bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Self-photography in Patients Presenting for Primary Aesthetic Rhinoplasty
Authors: Araslanova Rakhna , Pearlman Steven
Published: September 2022

Introduction:

Habitual self-photographs or selfies have been anecdotally associated with patients presenting for cosmetic rhinoplasty. Our objective was to establish the prevalence of self-photography in patients presenting for aesthetic rhinoplasty. Secondary objective was to determine if presenting nasal concerns have changed since taking selfies became widely accepted in 2013.

Methods:

Demographic data, referral source, and nasal concerns were retrospectively collected for 100 consecutive patients seeking cosmetic rhinoplasty consultations in 2018 and 2012. Revision cases were excluded. A voluntary, paper-based survey was used to capture the frequency of self-photography during the initial consultation in 2018.

Results:

One hundred consecutive patients were included from January through September of 2018. Out of 92 survey respondents, 80.4% admitted to taking selfies. Patients engaging in self-photography less than once per month composed 23.9%, followed by weekly in 21.7% and daily in 20.7% of survey respondents. A 17% increase in Internet-sourced patient referrals was observed in 2018. The top 3 nasal complaints in the 2018 cohort were tip-related followed by hump and big nose. Whereas the 2012 cohort was mostly concerned with hump, tip shape, and nasal obstruction.

Conclusions:

Most patients seeking primary cosmetic rhinoplasty engage in self-photography. Monitoring changes in the patterns of referrals and patient’s aesthetic concerns about nasal appearance are important for rhinoplasty surgeons as their practice evolves to integrate social networking and Internet-based communications.

Level of Evidence:

III
Pilot Study of Associations Among Functional Connectivity and Neurocognition in Survivors of Pediatric Brain Tumor and Healthy Peers
Authors: Seck Safiyah , Kim Young Jin (Ginnie) , Cunningham William A. , Olshefski Randal , Yeates Keith Owen , Vannatta Kathryn , Hoskinson Kristen R.
Published: September 2022

This pilot study examined the associations among functional connectivity in the salience, central executive, and default mode networks, and neurocognition in pediatric brain tumor survivors and healthy children. Thirteen pediatric brain tumor survivors (9 boys, M = 12.76 years) and 10 healthy children (6 boys, M = 12.70 years) completed magnetic resonance imaging (MRI) and assessment of processing speed and executive function. Pediatric brain tumor survivors performed more poorly than healthy children on measures of processing speed, divided attention, and working memory; parent ratings of day-to-day executive function did not differ significantly by group, though both pediatric brain tumor survivors who underwent only surgical resection and healthy children were rated by parents as having difficulties approaching a standard deviation above the normative mean. Connectivity was lower in the salience network and greater in the default mode network in pediatric brain tumor survivors. Cross-method correlations showed that increased salience network and default mode network connectivity were associated with better task performance and parent-rated executive skills and higher central executive network connectivity with poorer parent-rated executive skills. This perhaps reflects an adaptive pattern of hyperconnectivity in pediatric brain tumor survivors.
Improvement in optical absorption and emission characteristics of polymethyl methacrylate in solution cast polymethyl methacrylate/polyvinyl carbazole polyblends
Authors: Kaur Jaspreet , Sharma Jitender Paul , Singh Narveer , Pathak Dinesh , Guleria Neelam , Singh Pramod Kumar , Sharma Praveen Kumar
Published: September 2022

Polymer blends have got considerable attention for their potential optoelectronic and photonic applications due to several advantages such as easy processing, low cost, flexibility, and good mechanical properties. This work reports the structure and optical properties of solution cast binary blends of poly (methyl methacrylate) (PMMA) and poly (vinyl carbazole) (PVK). Here, the position and/or intensity of characteristic FTIR peaks reveal the changes of the structure of PMMA on PVK content while the surface morphology changes from highly smooth for pure PMMA to flaky structured (PVK 5%) and then to agglomerated morphologies for these blends. A red shift in optical absorption edge and decrease in optical transmission with PVK content in PMMA based blends. The emission spectra exhibit intensity escalation by 340 times with respect to PMMA for PVK-15 blends and then decreases with further addition of PVK in these blends. These results are very important for the advent of new optoelectronic functionalities for these polymer blends.
Residual lifetime estimation for the mining truck tires
Authors: Rahimdel Mohammad Javad
Published: September 2022

Reliability analysis has a very important role in supporting the operation of a system in harsh working conditions such as mines. Haul trucks are considering as a main asset of an open pit mine. Dump trucks are comprised of different sub-systems and among them, tires have a significant effect on the haulage economy. This study focused on the remaining life estimation of the mining truck tires considering the environmental operating conditions at an open pit iron ore mine in Iran. To achieve this, the proportional hazard model was used to estimate the conditional reliability functions and then the mean residual life of tires at the various initial survival times. The results of this study show that the ambient temperature has a significant effect on the reliability performance. By increasing the initial life of tires from 500 to 1000 h, the mean residual life will be decreased by 21% and 30% in low (below 15°C) and high (above 15°C) ambient temperature levels. These results are helpful to keep the truck tire performance at a desirable level by considering the appropriate preventive maintenance intervals.
AIDS-related cytomegalovirus encephalitis in the late ART era: A retrospective cohort study at a referral center in Brazil
Authors: Lucas Júnior Rodovaldo M , Bogoni Giuliane , Reis Schneider Gustavo A , Castanheira de Souza Nidyanara F , Carvalho Maria Kassab , Vidal José Ernesto
Published: September 2022

Background

AIDS-related cytomegalovirus (CMV) encephalitis has declined in the combined antiretroviral therapy (ART) era in high-income countries. However, there is scarce information on CMV encephalitis in low- and middle-income countries. The objectives of this study were to identify the prevalence of AIDS-related CMV encephalitis and describe its main features.

Methods

This was a retrospective cohort study carried out at a referral center in São Paulo, Brazil. We included adult people living with HIV/AIDS (PLWHA), hospitalized in 2019, with a CD4 cell count ≤100/mm3 and quantitation CMV DNA results in plasma. Cases with compatible neurological manifestations and detection of CMV DNA by polymerase chain reaction (PCR) in cerebrospinal fluid samples were defined as CMV encephalitis.

Results

Among 761 PLWHA hospitalized, 248 (32.5%) cases were included in this study. Prevalence of CMV encephalitis was 2.4% (6/248) among all included cases and 7.7% (6/78) among individuals with neurological opportunistic diseases. The six patients with CMV encephalitis were males and had CD4 cell count <50/mm3. Five (83%) cases had CMV encephalitis as AIDS-defining disease and showed CMV DNA detection by PCR >50,000 UI/mL plasma. All six cases received anti-CMV therapy (ganciclovir, n = 4; ganciclovir plus foscarnet, n = 2) and five were discharged to home. CMV encephalitis was not uncommon among hospitalized PLWHA with neurological opportunistic diseases.

Conclusions

The epidemiological and immunological profile of individuals with CMV encephalitis was similar to that described in the pre-ART era, but in contrast, most cases were treated and discharged from the hospital.
Fracture behavior and damage evolution model of sandstone containing a single pre-existing flaw under discontinuous fatigue loading
Authors: Shi Zhanming , Li Jiangteng , Wang Ju , Chen Jinci
Published: September 2022

The process of disaster incubating in deep rock mass engineering is mainly related to the fracture behavior and damage mechanism of the rock mass. This paper proposes a new damage model based on Lemaitre's equivalent strain hypothesis with improved Harris distribution and laboratory discontinuous fatigue loading test (DFLT). Firstly, discontinuous fatigue loading tests were carried out on the jointed sandstone specimens and acoustic emission (AE) was used as a research tool. Based on the b-value and AF-RA theory, the failure mode of specimens was further explored in terms of the crack evolution process and crack classification. Meanwhile, digital image correlation (DIC) techniques were used to analyze the evolution of the deformation field on the surface of the specimen. Subsequently, the fracture morphological characteristics of the rock masses were analyzed from a microscopic perspective by scanning electron microscopy (SEM) techniques. The investigations found that in a short time, the low-level constant load will lead to the interlocking of particles inside the rock mass, reduced incremental coupled damage, and enhanced plasticity “with” reducing the coupled damage increment and enhancing the plasticity, thereby inhibiting the damage growth rate. In addition, as the stress level increases, the friction between the grains intensifies, the cuttings and roughness of the fracture surface increase, the fatigue softening effect is enhanced, and the specimen gradually transforms from brittle failure to ductile failure. At the same time, the proportion of stress-induced tensile cracks and shear cracks gradually increased, resulting in the specimen finally presenting tensile-shear composite failure.
Counseling Families with Children with Medical Complexity
Authors: Holmes Courtney , Kimbrough Tiffany , Davis Taylor , Samuel Ariana , Smyth Finn
Published: September 2022

Approximately 3 million U.S. children are considered to have medical complexity, a subset of children that are the most medically fragile and have the most intensive health care needs of all children with special health care needs. Families with children with medical complexity often experience myriad physical, mental, and financial stressors impacting their well-being, family functioning, and mental health. Background information and clinical implications for counselors working with this population will be discussed.
Poststructuralism and Post Qualitative Inquiry: What Can and Must Be Thought
Authors: St. Pierre Elizabeth Adams
Published: September 2022

St. Pierre argues that the immanent concepts and onto-epistemological arrangements of scholars we call poststructural, postmodern, posthuman, and other “posts” do not enable preexisting, conventional, humanist 20th-century social science research methodologies that are not immanent. For that reason, scholars are now inventing and teaching new approaches to inquiry based on old philosophies of immanence in which those methodologies cannot be thought or done.
Reforming non-consensual sexual offences in Hong Kong: How do the Law Reform Commission of Hong Kong's proposals compare with recent recommendations in other jurisdictions?
Authors: Dyer Andrew , Crofts Thomas
Published: September 2022

In this article, we consider the reforms to non-consensual sexual offences that the Law Reform Commission of Hong Kong (‘LRCHK’) has recently advocated in its Final Report about the law relating to sexual offending in that jurisdiction. We argue that a comparison between the LRCHK's proposals and those supported in recent years by Law Reform Commissions in other jurisdictions – most particularly, in New South Wales (‘NSW’) and Queensland – reveals the LRCHK's recommendations generally to be sensible, balanced and progressive. The LRCHK's approach to the question of what it is to consent, and to the issue of how a person withdraws consent, is preferable to that supported by the NSW Law Reform Commission (‘NSWLRC’). Further, it seems right to have supported an objective culpability requirement for the non-consensual offences with which it was concerned. And while there are difficulties concerning certain of the LRCHK's proposals – especially, perhaps, those pertaining to fraudulently procured sexual activity – the NSWLRC's and the Queensland Law Reform Commission's respective approaches to the last mentioned topic also seem imperfect.
Quantitative evaluation of crack damage under a variable temperature environment based on a Gaussian mixture model
Authors: Zhang Xiaozhen , Yang Jinsong , Wang Tiantian , Xie Jingsong , Tian Longzhen
Published: September 2022

During the operation of high-speed trains, components are prone to fatigue crack damage under the action of cyclic loading and extreme temperature environments. Temperature change has become an important factor for monitoring the health of high-speed train structures. A new fatigue crack size quantification method under a variable temperature environment based on a Gaussian mixture model (GMM) is presented in this paper. A series of damage indexes are proposed to characterize the interaction mechanism between the signal and crack under temperature change. Moreover, multidimensional damage indexes extracted by the fusion of dimensionality reduction technology are used to establish a complete working condition baseline GMM database. The service temperature of the structure is determined according to the maximum similarity criterion between the baseline GMMs and detection GMMs. Furthermore, the quantitative crack length detection model is established at each temperature. To validate the effectiveness of the method, fatigue crack experiments in a variable temperature environment are carried out. The verification results show that this method can detect fatigue crack growth at different temperatures.
Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study
Authors: Blanchette Virginie , Houde Louis , Armstrong David G. , Schmidt Brian M.
Published: September 2022

There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.
Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients
Authors: Yastı Ahmet Çınar , Karaca Turgut , Kendirci Murat , Akgün Ali Emre , Şahiner İbrahim Tayfun , Akın Merve
Published: September 2022

Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT ( P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.
Allopurinol Use and the Risk of Type 2 Diabetes Mellitus: A Meta-Analysis of Cohort Studies
Authors: Lai Shih-Wei , Hwang Bing-Fang , Kuo Yu-Hung , Liu Chiu-Shong , Liao Kuan-Fu
Published: September 2022

Objective

To assess whether there is a relation between allopurinol use and the probability of type 2 diabetes mellitus (T2DM) in persons with gout and/or hyperuricemia.

Methods

According to the PRISMA 2020 guidelines, a meta-analysis was performed by searching literature published from 2000 to 2021 in two electronic databases (Ebscohost and PubMed). The end point was set as a new diagnosis ofT2DM between people with the use of allopurinol and people with non-use of allopurinol. The random-effects model was performed to evaluate the pooled hazard ratio (HR) with 95% confidence interval (CI) for T2DM associated with allopurinol use.

Results

Three cohort studies could meet the inclusion criteria in the meta-analysis. There was a high heterogeneity of the outcome between studies (I2 = 99%). The research duration ranged from 13 to 16 years. The subject number in each work ranged from 1114 to 138,652. A meta-analysis disclosed that there was not an association between allopurinol use and the risk of developing T2DM (pooled HR = 1.01 and 95%CI = .55–1.84).

Conclusions

The meta-analysis shows that no correlation is detected between allopurinol use and the risk of T2DM in individuals with gout and/or hyperuricemia. Because there are not enough eligible studies, the strength of evidence in our meta-analysis is weak. More cohort studies are needed to determine an association between use of allopurinol and the probability of T2DM for individuals with gout and/or hyperuricemia.
Psychosocial factors associated with health-related quality of life in patients with chronic disease: Results of a cross-sectional survey
Authors: Van Wilder Lisa , Vandepitte Sophie , Clays Els , Devleesschauwer Brecht , Pype Peter , Boeckxstaens Pauline , Schrans Diego , De Smedt Delphine
Published: September 2022

Objective

The impact of various psychosocial factors (sense of coherence, illness perception, patient enablement, self-efficacy, health literacy, personality) is not fully understood across a wide range of chronic diseases, and in particular in patients with multimorbidity. As such, this study assessed the key psychosocial factors associated with impaired health-related quality of life (HRQoL) in patients with one or more chronic diseases based on cross-sectional data collected in Flanders (Belgium).

Methods

Cross-sectional data on 544 chronically ill patients were analysed. Multiple linear regression models were built to analyze the key psychosocial factors associated with HRQoL (EQ-5D-5Lindex as dependent factor).

Results

Overall, the strongest independently associated factor with HRQoL was illness perceptions (β = −0.52, P < 0.001). In addition, sense of coherence (β = 0.14, P = < 0.05) was independently positively associated with HRQoL. Moreover, after stratification for multimorbidity, the negative association of illness perceptions with HRQoL was stronger when multimorbidity is present compared to when it is absent (β = −0.62, P < 0.001 vs β = −0.38, P < 0.001).

Conclusions

This study revealed interesting associations of the modifiable psychosocial factors of illness perceptions and sense of coherence with HRQoL in a population of chronically ill persons. Given that the burden of chronic diseases will rise in the next decades, designing and implementing interventions that enhance these psychosocial abilities of patients, especially illness perceptions in multimorbid patients, is needed in order to reduce the burden of chronic diseases in terms of impaired HRQoL.
Profiles of Odorant Specific Performance in Olfactory Testing
Authors: Schlosser Rodney J. , Soler Zachary M. , Mace Jess , Farrell Nyssa , Rimmer Ryan , Alt Jeremiah A. , Ramakrishnan Vijay R. , Edwards Thomas S. , Smith Timothy L.
Published: September 2022

Background

Olfactory dysfunction (OD) can occur from a variety of etiologies. However, there are few reports examining whether varying etiologies have unique profiles of psychophysical testing that may provide insight into the pathophysiology of OD.

Methods

Adults with chronic rhinosinusitis with and without nasal polyps (CRSwNP/CRSsNP) and healthy control adults with no sinus complaints underwent olfactory assessment with Sniffin’ Sticks. Profiles of identification and discrimination were compared between CRS and non-CRS subjects across the spectrum of OD.

Results

Normosmics with or without CRS identified apple, pineapple, and turpentine less frequently than expected (range 52%-68% correct). Hyposmics with CRS correctly identified orange more frequently than control hyposmics (83%-93% vs 68% for controls) with similar findings for rose. Hyposmics of all cohorts were unable to identify apple (26%). Discrimination profiles were similar across the spectrum of OD and between diagnostic groups.

Conclusions

Identification and discrimination rates of specific odorants may provide unique information regarding the etiology of OD, however psychophysical testing is a complex interplay of olfactory and trigeminal function, the strength of target odorant, distractor choices, and familiarity with odorants.
A Genome-Wide Association Study Reveals Two Genetic Markers for Chondromalacia
Authors: Kim Stuart K. , Kahn Condor , Abrams Geoffrey D.
Published: September 2022

Objective

It is unknown why some athletes develop chondromalacia and others do not, even when accounting for similar workloads between individuals. Genetic differences between individuals may be a contributing factor. The purpose of this work was to screen the entire genome for genetic markers associated with chondromalacia.

Design

Genome-wide association (GWA) analyses were performed utilizing data from the Kaiser Permanente Research Board (KPRB) and the UK Biobank. Chondromalacia cases were identified based on electronic health records from KPRB and UK Biobank. GWA analyses from both cohorts were tested for chondromalacia using a logistic regression model adjusting for sex, height, weight, age of enrollment, and race/ethnicity using allele counts for single-nucleotide polymorphisms (SNPs). The data from the 2 GWA studies (KPRB and UK Biobank) were combined in a meta-analysis.

Results

There were a total of 3,872 combined cases of chondromalacia from the KPRB and the UK Biobank cohorts. Genome-wide significant associations with chondromalacia were found for rs144449054 in the ARHGAP15 gene (OR = 3.70 [2.32-5.90]; P = 1.4 × 10−8) and rs188900564 in the MAGEC2 (OR = 2.07 [1.61-2.65]; P = 3.7 × 10−9).

Conclusions

Genetic markers in ARHGAP15 and MAGEC2 appear to be associated with chondromalacia and are potential risk factors that deserve further validation regarding molecular mechanisms.
An experimentally validated numerical analysis of UHP-FRC subjected to blast loading
Authors: Sherif Mohtady , Othman Hesham , Marzouk Hesham , Aoude Hassan
Published: September 2022

This paper presents a new material constitutive model for simulating the uniaxial material behavior of ultra-high performance fiber reinforced concrete (UHP-FRC). The model accounts for the contribution of the steel fiber content to the tensile behavior. The model variables are the fracture energy, the characteristic length, and the crack bandwidth. Thus, it guarantees a mesh size independent numerical modeling of UHP-FRC. The model is developed based on the reported results of a state-of-the-art and highly accurate experimental investigation for the uniaxial behavior of UHP-FRC. This paper also adopts the concrete damage plasticity model (CDP) as a multi-axial yield surface criterion and presents the applicability of the material constitutive model and CDP for modeling UHP-FRC under unconfined non-contact blast loading. The results of the numerical models are validated against the experimental data of shock tube testing conducted by the authors at the University of Ottawa shock tube in collaboration with Ryerson University. The results revealed that the developed material constitutive model accurately represented the uniaxial behavior of UHP-FRC. The CDP model combined with the material constitutive model developed in this study can accurately model UHP-FRC structures under unconfined non-contact blast loading.
The interpretation of chemical epidemiology studies requires integration with experts on the nature of the reported adverse outcome and toxicologists
Authors: Doherty John D
Published: September 2022

Chemical Epidemiology Studies (CES) can be both protective for humans of adverse health effects of chemicals as well as cause alarm leading to unwarranted remedial action and litigation. Inherent problems in conducting CES especially related to the study design goals and assessment of exposure are recognized. Many CES report adverse health outcomes at very low exposure levels implying that humans are uniquely or especially sensitive to the toxicity of these chemicals. Such unique sensitivity to humans would be especially important to scientists in human physiology, medical and toxicology communities. CES are currently appearing in the open literature more frequently and it is expected that they will be appearing even more frequently in the future especially if animal toxicity testing is reduced or eliminated. Experts on the nature of the reported adverse health outcomes should be playing a more critical role in the interpretation of CES because they are best suited to understand the many factors affecting natural and induced variability. Should animal toxicity testing be reduced, the role of toxicologists in the interpretation of CES will need to evolve. This manuscript addresses the need for more uniform standards in conducting, reporting, and review by independent, fully focused experts if CES studies reported in the open literature will be included in the health risk characterization and litigation of chemicals.
In and Out of Focus: An Urban Lens on COVID-19 in the Global South
Authors: Heymann David
Published: September 2022

How has COVID-19 affected the everyday lives of citizens in the global South?

Through a visual narrative, this photographic essay brings forth the impact that the pandemic has had on the lives and livelihoods of the urban poor that has been ‘out of focus’, ranging from the urban emptiness of vacated streets to the hands-on community spirit to help those in need. This visual essay uses imagery sourced from city partners within the KNOW programme, to depict and compare urban realities before (in focus) and during (out of focus) the pandemic. By visually presenting the people and places in pre-pandemic circumstances, this piece juxtaposes localised lived experiences, alongside the disruption, inherent solidarity and urban inequalities that have arisen during the progression of the pandemic in the global South.
Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives
Authors: Cottin Vincent , Martinez Fernando J. , Smith Vanessa , Walsh Simon L.F.
Published: September 2022

Multidisciplinary team (MDT) meetings, involving the integrated collaboration of healthcare professionals, are increasingly used in clinical practice to inform the diagnosis and treatment of interstitial lung diseases (ILDs). Over time, the assessment of patients with ILD has transitioned from discussions among clinicians, radiologists and pathologists to the inclusion of a broader range of clinical data and specialist expertise. Studies have shown that a multidisciplinary approach can have many benefits for the clinical care of patients with ILD by improving the diagnostic confidence for different ILDs and guiding treatment decisions. The utility of MDT discussions for diagnosis, monitoring disease progression and management decisions, will need to be considered based on how it is best positioned in the diagnostic and therapeutic process, as well as the practicality and challenges of its use. There are also uncertainties and heterogeneity concerning the optimal practices of MDT meetings in ILD care. In this review, we describe recent developments refining the approach to MDTs in clinical practice, including who should be involved in the MDTs, when it is most needed, their use in patient management, challenges in their implementation, and ongoing controversies in the field that need further research.
Efficacy and safety of monoclonal antibody against calcitonin gene-related peptide or its receptor for migraine patients with prior preventive treatment failure: a network meta-analysis
Authors: Wang Xing , Wen Dingke , He Qiang , You Chao , Ma Lu
Published: September 2022

Objective

The relative effects of monoclonal antibody against calcitonin gene-related peptide (CGRP) or its receptor for adult migraine patients with prior treatment failure remains uncertain. Therefore, this study systematically assessed the comparative effectiveness of different CGRP binding monoclonal antibodies (mAbs) for these patients.

Methods

Several online databases including Ovid MEDILNE, Ovid EMBASE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to June 15, 2022. We included randomized clinical trials (RCT) of adult migraine patients with previous treatment failure that assessed any CGRP monoclonal antibody. The primary efficacy outcome was change in monthly migraine days (MMDs), and the primary safety outcome was treatment-emergent adverse events (TEAEs).

Results

Overall, seven studies totaling 3, 052 patients were included. Three-node analysis showed that CGRP mAbs was superior to CGRP receptor mAbs in reducing MMDs (MD: -1.55, 95% CrI: − 2.43 to − 0.44) and improving at least 50% response rates (RR: 1.52, 95% CrI: 1.04 to 2.21). Nine-node analysis showed galcanezumab 240 mg ranked first in reducing MMDs (MD -4.40, 95% CrI − 7.60 to − 1.19) and improving 50% response rates (RR: 4.18, 95% CrI: 2.63 to 6.67). Moreover, treatment with fremanezumab or eptinezumab 300 mg provides a significant advantage over erenumab 140 mg regarding an improved response rate of at least 50%. The analysis did not show difference in incidences of TEAEs and serious adverse events in any of the comparisons.

Conclusions

It appears that CGRP mAbs, especially galcanezumab 240 mg, monthly fremanezumab, and eptinezumab 300 mg, seem to be the best choice for the treatment of migraine patients with previous treatment failures. This finding also calls for future research that examine the associations between these medications in migraine therapy among the same patient group to testify the present findings.
Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study
Authors: Xu Lin , Lyu Wenyuan , Wei Penghui , Zheng Qiang , Li Chengwei , Zhang Zheng , Li Jianjun
Published: September 2022

Background

Postoperative delirium (POD) is a common complication after hip fracture surgery that is associated with various short- and long-term outcomes. The mechanism of POD may be associated with the oxidative stress process. Uric acid has been shown to provide a neuroprotective effect in various neurodegenerative diseases through its antioxidant properties. However, it is unclear whether lower preoperative serum uric acid levels are associated with the development of POD after hip fracture surgery. Therefore, this study assessed the association of lower preoperative uric acid levels in patients with POD during hospitalization.

Methods

This is a matched retrospective case-control study that included 96 older patients (≥65 y) who underwent hip fracture surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients diagnosed with POD (cases) were matched 1:1 with patients without POD (controls) on the basis of age, sex, and anesthesia type. The relationship between preoperative uric acid and POD was analyzed by multivariable analysis.

Results

The POD and non-POD groups each had 48 patients. In the univariate analysis, lower log preoperative serum uric acid value, higher neutrophil-to-lymphocyte ratio, and cerebrovascular disease were more likely in patients with POD than in those with no POD. Multivariable conditional logistic regression analysis showed that lower log preoperative serum uric acid (adjusted odds ratio [aOR], 0.028; confidence interval [CI], 0.001–0.844;p= 0.040), higher neutrophil-to-lymphocyte ratio (aOR, 1.314; 95% CI, 1.053–1.638;p= 0.015), and increased surgery duration (aOR, 1.034; 95% CI, 1.004–1.065;p= 0.024) were associated with increased risk of POD.

Conclusions

Lower preoperative serum uric acid levels may be an independent risk factor for POD after adjustment for possible confounding factors. However, large prospective studies are needed to confirm this finding.
Association of intensive care unit or paediatric intensive care unit admissions with the method of transporting patients: a multicentre retrospective study
Authors: Ishihara Tadashi , Okamoto Ken , Tanaka Hiroshi
Published: September 2022

Background

Reports regarding transportation methods of severely critical patients admitted to an intensive care unit (ICU) or paediatric ICU (PICU) are limited. In an attempt to address this research gap, this study aimed to test the hypothesis that prognosis is worse in patients transported by family members.

Methods

This multicentre study collected data from the Japanese Registry of Paediatric Acute Care database. Data concerning patients aged ≤16 years admitted to a participating hospital ICU or PICU and their transportation method to the hospital were extracted and divided into two groups: transported by family and transported by emergency medical services (EMS).

Results

Of the 2963 patients who met the criteria, 871 (29.4%) were transported by family and 2092 (70.6%) were transported by EMS. Significantly more patients with chronic conditions (551 patients, 63.3% vs. 845 patients, 40.4%; p <  0.01) or respiratory failure (414 patients, 47.5% vs. 455 patients, 21.7%; p <  0.01) were admitted to the ICU or PICU in the family transport group. There was no significant difference in survival rate between EMS and family transport group, matched by PIM2, chronic condition status and transport distance (OR:1.17, 95%CI:0.39–3.47, p = 0.78).

Conclusion

The results of this study show that the transportation method does not affect the survival rate of paediatric patients. The proportion of patients with chronic conditions or those admitted because of respiratory failure was higher in the family transport group than in the EMS group. Therefore, as these patients are more likely to be admitted to the ICU or PICU, it is important to provide prompt respiratory care and medical interventions to achieve the best outcomes.
Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey
Authors: Abebe Gossa Fetene , Belachew Dereje Zeleke , Girma Desalegn , Aydiko Alemseged , Negesse Yilkal
Published: September 2022

Background

Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia.

Methods

A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05.

Results

In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care.

Conclusion

Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.
Modifiable factors of depressive-symptom trajectories from caregiving through bereavement
Authors: Wen Fur-Hsing , Chou Wen-Chi , Su Po-Jung , Hou Ming-Mo , Shen Wen-Chi , Hsu Mei Huang , Tang Siew Tzuh
Published: September 2022

Background/purpose

The purpose of this secondary-analysis study was to identify never-before-examined factors associated with distinct depressive-symptom trajectories among family caregivers from end-of-life caregiving through the first 2 bereavement years.

Participants/methods

Participants (N=661) were family caregivers who provided end-of-life caregiving for terminally ill cancer patients. Multinomial logistic regressions were conducted to identify modifiable factors associated with caregivers’seven previously identified depressive-symptom trajectories: minimal-impact resilience, recovery, preloss-depressive-only, delayed symptomatic, relief, prolonged symptomatic, and chronically persistent distressed. Drawing from the stress-appraisal-coping model, modifiable time-varying factors associated with distinct depressive-symptom trajectories were examined in three domains: (1) stressors, (2) stress appraisal, and (3) available resources (internal coping capacity and external social support).

Results

Profound objective caregiving demands were associated with caregivers’ increased likelihood of belonging to more distressing depressive-symptom trajectories than to the minimal-impact-resilience trajectory. But, stronger negative appraisal of end-of-life caregiving increased odds of caregiver membership in preloss-depressive-only and relief trajectories over the recovery, delayed, and prolonged-symptomatic trajectories. Stronger internal coping capacity and perceived social support buffered the tremendous stress of end-of-life caregiving and permanent loss of a relative, as evidenced by higher odds of being in the minimal-impact-resilience and recovery trajectories.

Conclusion

Family caregivers’ distinct depressive-symptom trajectories were linked to their preloss caregiving demands, appraisal of negative caregiving impact, personal coping capacity, and perceived social support. Our results highlight actionable opportunities to improve end-of-life-care quality by boosting family caregivers’ coping capacity and enhancing their social support to help them adequately manage daily caregiving loads/burdens thus relieving the emotional toll before patient death and throughout bereavement.
‘Painting my pain’: the use of pain drawings to assess multisite pain in women with primary dysmenorrhea
Authors: Rodrigues Jéssica Cordeiro , Avila Mariana Arias , dos Reis Felipe Jose Jandre , Carlessi Roberta Moraes , Godoy Amanda Garcia , Arruda Guilherme Tavares , Driusso Patricia
Published: September 2022

Background

To verify the use of pain drawing to assess multisite pain in with primary dysmenorrhea (PD) and to assess its divergent validity, test–retest reliability, intra- and inter-rater reliability and measurement errors.

Methods

Cross-sectional study. Adult women with self-reported PD three months prior to the study. Women answered the Numerical Rating Scale (NRS) and the pain drawing during two consecutive menstruations. The pain drawings were digitalized and assessed for the calculation of total pain area (%). Intra- and inter-rater reliability and the test–retest reliability between the first and the second menstruations were assessed with the intraclass correlation coefficient (ICC). Measurement errors were calculated with the standard error of measurement (SEM), smallest detectable change (SDC) and the Bland–Altman plot. Spearman correlation (rho) was used to check the correlation between the total pain area and pain intensity of the two menstruations.

Results

Fifty-six women (24.1 ± 3.1 years old) participated of the study. Their average pain was 6.2 points and they presented pain in the abdomen (100%), low back (78.6%), head (55.4%) and lower limbs (50%). All reliability measures were considered excellent (ICC > 0.75) for the total pain area; test–retest SEM and SDC were 5.7% and 15.7%, respectively. Inter-rater SEM and SDC were 8% and 22.1%, respectively. Correlation between total pain area and pain intensity was moderate in the first (rho = 0.30; p = 0.021) and in the second menstruations (rho = 0.40; p = 0.002).

Conclusion

Women with PD presented multisite pain, which could be assessed with the pain drawing, considered a reliable measurement.
Factors facilitating and hindering counselling about generic substitution and a reference price system in community pharmacies - a survey among Finnish dispensers
Authors: Rainio Riikka , Ahonen Riitta , Lämsä Elina , Timonen Johanna
Published: September 2022

Background

Pharmacies play the key role in implementing generic substitution (GS) and counselling customers about it. This study aimed to explore dispensers’ perceptions of the factors that facilitate or hinder counselling customers on GS and the reference price system (RPS) in community pharmacies. It also studied dispensers’ opinions about the benefits and problems of these systems and discusses them from the counselling point of view.

Methods

A postal survey was conducted among Finnish community pharmacy dispensers in spring 2018. The research questions were studied through open-ended questions and analyzed both qualitatively and quantitatively. The questions were analyzed first with inductive content analysis by two researchers independently. The responses were encoded and categorized according to the analytical framework, which was inductively developed alongside the analysis. The categorized responses were further analyzed using frequencies and percentages.

Results

The response rate was 50.8% (n = 498). Of the respondents, 75.9% reported factors that facilitated counselling about GS and RPS. The most commonly mentioned factors included customers’ characteristics (36.5%), the information systems used in the pharmacy (28.3%), and the features of interchangeable medicines (21.7%). Of the respondents, 89.0% reported factors that hindered counselling, of which customers’ characteristics (45.8%), the unavailability of medicines and other availability issues (32.5%), the features of interchangeable medicines (22.6%) and time pressure in the pharmacy (22.1%) were the most commonly reported. The benefits of the systems focused on cost savings for customers and society (74.4%). The most commonly reported problems concerned medicine availability (31.9%), changes in medicine prices and in reference price band (28.9%), as well as how GS is time-consuming and increases workload (24.2%).

Conclusions

Finnish dispensers reported more hindering than facilitating factors in GS and RPS counselling. Customers’ characteristics were the most often mentioned in both cases. Customers’ knowledge could be increased by providing information and education. However, developing simpler regulations for GS and RPS, intelligent assisting software, and solutions for secured medicine availability would facilitate implementation of GS. Simplified price counselling would also guarantee the time needed and focus on instructions on the correct and safe use of medicines.