bluuebunny/crossref_metadata_2025 huggingface dataset:
Musculoskeletal care – at the confluence of data science, sensors, engineering, and computation
Authors: Kataria Suchitra , Ravindran Vinod
Published: February 2022

Data has always been integral to modern medicine in almost all aspects of patient care and the recent proliferation of data has opened up innumerable opportunities for all the stakeholders in trying to improve the quality of care and health outcomes including quality of life and rehabilitation. Greater usage and adoption of digital technologies have led to the convergence of health data in different forms – clinical, self-reported, electronic health records social media, etc. The application and utilization of patient data set continue to get broadened each day with greater availability and access. These are empowering newer cutting-edge solutions such as connected care and artificial intelligence, 3D printing and real-life mimicking prosthetics. The availability of data at micro and macro levels has the potential to act as a catalyst for personalized care based on behavioral, cultural, genetic, and psychological needs for patients with musculoskeletal disorders. Realistic algorithms coupled with biomarkers which can identify relevant interventions and alert the care providers regarding any deterioration. Although in the nascent stage currently, 3D printing, exoskeletons, and virtual rehabilitation hold tremendous potential of cost-effective, precise interventions for the patients.
Primary total knee arthroplasty assisted by computed tomography-free navigation for secondary knee osteoarthritis following massive calcium phosphate cement packing for distal femoral giant-cell bone tumor treatment: a case report
Authors: Takeuchi Akihiko , Yamamoto Norio , Ohmori Takaaki , Hayashi Katsuhiro , Miwa Shinji , Igarashi Kentaro , Higuchi Takashi , Abe Kensaku , Yonezawa Hirotaka , Morinaga Sei , Araki Yoshihiro , Asano Yohei , Saito Shiro , Tsuchiya Hiroyuki
Published: February 2022

Background

Giant cell tumor of bone (GCTB) is an intermediate tumor commonly arising from the epiphysis of the distal femur and proximal tibia. Standard GCTB treatment is joint-preserving surgery performed using thorough curettage and the filling of the cavity with allo-, auto-, polymethyl methacrylate (PMMA), or synthetic bone graft. Calcium phosphate cement (CPC) is an artificial bone substitute, which has the benefit of being able to adjust defects, consequently inducing immediate mechanical strength, and promoting biological healing. Secondary osteoarthritis may occur following GCTB treatment and may need additional surgery if severe. However, details regarding surgery for secondary osteoarthritis have not been fully elucidated. There are no reports on the use of total knee arthroplasty (TKA) for the treatment of secondary osteoarthritis following CPC packing. The insertion of an alignment rod is a standard procedure in TKA; however, it was difficult to perform in this case due to CPC. Therefore, we used a computed tomography (CT)-free navigation system to assist the distal femur cut. This study presents a knee joint secondary osteoarthritis case following CPC packing for GCTB curettage that was treated with standard TKA.

Case presentation

A 67-year-old Japanese woman, who was previously diagnosed with left distal femur GCTB and was treated by curettage and CPC packing 7 years ago, complained of severe knee pain. Left knee joint plain radiography revealed Kellgren and Lawrence (K-L) grade 4 osteoarthritis without evidence of tumor recurrence. Therefore, she was scheduled for TKA. There are no reports on the cutting of a femoral condyle surface with massive CPC with accurate alignment. Because it is difficult to insert the alignment rod intramedullary and cut the femoral condyle with CPC, we planned CT-free navigation-guided surgery for accurate bone cutting using an oscillating tip saw system to prevent CPC cracks. We performed standard TKA without complications, as planned. Postoperative X-ray showed normal alignment. Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) ameliorated from 27 and 29 to 64 and 68, respectively The patient can walk without a cane postoperatively.

Conclusion

There was no report about the surface TKA guided by CT-free navigation after primary GCT surgery with CPC. We believe that this case report will help in planning salvage surgery for secondary osteoarthritis after CPC packing.
In correspondence to “Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature”
Authors: Augustin Goran
Published: February 2022

Aim

The correspondence letter aims to correct the historical perspective on common bile duct perforations (CBD) during pregnancy and complete the number of published cases.

Findings

Instead of declared article by Piotrowski et al., from 1990, and according to available English language literature, the first two descriptions of maternal spontaneous CBD perforation in pregnancy were by JT Hogan Jr in 1957 and then Maurice Abitbol in 1958. Additional six cases of this condition were found, which is an increase of 50% of published cases.

Purpose

The purpose of this correspondence letter is to correct the historical perspective on CBD perforation during pregnancy. Also, only all published cases in English language literature can shed new light on incidence, diagnosis, treatment, and maternal and fetal prognosis from maternal CBD perforation in pregnancy.
Development of a list of competencies and entrustable professional activities for resident physicians during death pronouncement: a modified Delphi study
Authors: Kessoku Takaomi , Uneno Yu , Urushibara-Miyachi Yuka , Oya Kiyofumi , Kusakabe Akihiko , Nakajima Atsushi , Kobayashi Noritoshi , Ichikawa Yasushi , Miyashita Mitsunori , Muto Manabu , Mori Masanori , Morita Tatsuya
Published: February 2022

Background

The appropriate delivery of death pronouncements potentially affects bereaved families’ wellbeing positively. Although younger physicians need to learn the competencies and entrustable professional activities (EPAs) to conduct death pronouncement independently, both of which have not been clarified. Therefore, this study aimed to develop a list of competencies and EPAs necessary for death pronouncement practice, which resident physicians need to acquire by the end of their residency training (postgraduate year 2).

Methods

An anonymous modified Delphi study was conducted with a panel of 31 experts. The experts were invited online from general wards in hospitals with resident physicians across Japan to participate in the study using the purposive and snowball sampling method. A non-anonymous web conference was held with three additional external evaluators to finalize the item list. The consensus criterion was defined as a mean response of at least 4 points on a 5-point Likert scale for each competency and EPA item and a rating of 4 or 5 points by at least 80% of the participants.

Results

Consensus was achieved, with consistently high levels of agreement across panel members, on 11 competencies and 9 EPA items. Additionally, a correspondence matrix table between competencies and EPAs was developed.

Conclusions

This study clarified the standardized educational outcomes as competencies in death pronouncement practice and the unit of professional practice of physicians who can perform this independently (EPAs), serving as a blueprint to aid the development of an educational model and evaluation method for clinical educational institutions and developers of medical school curriculums.
An electronic medical records study of population obesity prevalence in El Paso, Texas
Authors: Salinas Jennifer J. , Sheen Jon , Shokar Navkiran , Wright Justin , Vazquez Gerardo , Alozie Ogechika
Published: February 2022

Background

In this study, we determine the feasibility of using electronic medical record (EMR) data to determine obesity prevalence at the census tract level in El Paso County, Texas, located on the U.S.-Mexico border.

Methods

2012–2018 Body Mass Index (BMI kg/m2) data from a large university clinic system in was geocoded and aggregated to a census tract level. After cleaning and removing duplicate EMR and unusable data, 143,524 patient records were successful geocoded. Maps were created to assess representativeness of EMR data across census tracts, within El Paso County. Additionally, maps were created to display the distribution of obesity across the same geography.

Results

EMR data represented all but one El Paso census tract. Representation ranged from 0.7% to 34.9%. Greatest representation were among census tracts in and around clinics. The mean EMR data BMI (kg/m2) was 30.1, this is approximately 6% less than the 36.0% estimated for El Paso County using the Behavioral Risk Factor Surveillance Study (BRFSS) estimate. At the census tract level, obesity prevalence ranged from 26.6 to 57.6%. The highest obesity prevalence were in areas that tended to be less affluent, with a higher concentration of immigrants, poverty and Latino ethnic concentration.

Conclusions

EMR data use for obesity surveillance is feasible in El Paso County, Texas, a U.S.-Mexico border community. Findings indicate substantial obesity prevalence variation between census tracts within El Paso County that may be associated with population distributions related to socioeconomics.
Overall performance of a drug–drug interaction clinical decision support system: quantitative evaluation and end-user survey
Authors: Van De Sijpe Greet , Quintens Charlotte , Walgraeve Karolien , Van Laer Eva , Penny Jens , De Vlieger Greet , Schrijvers Rik , De Munter Paul , Foulon Veerle , Casteels Minne , Van der Linden Lorenz , Spriet Isabel
Published: February 2022

Background

Clinical decision support systems are implemented in many hospitals to prevent medication errors and associated harm. They are however associated with a high burden of false positive alerts and alert fatigue. The aim of this study was to evaluate a drug–drug interaction (DDI) clinical decision support system in terms of its performance, uptake and user satisfaction and to identify barriers and opportunities for improvement.

Methods

A quantitative evaluation and end-user survey were performed in a large teaching hospital. First, very severe DDI alerts generated between 2019 and 2021 were evaluated retrospectively. Data collection comprised alert burden, override rates, the number of alert overrides reviewed by pharmacists and the resulting pharmacist recommendations as well as their acceptance rate. Second, an e-survey was carried out among prescribers to assess satisfaction, usefulness and relevance of DDI alerts as well as reasons for overriding.

Results

A total of 38,409 very severe DDI alerts were generated, of which 88.2% were overridden by the prescriber. In 3.2% of reviewed overrides, a recommendation by the pharmacist was provided, of which 79.2% was accepted. False positive alerts were caused by a too broad screening interval and lack of incorporation of patient-specific characteristics, such as QTc values. Co-prescribing of a non-vitamin K oral anticoagulant and a low molecular weight heparin accounted for 49.8% of alerts, of which 92.2% were overridden. In 88 (1.1%) of these overridden alerts, concurrent therapy was still present. Despite the high override rate, the e-survey revealed that the DDI clinical decision support system was found useful by prescribers.

Conclusions

Identified barriers were the lack of DDI-specific screening intervals and inclusion of patient-specific characteristics, both leading to a high number of false positive alerts and risk for alert fatigue. Despite these barriers, the added value of the DDI clinical decision support system was recognized by prescribers. Hence, integration of DDI-specific screening intervals and patient-specific characteristics is warranted to improve the performance of the DDI software.
Relative contributions of statin intensity, achieved low-density lipoprotein cholesterol level, and statin therapy duration to cardiovascular risk reduction in patients with type 2 diabetes: population based cohort study
Authors: Kim Ji Yoon , Choi Jimi , Kim Sin Gon , Kim Nam Hoon
Published: February 2022

Background

Current guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), however, a number of patients discontinue statin therapy in clinical practice. We aimed to estimate the optimal statin therapy including statin therapy duration, statin intensity, and low-density lipoprotein cholesterol (LDL-C) level among patients with T2D in a real-world setting.

Methods

From Korean National Health Insurance Service Cohort (2007–2015), 8937 patients with T2D (≥ 40 years of age) who received statin therapy for at least 90 days were included. Risk of major adverse cardiovascular event (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death was estimated according to statin intensity, achieved serum LDL-C level, and statin therapy duration, respectively. The relative contributions of these factors to MACE risk were quantified by calculating the proportion of log-likelihood explained by each factor.

Results

The hazard ratio (HR) of MACE was lower in patients receiving moderate- or high-intensity statins than in those receiving low-intensity statins (HR, 0.72; p = 0.027). Among patients who received moderate- or high-intensity statins, lower achieved LDL-C level was associated with lower cardiovascular risk. Notably, the longer the patients received statins, the lower was the risk of MACE; the HR of MACE was significantly reduced after at least 18 months (adjusted HR, 0.70; p = 0.009) as a reference to 3–6 months of therapy. The proportion of explainable log-likelihood for MACE was greatest for statin duration (2.55), followed by achieved LDL-C level (2.18), and statin intensity (0.95).

Conclusions

Statin therapy duration is as important as or more crucial than statin intensity or achieved LDL-C level for the reduction of cardiovascular risk in T2D patients. The concept of “longer is better” regarding statin therapy should be considered in clinical practice.
Metabolic engineering of Escherichia coli for efficient biosynthesis of butyl acetate
Authors: Ku Jason T. , Chen Arvin Y. , Lan Ethan I.
Published: February 2022

Background

Butyl acetate is a versatile compound that is widely used in the chemical and food industry. The conventional butyl acetate synthesis via Fischer esterification of butanol and acetic acid using catalytic strong acids under high temperature is not environmentally benign. Alternative lipase-catalyzed ester formation requires a significant amount of organic solvent which also presents another environmental challenge. Therefore, a microbial cell factory capable of producing butyl acetate through fermentation of renewable resources would provide a greener approach to butyl acetate production.

Result

Here, we developed a metabolically engineered strain of Escherichia coli that efficiently converts glucose to butyl acetate. A modified Clostridium CoA-dependent butanol production pathway was used to synthesize butanol which was then condensed with acetyl-CoA through an alcohol acetyltransferase. Optimization of alcohol acetyltransferase expression and redox balance with auto-inducible fermentative controlled gene expression led to an effective titer of 22.8 ± 1.8 g/L butyl acetate produced in a bench-top bioreactor.

Conclusion

Building on the well-developed Clostridium CoA-dependent butanol biosynthetic pathway, expression of an alcohol acetyltransferase converts the butanol produced into butyl acetate. The results from this study provided a strain of E. coli capable of directly producing butyl acetate from renewable resources at ambient conditions.
HPV16 E6 gene polymorphisms and the functions of the mutation site in cervical cancer among Uygur ethnic and Han nationality women in Xinjiang, China
Authors: Xin Huizhen , Pan Zhenzhen , Zhe Xiangyi , Zhang Chunhe , Li Hongtao , Zheng Weinan , Long Haichen , Shao Renfu , Li Dongmei , Pan Zemin
Published: February 2022

Background

To investigate the genotype distribution of human papillomavirus (HPV) in infected Uygur and Han women in Xinjiang, China; analyze the HPV16 E6 gene polymorphism site and relationship with the development of cervical cancer.

Methods

The HPV16 E6 sequence was analyzed using the European standard prototype to perform an evolutionary tree. HPV16 E6-T295/T350, G295/G350, and T295/G350 GV230 vectors were stably transfected into cervical cancer C33A cells to analyze the cell proliferation, migration and invasion, apoptosis by CCK8 and clonogenic assays, transwell and cell scratch assays, FACS experiments.

Results

The total HPV infection rate was 26.390% (760/2879), whereas the Uygur 22.87% (196/857) and the Han was 27.89% (564/2022) (P < 0.05). Among 110 mutations, 65 cases of E6 genes were mutated at nucleotide 350 (T350G) with the leucine changing to valine (L83V). Moreover, there were 7 cases of E6 gene mutated at nucleotide 295 (T295G) with aspartic changing to glutamic (D64E). When E6 vector(s) of mutations sites were transfected into C33A cells, they were found to promote cellular proliferation, migration, invasion, and inhibit apoptosis. T295/G350-E6 was significantly stronger than G295/G350 and T295/T350, G295/G350 was significantly stronger than T295/T350 (P < 0.05). The T295/G350 had the strongest effect on C33A cells and G295/G350 was significantly stronger than T295/T350 (P < 0.05).

Conclusions

The positive HPV infection rates differed between the Uygur and Han in Xinjiang, China, and the genotype distribution of infection was different. After transfecting C33A cells with different eukaryotic expression vectors, the T295/G350 mutation site promoted the proliferation, migration, and invasion of C33A cells to a greater extent than G295/G350; however, G295/G350 had a stronger effect than T295/T350.
A novel qualitative signature based on lncRNA pairs for prognosis prediction in hepatocellular carcinoma
Authors: Bu Xiaoyun , Ma Luyao , Liu Shuang , Wen Dongsheng , Kan Anna , Xu Yujie , Lin Xuanjia , Shi Ming
Published: February 2022

Background

Prognostic assessment is imperative for clinical management of patients with hepatocellular carcinoma (HCC). Most reported prognostic signatures are based on risk scores summarized from quantitative expression level of candidate genes, which are vulnerable against experimental batch effects and impractical for clinical application. We aimed to develop a robust qualitative signature to assess individual survival risk for HCC patients.

Methods

Long non-coding RNA (lncRNA) pairs correlated with overall survival (OS) were identified and an optimal combination of lncRNA pairs based on the majority voting rule was selected as a classification signature to predict the overall survival risk in the cancer genome atlas (TCGA). Then, the signature was further validated in two external datasets. Besides, biomolecular characteristics, immune infiltration status, and chemotherapeutics efficacy of different risk groups were further compared. Finally, we performed key lncRNA screening and validated it in vitro.

Results

A signature consisting of 50 lncRNA pairs (50-LPS) was identified in TCGA and successfully validated in external datasets. Patients in the high-risk group, when at least 25 of the 50-LPS voted for high risk, had significantly worse OS than the low-risk group. Multivariate Cox, receiver operating characteristic (ROC) curve and decision curve analyses (DCA) demonstrated that the 50-LPS was an independent prognostic factor and more powerful than other available clinical factors in OS prediction. Comparison analyses indicated that different risk groups had distinct biomolecular characteristics, immune infiltration status, and chemotherapeutics efficacy. TDRKH-AS1 was confirmed as a key lncRNA and associated with cell growth of HCC.

Conclusions

The 50-LPS could not only predict the prognosis of HCC patients robustly and individually, but also provide theoretical basis for therapy. Besides, TDRKH-AS1 was identified as a key lncRNA in the proliferation of HCC. The 50-LPS might guide personalized therapy for HCC patients in clinical practice.
Identification and validation a costimulatory molecule gene signature to predict the prognosis and immunotherapy response for hepatocellular carcinoma
Authors: Hu Yinan , Liu Jingyi , Yu Jiahao , Yang Fangfang , Zhang Miao , Liu Yansheng , Ma Shuoyi , Zhou Xia , Wang Jingbo , Han Ying
Published: February 2022

Background

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. Costimulatory molecules have been proven to be the foundation of immunotherapy. However, the potential roles of costimulatory molecule genes (CMGs) in HCC remain unclear. Our study is aimed to develop a costimulatory molecule-related gene signature that could evaluate the prognosis of HCC patients.

Methods

Based on The Cancer Gene Atlas (TCGA) database, univariate Cox regression analysis was applied in CMGs to identify prognosis-related CMGs. Consensus clustering analysis was performed to stratify HCC patients into different subtypes and compared them in OS. Subsequently, the LASSO Cox regression analysis was performed to construct the CMGs-related prognostic signature and Kaplan–Meier survival curves as well as ROC curve were used to validate the predictive capability. Then we explored the correlations of the risk signature with tumor-infiltrating immune cells, tumor mutation burden (TMB) and response to immunotherapy. The expression levels of prognosis-related CMGs were validated based on qRT-PCR and Human Protein Atlas (HPA) databases.

Results

All HCC patients were classified into two clusters based on 11 CMGs with prognosis values and cluster 2 correlated with a poorer prognosis. Next, a prognostic signature of six CMGs was constructed, which was an independent risk factor for HCC patients. Patients with low-risk score were associated with better prognosis. The correlation analysis showed that the risk signature could predict the infiltration of immune cells and immune status of the immune microenvironment in HCC. The qRT-PCR and immunohistochemical results indicated six CMGs with differential expression in HCC tissues and normal tissues.

Conclusion

In conclusion, our CMGs-related risk signature could be used as a prediction tool in survival assessment and immunotherapy for HCC patients.
Thermo/pH dual-responsive micelles based on the host–guest interaction between benzimidazole-terminated graft copolymer and β-cyclodextrin-functionalized star block copolymer for smart drug delivery
Authors: Adeli Floria , Abbasi Farhang , Babazadeh Mirzaagha , Davaran Soodabeh
Published: February 2022

Novel temperature and pH dual-sensitive amphiphilic micelles were fabricated exploiting the host–guest interaction between benzimidazole-terminated PHEMA-g-(PCL-BM) and β-CD-star-PMAA-b-PNIPAM. The fabricated graft copolymer had a brush-like structure with star side chains. The micelles were utilized as dual-responsive nanocarriers and showed the LCST between 40 and 41 °C. The acidic pH promoted the dissociation of the PHEMA-g-(PCL-BM: β-CD-star-PMAA-b-PNIPAM) micelles. DOX.HCl was loaded into the core of the micelles during self-assembly in an aqueous solution with a high encapsulation efficacy (97.3%). The average size of the amphiphilic micelles was about 80 nm, suitable size for the enhanced permeability and retention effect in tumor vasculature. In an aqueous environment, these micelles exhibited very good self-assembly ability, low CMC value, rapid pH- and thermo-responsiveness, optimal drug loading capacity, and effective release of the drug. The biocompatibility was confirmed by the viability assessment of human breast cancer cell line (MCF-7) through methyl tetrazolium assay. DOX-loaded micelles displayed excellent anti-cancer activity performance in comparison with free DOX.

Graphical Abstract
Carrier-free multifunctional nanomedicine for intraperitoneal disseminated ovarian cancer therapy
Authors: Huang Xiuyu , Qiu Miaojuan , Wang Tianqi , Li Binbin , Zhang Shiqiang , Zhang Tianzhi , Liu Peng , Wang Qiang , Qian Zhi Rong , Zhu Chengming , Wu Meiying , Zhao Jing
Published: February 2022

Background

Ovarian cancer is the most lethal gynecological cancer which is characterized by extensive peritoneal implantation metastasis and malignant ascites. Despite advances in diagnosis and treatment in recent years, the five-year survival rate is only 25–30%. Therefore, developing multifunctional nanomedicine with abilities of promoting apoptosis and inhibiting migration on tumor cells would be a promising strategy to improve the antitumor effect.

Methods and results

In this study, we developed a novel ACaT nanomedicine composed of alendronate, calcium ions and cyclin-dependent kinase 7 (CDK7) inhibitor THZ1. With the average size of 164 nm and zeta potential of 12.4 mV, the spherical ACaT nanoparticles were selectively internalized by tumor cells and effectively accumulated in the tumor site. Results of RNA-sequencing and in vitro experiments showed that ACaT promoted tumor cell apoptosis and inhibited tumor cell migration by arresting the cell cycle, increasing ROS and affecting calcium homeostasis. Weekly intraperitoneally administered of ACaT for 8 cycles significantly inhibited the growth of tumor and prolonged the survival of intraperitoneal xenograft mice.

Conclusion

In summary, this study presents a new self-assembly nanomedicine with favorable tumor targeting, antitumor activity and good biocompatibility, providing a novel therapeutic strategy for advanced ovarian cancer.

Graphical Abstract
The portrayal and perceptions of cesarean section in Mexican media Facebook pages: a mixed-methods study
Authors: Vazquez Corona Martha , Betrán Ana Pilar , Bohren Meghan A.
Published: February 2022

Background

Mexico has one of the highest rates of cesarean sections globally at over 45%. There is limited research about social factors influencing these rates. This study explores the portrayal and perceptions of cesarean section in Facebook media pages to better understand the socio-cultural context of childbirth in Mexico.

Methods

This is a mixed-methods social media analysis using two data sources. First, to study the portrayal of cesarean section, we identified ten Mexican media Facebook pages with the largest audiences (based on number of page “likes”). We searched these pages for articles containing the word “cesárea” (Spanish for cesarean section), and posts (articles) were eligible for inclusion if they contained the word “cesárea”. Second, to understand perceptions of cesarean section portrayal, we extracted comment threads of each Facebook post sharing the included articles. We performed a qualitative thematic analysis of articles and a quantitative content analysis of comments.

Results

We included 133 Facebook posts depicting 80 unique articles and identified three major themes: (1) information about cesarean section, (2) inequality and violence against women, (3) governance failures. Cesarean section was portrayed as a lifesaving procedure when medical necessary, and riskier than vaginal birth, with a longer recovery time, and possible negative health consequences. We extracted comments from 133 Facebook posts, and 6350 comments were included. We inductively developed 20 codes to then classify comments under six major categories: (1) violence and discrimination, (2) health and health services, (3) mode of birth choice, (4) disbelief at information about cesarean section, (5) abortion, and (6) discontent at the government.

Conclusions

We found that Facebook media did not promote cesarean section over vaginal birth, and risks and consequences were mostly represented reliably. Perceptions about the portrayal of cesarean section showed strong discontent and distrust against providers and the health system, as well as rejection of factual information about the consequences of cesarean section. We documented gross gender inequality and violence against women, highlighting the urgent need for human rights approaches to maternal health to address these inequalities and prevent harmful practices. Our study also contributes to the emerging field of social media analysis, and demonstrates clear areas where social media communication can be improved.
Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines
Authors: Dawson Angela , Assifi Anisa , Turkmani Sabera
Published: February 2022

Background

A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation.

Method

We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents.

Findings

One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities.

Conclusion

This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.
CD161 expression defines new human γδ T cell subsets
Authors: Karunathilaka Amali , Halstrom Samuel , Price Patricia , Holt Michael , Lutzky Viviana P. , Doolan Denise L. , Kupz Andreas , Bell Scott C. , Thomson Rachel M. , Miles John J. , Ratnatunga Champa N.
Published: February 2022

γδ T cells are a highly versatile immune lineage involved in host defense and homeostasis, but questions remain around their heterogeneity, precise function and role during health and disease. We used multi−parametric flow cytometry, dimensionality reduction, unsupervised clustering, and self-organizing maps (SOM) to identify novel γδ T cell naïve/memory subsets chiefly defined by CD161 expression levels, a surface membrane receptor that can be activating or suppressive. We used middle-to-old age individuals given immune blockade is commonly used in this population. Whilst most Vδ1+subset cells exhibited a terminal differentiation phenotype, Vδ1−subset cells showed an early memory phenotype. Dimensionality reduction revealed eight γδ T cell clusters chiefly diverging through CD161 expression with CD4 and CD8 expression limited to specific subpopulations. Comparison of matched healthy elderly individuals to bronchiectasis patients revealed elevated Vδ1+terminally differentiated effector memory cells in patients potentially linking this population with chronic proinflammatory disease.
Redressing COVID-19 vaccine inequity amidst booster doses: charting a bold path for global health solidarity, together
Authors: Rackimuthu Sudhan , Narain Kapil , Lal Arush , Nawaz Faisal A. , Mohanan Parvathy , Essar Mohammad Yasir , Charles Ashworth Henry
Published: February 2022

Background

With large swathes of the world’s population—majority clustered in low- and middle-income countries—still yet to receive the minimum of two doses of the COVID-19 vaccine; The need to address the failures of international solidarity to equitably distribute COVID-19 vaccines is now more urgent than ever to help curb the pandemic and prevent future variants. However, many high-income countries have adopted a “me first” approach, proceeding to offer COVID-19 booster doses to their entire populations, including those at least risk of severe illness, whilst the rest of the world is left unvaccinated or partially vaccinated with one dose for even their most vulnerable communities.

Main body

COVID-19 vaccine inequity places the health of the global population at risk and exacerbates socio-economic repercussions, especially in low- and middle-income countries. Initiatives launched to combat vaccine inequity such as the Fair Allocation Framework for the COVID-19 Vaccines (COVAX) have been unsuccessful as several governments, primarily from high-income countries, have scaled down their contributions to the initiative. Furthermore, COVAX has not seriously engaged with the Access to COVID-19 Tools (ACT) Health Systems Connector, as was originally intended, leading to crucial health systems components critical to vaccine delivery to be overlooked. Several strategies can be employed to help achieve the desired global immunization goals, such as Intellectual Property waivers, increased donations, and activation of new COVID-19 vaccine manufacturing hubs. In addition, continued advocacy for vaccine equity by all involved and affected stakeholders, as well as critical amendments to existing or upcoming legislation and funding mechanisms will help address the shortcomings of current inequitable vaccine distribution.

Conclusions

Global solidarity and collective action through pandemic governance mechanisms are urgently needed to ensure vaccine equity. These interventions are vital to rapidly mitigate ongoing health and humanitarian crises and ultimately curb the pandemic, sooner rather than later.
Implementation of initiatives designed to improve healthcare worker health and wellbeing during the COVID-19 pandemic: comparative case studies from 13 healthcare provider organisations globally
Authors: O’Brien N , Flott K , Bray O , Shaw A , Durkin M
Published: February 2022

Background

Healthcare workers are at a disproportionate risk of contracting COVID-19. The physical and mental repercussions of such risk have an impact on the wellbeing of healthcare workers around the world. Healthcare workers are the foundation of all well-functioning health systems capable of responding to the ongoing pandemic; initiatives to address and reduce such risk are critical. Since the onset of the pandemic healthcare organizations have embarked on the implementation of a range of initiatives designed to improve healthcare worker health and wellbeing.

Methods

Through a qualitative collective case study approach where participants responded to a longform survey, the facilitators, and barriers to implementing such initiatives were explored, offering global insights into the challenges faced at the organizational level. 13 healthcare organizations were surveyed across 13 countries. Of these 13 participants, 5 subsequently provided missing information through longform interviews or written clarifications.

Results

13 case studies were received from healthcare provider organizations. Mental health initiatives were the most commonly described health and wellbeing initiatives among respondents. Physical health and health and safety focused initiatives, such as the adaption of workspaces, were also described. Strong institutional level direction, including engaged leadership, and the input, feedback, and engagement of frontline staff were the two main facilitators in implementing initiatives. The most common barrier was HCWs’ fear of contracting COVID-19 / fear of passing COVID-19 to family members. In organizations who discussed infection prevention and control initiatives, inadequate personal protective equipment and supply chain disruption were highlighted by respondents.

Conclusions

Common themes emerge globally in exploring the enablers and barriers to implementing initiatives to improve healthcare workers health and wellbeing through the COVID-19 pandemic. Consideration of the themes outlined in the paper by healthcare organizations could help influence the design and deployment of future initiatives ahead of implementation.
Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial
Authors: Kolko David J. , McGuier Elizabeth A. , Turchi Renee , Thompson Eileen , Iyengar Satish , Smith Shawna N. , Hoagwood Kimberly , Liebrecht Celeste , Bennett Ian M. , Powell Byron J. , Kelleher Kelly , Silva Maria , Kilbourne Amy M.
Published: February 2022

Background

Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the “black box” of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms.

Methods

We will conduct a hybrid type 3 effectiveness–implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor–Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life.

Discussion

This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home.

Trial registration

ClinicalTrials.gov, NCT04946253. Registered June 30, 2021.
Analysis of the fecal and oral microbiota in chronic recurrent multifocal osteomyelitis
Authors: Rausch Philipp , Hartmann Meike , Baines John F. , von Bismarck Philipp
Published: February 2022

Background

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disease for which a lack of bacterial involvement is a key diagnostic feature to distinguish it from other symptomatically related diseases. However, the growing evidence suggesting an involvement of the host-associated microbiota in rheumatic disorders together with the now wide accessibility of modern culture-independent methods warrant a closer examination of CRMO.

Methods

In this study, we show through bacterial 16S rRNA gene profiling that numerous features of the oral- and fecal microbial communities differentiate children with and without CRMO.

Results

Notably, communities in diseased children are characterized by a lack of potential probiotic bacteria in the fecal community and an overabundance of known pathobionts in the oral microbial communities. Of special interest is the HACEK group, a set of commonly known oral pathogens that are implicated in the development of several acute and chronic diseases such as osteitis and rheumatoid arthritis. Furthermore, we observe that gut bacterial communities in the diseased children appear to reflect an altered host physiology more strongly than the oral community, which could suggest an oral disease origin followed by propagation and/or responses beyond the oral cavity.

Conclusions

Bacterial communities, in particular the oral microbiota, may serve as an indicator of underlying susceptibility to CRMO, or play a yet undefined role in its development.
Factors affecting patient satisfaction related to cost and treatment effectiveness in rheumatoid arthritis: results from the multicenter observational cohort study, FRANK Registry
Authors: Fujiwara Toshifumi , Kondo Masakazu , Yamada Hisakata , Haraguchi Akihisa , Fujimura Kenjiro , Sakuraba Koji , Kamura Satoshi , Fukushi Jun-ichi , Miyahara Hisaaki , Inoue Yasushi , Tsuru Tomomi , Shuto Toshihide , Yoshizawa Seiji , Suematsu Eiichi , Miyamura Tomoya , Ayano Masahiro , Mitoma Hiroki , Arinobu Yojiro , Niiro Hiroaki , Ohishi Masanobu , Hirata Akie , Tokunaga Shoji , Takada Atsushi , Hara Daisuke , Tsushima Hidetoshi , Akasaki Yukio , Ikemura Satoshi , Sueishi Takuya , Toya Masakazu , Sakuragi Takahide , Tsutsui Tomoko , Kai Kazuhiro , Arisumi Shinkichi , Nakashima Yasuharu
Published: February 2022

Background

To further improve rheumatoid arthritis (RA) treatment, it is necessary to understand each RA patient’s satisfaction and to identify the factors affecting their satisfaction. Despite the rise in medical costs for RA, little is known about the factors that influence patient satisfaction with the cost of treatment in RA patients.

Methods

This is a multicenter observational study of Japanese RA patients from the FRANK Registry with data analyzed from March 2017 to August 2020. We collected data on demographic characteristics, clinical data, quality of life which was evaluated using the EuroQol 5-dimensional questionnaire (EQ5D), and patient satisfaction. The four categories of patient satisfaction were evaluated individually (i.e., cost, treatment efficacy, activities of daily living [ADL], and global treatment satisfaction). We analyzed the factors that affected each patient’s satisfaction, such as age, sex, EQ5D, disease duration, disease activity, and treatment.

Results

This study included 2235 RA outpatients (406 males, 1829 females). In RA patients, “very satisfied” and “satisfied” were given for nearly half of each satisfaction aspect (cost 49%; efficacy 72%; ADL 58%; global treatment 66%) at the time of the initial registration. To investigate the factors influencing each satisfaction, multivariate analysis has revealed that the use of b/tsDMARDs increased satisfaction of treatment effect (odds ratio [OR] 0.66) and ADL (OR 0.78) but decreased cost satisfaction (OR 2.21). Age (50–64 years; OR 0.91; 65–74 years, 0.55: ≥ 75 years, 0.35), female (OR 0.81), and history of musculoskeletal surgery (OR 0.60) all increased cost satisfaction. Patients with lower disease activity and higher EQ5D scores had higher levels of satisfaction in all areas.

Conclusions

In this study, patient satisfaction in terms of cost, treatment effect, ADL, and overall treatment was generally higher, but some patients were dissatisfied. The cost of satisfaction increased with age and a history of musculoskeletal surgery, while it decreased with a lower EQ5D score and the use of b/tsDMARDs.
Diagnosis of spontaneous secondary tension pneumothorax following apparent recovery from coronavirus disease 2019 pneumonitis: a case report
Authors: Tirimanna Romesh , Myerson James , Okorie Michael , Dorman Eleanor
Published: February 2022

Background

Coronavirus disease 2019 has been associated with a plethora of different manifestations of systems affected (including pulmonary, gastrointestinal, and thrombotic disease) and time to presentation of complications. Pneumothorax has been established as a complication in the literature. However, tension pneumothorax remains a rare presentation with higher mortality. We report a case of secondary tension pneumothorax in a patient following apparent recovery from coronavirus disease 2019 pneumonitis.

Case presentation

Eight days after resolution of coronavirus disease 2019 pneumonitis symptoms, a 51-year-old Caucasian man with no pre-existing pulmonary disease was brought into the emergency department following 48 hours of progressive shortness of breath. Further clinical assessment revealed reduced breath sounds in the right lung, blood pressure was 116/95 mmHg, and jugular venous pressure was not elevated. Chest x-ray showed right-sided tension pneumothorax with mediastinal shift. Insertion of a chest drain led to rapid resolution of symptoms, and the patient was discharged following full re-expansion of the lung.

Conclusions

The period of recovery from coronavirus disease 2019 is variable. Clinicians should consider tension pneumothorax as a possible complication of coronavirus disease 2019 pneumonitis in patients presenting with type 1 respiratory failure, even after resolution of pneumonitis symptoms and a considerable time period following initial contraction of coronavirus disease 2019.
Young people are medically invulnerable to COVID-19 but vulnerable in the labor market: Korean evidence
Authors: Park Saejung , Cho Joonmo
Published: February 2022

Background

COVID-19 and its preventive measures affect not only the state of public health but also the economy. The economic impact of COVID-19 varies depending on age, and it is argued that young people have experienced the greatest negative impacts.

Methods

This study was an analysis of the impact of the COVID-19 outbreak in January 2020 on the Korean labor market. Large-scale data from the Economically Active Population Survey from January to June of 2018 to 2020 were used when analyzing the impacts of COVID-19 on unemployment and the economically inactive population by age group. Through this study’s empirical analysis, we examined for this study whether the COVID-19 outbreak has affected the labor market differently based on age. By analyzing the interaction terms of the young person’s status and the time of the COVID-19 outbreak, we determined the impacts of the outbreak on economic inactivity among young people, as well as examining the reasons for these differential effects.

Results

Compared with the middle-aged or older group, young people were more likely to become economically inactive than unemployed. Our empirical results using multinomial logistic regression revealed several reasons for the increase in economic inactivity, such as discouragement during the job search, childcare, housework, and studying at an institution, along with other determinants of economic inactivity. Young people showed a significantly higher relative probability of becoming economically inactive or discouraged job seekers following the COVID-19 outbreak when compared to other age groups. In addition, through the analysis of the possibility of employment, the young people responded negatively to the possibility of employment in the future compared to the middle-aged after COVID-19.

Conclusion

Young people in South Korea possess little career experience in the labor market and tend to be seeking work rather than working. Because economic activities are likely to shrink structurally during a pandemic, it is necessary to empirically determine the damage incurred by people who are vulnerable in the labor markets, such as the younger population which was the subject of this study. Accordingly, future policy directions are suggested for the prevention of a rapid increase in the rate of economic inactivity among the younger population during the pandemic.