bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Clinical Excellence for Palliative Care Specialists: A Concept Whose Time Has Come
Authors: Wu David Shih , Mehta Ambereen K. , Brewer C. Brandon , Sloan Danetta , Dy Sydney Morss , McPherson Mary Lynn , Dahlin Constance
Published: January 2022

Experts in the field of palliative care in the United States (U.S.) have defined competence, or “good,” mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or “great,” applicable to palliative care specialists of all professions will elevate the field in the U.S. by providing an aspirational target usable for individual assessment and self-assessment, highlighting the common ground between team roles, and promoting a deeper understanding of teamwork, utilization, and productivity. We call for research that utilizes inclusive methods and broad representation of diverse voices to design a vivid, practical, and evidence-based definition of clinical excellence for palliative care specialists.
Blocking the Increase of Intracellular Deuterium Concentration Prevents the Expression of Cancer-Related Genes, Tumor Development, and Tumor Recurrence in Cancer Patients
Authors: Kovács Beáta Zs. , Puskás László G. , Nagy Lajos I. , Papp András , Gyöngyi Zoltán , Fórizs István , Czuppon György , Somlyai Ildikó , Somlyai Gábor
Published: January 2022

The possible role of the naturally occurring deuterium in the regulation of cell division was first described in the 1990s. To investigate the mechanism of influence of deuterium (D) on cell growth, expression of 236 cancer-related and 536 kinase genes were tested in deuterium-depleted (40 and 80 ppm) and deuterium-enriched (300 ppm) media compared to natural D level (150 ppm). Among genes with expression changes exceeding 30% and copy numbers over 30 (124 and 135 genes, respectively) 97.3% of them was upregulated at 300 ppm D-concentration. In mice exposed to chemical carcinogen, one-year survival data showed that deuterium-depleted water (DDW) with 30 ppm D as drinking water prevented tumor development. One quarter of the treated male mice survived 344 days, the females 334 days, while one quarter of the control mice survived only 188 and 156 days, respectively. In our human retrospective study 204 previously treated cancer patients with disease in remission, who consumed DDW, were followed. Cumulative follow-up time was 1024 years, and average follow-up time per patient, 5 years (median: 3.6 years). One hundred and fifty-six patients out of 204 (77.9%) did not relapse during their 803 years cumulative follow-up time. Median survival time (MST) was not calculable due to the extremely low death rate (11 cancer-related deaths, 5.4% of the study population). Importantly, 8 out of 11 deaths occurred several years after stopping DDW consumption, confirming that regular consumption of DDW can prevent recurrence of cancer. These findings point to the likely mechanism in which consumption of DDW keeps D-concentration below natural levels, preventing the D/H ratio from increasing to the threshold required for cell division. This in turn can serve as a key to reduce the relapse rate of cancer patients and/or to reduce cancer incidence in healthy populations.
When Two Worlds Collide: Creatively Reassessing the Concept of a House Beyond the Human
Authors: Cole David R. , Baghi Yeganeh
Published: January 2022

This article reassesses the concept of a house from a non-human perspective. The two worlds that collide in this article are philosophical analyses that are “beyond the human” and sustainable engineering house design. By analyzing the houses of ten animal species for shelter/skin properties, life pedagogy (how to live), materials and resources, thermal dynamics, and structural elements, we speculate on the future of housing. The premise of this article is that “beyond the human” philosophy opens a new visage to comprehend and conceptualize what a house could be. Beyond the human theorizing is defined by philosophy that has gone beyond framing an exploration internally to the benefit of themselves, as human subject(s). This article speculates that considering animal house construction is a way forward for thought in a changing climate.
Engaging Adolescents in the Fight Against Drug Abuse and Addiction: A Concept Mapping Approach
Authors: Montgomery LaTrice , Vaughn Lisa M. , Jacquez Farrah
Published: January 2022

Background

To identify contextually-relevant strategies for reducing and eventually eliminating addiction, it is imperative to engage stakeholders that are most affected by drug abuse but typically left out of the conversation, such as adolescents.

Aim

The aim of this study was to collaborate with 45 adolescent stakeholders participating in a school-based research program to identify areas to address addiction.

Methods

Guided by a modified version of the mixed-methods concept mapping approach, adolescents were asked to brainstorm and sort a list of statements about how to address addiction in their community. The data were then analyzed via multidimensional scaling and hierarchical cluster analysis.

Results

The concept map identified eight clusters from 75 edited statements: policing/security (e.g., increase punishment for selling drugs), helping community (e.g., create more jobs), treatment (e.g., make treatments more affordable), increased awareness (e.g., identify and help at-risk youth), communication (e.g., more communication with people who are abusing drugs), increased understanding/education (e.g., online communities for people who are abusing drugs), clean up community (e.g., clean up abandoned houses) and prevent addiction (e.g., effectively deal with peer pressure).

Discussion

These stakeholder-driven ideas are consistent with the socioecological framework of addressing substance use and add to the credibility and transferability of individual and systemic level approaches to reducing substance use in marginalized communities.

Conclusion

This study emphasizes the feasibility of engaging adolescents in the development of contextually-relevant addiction education, prevention, and treatment interventions in underserved communities.
Local preferences in candidate selection: Evidence from a conjoint experiment among party leaders in Germany
Authors: Berz Jan , Jankowski Michael
Published: January 2022

Candidate selection is one of the most relevant tasks of parties and has important consequences for various aspects of political representation. While previous research has addressed many important aspects of the candidate selection process, we know little about the question of which candidate characteristics are preferred by party members. We address this research gap by conducting a conjoint experiment among more than 300 local party leaders in Germany. In the experiment, potential candidates differed on various important dimensions regarding their socio-demographic background, prior political experience, local roots, and work within the political party. We find that prior political experience and engagement within the party are the most important features. However, socio-demographic characteristics and deviation from the party line also matter. These findings have implications for theories of descriptive representation as well as the impact of decentralization on party cohesiveness.
Alternative receptive language assessment modalities and stimuli for autistic children who are minimally verbal
Authors: Muller Kristen , Brady Nancy C , Fleming Kandace K
Published: January 2022

The primary aim of this study was to evaluate and compare alternative modalities and stimuli used to measure receptive vocabulary skills in autistic children who are minimally verbal. This study systematically compared participants’ outcomes on three different receptive vocabulary assessment conditions: a low-tech assessment that used a stimulus book, a touchscreen assessment, and an assessment that used real-object stimuli. A secondary aim of this study was to examine how individual characteristics such as nonverbal cognition, maladaptive behavior, and autism symptomology impact performance on assessment conditions. Participants were 27 autistic students between the ages of 3 and 12 who had minimal verbal skills. Participants responded to 12 items in 3 assessment conditions (972 total items). Results from a crossed random effects model showed that participants’ scores in the real-object assessment condition were significantly higher than in the low-tech book condition and marginally higher than scores in the touchscreen assessment condition. Nonverbal cognition accounted for 44% of the variance in participants’ scores.

Lay abstract

It is difficult to measure language comprehension abilities in autistic children who have limited expressive language skills. Results from available assessments may underestimate autistic children’s receptive language skills. The primary purpose of this study was to compare alternative modalities and stimuli used to measure receptive vocabulary skills in autistic children who are minimally verbal. This study compared participants’ outcomes on three different receptive vocabulary assessment conditions: an assessment that used a low-tech stimulus book, a touchscreen assessment, and an assessment that used real-object stimuli. Twenty-seven students between the ages of 3 and 12 who had minimal verbal skills and a diagnosis of autism spectrum disorder participated in this study. Results showed that participants’ scores in the real-object assessment condition were significantly higher than in the low-tech condition and marginally higher than scores in the touchscreen condition. These results suggest real-object stimuli may provide a more robust measure of autistic children’s receptive vocabulary skills than traditional low-tech picture stimuli. Although many direct standardized assessments use picture stimuli to measure word understanding, when assessing autistic individuals who have limited expressive language, real objects can be used in replacement of, or in addition to, picture stimuli.
The Effect of Plantago major Hydroalcoholic Extract on the Healing of Diabetic Foot and Pressure Ulcers: A Randomized Open-Label Controlled Clinical Trial
Authors: Ghanadian Mustafa , Soltani Rasool , Homayouni Alireza , Khorvash Farzin , Jouabadi Soroush Mohammadi , Abdollahzadeh Moein
Published: January 2022

Aims: Diabetic foot ulcer (DFU) and pressure ulcer (PU) both are common types of ulcers worldwide. The wound healing effect of Plantago major leaves has been shown in a few animal studies. This study aimed to evaluate the clinical efficacy of P. major hydroalcoholic extract on DFU and PU healing. Methods: In this clinical trial, patients with DFU or PU who met the inclusion criteria were randomly assigned to drug ( P. major) or control groups. For patients in the drug group, Plantago extract 10% topical gel was applied on the wound once daily concurrent with dressing and routine wound care for two weeks, while for the control group, an appropriate novel dressing was used along with routine wound care for the same duration. The percentage of wound size reduction at the end of the seventh and 14th days of intervention was recorded and compared between the groups. Results: Fifty and 44 patients in drug and control groups, respectively, completed the interventions. Plantago extract gel significantly resulted in more reduction in the wound size compared to control at the end of the first (64.90 ± 29.75% vs. 33.11 ± 26.55%; P < 0.001) and second week (86.85 ± 24.34% vs. 52.87 ± 32.41%; P < 0.001). Furthermore, the number of patients with complete wound healing in the drug group (n = 32, 64%) was significantly more than the control group (n = 9, 20.45%; OR: 3.129, 95% CI: 1.685-5.809, P < 0.001). Conclusion: The use of 10% topical gel of P. major leaf extract results in the acceleration of DFU and PU healing. Key points: Application of P. major topical gel results in the acceleration of diabetic foot ulcer and pressure ulcer healing. - P. major extract helps reducing the wound's erythema. - P. major leaf extract assists decreasing the wound size. - The number of patients completing wound healing process is higher among whom undergoing P. major dressing.
Specialized pro-resolution mediators in the bladder: Receptor expression and recovery of bladder function from cystitis
Authors: Hughes Francis M , Allkanjari Armand , Odom Michael R , Jin Huixia , Purves J Todd
Published: January 2022

Inflammation is a central process in most benign bladder disorders, and its control is a delicate balance between initiating factors and resolving factors. While recent discoveries have shown a central role for the NLRP3 inflammasome in initiation, the resolving pathways remain unexplored. Resolution is controlled by specialized pro-resolution mediators (SPMs) functioning through seven receptors (six in rodents). Here we demonstrate expression of all seven in humans (six in mice) through immunocytochemistry. Expression was universal in urothelia with most also expressed in smooth muscle. We next explored the therapeutic potential of three SPMs; Resolvin E1 (RvE1), Maresin 1 (MaR1), and Protectin D1 (PD1). SPMs promote epithelial wound/barrier repair and RvE1 triggered dose-dependent wound closure in urothelia in vitro (scratch assay) (EC90 = 12.5 nM). MaR1 and PD1 were equally effective at this concentration. In vivo analyses employed a cyclophosphamide (CP) model of bladder inflammation (Day 0-CP [150 mg/kg], Day 1 to 3 SPM [25 µg/kg/day], Day 4 – analysis). All three SPMs reduced bladder inflammation (Evans blue) and bladder weights to control levels. Effects of RvE1 were also examined by urodynamics. CP decreased void volume, increased frequency and decreased bladder capacity while RvE1 restored values to control levels. Finally, SPMs reduce fibrosis and RvE1 reduced urothelial expression of TGF-β and collagen I to control values. Together these results expand the known SPMs active in the bladder tissue and provide promising therapeutic targets for controlling inflammation in a wide variety of inflammation-associated benign bladder diseases.
Beyond family: Separation and reunification for young people negotiating transnational relationships
Authors: Shaw Jennifer E
Published: January 2022

This paper explores perspectives on family reunification and emergent forms of separation among young migrants. These young people lived apart from and later reunited with their migrant parents who moved from the Philippines to Canada for work. I draw from 15 months of ethnographic, arts-based, and participatory research with ten participants living in Greater Vancouver. I demonstrate that while reunification literature and child rights discourse often focus on the process of a mother and child coming back together, this can obscure the relationships that young people form with others in the meantime. Cared for by grandmothers, aunts, or siblings, as well as becoming close to best friends, romantic partners, and confidantes, meant that the time these young people spent apart from mothers was utilized to cultivate vital connections to others. These connections were often quite painfully ruptured upon emigration, paradoxically turning “family reunification” into new separations. I explore how young people engaged in dual forms of relational work as they sought to foster a bond with their mothers while also maintaining—or grieving—connections with now-distanced loved ones in the Philippines. My findings, focused mainly on the emergent artistic and participatory methods, complicate family reunification discourse that stresses the importance of nuclear family bonds by calling into question who is family and who becomes family in a global economy that pulls such kindred apart. The young people I introduce speak creatively through poetry, story, and music to how familial separations are not resolved upon reunification but rather that reunification can give rise to new separations that navigated or even grieved in lesser-known ways.
Small bowel obstruction precipitated by intussusception of Meckel’s diverticulum
Authors: Zorn Julia , Zhang Susan , Brandt Joseph , Keckeisen George
Published: January 2022

Small bowel obstruction (SBO) secondary to intussusception of Meckel’s diverticulum (MD) is a rare cause of acute abdominal pain that may warrant urgent surgical treatment. Volvulus or intussusception of the small bowel with presence of MD as the lead point is the most commonly reported etiology of Meckel’s related obstructions. We report an interesting case of a small bowel obstruction caused by the intussusception of an MD within its own lumen. The case involves a 30-year-old male who presented to the emergency room with acute, severe abdominal pain with an abdominal computed tomography (CT) showing a distal high-grade SBO. Decision was made to take the patient to the operating room urgently due to his clinical examination and radiologic imaging, specifically CT scan. Diagnostic laparoscopy was performed and subsequently converted to an exploratory laparotomy, which revealed the intussuscepted MD with focal necrosis into the distal small bowel causing an SBO. A segmental small bowel resection with hand sewn primary anastomosis was performed. The case presents an interesting challenge in deciding when to take a patient with an SBO to the operating room versus initial conservative management and what the treatment should be if an MD is encountered. In addition, the case emphasizes the importance of history and physical exam findings in coordination with radiologic imaging in helping to make appropriate decisions in a timely manner for operative vs conservative management of an SBO. It reminds us that, Meckel’s diverticulum, although less commonly the cause of a small bowel obstruction in the adult population, needs to be on the differential diagnosis and we need to have a high clinical suspicion for this possibility to ensure appropriate treatment in a timely manner.
Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on Biomarkers: A Systematic Review and Meta-Analysis
Authors: Kandi Maryam , Brignardello-Petersen Romina , Couban Rachel , Wu Celina , Nesrallah Gihad
Published: January 2022

Background:

Medium cut-off (MCO) membranes enhance large middle-molecule clearance while selectively retaining molecules >45 000 Da.

Objectives:

We undertook a systematic review and meta-analysis comparing the effects of MCO versus high-flux membranes on biomarkers.

Methods:

We searched MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science from January 2015 to July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults (>18 years) receiving maintenance hemodialysis. We performed study selection, data extraction, and quality appraisals in duplicate and used the Grading of Recommendations Assessment, Development, and Evaluation framework. Outcomes included solute removal (plasma clearance or dialysate quantitation), reduction ratios, and predialysis serum concentrations for a range of prespecified large middle molecules.

Results:

We identified 26 eligible studies (10 RS and 16 NRS; N = 1883 patients; patient-years = 1366.3). The mean difference (MD) for albumin removal was 2.31 g per session (95% confidence interval [CI], 2.79 to 1.83; high certainty), with a reduction in predialysis albumin of −0.12 g/dl (95% CI, −0.16 to −0.07; I2 = 0%; high certainty) in the first 24 weeks, returning to normal (MD = −0.02 g/dl, 95% CI, −0.07 to −0.03; I2 = 56%; high certainty) after 24 weeks. We also found with high certainty that MCO dialysis resulted in a large increase (standardized mean difference [SMD]> 2.0 for all) in β2-microglobulin, κ- and λ-free light chains, and myoglobin removal, resulting in moderate (SMD > 0.5) to large (SMD > 0.8) reductions in predialysis concentrations for all of these solutes. Medium cut-off dialysis increased the reduction ratio for tumor necrosis factor-alpha (TNF-α) by 7.7% (95% CI, 4.7 to 10.6; moderate certainty), and reduced predialysis TNF-α by SMD −0.48 (95% CI, −0.91 to −0.04; moderate certainty). We found with moderate certainty that MCO dialysis had little to no effect on predialysis interleukin-6 (IL-6) plasma concentrations. Medium cut-off dialysis reduced mRNA expression of TNF-α and IL-6 in peripheral leukocytes by MD −15% (95% CI, −19.6 to −10.4; moderate certainty) and −8.8% (95% CI, −10.2 to −7.4; moderate certainty), respectively.

Conclusion:

Medium cut-off dialysis increases the clearance of a wide range of large middle molecules and likely reduces inflammatory mediators with a concomitant transient reduction in serum albumin concentration. The net effect of MCO dialysis on large middle molecules could translate into important clinical effects.
Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis
Authors: Tetreault Lindsay , Kalsi-Ryan Sukhvinder , Benjamin Davies  , Nanna-Lohkamp Laura , Garwood Philip , Martin Allan R. , Wilson Jefferson R. , Harrop James S. , Guest James D. , Kwon Brian K. , Milligan James , Arizala Alberto Martinez , Kotter Mark R. , Fehlings Michael G.
Published: January 2022

Study Design

Narrative Review.

Objectives

The objective of this review is to provide a stepwise approach to the assessment of patients with potential symptoms of degenerative cervical myelopathy (DCM).

Methods

N/A

Results

DCM is an overarching term used to describe progressive compression of the cervical spinal cord by age-related changes to the spinal axis. These alterations to normal anatomy narrow the spinal canal, reduce the space available for the spinal cord, and may ultimately compress the ascending and descending neural tracts. Patients with DCM present with a wide range of symptoms that can significantly impact quality of life, including bilateral hand numbness and paresthesia, gait impairment, motor weakness of the upper and lower extremities, and bladder and bowel dysfunction. Unfortunately, DCM is often misdiagnosed, resulting in delayed assessment and management by the appropriate specialist. The proper evaluation of a patient with suspected DCM includes obtaining a detailed patient history, conducting a comprehensive neurological examination, and ordering appropriate tests to rule in or out other diagnoses.

Conclusion

This review summarizes a stepwise approach to the diagnosis of patients with DCM.
Augmenting the role of higher education institutions in lifelong learning: Designing an indicator framework for policy application
Authors: Sung Johnny , Sheng Yee Zher , Liau Albert K , Xinhui Aggie C , Liu Liu , Coates Hamish
Published: January 2022

Advanced economies lack mechanisms for spotlighting lifelong learning needs and helping higher education institutions provide programs and activities which serve these. This paper presents research underway in Singapore since 2019 which has sought ways to help institutions to identify and meet opportunities to deliver lifelong learning. The paper sets out the policy context, articulates a validated indicator framework, discusses prospects for deployment, and touches on implications for Asia and beyond. The analysis sheds light on this important Singapore context and is immediately relevant to all high-participation higher education systems and advanced economies across Asia around the world. The paper makes a policy contribution and contributes to a growing body of research focused on higher education and lifelong learning.
Ideal Combination of Anatomic Tibial and Femoral Tunnel Positions for Single-Bundle ACL Reconstruction
Authors: Yoon Kyoung Ho , Kim Yoon-Seok , Park Jae-Young , Kim Sang-Gyun , Lee Jong-Hwan , Choi Sun Hwan , Kim Sang Jin
Published: January 2022

Background:

Anatomic anterior cruciate ligament reconstruction (ACLR) is preferred over nonanatomic ACLR. However, there is no consensus on which point the tunnels should be positioned among the broad anatomic footprints.

Purpose/Hypothesis:

To identify the ideal combination of tibial and femoral tunnel positions according to the femoral and tibial footprints of the anteromedial (AM) and posterolateral (PL) anterior cruciate ligament bundles. It was hypothesized that patients with anteromedially positioned tunnels would have better clinical scores, knee joint stability, and graft signal intensity on follow-up magnetic resonance imaging (MRI) than those with posterolaterally positioned tunnels.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 119 patients who underwent isolated single-bundle ACLR with a hamstring autograft from July 2013 to September 2018 were retrospectively investigated. Included were patients with clinical scores and knee joint stability test results at 2-year follow-up and postoperative 3-dimensional computed tomography and 1-year postoperative MRI findings. The cohort was divided into 4 groups, named according to the bundle positions in the tibial and femoral tunnels: AM-AM (n = 33), AM-PL (n = 26), PL-AM (n = 29), and PL-PL (n = 31).

Results:

There were no statistically significant differences among the 4 groups in preoperative demographic data or postoperative clinical scores (Lysholm, Tegner, and International Knee Documentation Committee subjective scores); knee joint stability (anterior drawer, Lachman, and pivot-shift tests and Telos stress radiographic measurement of the side-to-side difference in anterior tibial translation); graft signal intensity on follow-up MRI; or graft failure.

Conclusion:

No significant differences in clinical scores, knee joint stability, or graft signal intensity on follow-up MRI were identified between the patients with anteromedially and posterolaterally positioned tunnels.
Interaction of sex and cannabis in adult in vivo brain imaging studies: A systematic review
Authors: Francis Ashley M. , Bissonnette Jenna N. , MacNeil Sarah E. , Crocker Candice E. , Tibbo Philip G. , Fisher Derek J.
Published: January 2022

Cannabis has been shown to cause structural and functional neurocognitive changes in heavy users. Cannabis use initiation aligns with brain development trajectories; therefore, it is imperative that the potential neurological implications of cannabis use are understood. Males and females reach neurodevelopmental milestones at different rates making it necessary to consider biological sex in all cannabis and brain-based research. Through use of a systamatic review in accordance with PRISMA guidelines, we aimed to understand the interaction between biological sex and cannabis use on brain-based markers. In total, 18 articles containing a sex-based analysis of cannabis users were identified. While the majority of studies ( n = 11) reported no sex by cannabis use interactions on brain-based markers, those that reported findings ( n = 8) suggest females may be more susceptible to cannabis’ neurotoxic effects. Unfortunately, a large portion of the literature was excluded due to no sex-based analysis. In addition, studies that reported no sex differences often contained a reduced number of females which may result in some studies being underpowered for sex-based analyses, making it difficult to draw firm conclusions. Suggestions to improve cannabis and sex-based reseach are proposed.
Surgical Management of Gastroesophageal Reflux in Patients With Obesity
Authors: Mazzini Guilherme S. , Campos Guilherme M.
Published: January 2022

With the growing prevalence of obesity and its association with gastro-esophageal reflux disease (GERD), the thoracic, foregut, and bariatric surgeons will be ever more commonly facing the challenge to treat GERD in patients with obesity, albeit having the opportunity to treat GERD and obesity simultaneously. In this review, we outline the outcomes of laparoscopic antireflux surgery (LARS) in patients with Class 1, 2, and 3 obesity, as well as GERD outcomes of Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG). We also discuss the revisional surgical options for patients with obesity and failed LARS, or with GERD after LRYGB and LSG.
Prevalence and determinants of activity of daily living and instrumental activity of daily living among elderly in India
Authors: Chauhan Shekhar , Kumar Shubham , Bharti Rupam , Patel Ratna
Published: January 2022

Background

The increase in life expectancy has proliferated the number of elderly and subsequently increased the prevalence of disability among the elderly. This study assesses the prevalence of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) and analyzes determinants of ADL and IADL among elderly aged 60 and over living in India.

Methods

The study utilized the Longitudinal Ageing Study in India (LASI, 2017–18) data, and information was sought from 31,464 elderly aged 60 years and above. An index of ADL and IADL was created on a scale of three levels, exhibiting no, moderate, or severe levels of ADL/IADL disability. Multinomial logistic regression was used to determine the effect of socio-demographic parameters on ADL and IADL disability among the elderly.

Results

Around 3% of the elderly reported severe ADL disability, and 6% elderly reported severe IADL disability. Elderly who were not involved in any physical activity than their counterparts were more likely to report severe ADL (RRR = 2.68, C.I. = 1.66–4.32) and severe IADL (RRR = 2.70, C.I. = 1.98–3.67) than no ADL and no IADL, respectively.

Conclusion

Amidst the study finding, the study emphasizes the importance of setting-up of geriatric care centers in rural and urban areas. It would be feasible to provide geriatric care under the umbrella of already functioning government health facilities in different parts of the country. Community interventions earmarking the elderly with a focus on physical activity, specifically based in group physical exercise and implemented through existing networks, are rewarding for the elderly.
Association between body mass index, multi-morbidity and activities of daily living among New Zealand nursing home older adults: a retrospective analysis of nationwide InterRAI data
Authors: Amankwaa Isaac , Nelson Katherine , Rook Helen , Hales Caz
Published: January 2022

Background

Obesity is a well-established risk factor for multi-morbidity and disability among older adults in the community and acute care settings. However, nursing home residents with body mass index (BMI) below 18.5 kg/m2 and above 25.0 kg/m2 have been understudied. We examined the prevalence of multi-morbidity and disability in activities of daily living (ADL) by BMI category and further investigated the association between BMI, multi-morbidity, and disability of ADL in a large cohort of older adults in nursing homes in New Zealand.

Methods

A retrospective review of nursing home residents’ data obtained from the New Zealand International Resident Assessment Instrument national dataset from 2015 to 2018. One hundred ninety-eight thousand seven hundred ninety older adults (≥60 years) living in nursing homes were included. BMI was calculated as weight in kilograms (kg) divided by height in meters squared (m2). Multimorbidity was defined as the presence of ≥2 health conditions. The risk of disability was measured by a 4-item ADL self-performance scale. The prevalence ratio (PR) of the association between BMI and multi-morbidity and between BMI and disability in ADL was assessed using Poisson regression with robust variance.

Results

Of the 198,790 residents, 10.6, 26.6, 11.3 and 5.4% were underweight, overweight, obese, and extremely obese, respectively. 26.4, 31.3 and 21.3% had one, two and three disease conditions, respectively, while 14.3% had four or more conditions. 24.1% could perform only one ADL, and 16.1% could perform none. The prevalence of multi-morbidity increased with increasing BMI, whereas mean disability in ADL decreased with increasing BMI. The risk of multi-morbidity was higher for the overweight (PR, 95%CI: 1.03, 1.02–1.03) and obese (PR, 95% CI: 1.07, 1.06–1.08) compared to normal weight after controlling for age, sex, ethnicity, and region. BMI was inversely associated with mean ADL; β, 95% CI for overweight (− 0.30, − 0.32, − 0.28) and obese − 0.43, − 0.45, − 0.40 compared to normal weight.

Conclusion

Being underweight was associated with a decline in the performance of ADL in nursing home residents. In contrast, being overweight and obese positively affected functional performance, demonstrating that the obesity paradox plays an important role in this population. The observed associations highlight areas where detection and management of underweight and healthy aging initiatives may be merited.
Global school-based student health survey: country profiles and survey results in the eastern Mediterranean region countries
Authors: Abdalmaleki Elham , Abdi Zhaleh , Isfahani Sahand Riazi , Safarpoor Sara , Haghdoost Bahar , Sazgarnejad Saharnaz , Ahmadnezhad Elham
Published: January 2022

Background

The increasing prevalence of non-communicable diseases (NCDs) has some major implications on many countries to achieve universal health coverage. This study aimed to investigate the implementation of Global School-based Student Health Survey (GSHS), which is used to assess the risk factors of NCDs among children and adolescents in the eastern Mediterranean region (EMR).

Methods

This study was a meta-analysis and systematic literature review of 2001–2018 published studies, which were found by searching PubMed, Google Scholar, WHO, and CDC databases. In this study, the target group was students aged between 13 and 17 years old. GSHS implementation as well as risk factors of NCDs were compared across different countries. The random-effect model for meta-analysis was considered at 95% confidence interval.

Result

In the EMR, 19 countries have implemented GSHS at least once following the survey manual (37 surveys). Overall, 201,795 students were included in our analysis. The overall estimation prevalence rateof the overweight was 24.5% (20.6–28.8), obesity was 7.3% (5.4–9.5), insufficient physical activity was 82.4% (80.7–84.1), tobacco usage was 14.3% (10.53–18.67), and smoking was 9.6% (8.1–11.3), respectively. Among those aged 13 to 17 years old, these rates were estimated as 19.8 (13.2–27.3), 9.7 (6.2–14.0), 86.1 (84.1–87.9), 17.8 (11.8–24.7), and 11.5 (9.4–13.8), respectively.

Conclusion

GSHS has been widely implemented across EMR countries. Using nationally representative data, the results show that more efforts are needed to target the NCDs risk factors among adolescents in the region.
Women’s empowerment through homestead food production in rural Bangladesh
Authors: Dupuis Sarah , Hennink Monique , Wendt Amanda S. , Waid Jillian L. , Kalam Md Abul , Gabrysch Sabine , Sinharoy Sheela S.
Published: January 2022

Background

Women in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial.

Methods

We conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants.

Results

The analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household.

Conclusions

This study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study.

Trial registration

FAARM is registered with ClinicalTrials.gov (NCT02505711).
Progress toward the UNAIDS 90–90-90 targets among female sex workers and sexually exploited female adolescents in Juba and Nimule, South Sudan
Authors: Hakim Avi J. , Bolo Alex , Coy Kelsey C. , Achut Victoria , Katoro Joel , Caesar Golda , Lako Richard , Taban Acaga Ismail , Sleeman Katrina , Wesson Jennifer , Okiria Alfred G.
Published: January 2022

Background

Little is known about HIV in South Sudan and even less about HIV among female sex workers (FSW). We characterized progress towards UNAIDS 90–90-90 targets among female sex workers (FSW) and sexually exploited female adolescents in Juba and Nimule, South Sudan.

Methods

We conducted a biobehavioral survey of FSW and sexually exploited female adolescents using respondent-driven sampling (RDS) in Juba (November 2015–March 2016) and in Nimule (January–March 2017) to estimate achievements toward the UNAIDS 90–90-90 targets (90% of HIV-positive individuals know their status; of these, 90% are receiving antiretroviral therapy [ART]; and of these, 90% are virally suppressed). Eligibility criteria were girls and women who were aged ≥15 years; spoke English, Juba Arabic, or Kiswahili; received money, goods, or services in exchange for sex in the past 6 months; and resided, worked, or socialized in the survey city for ≥1 month. Data were weighted for RDS methods.

Results

We sampled 838 FSW and sexually exploited female adolescents in Juba (HIV-positive, 333) and 409 in Nimule (HIV-positive, 108). Among HIV-positive FSW and sexually exploited female adolescents living in Juba, 74.8% self-reported being aware of their HIV status; of these, 73.3% self-reported being on ART; and of these, 62.2% were virally suppressed. In Nimule, 79.5% of FSW and sexually exploited female adolescents living with HIV self-reported being aware of their HIV status; of these, 62.9% self-reported being on ART; and of these, 75.7% were virally suppressed.

Conclusions

Although awareness of HIV status is the lowest of the 90–90-90 indicators in many countries, treatment uptake and viral suppression were lowest among FSW and sexually exploited female adolescents in South Sudan. Differentiated service delivery facilitate linkage to and retention on treatment in support of attainment of viral suppression.
Effectiveness and safety of basal insulin therapy in type 2 diabetes mellitus patients with or without metformin observed in a national cohort in China
Authors: Zhang Puhong , Chen Minyuan , Zhang Heng , Luo Yingying , Zhu Dongshan , Li Xian , Ji Jiachao , Wang Du , Duolikun Nadila , Ji Linong
Published: January 2022

Background

Though many randomized control trials had examined the effectiveness and safety of taking insulin therapy with or without metformin, there are limited real-world data, especially among Chinese type 2 diabetes patients initiating basal insulin (BI) with uncontrolled hyperglycemia by oral agents. This study was designed to assess the effectiveness and safety of BI therapy combined with or without metformin in a real-world national cohort study.

Methods

Patients with type 2 diabetes mellitus who initiated BI treatment due to uncontrolled hyperglycemia (HbA1c≥7 %) by oral antidiabetic drugs (OADs) were recruited in Chinese real-world settings between 2011 and 2013. A total of 12,358 patients initiated BI without bolus insulin and completed a 6-month follow-up were selected as the study population and divided into BI with metformin or BI without metformin group based on whether metformin was simultaneously prescribed or not at baseline. Propensity score adjustment was used to balance baseline covariates between two groups. A sub-analysis was also conducted among 8,086 patients who kept baseline treatment regimen during the follow-up. Outcomes were HbA1c, hypoglycemia, weight gain and insulin dose in two groups.

Results

53.6 % (6,621 out of 12,358) patients initiated BI therapy concomitant with metformin. After propensity score adjustment, multivariate regression analysis controlled with number of OADs, total insulin dose, physical activity and diet consumption showed that BI with metformin group had a slightly higher control rate of HbA1c <7.0 % (39.9 % vs. 36.4 %, P = 0.0011) at 6-month follow-up, and lower dose increment from baseline to 6-month (0.0064 vs. 0.0068 U/day/kg, P = 0.0035). The sub-analysis with patients remained at same BI therapy further showed that BI with metformin group had higher HbA1c control rate (47.9 % vs. 41.9 %, P = 0.0001), less weight gain (-0.12 vs. 0.15 kg P = 0.0013), and lower dose increment during 6-month follow-up (0.0033 vs. 0.0037 U/day/kg, P = 0.0073) when compared with BI without metformin group.

Conclusions

In alliance with current guidelines, the real-world findings also support the insulin initiation together with metformin. Continuous patients’ education and clinicians training are needed to improve the use of metformin when initiating BI treatment.
Autonomy and focus of attention in medical motor skills learning: a randomized experiment
Authors: Pollok Franziska , Cook David A. , Shaikh Nizamuddin , Pankratz V. Shane , Morrey Mark E. , Laack Torrey A.
Published: January 2022

Background

The ‘OPTIMAL’ (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning suggests that autonomy, external focus of attention, and perceived competence can improve learning of simple motor tasks. The authors hypothesized that enhanced (vs. routine) autonomy and external (vs. internal) focus of attention would improve first-try performance of two medical motor tasks.

Methods

The authors conducted a randomized two-by-two factorial design study with high school students as participants. Task instructions promoted either enhanced or routine autonomy, and either external or internal focus of attention. These conditions were replicated in a crossover design for two common medical tasks (chest compressions on a manikin and a Fundamentals of Laparoscopic Surgery peg transfer task). Primary outcomes were objective measures of task performance (chest compression deviation from target depth; peg transfer time with penalties for errors). Secondary outcomes included subjective perceptions of confidence, autonomy, and workload.

Results

One hundred thirty-three high school students participated in this study. The primary outcomes concerning enhanced vs. routine autonomy demonstrated no statistically significant difference in either task (chest compression depth deviation: difference -0.7 mm [score range 0 to 37.5 mm]; 95% confidence interval (CI95) -3.85, 2.41; p = .65; peg transfer penalized time: rate ratio 1.03; CI95 0.91, 1.31; p = .79). The authors likewise found no statistically significant difference for external vs. internal focus of attention (depth deviation: difference 1.1 mm; CI95 -2.04, 4.17; p = .50; penalized time: rate ratio 0.89; CI95 0.75, 1.13; p = .33). The authors found no statistically significant differences for either comparison in confidence, autonomy and workload (p > .09; differences ranged from -0.83 to 0.79 [scale range 0 to 10]).

Conclusions

First-try performance of chest compressions and peg transfer by novice learners is not significantly affected by enhanced (vs. routine) autonomy or external (vs. internal) focus of attention.
Machine learning model for predicting acute kidney injury progression in critically ill patients
Authors: Wei Canzheng , Zhang Lifan , Feng Yunxia , Ma Aijia , Kang Yan
Published: January 2022

Background

Acute kidney injury (AKI) is a serve and harmful syndrome in the intensive care unit. Comparing to the patients with AKI stage 1/2, the patients with AKI stage 3 have higher in-hospital mortality and risk of progression to chronic kidney disease. The purpose of this study is to develop a prediction model that predict whether patients with AKI stage 1/2 will progress to AKI stage 3.

Methods

Patients with AKI stage 1/2, when they were first diagnosed with AKI in the Medical Information Mart for Intensive Care, were included. We used the Logistic regression and machine learning extreme gradient boosting (XGBoost) to build two models which can predict patients who will progress to AKI stage 3. Established models were evaluated by cross-validation, receiver operating characteristic curve, and precision–recall curves.

Results

We included 25,711 patients, of whom 2130 (8.3%) progressed to AKI stage 3. Creatinine, multiple organ failure syndromes were the most important in AKI progression prediction. The XGBoost model has a better performance than the Logistic regression model on predicting AKI stage 3 progression. Thus, we build a software based on our data which can predict AKI progression in real time.

Conclusions

The XGboost model can better identify patients with AKI progression than Logistic regression model. Machine learning techniques may improve predictive modeling in medical research.
Survey of the demand for care services for older people and the training needs of their care workers: a cross-sectional study in Northeast China
Authors: Li Shuqin , Zhang Jun , Liu Yan , Wang Ai-ping , Qiu Guixing
Published: January 2022

Background

The older population is increasingly utilizing professional healthcare services, while the requirements for caregivers are becoming more demanding. Therefore, it is important to be mindful not only of the service needs of older people but also to consider the training needs of their care workers. The present study aimed to investigate the care service needs for older people and the training needs of their care workers.

Methods

A cross-sectional questionnaire was used to survey 589 residents of 6 nursing homes and 2 geriatric hospitals, 415 medical staff from 7 geriatric hospitals, 5 nursing homes, and 1 community institution, and 372 nursing assistants from 21 nursing institutions in northeast China.

Results

The service with the greatest demand and that with which users were most satisfied was regular visits by healthcare personnel, which was the case for 87.27% of the care recipients. Of the medical staff, 75.42% had training needs related to geriatric healthcare, while the most requested training content was the comprehensive assessment of old people. The most requested method for the delivery of training was by self-study online video courses. Of nursing assistants, only 53.4% had obtained the relevant practicing certificate. While 83.6% participated in relevant training, 86% expressed the need for additional training. The majority of this category of staff wished to receive training in everyday care routines, and the majority wanted to learn by way of practical training.

Conclusions

The care needs of the older population are diverse, and the work performed by healthcare personnel is increasing in scope. The existing training system for such care personnel is not perfect, and the demand for training is high. Existing training methods and content require improvement.