammadAli , Soroosh Soosan , Anjidani Nassim , Gharibdoost Farhad
Published: June 2022

Background/objective

Osteoporosis is a global health concern with an increasing prevalence worldwide. Denosumab is an antiresoptive agent that has been demonstrated to be effective and safe in osteoporotic patients. This study aimed to compare the efficacy and safety of the biosimilar denosumab candidate (Arylia) to the originator product (Prolia®) in postmenopausal osteoporotic patients.

Methods

In this randomized, double-blind, active-controlled, noninferiority trial, postmenopausal osteoporotic patients received 60 mg of subcutaneous Arylia or Prolia® at months 0, 6, and 12 and were followed up for 18 months. The primary endpoint was the noninferiority of the biosimilar product to the reference product in the percentage change of bone mineral density (BMD) in 18 months at the lumbar spine (L1-L4), total hip, and femoral neck. The secondary endpoints were safety assessment, the incidence of new vertebral fractures, and the trend of bone turnover markers (BTMs).

Results

A total of 190 patients were randomized to receive either biosimilar (n = 95) or reference (n = 95) denosumab. In the per-protocol (PP) analysis, the lower limits of the 95% two-sided confidence intervals of the difference between Arylia and Prolia® in increasing BMD were greater than the predetermined noninferiority margin of − 1.78 at the lumbar spine, total hip, and femoral neck sites (mean differences [95% CIs] of 0.39 [− 1.34 to 2.11], 0.04 [− 1.61 to 1.69], and 0.41 [− 1.58 to 2.40], respectively). The two products were also comparable in terms of safety, new vertebral fractures, and trend of BTMs.

Conclusion

The efficacy of the biosimilar denosumab was shown to be noninferior to that of the reference denosumab, with a comparable safety profile at 18 months.

Trial registration

ClinicalTrials.gov, NCT03293108; Registration date: 2017–09-19.
How selves differ within and across cognitive domains: self-prioritisation, self-concept, and psychiatric traits
Authors: Perrykkad Kelsey , Hohwy Jakob
Published: June 2022

Background

How we build and maintain representations of ourselves involves both explicit features which are consciously accessible on reflection and implicit processes which are not, such as attentional biases. Understanding relations between different ways of measuring self-cognition both within and across such cognitive domains is important for understanding how selves may differ from one another, and whether self-cognition is best understood as largely uni-dimensional or more multi-dimensional. Further, uncovering this structure should inform research around how self-cognition relates to psychiatric and psychological conditions. This study explores the relations between different constructs of self-cognition and how variability within them relates to psychiatric traits.

Methods

Our final dataset includes within-subject (n = 288, general population) measures of explicit self-concept (using both the Self Concept Clarity Scale and Self Concept and Identity Measure), implicit self-prioritisation in a shape-label matching task (for both reaction time and sensitivity) and measurement of traits for five psychiatric conditions (autism, borderline personality disorder, schizophrenia, depression and anxiety). We first test whether self-cognitive measures within and across domains are correlated within individuals. We then test whether these dimensions of self-cognition support a binary distinction between psychiatric conditions that either are or are not characterised in terms of self, or whether they support self-cognition as transdiagnostically predictive of the traits associated with psychiatric conditions. To do this we run a series of planned correlations, regressions, and direct correlation comparison statistics.

Results

Results show that implicit self-prioritisation measures were not correlated with the explicit self-concept measures nor the psychiatric trait measures. In contrast, all the psychiatric traits scores were predicted, to varying degrees, by poorer explicit self-concept quality. Specifically, borderline personality disorder traits were significantly more strongly associated with composite explicit self-concept measures than any of depression, anxiety, or autism traits scores were.

Conclusions

Our results suggest that selves can differ considerably, along different cognitive dimensions. Further, our results show that self-cognition may be a promising feature to include in future dimensional characterisations of psychiatric conditions, but care should be taken to choose relevant self-cognitive domains.
Microearthquake location and uncertainty analysis using a Kirchhoff wavefront imaging method: A comparison with traveltime inversion and full wavefield imaging methods
Authors: Duan Chenglong , Lumley David , Zhu Hejun
Published: June 2022

The uncertainty and resolution of microearthquake location are an important topic for reservoir characterization and early warning of induced earthquakes. Many independent studies have either improved certain source location methods or applied a certain method to a data set without perhaps studying the full limitations compared with other methods. We have developed a P- and PS-wavefront imaging (WI) method to estimate the source origin time sequentially, which overcomes the unknown variable of source origin time in Kirchhoff-type imaging and helps to reduce the location uncertainties originating from the source origin time. We develop a 3D synthetic example by finite-difference modeling the realistic elastic 3C data using the SEG advanced modeling (SEAM) 4D earth model, and jointly compare the reservoir and basement microearthquake source location uncertainties based on traveltime inversion (TI), WI, and full wavefield imaging (FWIMG) methods. For each method, we also investigate the source location uncertainties between the P- and PS-wave results. Our results indicate that, using P waves and typical surface receiver arrays, TI has larger depth location uncertainties and cannot separately resolve the reservoir and basement events, whereas WI has larger horizontal uncertainties; FWIMG has the smallest horizontal location uncertainty, its depth uncertainty is similar to the WI method, and it is much smaller than the TI. Using PS waves can significantly reduce the location uncertainty compared with using only P waves for the three methods, and the full wavefield method has the smallest location uncertainty. The WI method has a moderate computation cost between TI and full wavefield methods. Data noise and velocity scaling errors change the source location uncertainties based on different imaging methods.
Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries: A Single-Center Experience From Sri Lanka
Authors: Hewamana Saman , Gunasena Prasanna , Jayasinghe Chathuri , Skandarajah Thurairajah , Harischandra Mahesh , Abeyaratne Sobitha , Ekanayake Lalith , Somasundaram Gnani , Somiah Surjit , Srinivasan Vadivelu , Arseculeratne Gehan , Perera Neomal , Fernando Jayaindra , Faiz Mazhar , Munasinghe Nihal , Mowlana Ashfaq , Deshapriya Samadhi , Mawathakubura Supun , Wickramarathna Chandana , Wijewickrama Ananda , Jayawardena Priyankara , Perera Eranga , Peiris Natasha , Paranawithane Sarath , Perera Chitranganie , Kariyawasam Chitranga , Munasinghe Sanjeewa , De Silva Chandu , Wadanamby Rohini , Galagoda Geethani , Lin Thet Thet , Wijesiriwardena Bandula , Balawardena Jayantha
Published: June 2022

PURPOSE

There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries.

MATERIALS AND METHODS

This is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates.

RESULTS

A total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%.

CONCLUSION

To our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting.