bluuebunny/crossref_metadata_2025 huggingface dataset:
Building peace through tourism: The analysis of an ongoing Siachen Glacier dispute between India and Pakistan
Authors: Wani Mehraj Ud Din , Dada Zubair Ahmad , Shah Shamim Ahmad
Published: August 2022

The current article aims to analyse the effectiveness of the conversion of the Siachen Glacier into a peace park on India–Pakistan relations. It further investigates how the peace park can build mutual understanding leading to cooperation and peace between the two countries. The article presents the conceptual framework for adequate supervision of the Siachen Glacier jointly by India and Pakistan to mitigate the existing tensions and conflicts through tourism within the context of the tourism–peace nexus and peace park concept. The Siachen Peace Park proposition offers an amazing way out for the policymakers to diffuse tensions between the military establishments of India and Pakistan. Both the nations have been losing the lives of their soldiers among the snow-capped peaks not due to any gunfight but mainly because of climatic extremities and frostbite. The suggestion of the Siachen Peace Park has been explicated with the help of a four-stage peace park conversion model conceived by the authors, which gives a conceptual understanding of the outcomes of this Peace Park for both countries.
Gendered Racial Microaggressions, Psychosocial Resources, and Depressive Symptoms among Black Women Attending a Historically Black University
Authors: Erving Christy L. , Williams Tiffany R. , Frierson Whitney , Derisse Megan
Published: August 2022

The current study integrates stress process model and intersectionality framework to explore psychological effects of an intersectional stressor experienced by black women: gendered racial microaggressions (GRMs). Prior research suggests GRMS negatively influence black women’s mental health. However, it is unclear whether specific dimensions of GRMS are more or less impactful to mental health. This study investigates: To what extent do black women experience GRMS overall and its specific dimensions: Assumptions of Beauty and Sexual Objectification; Silenced and Marginalized; Strong Black Woman Stereotype; Angry Black Woman Stereotype? What is the relationship between GRMS and depressive symptoms? Do psychosocial resources (i.e., social support, self-esteem, mastery) mediate the association between GRMS and depressive symptoms? We use data from black women attending a historically Black university in the Southeast ( N = 202). We employed ordinary least squares regression analysis and performed mediation analysis. Study results revealed a positive association between GRMS and depressive symptoms; the Angry Black Woman Stereotype GRMS dimension had the most robust influence on depressive symptoms. Psychosocial resources partially mediated the relationship between GRMS and depressive symptoms. Study results suggest that sociological stress research underestimates the influence of stress on black women’s health when intersectional stressors like GRMS are not included in analytic models.
Empirically Derived Psychological Profiles of College Students: Differential Associations With COVID-19 Impact and Social Adjustment
Authors: Kochel Karen P. , Bagwell Catherine L. , Abrash Ross W.
Published: August 2022

Using latent profile analysis, we derived psychological profiles of undergraduates during the pandemic and investigated profiles’ differential associations with COVID-19 impact and social adjustment. Participants ( N = 517) completed measures of depression, loneliness, and anxiety, and two indices of social adjustment: friendship support and social connectedness. We identified Severe, Moderate, and Mild symptom profiles. Higher COVID-19 impact was associated with increased odds of belonging to the Severe versus Moderate and Mild profiles, and the Moderate versus Mild profile. On social adjustment, the Mild profile outscored the Moderate profile, which outscored the Severe profile. Overall, findings imply that individuals who perceive high levels of COVID-19 impact are especially likely to belong to a profile characterized by severe psychological symptoms and that membership in this profile is associated with social maladjustment.
Cost-Effectiveness of Intraoperative Electromyography to Determine Adequate Screw Position
Authors: Yu Charles , Owens Roger K. , Crawford Charles H. , Djurasovic Mladen , Gum Jeffrey L. , Brown Morgan , Carreon Leah Y.
Published: August 2022

Study Design

Prospective observational cohort.

Objectives

To examine the cost-effectiveness of IntraOperative ElectroMyeloGraphy (IO-EMG) by evaluating how often an abnormal IO-EMG signal changed the surgeon’s surgical plan, or replaced a pedicle screw either intra-operatively or as a second unplanned surgery.

Methods

Patients undergoing instrumented posterolateral lumbar fusion were monitored with intraoperative triggered EMG’s. Pedicle screws were placed freehand from L1 to S1 by attending physicians and fellows. Concern for pedicle breach was a screw stimulation<10 mA.

Results

There were 145 cases with a total of 725 pedicle screws placed. Mean age was 57.8 ± 14.2 yrs, OR time was 238 ± 95 minutes, EBL was 426.8 ± 354.3cc. Mean number of surgical levels fused was 2.7 ± 1.1. 686 (95%) screws stimulated at >10 mA and 39 (5%) screws stimulated at <10 mA. All 39 screws were removed and pedicles re-examined. Intraoperative screw repositioning was necessary in 8 of 145 cases (6%). No patient required a return to the OR for screw repositioning. As a worst case cost analysis, assuming the 8 patients requiring intraoperative screw positioning would have returned to the OR at a cost of $11,798 per readmission, the per patient cost is $651 which is less than the ION per patient cost of $750.

Conclusions

Only 1% of the 725 lumbar pedicle screws placed in 8 of 145 cases required repositioning. Due to the infrequency of pedicle wall breaches and the cost of ION, the utility of this modality in straightforward lumbar fusions should be critically evaluated.
A 3-Dimensional Classification for Degenerative Glenohumeral Arthritis Based on Humeroscapular Alignment
Authors: Kleim Benjamin D. , Hinz Maximilian , Geyer Stephanie , Scheiderer Bastian , Imhoff Andreas B. , Siebenlist Sebastian
Published: August 2022

Background:

Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity.

Purpose/Hypothesis:

The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3.

Results:

Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation >60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified.

Conclusion:

There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
External Validation of the FEAR Index in Borderline Acetabular Dysplasia
Authors: Schwabe Maria T. , Clohisy John C. , A. Graesser Elizabeth , Pascual-Garrido Cecilia , Nepple Jeffrey J.
Published: August 2022

Background:

Given the lack of established, externally validated criteria for the diagnosis of unstable hips, the Femoro-Epiphyseal Acetabular Roof (FEAR) index has been proposed as a useful tool for identifying hips with instability in the setting of borderline acetabular dysplasia.

Purposes:

To (1) determine the external performance of the FEAR index in identifying hips with a clinical diagnosis of instability in the setting of borderline dysplasia and (2) assess the performance of the FEAR index compared with acetabular inclination or physeal scar angle alone.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

The authors reviewed 176 patients with borderline acetabular dysplasia (lateral center-edge angle, 20°-25°). A positive FEAR index was defined as ≥5°. An alternative threshold ≥2° was also assessed. Significant instability was determined by the senior surgeon based on the combination of patient and radiographic features; unstable hips were treated with periacetabular osteotomy (with or without hip arthroscopy), and stable hips were treated with isolated hip arthroscopy.

Results:

Only 18% of borderline hips had a positive FEAR index. The ≥5° positive FEAR index threshold had a sensitivity of 33% (23/70) and specificity of 92% (98/106) in predicting the clinical diagnosis of instability. The ≥2° FEAR index threshold had a sensitivity of 39% (27/70) and specificity of 89% (94/106) in predicting the clinical diagnosis of instability. No alternative threshold for the FEAR index resulted in high levels of sensitivity and specificity. A threshold of –5° was required to reach an adequate sensitivity of 74%. The FEAR index remained a significant predictor of hip instability even after controlling for acetabular inclination (odds ratio, 1.12; P < .001) or physeal scar angle (odds ratio, 1.6; P < .001).

Conclusion:

In the current study, a positive FEAR index was generally indicative of the presence of clinical instability, but the FEAR index alone remained inadequate to fully define the instability of a given hip, as it demonstrated low sensitivity (only 33%) in the external validation. The FEAR index is best used in the context of other clinical and radiographic features.
Fluorsigaiite, Ca2Sr3(PO4)3F, a new mineral of the apatite supergroup from the Saima alkaline complex, Liaoning Province, China
Authors: Wu Bin , Gu Xiang-ping , Rao Can , Wang Ru-cheng , Xing Xing-qing , Zhong Fu-jun , Wan Jian-jun , Bonnetti Christophe
Published: August 2022

Fluorsigaiite, ideally Ca2Sr3(PO4)3F, is a new Sr analogue of fluorphosphohedyphane and a new member of the apatite supergroup. It was discovered in lujavrite from the Saima alkaline complex, Liaoning Province, China. Fluorsigaiite commonly occurs as individual prismatic, columnar and platy crystals of 10 to 50 μm in size, associated with microcline, nepheline, aegirine, natrolite, eudialyte, fluorapatite, a fluorstrophite-like mineral, stronadelphite and calcite. Occasionally, crystals of fluorsigaiite form prismatic aggregates in the interstices of lujavrite. Fluorsigaiite is translucent to transparent, colourless to yellowish white with a vitreous lustre and without fluorescence. The estimated Mohs hardness is 5, and the tenacity is brittle with uneven fractures. The calculated density is 3.842 g/cm3. Optically, fluorsigaiite is uniaxial (–) with ω = 1.64(1) and ɛ = 1.63(1) in white light and without dispersion. The mean chemical composition (in wt.%) of fluorsigaiite is Na2O 0.75, CaO 15.17, SrO 44.44, La2O3 3.64, Ce2O3 2.22, Pr2O3 0.19, Nd2O3 0.13, Sm2O3 0.05, Gd2O3 0.23, P2O5 31.87, F 1.91, H2O 0.46, sum 100.26, giving the empirical formula (Sr2.82Ca1.79Na0.16La0.15Ce0.09Pr0.01Nd0.01Gd0.01)Σ5.04P2.97O12[F0.66(OH)0.34]Σ1, which is calculated on the basis of 13 total anions and F+(OH) = 1. The strongest eight lines of its powder X-ray diffraction pattern [d, Å (I, %) (hkl)] are: 3.563 (15) (002), 3.275 (15) (102), 3.144 (19) (120), 2.876 (100) (121), 2.861 (96) (112), 2.772 (27) (300), 1.991 (17) (222) and 1.895 (23) (213). Fluorsigaiite is hexagonal, in the space group P63/m and unit-cell parameters refined from single-crystal X-ray diffraction data are: a = 9.6101(2) Å, c = 7.1311(1) Å, V = 570.35(3) Å3 and Z = 2. It is isostructural with hedyphane-group minerals, and contains different prevailing (species-defining) Ca and Sr cations at the Ca1 and Ca2 sites, respectively. Fluorsigaiite was probably formed from Sr-rich fluids at late-magmatic or hydrothermal stage of the Saima lujavrite.
Living without eosinophils: evidence from mouse and man
Authors: Jackson David J. , Pavord Ian D.
Published: August 2022

The enduring view of eosinophils, as immune effector cells whose primary function is host defence against infection by helminths and other microbial pathogens, sets the stage for a fundamental question regarding the safety of therapeutic eosinophil depletion. If eosinophils are significantly reduced or altogether depleted in an effort to alleviate the negative effects of tissue eosinophilia and eosinophilic inflammation in conditions such as asthma, COPD, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome, would these patients become susceptible to infection or another illness? Development of mouse models in which the eosinophil lineage has been ablated, observations in patients naturally lacking eosinophils and data from studies of eosinophil-depleting medical therapies indicate that the absence of eosinophils is not detrimental to health. The evidence available to date, as presented in this review, supports the conclusion that even if certain homeostatic roles for the eosinophil may be demonstrable in controlled animal models and humanin vitrosettings, the evolution of the human species appears to have provided sufficient immune redundancy such that one may be hale and hearty without eosinophils.
Functional clinical impairments and frailty in interstitial lung disease patients
Authors: Tremblay Labrecque Pierre-François , Dion Geneviève , Saey Didier
Published: August 2022

Background

Patients with interstitial lung disease (ILD) often present with persistent dyspnoea and reduced exercise capacity and quality of life (QoL), but their functional limitation in relation to their frailty status remains unclear. We thus aimed to compare exercise tolerance, functional mobility, and muscle function and composition between ILD participants and healthy subjects and according to their frailty status.

Methods

A total of 36 ILD participants and 15 heathy subjects performed a 6-min walk test, a 1-min sit-to-stand test, a Short Physical Performance Battery test, a hand grip test and complete quadriceps function testing. Patient-related impacts were assessedviaquestionnaires. Muscle composition was obtained using noncontrast computed tomography scans. The frailty status of patients with ILD was determined using the Fried frailty phenotype assessment.

Results

Compared with control subjects, ILD participants exhibited significantly lower performance in every exercise and functional capacity test, higher dyspnoea and depression scores, and worse QoL. In ILD participants, the same observations were noted for the frail subgroup compared with the robust subgroup. No differences in muscle function and composition were observed between the ILD and control group, but mid-thigh muscle cross-sectional area and skeletal muscle index were significantly reduced in frail ILD participants.

Conclusions

ILD patients present reduced exercise tolerance and functional capacity, and have decreased health-related QoL, when compared with healthy subjects. Physical frailty seems to be associated with worse clinical status, exercise tolerance, muscle and functional impairment, and decreased QoL. The 1-min sit-to-stand test may be a good discriminatory test for frailty status in ILD patients.
Analysis of real-world data and a mouse model indicates that pirfenidone causes pellagra
Authors: Kuronuma Koji , Susai Natsumi , Kuroita Tomohiro , Yamamoto Hiroki , Yoshioka Takeshi , Kaneko Shuji , Chiba Hirofumi
Published: August 2022

Background

Pirfenidone (PFD) is widely used in patients with idiopathic pulmonary fibrosis (IPF) and its adverse effects, such as nausea and photosensitivity, are well known. Many patients with IPF have reduced doses or even cessation of PFD because of its side-effects. No solutions have been found for these side-effects because the current mechanistic insights are insufficient.

Methods

Using the results of real-world data analysis from the US Food and Drug Administration Adverse Events Reporting System, we hypothesised that PFD-related symptoms may be similar to pellagra. Reverse translational experiments using female BALB/c mice were performed to validate and estimate this hypothesis. Niacin and its metabolite responses were compared between patients with IPF treated with PFD and those treated without PFD.

Results

The pellagra hypothesis was translated from real-world data analysis. Pharmacological and comprehensive genetic investigations showed that PFD caused pellagra-related nausea and photosensitivity in a mouse model, which may have been mediated by the actions of nicotinamide
N-
methyltransferase (NNMT). Higher NNMT substrate responses were observed in urine from patients and mice with PFD than in those without PFD.

Conclusions

PFD may cause pellagra or pellagra-like symptoms such as photosensitivity. Further studies are required to investigate whether niacin prevents pellagra-like symptoms caused by PFD in patients with IPF.
Pulmonary hypertension in interstitial lung disease: an area of unmet clinical need
Authors: Dhont Sebastiaan , Zwaenepoel Bert , Vandecasteele Els , Brusselle Guy , De Pauw Michel
Published: August 2022

Pulmonary hypertension (PH) is present in an important proportion of patients with interstitial lung diseases (ILDs), encompassing a large, heterogeneous group of diffuse parenchymal lung diseases. Development of ILD-related PH is associated with reduced exercise capacity, increased need for supplemental oxygen, decreased quality of life and earlier death. Diagnosis of ILD-related PH is important and requires a high index of suspicion. Noninvasive diagnostic assessment can suggest the presence of PH, although right heart catheterisation remains the gold standard to confirm the diagnosis and to assess its severity. A comprehensive assessment is needed to make sure reversible causes of PH have been ruled out, including thromboembolic events, untreated hypoxaemia and sleep disordered breathing. The results of trials concerning pulmonary vasodilators in this particular patient group have been disappointing and, in some cases, were even associated with an increased risk of harm. Newer strategies such as medications administered through inhalation and combinations with antifibrotic drugs show encouraging results. Moreover, unravelling the role of the vasculature in the pathophysiology of pulmonary fibrosis and ILD-related PH may potentially unlock new therapeutic opportunities.
Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis
Authors: Farmakis Ioannis T. , Vrana Elena , Mouratoglou Sophia-Anastasia , Zafeiropoulos Stefanos , Zanos Stavros , Giannakoulas George
Published: August 2022

Background

Although the initial use of combination treatment has been proven to be beneficial for patients’ clinical outcomes, there are scarce data on its haemodynamic effects. The objective of the present study was to evaluate the effect of an initial combination of pulmonary arterial hypertension (PAH)-targeted therapies on haemodynamic parameters in treatment-naïve PAH patients.

Methods

A systematic search of PubMed, Cochrane Central Register of Controlled Trials and Web of Science was performed. We considered eligible studies with an intervention of initial PAH-targeted combination therapy in treatment-naïve PAH patients with or without monotherapy control. A random-effects meta-analysis was performed for the difference between baseline and follow-up in pulmonary vascular resistance (PVR) and other haemodynamic parameters.

Results

In 880 patients receiving initial combination therapy PVR was reduced by −6.5 Wood Units (95% CI −7.4–−5.7 Wood Units) or by −52% (95% CI −56%–−48%, I2=0%) compared to baseline. Initial triple therapy including a parenteral prostanoid resulted in significantly greater PVR reduction (−67%versus−50% with all other combination therapies, p=0.01). The effect was more pronounced in younger patients (p=0.02). Compared to baseline, there was −12.2 mmHg (95% CI −14.0–−10.4 mmHg) decrease in mean pulmonary artery pressure, 0.9 L·min−1·m−2(95% CI 0.8–1.1 L·min−1·m−2) increase in cardiac index, −3.2 mmHg (95% CI −4.1–−2.3 mmHg) decrease in right atrial pressure and 8.6% (95% CI 6.9–10.3%) increase in mixed venous oxygen saturation. In the controlled studies, initial combination therapy reduced PVR by −4.2 Wood Units (95% CI −6.1–−2.4 Wood Units) compared to monotherapy.

Conclusion

Initial combination therapy leads to remarkable haemodynamic amelioration. Parenteral prostanoids should be considered early, especially in more severely affected patients, to enable right ventricular reverse remodelling.
Defining the normal range of fractional exhaled nitric oxide in children: one size does not fit all
Authors: Wang Ran , Fowler Stephen J. , Turner Stephen W. , Drake Sarah , Healy Laura , Lowe Lesley , Wardman Hannah , Bennett Miriam , Custovic Adnan , Simpson Angela , Murray Clare S.
Published: August 2022

Background

The normal range of fractional exhaled nitric oxide (FENO) is influenced by demographic factors. However, single, fixed cut-off values are used for clinical interpretation in children despite rapid growth. We aimed to define the normal range ofFENOduring childhood and evaluate its utility in a diagnostic setting.

Method

FENOpercentile charts were developed using data from nonasthmatic children in a population-based birth cohort (Manchester Asthma and Allergy Study). Children were skin prick tested,FENOmeasured at the ages of 8, 11, 13–16 and 18 years and clinical information collected. This chart was externally validated in the Study of Eczema and Asthma to Observe the Influence of Nutrition (SEATON) cohort before being prospectively tested in symptomatic, treatment-naïve patients with suspected asthma in a diagnostic setting (Rapid Access Diagnostics for Asthma study).

Results

Height, weight, body mass index and age were predictive ofFENOin univariate analysis using 1220FENOmeasurements. Only height remained significant after adjustment in the overall, nonatopic and atopic populations, and was included in the predictive equations for 50th, 75th 90th and 98th percentiles. The proposed percentile lines corresponded to the 57th (95% CI 53rd–61st), 80th (76th–83rd), 90th (87th–92nd) and 98th (96th–99th) percentiles in the SEATON cohort (660 measurements). When tested in 73 symptomatic treatment-naïve children and young adults (median (interquartile range) age: 11 (8–14) years), anFENO>90th percentile gave a 96% specificity and positive predictive value of 97%, identifying 59% of children who were subsequently diagnosed with asthma after extensive testing.

Conclusion

We developed a height-basedFENOpercentile chart which quantifies the probability of asthma in symptomatic children and merits further validation towards clinical implementation.
Digital Twin-based Quality Management Method for the Assembly Process of Aerospace Products with the Grey-Markov Model and Apriori Algorithm
Authors: Zhuang Cunbo , Liu Ziwen , Liu Jianhua , Ma Hailong , Zhai Sikuan , Wu Ying
Published: August 2022

The assembly process of aerospace products such as satellites and rockets has the characteristics of single- or small-batch production, a long development period, high reliability, and frequent disturbances. How to predict and avoid quality abnormalities, quickly locate their causes, and improve product assembly quality and efficiency are urgent engineering issues. As the core technology to realize the integration of virtual and physical space, digital twin (DT) technology can make full use of the low cost, high efficiency, and predictable advantages of digital space to provide a feasible solution to such problems. Hence, a quality management method for the assembly process of aerospace products based on DT is proposed. Given that traditional quality control methods for the assembly process of aerospace products are mostly post-inspection, the Grey-Markov model and T-K control chart are used with a small sample of assembly quality data to predict the value of quality data and the status of an assembly system. The Apriori algorithm is applied to mine the strong association rules related to quality data anomalies and uncontrolled assembly systems so as to solve the issue that the causes of abnormal quality are complicated and difficult to trace. The implementation of the proposed approach is described, taking the collected centroid data of an aerospace product’s cabin, one of the key quality data in the assembly process of aerospace products, as an example. A DT-based quality management system for the assembly process of aerospace products is developed, which can effectively improve the efficiency of quality management for the assembly process of aerospace products and reduce quality abnormalities.
Comparative analyses of chloroplast genomes from Six Rhodiola species: variable DNA markers identification and phylogenetic relationships within the genus
Authors: Zhao Kaihui , Li Lianqiang , Quan Hong , Yang Junbo , Zhang Zhirong , Liao Zhihua , Lan Xiaozhong
Published: August 2022

Background

As a valuable medicinal plant, Rhodiola has a very long history of folk medicine used as an important adaptogen, tonic, and hemostatic. However, our knowledge of the chloroplast genome level of Rhodiola is limited. This drawback has limited studies on the identification, evolution, genetic diversity and other relevant studies on Rhodiola.

Results

Six Rhodiola complete chloroplast genomes were determined and compared to another Rhodiola cp genome at the genome scale. The results revealed a cp genome with a typical quadripartite and circular structure that ranged in size from 150,771 to 151,891 base pairs. High similarity of genome organization, gene number, gene order, and GC content were found among the chloroplast genomes of Rhodiola. 186 (R. wallichiana) to 200 (R. gelida) SSRs and 144 pairs of repeats were detected in the 6 Rhodiola cp genomes. Thirteen mutational hotspots for genome divergence were determined and could be used as candidate markers for phylogenetic analyses and Rhodiola species identification. The phylogenetic relationships inferred by members of Rhodiola cluster into two clades: dioecious and hermaphrodite. Our findings are helpful for understanding Rhodiola's taxonomic, phylogenetic, and evolutionary relationships.

Conclusions

Comparative analysis of chloroplast genomes of Rhodiola facilitates medicinal resource conservation, phylogenetic reconstruction and biogeographical research of Rhodiola.
Paramedic use of the Physician Order for Life-Sustaining Treatment (POLST) for medical intervention and transportation decisions
Authors: Breyre Amelia M. , Sporer Karl A. , Davenport Glen , Isaacs Eric , Glomb Nicolaus W.
Published: August 2022

Background

Physician Order for Life-Sustaining Treatment forms (POLST) exist in some format in all 50 states. The objective of this study is to determine paramedic interpretation and application of the California POLST for medical intervention and transportation decisions.

Methods

This study used a prospective, convenience sample of California Bay Area paramedics who reviewed six fictional scenarios of patients and accompanying mock POLST forms. Based on the clinical case and POLST, paramedics identified medical interventions that were appropriate (i.e. non-invasive positive pressure airway) as well as transportation decisions (i.e. non-transport to the hospital against medical advice). EMS provider confidence in their POLST interpretation was also assessed.

Results

There were 118 paramedic participants with a mean of 13.3 years of EMS experience that completed the survey. Paramedics routinely identified the selected medical intervention on a patients POLST correctly as either comfort focused, selective or full treatment (113-118;96%-100%). For many clinical scenarios, particularly when a patient’s POLST indicated comfort focused treatment, paramedics chose to use online medical oversight through base physician contact (68-73;58%-62%). In one case, a POLST indicated “transport to hospital only if comfort needs cannot be met in current location”, 13 (14%) paramedics elected to transport the patient anyway and 51 (43%) chose “Non-transport, Against Medical Advice”. The majority of paramedics agreed or strongly agreed that they knew how to use a POLST to decide which medical interventions to provide (106;90%) and how to transport a patient (74;67%). However, after completing the cases, similar proportions of paramedics agreed (42;36%), disagreed (43;36%) or were neutral (30;25%) when asked if they find the POLST confusing.

Conclusion

The POLST is a powerful tool for paramedics when caring patients with serious illness. Although paramedics are confident in their ability to use a POLST to decide appropriate medical interventions, many still find the POLST confusing particularly when making transportation decisions. Some paramedics rely on online medical oversight to provide guidance in challenging situations. Authors recommend further research of EMS POLST utilization and goal concordant care, dedicated paramedic POLST education, specific EMS hospice and palliative care protocols and better nomenclature for non-transport in order to improve care for patients with serious illness.
Resilience of the primary health care system – German primary care practitioners’ perspectives during the early COVID-19 pandemic
Authors: Stengel Sandra , Roth Catharina , Breckner Amanda , Cordes Lara , Weber Sophia , Ullrich Charlotte , Peters-Klimm Frank , Wensing Michel
Published: August 2022

Background

Primary care is a relevant pillar in managing not only individual, but also societal medical crises. The COVID-19 pandemic has demanded a rapid response from primary care with interventions in the health care system. The aim of this paper was to explore the responses of primary care practitioners (PCP) during the early COVID-19 pandemic and to analyze these with a view on the resilience of the primary health care system from the PCPs perspective.

Methods

Shortly after the first COVID-19 wave (July—October 2020) n = 39, semi-structured telephone interviews were conducted with PCP in practices and at Corona contact points (CCP) in Baden-Wuerttemberg (Germany). Qualitative content analysis was applied, and the evolved categories were related to in a framework for resilience.

Results

Primary care had an overall strong ability to adapt and show resilience, albeit with wide variance in speed and scope of the responses. When coping with uncertainty, the reasons given by PCPs in favor of opening a CCP mainly involved intrinsic motivation and self-initiative; the reasons against doing so were i.e. the lack of personal protective equipment, problems with space, and worries about organizational burden. A strong association existed between the establishment of a CCP and the use of resources (i.e. existing networks, personal protective equipment, exercising an office of professional political function). Our study predominantly found adaptive aspects for measures taken at medical practices and transformative aspects for setting up outpatient infection centers. PCPs played an important role in the coordination process (i.e. actively transferring knowledge, integration in crisis management teams, inclusion in regional strategic efforts) reaching a high level in the dimensions knowledge and legitimacy. The dimension interdependence repeatedly came into focus (i.e. working with stakeholders to open CCP, interacting among different types of primary care facilities, intersectoral interfaces). A need for regional capacity planning was visible at the time of the interviews.

Conclusions

The results can be used for practical and research-based institutional and capacity planning, for developing resilience in primary care and for augmentation by perspectives from other stakeholders in the primary health care system.
Implementing a new physiotherapist-led primary care model for low back pain: a qualitative study of patient and primary care team perspectives
Authors: Vader Kyle , Donnelly Catherine , French Simon D. , Grady Colleen , Hill Jonathan C. , Tripp Dean A. , Williams Ashley , Miller Jordan
Published: August 2022

Background

Low back pain (LBP) is one of the most common reasons for primary care visits and is the leading contributor to years lived with disability worldwide. The purpose of this study was to understand the perspectives of patients and primary care team members related to their experiences with a new physiotherapist-led primary care model for LBP.

Methods

We conducted an interpretive description qualitative study. Data were collected using a combination of semi-structured interviews and focus group discussions and analyzed using thematic analysis. Participants included adults (> 18 years of age) with LBP and primary care team members who participated in a physiotherapist-led primary care model for LBP in Kingston, Ontario, Canada.

Results

We conducted 18 semi-structured interviews with patients with LBP (10 women; median age of 52) as well as three focus group discussions with a total of 20 primary care team members representing three teams. Four themes (each with sub-themes) were constructed: 1) enhanced primary care delivery for LBP (improved access and engagement in physiotherapy care, improved communication and care integration between the physiotherapist and primary care team, less inappropriate use of healthcare resources); 2) positive patient experiences and perceived outcomes with the new model of care (physiotherapist built therapeutic alliance, physiotherapist provided comprehensive care, improved confidence in managing LBP, decreased impact of pain on daily life); 3) positive primary care team experiences with the new model of care (physiotherapist fit well within the primary care team, physiotherapist provided expertise on LBP for the primary care team, satisfaction in being able to offer a needed service for patients); and 4) challenges implementing the new model of care (challenges with prompt access to physiotherapy care, challenges making the physiotherapist the first contact for LBP, and opportunities to optimize communication between the physiotherapist and primary care team).

Conclusions

A new physiotherapist-led primary care model for LBP was described by patients and primary care team members as contributing to positive experiences and perceived outcomes for patients, primary care team members, and potentially the health system more broadly. Results suggest that this model of care may be a viable approach to support integrated and guideline adherent management of LBP in primary care settings.
Evaluating the discriminatory power of the velocity field diagram and timed-up-and-go test in determining the fall status of community-dwelling older adults: a cross-sectional observational study
Authors: Ibeneme Sam Chidi , Eze Joy Chinyere , Okonkwo Uchenna Prosper , Ibeneme Georgian Chiaka , Fortwengel Gerhard
Published: August 2022

Background

Systematic reviews demonstrated that gait variables are the most reliable predictors of future falls, yet are rarely included in fall screening tools. Thus, most tools have higher specificity than sensitivity, hence may be misleading/detrimental to care. Therefore, this study aimed to determine the validity, and reliability of the velocity field diagram (VFD -a gait analytical tool), and the Timed-up-and-go test (TUG)-commonly used in Nigeria as fall screening tools, compared to a gold standard (known fallers) among community-dwelling older adults.

Method

This is a cross-sectional observational study of 500 older adults (280 fallers and 220 non-fallers), recruited by convenience sampling technique at community health fora on fall prevention. Participants completed a 7-m distance with the number of steps and time it took determined and used to compute the stride length, stride frequency, and velocity, which regression lines formed the VFD. TUG test was simultaneously conducted to discriminate fallers from non-fallers. The cut-off points for falls were: TUG times ≥ 13.5 s; VFD’s intersection point of the stride frequency, and velocity regression lines (E1) ≥ 3.5velots. The receiver operating characteristic (ROC) area under the curves (AUC) was used to explore the ability of the E1 ≥ 3.5velots to discriminate between fallers and non-fallers. The VFD’s and TUG’s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Alpha was set atp < 0.05.

Results

The VFD versus TUG sensitivity, specificity, PPV and NPV were 71%, 27%, 55%, and 42%, versus 39%, 59%, 55%, and 43%, respectively. The ROC’s AUC were 0.74(95%CI:0.597,0.882, p = 0.001) for the VFD. The optimal categorizations for discrimination between fallers/non-fallers were ≥ 3.78 versus ≤ 3.78 for VFD (fallers versus non-fallers prevalence is 60.71% versus 95.45%, respectively), with a classification accuracy or prediction rate of 0.76 unlike TUG with AUC = 0.53 (95% CI:0.353,0.700,p = 0.762), and a classification accuracy of 0.68, and optimal characterization of ≥ 12.81 s versus ≤ 12.81 (fallers and non-fallers prevalence = 92.86% versus 36.36%, respectively).

Conclusion

The VFD demonstrated a fair discriminatory power and greater reliability in identifying fallers than the TUG, and therefore, could replace the TUG as a primary tool in screening those at risk of falls.
The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults
Authors: Sieswerda Elske , Bax Hannelore I. , Hoogerwerf Jacobien J. , de Boer Mark G. J. , Boermeester Marja , Bonten Marc J. M. , Dekker Douwe , van Wijk Roy Gerth , Juffermans Nicole P. , Kuindersma Marnix , van der Linden Paul D. , Melles Damian C. , Pickkers Peter , Schouten Jeroen A. , Rebel Jasper R. , van Zanten Arthur R. H. , Prins Jan M. , Wiersinga W. Joost
Published: August 2022

Background

The Dutch Working Party on Antibiotic Policy (SWAB) in collaboration with relevant professional societies, has updated their evidence-based guidelines on empiric antibacterial therapy of sepsis in adults.

Methods

Our multidisciplinary guideline committee generated ten population, intervention, comparison, and outcome (PICO) questions relevant for adult patients with sepsis. For each question, a literature search was performed to obtain the best available evidence and assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The quality of evidence for clinically relevant outcomes was graded from high to very low. In structured consensus meetings, the committee formulated recommendations as strong or weak. When evidence could not be obtained, recommendations were provided based on expert opinion and experience (good practice statements).

Results

Fifty-five recommendations on the antibacterial therapy of sepsis were generated. Recommendations on empiric antibacterial therapy choices were differentiated for sepsis according to the source of infection, the potential causative pathogen and its resistance pattern. One important revision was the distinction between low, increased and high risk of infection with Enterobacterales resistant to third generation cephalosporins (3GRC-E) to guide the choice of empirical therapy. Other new topics included empirical antibacterial therapy in patients with a reported penicillin allergy and the role of pharmacokinetics and pharmacodynamics to guide dosing in sepsis. We also established recommendations on timing and duration of antibacterial treatment.

Conclusions

Our multidisciplinary committee formulated evidence-based recommendations for the empiric antibacterial therapy of adults with sepsis in The Netherlands.
Antibodies in the breastmilk of COVID-19 recovered women
Authors: Szczygioł Paulina , Łukianowski Błażej , Kościelska-Kasprzak Katarzyna , Jakuszko Katarzyna , Bartoszek Dorota , Krajewska Magdalena , Królak-Olejnik Barbara
Published: August 2022

Objective

Human milk contains antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which may serve as a protective factor through passive immunization in infants. The objective of this study was to measure the levels of anti-SARS-CoV-2 IgG and IgA in human milk and serum after a SARS-CoV-2 infection.

Design

Breast milk and serum samples from 72 lactating mothers with confirmed SARS-CoV-2 asymptomatic or symptomatic infection were collected 1-229 days after the onset of clinical symptoms related to COVID-19. Seventeen mothers with no history of COVID-19 served as a control group. Enzyme-Linked ImmunoSorbent Assay was performed to analyze antibodies against SARS-CoV-2.

Results

SARS-CoV-2-IgA human milk antibodies were detected in mothers and their concentrations were consistently higher than SARS-CoV-2-IgG antibodies. The serum and breastmilk samples of women with COVID-19 was characterized by a higher concentration of anti-RBD IgA and IgG than the serum from the control group without COVID-19. No statistically significant difference was observed between the antibody levels in the serum samples obtained from symptomatic and asymptomatic women exposed to SARS-CoV-2 and between the antibody level and the time from a positive SARS-CoV-2 test result over the period studied.

Conclusion

Our results confirm the presence of SARS-CoV-2 IgA and IgG antibodies in the breastmilk of COVID-19 recovered women and the possibility of these antibodies in providing specific immunologic benefits to breastfeeding infants such as protection against the virus transmission and severity of the acquired COVID-19 disease.
Prevalence and risk factors of ischemic stroke-related headache in China: a systematic review and meta-analysis
Authors: Xie Qi , Wu Yinping , Pei Juhong , Gao Qianqian , Guo Qiang , Wang Xinglei , Zhong Juanping , Su Yujie , Zhao Junqiang , Zhang Lanfang , Dou Xinman
Published: August 2022

Background

Headache accompanying ischemic stroke is considered an independent predictor of neurological deterioration. This meta-analysis aims to estimate the prevalence of ischemic stroke-related headaches and identify its risk factors in China.

Methods

PubMed, Embase, Cochrane Library database, Web of Science, PsycINFO, and four Chinese databases for the related publications were searched. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with R software to calculate the pooled prevalence of ischemic stroke-related headaches in Chinese patients, and to merge the odds ratio (OR) of risk factors. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed by a funnel plot and Egger test.

Results

Ninety-eight studies were eligible for inclusion. The overall pooled prevalence of ischemic stroke-related headache was 18.9%. Subgroup analysis showed that the prevalence of ischemic stroke related-headaches was higher among studies using self-report to diagnosis headache (18.9%; 95%CI, 8.9% to 40.2%), and those focused on age ≥ 55 years (19.7%; 95%CI, 14.9% to 25.9%), rural settings (24.9%; 95%CI, 19.7% to 31.6%). There were no significant differences in the headache prevalence between studies in the south and north, and inland and coastal studies. The prevalence of pre onset headache (13.9%) and tension-type headache (15.5%) and was higher compared with other types. History of headache (OR = 3.24; 95%CI, 2.26 to 4.65.), female gender (OR = 2.06; 95%CI, 1.44 to 2.96.), midbrain lesions (OR = 3.56; 95%CI, 1.86 to 6.83.), and posterior circulation stroke (OR = 2.13; 95%CI, 1.14 to 4.32) were major risk factors.

Conclusion

The prevalence of ischemic stroke-associated headache is high in China. In addition, women, presence of midbrain lesions, posterior circulation stroke and a history of migraine were high-risk factors for ischemic stroke-related headaches. Designing effective interventions to prevent or alleviated headaches is necessary to promote patients’ neurological recovery and quality of life.
Dynamic early warning scores for predicting clinical deterioration in patients with respiratory disease
Authors: Gonem Sherif , Taylor Adam , Figueredo Grazziela , Forster Sarah , Quinlan Philip , Garibaldi Jonathan M. , McKeever Tricia M. , Shaw Dominick
Published: August 2022

Background

The National Early Warning Score-2 (NEWS-2) is used to detect patient deterioration in UK hospitals but fails to take account of the detailed granularity or temporal trends in clinical observations. We used data-driven methods to develop dynamic early warning scores (DEWS) to address these deficiencies, and tested their accuracy in patients with respiratory disease for predicting (1) death or intensive care unit admission, occurring within 24 h (D/ICU), and (2) clinically significant deterioration requiring urgent intervention, occurring within 4 h (CSD).

Methods

Clinical observations data were extracted from electronic records for 31,590 respiratory in-patient episodes from April 2015 to December 2020 at a large acute NHS Trust. The timing of D/ICU was extracted for all episodes. 1100 in-patient episodes were annotated manually to record the timing of CSD, defined as a specific event requiring a change in treatment. Time series features were entered into logistic regression models to derive DEWS for each of the clinical outcomes. Area under the receiver operating characteristic curve (AUROC) was the primary measure of model accuracy.

Results

AUROC (95% confidence interval) for predicting D/ICU was 0.857 (0.852–0.862) for NEWS-2 and 0.906 (0.899–0.914) for DEWS in the validation data. AUROC for predicting CSD was 0.829 (0.817–0.842) for NEWS-2 and 0.877 (0.862–0.892) for DEWS. NEWS-2 ≥ 5 had sensitivity of 88.2% and specificity of 54.2% for predicting CSD, while DEWS ≥ 0.021 had higher sensitivity of 93.6% and approximately the same specificity of 54.3% for the same outcome. Using these cut-offs, 315 out of 347 (90.8%) CSD events were detected by both NEWS-2 and DEWS, at the time of the event or within the previous 4 h; 12 (3.5%) were detected by DEWS but not by NEWS-2, while 4 (1.2%) were detected by NEWS-2 but not by DEWS; 16 (4.6%) were not detected by either scoring system.

Conclusion

We have developed DEWS that display greater accuracy than NEWS-2 for predicting clinical deterioration events in patients with respiratory disease. Prospective validation studies are required to assess whether DEWS can be used to reduce missed deteriorations and false alarms in real-life clinical settings.