bluuebunny/crossref_metadata_2025 huggingface dataset:
From Pills to Practices: Interpretative Phenomenological Analysis of Medication Experience and Self-Management in Schizophrenia
Authors: Zhang Linghui , Chen Yubin , Yu Hong , Zhang Jiayuan , Sun Yujing , Li Qi , Zhou Yuqiu
Published: December 2024

Schizophrenia, a mental disorder characterized by delayed onset, high relapse rates, and significant disability, ranks among the top 20 contributors to the global burden of disease and poses a substantial public health challenge. Effective self-management is crucial for the recovery of individuals with schizophrenia, with medication experience playing a vital role. However, the underlying mechanisms and logical relationships remain elusive, hindering the development of effective self-management and enhancement strategies from the perspective of medication experience. This research aimed to illuminate these aspects by conducting semi-structured interviews to delve into the impacts of medication experience on self-management behaviors among individuals with schizophrenia. The goal was to elucidate the role of medication in self-management and to identify potential barriers and facilitators via patient narratives. We employed interpretive phenomenological analysis to examine interview transcripts from 12 participants diagnosed with schizophrenia. This analysis yielded three superordinate themes: “Medicine isn’t just medicine,” “Experience is a catalyst for action,” and “Action shaped by experience.” We discuss these themes in the context of existing literature and theoretical frameworks and propose specific recommendations, such as motivational interviewing for clinicians, tailored psycho-educational programs, and supportive systems respecting patient autonomy. This study offers a contextual understanding of the medication experience for individuals with schizophrenia, enhancing our knowledge of self-management behaviors and how they can be promoted in this population.
Investigating computer vision syndrome and associated factors before and during the COVID-19 pandemic: A comparative cross-sectional study in faculty members
Authors: Jalali Mahdi , Esmaeili Reza , Hesam Ghasem , Moradpour Zahra , Farhadi Sajjad
Published: December 2024

Background

One of the most significant impacts of the COVID-19 pandemic on human societies was the transformation of face-to-face training (F2F) into distance education (DE) processes.

Objective

This study aimed to investigate computer vision syndrome (CVS) before and during the COVID-19 pandemic and identify the risk factors that may lead to increased incidence of CVS in university professors due to DE.

Methods

Using an online questionnaire, occupational and demographic information, hours of computer, laptop, smartphone, and tablet usage before and during the COVID-19 pandemic were collected. In the second part, participants were asked to report the frequency of occurrence and severity of 16 CVS symptoms over the past year and the last 7 days. The third section of the questionnaire recorded CVS risk factors such as ergonomic status of workstations, during virtual live training (VLT) and offline content creation during the COVID-19 period.

Results

The prevalence of CVS was 9.03% before COVID-19 and 34.19% during COVID-19. The cumulative incidence of CVS was 25.48%. The mean ± SD of the CVS final score significantly increased before (6.82 ± 4.29) and during COVID-19 (8.48 ± 7.11) ( p < 0.001). Associated factors with CVS revealed using Univariate analyses (OR >1; 95% CI 0.75–11.27, p < 0.05).

Conclusion

DE has led to increased prevalence and incidence of CVS in university professors during the COVID-19 pandemic. It appears that associated factors with CVS such as increased usage time of smartphones can contribute to increase CVS in university professors.
Optimal Payment for Dynamic Treatment Regimes
Authors: Gao Long , Zhang Wei , Chen Youhua Frank , Fei Xinyue
Published: December 2024

Dynamic treatment regimes improve health outcomes by tailoring each treatment to a patient’s evolving condition, but they also allow providers to learn and game the system over time. How should insurers pay? We study this new class of reimbursement problems, where the provider can privately learn and manipulate the progression of the patient’s condition. (i) We characterize the optimal payment policy: it internalizes two intertemporal effects of each treatment, and rewards provider honesty with incentive pay; moreover, it admits a simple implementation of risk-adjusted cost-sharing policy. (ii) We show that, ignoring dynamic learning and gaming, the existing payment models may have overestimated the harm of information asymmetry. Using the optimal policy, insurers only need to pay for initial private information; they can exploit provider uncertainty and elicit future private information at no cost. (iii) Our study informs U.S. healthcare payment reform with new insights; using two sets of real data, our study also quantifies when and why the optimal policy outperforms the existing ones. By highlighting the critical role of dynamic learning and gaming, this study advances our understanding of healthcare payment theory and practice.
The Direct Effect of Managerial Responses: When Politeness Backfires
Authors: Jin Haofeng , Wang Lili , Liu Yayuan , Tong Yu
Published: December 2024

Managerial responses, which represent firms’ public replies to online reviews, are commonly employed in customer communications. Using a dataset collected from a leading mobile game app platform in China, this research examines the effect of managerial responses on the review updates of customers who receive them, that is, the direct effect of managerial responses. Platform users can update their reviews, and complete records of review updates are observable, which allows us to utilize variations in the same customer’s review ratings of a single game both before and after receiving a managerial response. Addressing concerns regarding the endogeneity of managerial responses, improvements in game quality, and censored data in rating updates, we find that users who update their reviews after receiving managerial responses upgrade their ratings by an average of one star. In addition, we find that the positive direct effect of managerial responses is negatively moderated by the level of response politeness, measured separately using both machine learning and large language models. By conducting a survey study, we further show that as the level of politeness increases, the likelihood of reviewers perceiving a managerial response as an attempt to persuade them also increases. These findings highlight the positive direct effect of managerial response and the importance of response style, specifically politeness, which can produce a backfire effect in online communications.
Elastance-based nonlinear dynamical controller synthesis for the in-vitro cardiovascular circulatory system: A backstepping approach
Authors: Hedayati Shahrzad , Abbasi Nozari Hasan , Sadati Rostami Seyed Jalil , Castaldi Paolo , Noshad Erfan
Published: December 2024

This paper investigates the application of a nonlinear system-dependent and system-independent dynamical backstepping (DBST) controller on a cardiovascular circulatory simulator (CCS) with non-triangular affine dynamics for the first time in literature. That is, this study introduces several novel contributions to the field, including the enhancement of cardiac output and physiological fidelity while addressing the limitations of existing control methods. Additionally, we present a comparative performance evaluation of feedback linearization (FBL) and the developed DBST controller with respect to integral squared error (ISE), integral absolute error (IAE), and integral time absolute error (ITAE), offering new insights into each control technique’s error minimization capabilities and overall system performance effectiveness. Furthermore, we pioneer the use of Monte-Carlo (MC) simulations as a reliable in-vitro alternative to clinical trials for controller performance assessment under intra- and inter-patient parameter variations. This innovative approach overcomes the limitations of in-vivo evaluations, enabling the analysis of crucial factors such as signal energy and reference tracking error value. Our results, supported by both MC simulations, demonstrate the complete superiority of the DBST controller over FBL in terms of error reduction and adaptability due to patient-to-patient variability, thus validating its potential for practical applications in cardiovascular circulatory systems.
Molecular-Guided Therapy for Melanoma in Canada: Overview of Current Practices and Recommendations
Authors: Shah Ahmed , Decoste Ryan , Vanderbeck Kaitlin , Sharma Anurag , Roy Simon F. , Naert Karen , Osmond Allison
Published: December 2024

The emergence of pathologist-driven molecular reflex testing for tumoural biomarkers is a significant advancement in cancer diagnostics, facilitating targeted cancer therapy for our patients. Based on our experience, the Canadian landscape of pathologist-driven reflex biomarker testing for melanoma lacks standardization and is plagued by a lack of awareness by pathologists and clinicians. This paper comprehensively examines the approaches to reflex biomarker testing for melanoma patients across Canada, highlighting the regional variations in the criteria for initiating molecular testing, the biomarkers tested, and the molecular techniques employed. We also discuss the clinical relevance of biomarkers, emphasizing their alignment with the National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) as well as ancillary tests such as BRAF VE1 immunohistochemistry to detect BRAF V600E mutation and molecular techniques such as real-time polymerase chain reaction, matrix-assisted laser desorption ionization-time of flight mass spectrometry and next-generation sequencing. Our proposed standardized minimum criteria for reflex testing prioritize melanomas with Breslow thickness >4 mm or disseminated disease, who will most benefit from enhanced delivery of biomarkers and expedited access to targeted therapies while attempting to balance cost-effectiveness and utilization of public healthcare resources with patient outcomes.
Randomized Controlled Trials of Rehabilitation in Multiple Sclerosis: Barriers and Unmet Needs
Authors: Motl Robert W.
Published: December 2024

Randomized controlled trials (RCTs) provide the foundation of evidence-based practice for the application of rehabilitation as complementary of medications for filling in the gaps and enhancing outcomes in people with multiple sclerosis (MS). This paper identifies seven field-wide areas of relevance for RCTs of rehabilitation that are barriers for (a) knowledge translation and implementation, (b) impact among those who most need rehabilitation, and (c) the field and its value in comprehensive MS care. The seven field-wide areas include improving the quality of RCTs; implementing discovery models for informing selection of interventions; focusing on primary end-points in samples screened for presence of symptoms/dysfunction; exploring response heterogeneity as an avenue for precision medicine; quantifying adherence and compliance for guiding future prescriptions; understanding mechanisms of outcomes through experimental medicine; and extending research into under-researched populations. These field-wide areas represent unmet needs for (a) optimizing quality of life and full participation through evidence-based rehabilitation among all people with MS, (b) reducing burdens and strains among caregivers, and (c) minimizing the financial and societal impact of MS.
Exercise as a Therapeutic Intervention in Multiple Sclerosis
Authors: Pilutti Lara A. , Donkers Sarah J.
Published: December 2024

The role of exercise as a therapeutic intervention in multiple sclerosis (MS) has shifted over time. Early views surrounding exercise in MS advocated for caution against participation. With increasing evidence, perspectives shifted to promote exercise as a therapeutic approach for symptom management. Recent efforts have focused on understanding the potential disease-modifying effects of exercise in MS, although this work is still in its infancy. While efforts continue to optimize exercise prescriptions and unravel underlying mechanisms of exercise effects, current knowledge and implementation gaps limit the accessibility of exercise as therapy for all people living with MS. This topical review is based on an invited presentation on ‘ Exercise as a Therapeutic Intervention in MS’ delivered at the ACTRIMS Forum 2024. The review summarizes current evidence for the role of exercise as a therapeutic intervention in MS from symptomatic to disease-modifying potential. We highlight directions for future research efforts to advance our understanding of potential exercise benefits and translate findings into real-world contexts for people living with MS.
A novel strategy for mitigating the vortex-induced vibration of long-span bridges by using flexible membranes
Authors: Xu Haoyu , Wang Chaoqun , Huang Zhiwen , Hua Xugang , Chen Zhengqing
Published: December 2024

The structural damping of a long-span bridge girder after completion is difficult to predict accurately in the design stage, and could be obviously lower than the value suggested by the code of wind-resistance design, which could lead to large-amplitude vortex-induced vibration (VIV) of the girder after completion. To address this problem, proposed here is a novel VIV mitigation strategy for a long-span bridge: in the design stage, aerodynamic design involving VIV of the girder is conducted based on the normal structural damping suggested by the design code, and flexible membranes (FMs) are designed for emergency VIV mitigation of the girder in case of very low structural damping after completion; if the girder experience large-amplitude VIV after completion because of very low structural damping, then the pre-designed FMs are used as a temporary emergency aerodynamic measure for fast VIV mitigation, providing a transition period until permanent measures (such as mechanical dampers, or aerodynamic measures) are implemented. To investigate the feasibility of this strategy, a case study was conducted involving a series of wind tunnel tests on a cable-stayed bridge with a Π-shaped girder, and the results indicate that appropriate FMs are effective for suppressing the VIV of the girder under very low structural damping. The FMs have great potential for emergency VIV mitigation because of the low cost, convenience, and rapidity.
Technology literacy and access to digital resources for remote assessment among adults enrolled in Alzheimer's disease research
Authors: Okafor Maureen , Yang Zhiyi , Vickers Kayci L , Sanders Katherine , Simama Najé , Hewitt Kelsey C , Lah James , Levey Allan I , Goldstein Felicia C , Hajjar Ihab
Published: December 2024

Background

The SARS-CoV-2 pandemic accelerated development of innovative methods for conducting research remotely via digital technologies. However, few studies have examined participant technological literacy skills or access as key social determinants of brain health in aging populations at risk of Alzheimer's disease and other dementias.

Objective

To identify associations of sociodemographic and clinical characteristics, cognitive status and geolocation with digital technology access and skill within dementia research cohorts.

Methods

A self-administered questionnaire surveyed digital access and literacy skills in persons enrolled across various studies conducted at Emory Goizueta Alzheimer's Disease Research Center. We investigated cognitive and sociodemographic characteristics, and neighborhood disadvantage related to these digital attributes.

Results

Of 1860 participants (mean age: 65.3 years (SD:11.4)) surveyed, 71.6% were women, 87.1% Whites, 10.4% African Americans, and 46.9% had postgraduate-level education. Most participants had access to digital devices: desktop (53.7%), laptop (81.6%), tablet (71.6%), smartphone (94.6%), internet (82.0%), or videoconferencing (95.5%). Cognitively unimpaired participants had higher odds of digital access (OR:3.75; 95% CI:2.45–5.73) and skill (OR:1.22; 95% CI:1.14–1.30). Although Whites were likelier to have access (OR:1.36; 95% CI:1.01–1.82) than African Americans, no differences were found in skill between the two groups. Living in more disadvantaged neighborhoods was significantly associated with lower technology skills (OR:0.86; 95% CI:0.82–0.91).

Conclusions

Cognitive impairment, race, and neighborhood socioeconomic disadvantage are significant barriers which limit digital access and skill. Improving digital knowledge, skill-building, and geographic access may encourage research participation especially in geographically remote or disadvantaged areas and help narrow sociodemographic and racial disparities existing in dementia research.
Voices from the margins: A qualitative study exploring components influencing psychosocial health and wellbeing among gender minority forced migrants
Authors: Gottvall Maria , Isaac Rummage , Péter-Szabó Osszián , Ainembabazi Ronah , Carlsson Tommy
Published: December 2024

Aims:

To explore the components that influence health and wellbeing of gender minority forced migrants residing in Sweden.

Methods:

Qualitative exploratory study based on semi-structured interviews with gender minority forced migrants recruited through a combination of convenience, purposeful and snowball sampling. Guided by the levels in the social ecological model, transcripts were analysed with systematic text condensation in a collaborative process between experts by lived experience, researchers and clinical psychologist.

Results:

Participants expressed resilience and hope about their future. Loneliness was a major issue contributing to health burdens and peer support was highly appreciated. Barriers hindering access to health services and judgemental behaviours among health professionals were described. Affirming support through empathy, trust, safety, confidentiality, continuity and respect was highlighted as essential in health services. While societal openness and safety for gender minority individuals was appreciated, participants faced an uncertain asylum process and unmet basic needs.

Conclusions:

Gender minority forced migrants show resilience and appreciate the newfound societal safety. However, they find themselves in the margins of society and encounter various multi-layered challenges. Loneliness is a public health concern that could be addressed through peer support, which is highly desired and valued. Ensuring access to affirming health services should be a prioritized area for researchers, professionals, stakeholders and policy-makers.
Correlates of active commuting to school across two generations: the Cardiovascular Risk in Young Finns Study
Authors: Suominen Th , Kukko T , Yang X , Pahkala K , Rovio S , Hirvensalo M , Kähönen M , Raitakari O , Tammelin Th , Salin K
Published: December 2024

Aims:

Active commuting to school (ACS), a source of physical activity (PA), has declined in many countries over recent decades. This study investigates ACS and the factors associated with it among Finnish children and adolescents across two generations: those born between 1965–74 and 1998–2010. We also explore potential generational differences in these associations.

Methods:

School commuting was self-reported by 2075 participants of the ongoing population-based Young Finns Study in 1983 (generation 1 (G1), aged 9–18, 52% female), and by their 1137 offspring in 2018 (generation 2 (G2), aged 8–20, 53% female). Factors associated with ACS and the moderating effect of generation on these associations were examined using generalized estimating equation models for clustered binary data, for summer and winter seasons separately.

Results:

A greater distance to school ( p < 0.001) and belonging to G2 ( p ⩽ 0.049) were negatively associated with ACS during both seasons. High parental leisure-time PA ( p ⩽ 0.025 for both seasons) and urban living area ( p < 0.001 for summer) were positively associated with ACS. Generation moderated the associations of school grade and parental income with ACS in the summer ( p ⩽ 0.015). Among G1 only, attending lower secondary school (vs. primary school) was negatively associated with ACS, while higher parental income was positively associated with ACS. Neither gender nor parental education was associated with ACS.

Conclusions:

ACS was less common among the younger generation. Several correlates of ACS were identified, with generational differences. These findings can inform further research and guide policy decisions to promote ACS and ultimately enhance the PA of children and adolescents.
Effect of renin-angiotensin system inhibitor in incident cancer among chronic hepatitis B patients: An emulated target trial using a nationwide cohort
Authors: Park Yewan , Kang Danbee , Sinn Dong Hyun , Kim Hyunsoo , Hong Yun Soo , Cho Juhee , Gwak Geum-Youn
Published: December 2024

Background

Although the renin-angiotensin system (RAS) has been reported to be associated with cancer development, the anticancer effects of RAS inhibitors (RASi) remain controversial.

Objectives

This study aimed to investigate the effect of RASi use on cancer incidence in chronic hepatitis B (CHB) patients.

Design

We designed a series of pragmatic trials for each week and followed the patients until the cancer diagnosis, death, or end of follow-up.

Methods

We analyzed CHB patients aged 40–84 years from the nationwide database between 2009 and 2017. We used 3:1 propensity score matching.

Results

Among 15,477 RASi non-users and 5263 RASi users, 2002 developed cancer. The adjusted hazard ratio (HR) for all cancer in RASi users was 0.89 [95% confidence interval (CI): 0.81–0.99]. The adjusted HR (95% CI) of hepatocellular carcinoma (HCC) and extrahepatic cancer were 0.79 (0.65–0.96) and 0.93 (0.82–1.04), respectively. When RASi was further divided, the adjusted HR (95% CI) for cancer of the angiotensin-converting enzyme inhibitor user and the angiotensin II receptor blocker user were 0.66 (0.50–0.87) and 0.93 (0.84–1.03), respectively.

Conclusion

RASi use was associated with a decreased incidence of all cancers, particularly HCC, in CHB patients, suggesting a chemopreventive effect of RASi in this population.
The Effect of Metformin on Radiation-Induced Lung Fibrosis in Mice
Authors: Chen Yu-Zhong , Zhao Lin , Wei Wei , Gu Jia , Liu Zhen-Hua , Shan Wen-Yue , Dong Jie , Li Chao , Qin Li-Qiang , Xu Jia-Ying
Published: December 2024

Introduction: Radiation-induced lung fibrosis (RILF) is a common complication of thoracic radiotherapy. Metformin has been suggested to have a radioprotective effect. Objective: This study explored the radioprotective effects of metformin on RILF and its mechanisms. Methods: C57BL/6J mice were randomly divided into control, ionizing radiation (IR), low-dose metformin (L-Met), and high-dose metformin (H-Met) groups. The IR, L-Met, and H-Met groups received 15 Gy chest irradiation. The L-Met and H-Met groups were administrated 100 or 200 mg/kg metformin from 3 days before irradiation and continued for 6 months. The mice were then sacrificed, and samples were collected for further analysis. Results: RILF was induced in the irradiated mice. Metformin improved lung pathology, inhibited collagen deposition, and reduced inflammatory factors such as high mobility group box 1 (HMGB1), interleukin-1 beta, interleukin-6, tumor necrosis factor alpha in lung tissue, lavage fluid, and serum. Western blot and quantitative real-time PCR analyses revealed that metformin downregulated HMGB1, toll-like receptor 4 (TLR4), and nuclear factor kappaB (NF-κB) expression. Additionally, metformin reversed the irradiation-induced reduction in the abundance of Lactobacillus and Lachnospiraceae at the genus level. Conclusion: Our findings indicated that metformin ameliorates RILF by downregulating the inflammatory-related HMGB1/TLR4/NF-κB pathway and improving intestinal flora disorder.
OCCURSUS: An Introduction to My Ghosts
Authors: Goodrich Peter
Published: December 2024

The present occursus is a collection of amicable essays and a somewhat erumpent desire on my part both to escape and in doing so to thank those who have so generously and variously hobbled, impaled, expanded, dissected, tracked, uplifted, gouged, wounded, excited and obliquely improved upon the limitations of my scribblings. I am variously, to take the more exotic appellations, a mouse, an infected space, a heterosocialite, a crow with an arrow through the eye, a dreamer, an aporia, a scandal, a spectre, an errancy, an intersection, a promiscuously polyamorous textualist, a threat, a satirist and a critic. So many faces, such introitus, a zarzuela of the laws of love. Whatever else is to be made of these missives familiar and philological, they force a reckoning, a reflection upon the paths taken, the uncertain trajectory, the dreams and the hauntings that fall under the equivocal designation or aporia of a life.
Engaging postgraduate students in the Global Virtual Exchange arena: Administrators’ insights across levels
Authors: Wang Rong , Wu Meng , Shcheglova Irina , Chen Jian , Mattinson Kirsty
Published: December 2024

Global Virtual Exchange (GVE) offers significant potential for Internationalization at Home (IaH). However, its effectiveness is hindered by challenges such as student disengagement, limited university support, and faculty resistance. Despite the importance of GVE administration, especially for postgraduate students, there is a lack of research on the experiences and challenges faced by administrators. This study investigates the motivations, challenges, and strategies of GVE administrators at various levels, including headquarters, university/department, and course. Our findings not only reveal a desire to expand student opportunities and empower faculty but also highlight challenges in student engagement, faculty buy-in, and leadership support. To address these issues, administrators could employ strategies like resource sharing, training programs, and policy advocacy. These interventions provide valuable insights for future GVE practices, emphasizing the importance of strong student-faculty relationships, innovation, and institutional support.
Facial occlusion with medical masks: Impacts on emotion recognition rates for emotion types and intensities
Authors: Wickline Virginia B , Hall A Shea , Lavrisa Ryan , McCook Kaylee , Woodcock Michael , Bani Marco , Strepparava Maria G , Russo Selena , Nowicki Stephen
Published: December 2024

During the COVID-19 pandemic, mask-wearing became prominent or required worldwide as a predominant preventive strategy up until and even after vaccines became widely available. Because masks make emotion recognition more challenging for both the face and voice, medical and behavioural/mental health providers became aware of the disruptions this generated in practitioner–patient relationships. The current set of studies utilised two adult samples, first from United States college students ( N = 516) and second from the U.S. American general public ( N = 115), to document the severity and types of errors in facial expression recognition that were exacerbated by medical mask occlusion. Using a within-subjects experimental design and a well-validated test of emotion recognition that incorporated multiethnic adult facial stimuli, both studies found that happy, sad, and angry faces were significantly more difficult to interpret with masks than without, with lesser effects for fear. Both high- and low-intensity emotions were more difficult to interpret with masks, with a greater relative change for high-intensity emotions. The implications of these findings for medical and behavioural/mental health practitioners are briefly described, with emphasis on strategies that can be taken to mitigate the impact in health care settings.
Ectopic corticotropin-releasing hormone syndrome caused by rectal large cell neuroendocrine carcinoma: a rare case report
Authors: Lou Yuan , Chen Huan , Fei Si-Jia , He Qing-Hua , Pan Qi
Published: December 2024

Ectopic corticotropin-releasing hormone (CRH) syndrome, a rare subtype of adrenocorticotropic hormone-dependent Cushing syndrome, is associated with tumors of diverse origins. Here, we present a case of a 37-year-old female diagnosed with ectopic CRH syndrome secondary to rectal large cell neuroendocrine carcinoma, a hitherto unprecedented site for CRH-secreting tumors. The patient presented with classical features of Cushing syndrome, supported by laboratory evidence of hypercortisolemia and disrupted diurnal cortisol secretion. Imaging studies ruled out a pituitary adenoma, whereas colonoscopy identified a rectal malignancy. Immunohistochemical staining confirmed the presence of ectopic CRH syndrome. Despite prompt chemotherapy initiation, the patient’s condition rapidly deteriorated, highlighting the aggressive nature and dismal prognosis associated with rectal large cell neuroendocrine carcinoma linked to ectopic CRH syndrome. This case underscores the importance of early recognition and comprehensive management to optimize patient outcomes.
Lucio’s phenomenon in a non-endemic region: A case report
Authors: Yu Adam C , Chan Airiss R , Chow Eunice Y
Published: December 2024

Leprosy remains a persistent health challenge in endemic regions with cases rising in non-endemic regions such as North America. Patients with leprosy present with a variety of symptoms including limited skin lesions in tuberculoid leprosy to extensive lesions and high bacterial proliferation in lepromatous leprosy. This case report details a 77-year-old Canadian man of South Asian descent with lepromatous leprosy and Lucio’s phenomenon in Western Canada. The patient exhibited widespread retiform purpura on the limbs with localized ulcerations, erosions, and necrosis on the left hand and feet, peripheral neuropathy, and digit shortening. Histopathological examination and PCR confirmed Mycobacterium leprae. Management involved a 24-month multidrug therapy, leading to significant symptom reduction. This report highlights the diagnostic challenges of leprosy in non-endemic regions and the importance of a multidisciplinary approach for accurate diagnosis and treatment.
Focal segmental glomerulosclerosis and neurogenic bladder in a Chinese patient with a novel de novo pathogenic variation in TRIM8 gene: A case report
Authors: Luo Di-Yi , Long Yan , Liu Li-Li , Chen Xiu-Ying , Guo Yan-Nan
Published: December 2024

To report a novel variation in the TRIM8 gene in a Chinese patient who developed focal segmental glomerulosclerosis (FSGS) and neurogenic bladder. Retrospective analysis of the clinical manifestations, laboratory results, renal biopsy results, and genetic data of the patient with FSGS complicated with neurogenic bladder. The patient was a 6-year and 8-month-old Chinese Zang ethnic boy with low-set ears, widely-spaced eyes (inner canthal distance exceeds the 95th percentile of normal inner canthal distance), a small jaw, and a short neck. He could not walk and speak complete sentences until age of 2 years. At age of 4 years, the boy was noticed to have daytime urinary incontinence, hesitancy, and urgency. Combined with urodynamic examination and magnetic resonance imaging examination results, the patient was diagnosed with a neurogenic bladder. Proteinuria was also found. The levels of uric acid, serum creatinine, and blood urea nitrogen were increased. Vitamin D deficiency, hypokalemia, hypocalcium, and hypophosphorus were detected. Urinary ultrasound showed shrinkage of both kidneys. After hospital admission, he was diagnosed with FSGS and stage 3b chronic kidney disease (CKD). Eight months after the first diagnosis, the disease progressed to stage 5 CKD. Gene analysis using whole-exome capture and sequencing revealed a de novo heterozygous pathogenic variation in the TRIM8 gene [NM_030912.2.2:c.1484G>A (p.RP495 *)]. This pathogenic TRIM8 variation and the combined clinical manifestations of neurogenic bladder and FSGS have not been previously reported in the literature. We report a rare Chinese case of FSGS and neurogenic bladder associated with a novel de novo heterozygous variation in the TRIM8 gene. The findings expanded the clinical spectrum of TRIM8 pathogenic variations.
Assessing the effectiveness of the Pregnancy And Newborn Diagnostic Assessment system on the quality of antenatal care in Burkina Faso: A cluster-randomised controlled trial
Authors: Coulibaly Abou , Sogo Armel Emmanuel , Chikvaidze Nutsa , Capello Cecilia , Gerbaba Tsion Kefene , Kouanda Séni
Published: December 2024

Introduction

The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a mobile application designed to facilitate diagnosis and decision-making by healthcare staff in antenatal care (ANC). This study aimed to evaluate its effectiveness in improving the quality of ANC.

Methods

This randomised controlled trial implemented the PANDA system in two groups of health facilities (intervention and comparison groups) using a matched-pair method in the Koupéla health district, Burkina Faso. Six health centres were included in each group. We included pregnant women presenting with more than 20 weeks of amenorrhea during their first antenatal consultation, and we followed them up until their sixth week postpartum. The primary outcome was a binary variable derived from the ANC quality score, coded yes or no. Six components of ANC quality were identified: welcoming the woman, history taking and dietary habits, physical examination, obstetric examination, preventive care, and counselling and advice. We used Poisson regression with robust variance to compare the unadjusted and adjusted primary outcomes results between the two study arms.

Results

We included 319 and 272 women in the intervention and comparison groups, respectively. In the intervention group, 15.67% (50 out of 319) of the women had at least 75% of the total ANC quality score, compared to 6.25% (17 out of 272) in the comparison group. Adjusted results showed that women in the intervention group were 2.71 times more likely to have an excellent total ANC quality score than women in the comparison group (RR = 2.71; 95% CI [1.60–4.60]; p < .001).

Conclusion

Although the proportion of women with good ANC quality was low, this study showed that the PANDA system significantly improves the ANC quality. These results are vital because Burkina Faso has decided to use these computerised clinical decision support systems for maternal and child health.
Parenting Education to Improve Relational Health Through Pediatric Primary Care: A Scoping Review
Authors: Marie-Mitchell Ariane , Delgado Cindy , Gilgoff Rachel
Published: December 2024

The objective of this study was to describe characteristics of effective pediatric primary care interventions that focused on parenting education about healthy parent-child relationships. A scoping review of 4 electronic databases searched for related systematic reviews published in English from January 2000 to June 2023. The full texts of 14 systematic reviews were evaluated by 2 independent reviewers and used to identify 25 unique parenting interventions of which 21 improved outcomes more than the comparison group. Results demonstrate that a range of low to high intensity interventions can improve parent-child relationships, and many of these also improve parent mental health and child behaviors. By contrast, multi-component interventions were needed to improve child development and reduce injuries. Interventions that decreased child injuries focused on reducing parental stress through professional support, access to community resources, and mental health information. Future research is needed on pediatric primary care parenting education that incorporates responsive parenting, includes patient samples with ACEs, and measures physical health outcomes or biomarkers.
Trunk Muscle Cross-Sectional Areas at Hip Fractures and Their Association With Recovery of Postoperative Gait Ability: A Multicenter, Retrospective Cohort Study
Authors: Kawanishi Kengo , Fukuda Daisuke , Tsutsumi Masahiro , Miyashita Toshinori , Katayama Naoya , Yokomori Masaki , Matsuzaki Shinsuke , Kudo Shintarou
Published: December 2024

Purpose

To determine the relationship between trunk muscle cross-sectional area (CSA) measured using trunk computed tomography at the time of injury and gait ability at discharge.

Methods

This multicenter retrospective cohort study was performed in comprehensive rehabilitation units of four hospitals in Japan. The study included 442 patients with hip fractures who underwent surgery (bipolar hip arthroplasty or open reduction and internal fixation) and were hospitalized for treatment between January 2020 and January 2023. The main outcome measure was bilateral trunk muscle CSA (multifidus, erector spinae, psoas major, lateral abdominal muscles, and rectus abdominis). Participants who met the eligibility criteria were classified into two groups based on gait ability at the time of hospital discharge: those who maintained their gait ability (the maintenance group) and those who declined (the decline group).

Results

The CSA of the multifidus muscle was 0.015 ± 0.005 (CSA/Weight/fourth lumbar vertebrae) and 0.013 ± 0.004 (CSA/Weight/fourth lumbar vertebrae) in the maintenance and decline groups, respectively, being significantly lower in the decline group ( P = 0.028, effect size = 0.457). The CSA of the psoas major was 15.3 [13.1⁠–⁠18.0] (CSA/Weight/fourth lumbar vertebrae) and 13.4 [11.9⁠–⁠16.0] (CSA/Weight/fourth lumbar vertebrae) in the maintenance and decline groups, respectively, being significantly lower in the decline group ( P = 0.020, effect size = 0.335).

Conclusion

Smaller CSAs of the multifidus and psoas major muscles before injury were associated with decreased gait ability after hip fractures.
Evolving Endoscopic Approaches to Pancreatic Pseudocysts and Walled-Off Necrosis: Case Series and Review of Evidence
Authors: Duggal Shivangini , Nagineni Lokesh , Trivedi Bhavi S. , Zuckerman Marc , Badillo Ricardo
Published: December 2024

Imaging followed by endoscopic ultrasound (EUS)-guided therapy has become the preferred modality for treating pancreatic pseudocysts over surgical or radiological interventions. However, there continues to be a lack of consensus regarding the utility of endoscopic retrograde cholangiopancreatography (ERCP) before and after cyst drainage. We describe 4 cases of large pancreatic pseudocyst causing extrinsic biliary obstruction treated successfully with endoscopic cystogastrostomy decompression using a lumen-apposing self-expandable metal stent (LAMS) without ERCP. Endoscopic cystogastrostomy with LAMS was successful in all cases; none required ERCP. As endoscopic therapeutic systems continue to evolve, ERCP is becoming less essential to improve outcomes in patients with extrinsic biliary obstruction by pseudocysts and walled-off necrosis.
Exploring the Impact of New York City’s Gifted and Talented Program: A Matched Comparison Study
Authors: Strickland Katherine J. , Chan Wendy , Gottfried Michael , Huang Jiexuan , Hildreth Daniel
Published: December 2024

The Gifted and Talented program in New York City is one of the largest and longest running programs for gifted students in the nation. Yet little is known about its effects on student outcomes. Using student-level administrative data of New York City public school students between the 2010–2011 and 2018–2019 academic years, we studied the effects of the Gifted and Talented program on students’ test score performance. Estimates from a matched comparison study show significant gains in middle school English language arts and math proficiency, after controlling for cohort, ethnicity, and district. Our balanced treatment and control groups provided sufficient sample sizes with which to analyze the performance of underrepresented minoritized groups, and we found significant treatment heterogeneity, where Black and Hispanic students showed the largest increase in academic proficiency scores after participating in the Gifted and Talented program. Implications of these findings for education policy—particularly related to new developments in selective school admissions—are discussed.
Black Bodies, White Communities: Interrogating Hierarchies That Impede Transformative Instruction for Refugee Students
Authors: Walker-Dalhouse Doris J.
Published: December 2024

Social and economic changes are shaped globally by voluntary and involuntary migration patterns. Voluntary migrations are associated with the desire for family unification, economic gain, and the pursuit of educational opportunities; while involuntary migrations include fleeing from civil or political unrest, human rights violations, and war. Contentious discourses about immigration are fueled by arguments about the perceived impact of migrants on the demographics, social well-being, and economics of communities. At the core of anti-immigration rhetoric about “who is included and who should be excluded” are views that privilege one group above another in terms of desirability based on race, culture, and gender. The debates about which languages, values, perspectives, and people who belong in the United States extend beyond the boundaries of society, the door of schools, and the homes of the families served by the school community. Black African refugees have experienced exclusion due to racism and othering in societies shaped by racialized histories. Deficit-oriented discourses about their abilities influence their identities, belonging, and educational outcomes, and shape their educational experiences and social and emotional health. In this address, I will provide a historical chronicling of the experiences of South Sudanese (Dinka) refugees resettling in a hegemonically White community in the upper midwestern United States and examine the issues related to acculturation and education of Black African refugee children. Central to this examination is the need to ascertain the preparedness of preservice teachers to teach Black African refugee children using transformative pedagogies that promote a humanizing view in today's classrooms.
From Theory to Action: Evaluation of a Longitudinal Project-Based Antiracism Course for Post-Graduate Physicians
Authors: Mateo Camila M. , McCormick Danny , Connors Chrissie , Basu Gaurab
Published: December 2024

Objectives

Few opportunities exist for postgraduate physicians to learn to address racism in their professional practice. We created a virtual, 5-session antiracism course that included the development of a formal action project to address racism at participants’ home institution.

Methods

We delivered this curriculum virtually to 2 cohorts (2021 and 2022) of postgraduate physicians, nationally. The curriculum had 3 educational aims: (1) to increase knowledge on antiracism, (2) to increase comfort and engagement in discussing antiracism at home institutions, and (3) to increase self-efficacy to execute an institution-based project. Theory-informed practice, community building, and project-based learning were used to achieve our educational aims. We analyzed changes in these domains in addressing racism using matched 7-item Likert-scale questions from pre- and post-course surveys and the Wilcoxon signed rank test. We assessed perceptions and impacts of the course with post-course survey items using descriptive statistics.

Results

Forty-three of 50 participants (86%) who completed pre- and post-course surveys were included in the analysis. We found pre–post course increases in mean scores (converted from Likert scales), for all 15 paired questions. For example, we found improvements in understanding the historical context of racism in medical institutions (mean score change: 5.12 [SD 1.00] to 6.42 [SD 0.76], P < .001), comfort in talking to colleagues about racism (5.21 [SD 1.08] to 6.19 [SD 0.70], P < .001), and capacity to address racism in patient care at their home institution (4.51 [SD 1.35] to 5.56 [SD 0.91], P < 0.001). 93% reported the course increased the likelihood of working to address racism at their institution.

Conclusion

This project-based antiracism course for postgraduate learners increased self-reported knowledge of, comfort with, and self-efficacy in addressing racism and was well received by participants.
Epigenetics as a link between environmental factors and dementia risk
Authors: Koulouri Adamantia , Zannas Anthony S
Published: December 2024

Dementia encompasses a broad spectrum of neuropsychiatric disease states marked by cognitive impairments that interfere with day-to-day functioning. Most dementias are complex phenotypes that result from a genome-environment interplay. Epigenetic regulation has emerged as a candidate mechanism for studying this interplay. In this narrative review, we discuss state-of-the-art evidence on environmental exposures relevant to dementia, including nutrition, physical exercise, psychosocial stress, and environmental toxins, and highlight epigenetic mechanisms that have been reported as a putative link between each exposure and dementia risk. We then discuss the clinical implications and future directions of this line of research. An improved understanding of the epigenetic mechanisms involved in dementia pathogenesis can promote the development of novel biomarkers for predicting outcomes but also targeted therapies to intervene early in the course of the disease.
Astrocyte dysfunction alters GABAergic communication and ammonia metabolism in the streptozotocin-induced sporadic Alzheimer's disease model
Authors: Brezolin Éverton Carlos , Gayger-Dias Vitor , Da Silva Vanessa-Fernanda , Cigerce Anderson , Schultz Bruna , Sobottka Thomas Michel , Nardin Patrícia , de Assis Adriano Martimbianco , Leite Marina Concli , Quincozes-Santos André , Bobermin Larissa Daniele , Gonçalves Carlos-Alberto
Published: December 2024

Background

In the sporadic model of Alzheimer's disease (AD), induced by intracerebroventricular streptozotocin (STZ) administration, cognitive impairment is accompanied by specific astrocytic changes in the hippocampus prior to amyloid deposition.

Objective

Hypothesizing that the synthesis of GABA, via MAO-B, contributes to ammonia elevation, thereby compromising antioxidant defense and ATP synthesis, and possibly contributing to cognitive damage, we determined the hippocampal levels of glutamine synthetase (GS), monoamine oxidase B (MAO-B) and other enzymes related to GABA metabolism.

Methods

Immunoblotting and RT-PCR assays were carried out in hippocampal samples of Wistar rats, at 4 and 16 weeks post-STZ, in the sporadic STZ-induced AD model, corresponding to the pre-amyloid and amyloid phases, respectively.

Results

We observed a reduction in GS activity and increased MAO-B content, both in 4 weeks and in 16 weeks, reinforcing the idea that astroglial dysfunction precedes the amyloid phase. These alterations were accompanied by an increase in the content of ornithine decarboxylase 1 (ODC1), which catalyzes the synthesis of putrescine (substrate for GABA synthesis, via MAO-B), and a reduction in the gene expression of arginine-glycine amidinotransferase (AGAT), an enzyme involved in the synthesis of creatine, and in the generation of GABA agonists. These changes were only seen in the amyloid phase of the AD model.

Conclusions

Our findings contribute to explain the greater damage that occurs in energy metabolism at this stage, in addition to the greater GABAergic loss. The changes reinforce the importance of the STZ model and further our understanding of the changes in both AD phases.