bluuebunny/crossref_metadata_2025 huggingface dataset:
Strengthening the evidence base for mHealth in clinical practice: Conducting research with standalone or interoperable systems – a viewpoint
Authors: Kooij Laura , van Harten Wim H
Published: December 2023

Objective

The aim of this viewpoint is to inform mobile health (mHealth) evidence development in using standalone or interoperable systems in hospital practice.

Methods

There is a gap between mHealth research and its widespread uptake in clinical practice. Evidence generation is not keeping up with the introduction and implementation of technologies. This is partly a consequence of the technology characteristics and the way research is conducted in a clinical setting. Research and development of mHealth technology can be conducted standalone in a laboratory like setting, standalone in a clinical setting or interoperable with already existing technology in hospital practice.

Results

Standalone systems operate relatively independent from an organizations' existing infrastructure. Using laboratory settings does not reflect the complexity of real-life, but in clinical practice this may be suitable for research assessing usability, feasibility or even clinical and process outcomes at a small scale. Realizing research and development on interoperable mHealth technology solutions, especially with operational EMR systems, is a challenging, time- and resource intensive process and requires large(r) investments, as it is often complicated by a myriad of interfering factors. Interoperable systems are however a more sustainable option in the long run, and generated evidence reflects the real hospital care setting and this option may therefore facilitate dissemination. Choosing either a standalone or interoperable setting affects the research design, the implementation pace and ultimately widespread adoption of the mHealth technology.

Conclusion

We recommend to include these technology characteristics in implementation frameworks and think of evaluation research designs in an early phase.
Using human-centered design to develop a nurse-to-family telehealth intervention for pediatric transfers
Authors: Rosenthal Jennifer L , Ketchersid Audriana , Horath Elva , Sanders April , Harper Thomas A , Hoyt-Austin Adrienne E , Haynes Sarah C
Published: December 2023

Objective

To develop a nurse-to-family telehealth intervention for pediatric inter-facility transfers using the human-centered design approach.

Methods

We conducted the inspiration and ideation phases of a human-centered design process from July 2022 to December 2022. For the inspiration phase, we conducted a qualitative cross-sectional case study design over 3 months. We used thematic analysis with the framework approach of parent and provider interviews. Five team members individually coded transcripts and then met to discuss memos, update a construct summary sheet, and identify emerging themes. The team adapted themes into “How Might We” statements. For the ideation phase, multidisciplinary stakeholders brainstormed solutions to the “How Might We” statements in a design workshop. Workshop findings informed the design of a nurse-to-family telehealth intervention, which was iteratively revised over 2 months based on stakeholder feedback sessions.

Results

We conducted interviews with nine parents, 11 nurses, and 13 physicians. Four themes emerged supporting the promise of a nurse-to-family telehealth intervention, the need to effectively communicate the intervention purpose, the value of a user-friendly workflow, and the essentiality of ensuring that diverse populations equitably benefit from the intervention. “How Might We” statements were discussed among 22 total workshop participants. Iterative adaptations were made to the intervention until feedback from workshop participants and 67 other stakeholders supported no further improvements were needed.

Conclusion

Human-centered design phases facilitated stakeholder engagement in developing a nurse-to-family telehealth intervention. This intervention will be tested in an implementation phase as a feasibility and pilot trial.
Assessing Functional Cognition and Health During COVID-19 Pandemic: Gender Differences Among Community-Dwelling Adults
Authors: Josman Naomi , Atiya Yael , Dagan Tal , Issa Elizabeth , Demeter Naor
Published: December 2023

Introduction/Objectives:

The COVID-19 pandemic has long-term implications for adult health and function, whether or not people were infected with the disease. Although cognitive disruptions are among the major symptoms of COVID-19, most research focused on managing medical symptoms, such as respiratory symptoms or pain. Thus, less is known about the pandemic’s long-term implications for assessing functional cognition. This study aimed to examine COVID-19’s effects on community-dwelling adults’ functional cognition and health, comparing gender differences.

Methods:

This cross-sectional study divided 118 community-dwelling adults (25 previously infected with COVID-19) into gender groups. Primary outcome measures included the Daily Living Questionnaire (DLQ) and short form health status survey, SF-12.

Results:

No significant differences were found in functional cognition or health between participants who had contracted COVID-19 and those who remained healthy, but men had better functional cognition and health measures in comparison with women.

Conclusions:

Gender differences in functional cognition and health state may relate to gender-based family roles. It is essential to assess functional cognition of young adults who were exposed to a pandemic, such as COVID-19, because it may significantly affect their health and functional status. The DLQ is a reliable, valid assessment of functional cognition that may suit individuals who previously contracted COVID-19.
The Capital Structure Decisions of Banks: An Evidence From MENA Region
Authors: Khan Shoaib , Bashir Usman , Attuwaijri Hend Abdulhadi Saleh , Khalid Usman
Published: December 2023

The study examines the significant factors affecting the capital structure decisions for banks’ in MENA region. An unbalanced panel data comprising of 132 banks operating in fifteen different countries of the MENA region from 2012 to 2017, data was extracted from Bank Scope resulting in 891 bank year observations. Macroeconomic indicators and institutional characteristics data has been taken from World Bank and World Bank governance indicators database and financial freedom data has been collected from heritage foundation. We use the two-step system Generalized Method of Moments (GMM) to explore the relationship between dependent and explanatory variables. The regression outcome between profitability and leverage shows a negative and significant relationship. No significant association between tangibility and leverage is found. Earnings volatility is negatively and significantly related to leverage. The relationship between growth and leverage is negative and significant. Macroeconomic indicators GDP growth and inflation show a positive relationship with leverage. Finally, the institutional factors, that is, government effectiveness, political stability, and rule of law have positive association with leverage. The study results will lend a hand to bank managers to make value-maximizing financing decisions to achieve an optimal capital structure. It will also help the policymakers to articulate an effective regulatory framework in the region. As per our knowledge, this is the first study to explore the determining factors of capital structure for banks operating in the MENA region. Moreover, the findings from MENA region banks could also support the comparative study with other regional blocks.
Analyzing the Concatenation Between Ethics and Knowledge Culture in Indian IT Sector
Authors: Gaur Nishant , Gupta Vikas
Published: December 2023

In this globally competitive environment, ethics has become the major area of concern for organizations to eliminate the issues that arise in knowledge sharing. Knowledge is considered to provide a competitive edge to individuals and organizations. This is especially true for industries engaged in the Information and Technology sector. In accordance with the above notion, the current study aims at assessing the role of ethics as a catalyst in affecting knowledge sharing in Indian IT organizations. For this purpose, the study adopted a self-developed questionnaire that was addressed to employees engaged in the IT sector of India. The study utilized SPSS and AMOS to outline the relationship between Ethics and Knowledge Sharing. The findings of the study revealed that the PRIMES model has a direct impact on knowledge creation culture, knowledge-sharing culture, and knowledge storage and knowledge application culture. Moreover, it was also revealed that ethical issues have a negative impact on the three constructs of knowledge sharing that is, knowledge creation culture; knowledge sharing culture; and knowledge storage and knowledge application culture. Personality traits and other constructs of the PRIMES model cannot be controlled by the organization. However, ethical issues can be curbed to enhance the knowledge sharing culture. Prior research has not empirically tested the role of PRIMES model and ethics on knowledge sharing culture.
Personality Traits, Student-Teacher Relationships and Boys’ Academic Crisis in China: Evidence From the Least Developed Regions
Authors: Huang Chunhan , Shi Junyun , Zeng Xiaodong
Published: December 2023

Gender disparity in education is a perpetually compelling issue. It is especially attention-grabbing in economically disadvantaged areas, as it may reinforce backwardness on top of economic vulnerability. Underpinned by the self-determination theory, this study examined the underlying mechanisms that gave rise to gender differences in the academic achievement of upper primary grades students from disadvantaged areas of China. We drew on a dataset of 5,032 students in grades four through six, assembled from 89 schools in three disadvantaged counties spanning two provinces. The results showed that girls significantly outperformed boys in Chinese and English across three grades. Unexpectedly, boys performed statistically identical to girls in math, where boys had generally been considered more adept. Personality explained the gender differences, while the mediating effects of student-teacher relationships were only found in the girls’ group. The findings emphasized the importance of increasing supportive efforts to address the boy’s academic risks.
Enhancing Cybersecurity: The Crucial Role of Self-Regulation, Information Processing, and Financial Knowledge in Combating Phishing Attacks
Authors: Waqas Muhammad , Hania Alishba , Yahya Farzan , Malik Iqra
Published: December 2023

In today’s technologically advanced world, the escalating prevalence of phishing attacks necessitates an urgent exploration of effective countermeasures. This study delves into the crucial investigation of how self-regulation influences phishing susceptibility, while also examining the mediating role of information processing and the moderating influence of financial knowledge. A comprehensive survey was meticulously crafted, targeting 370 recent university graduates. The collected data underwent rigorous analysis using Hayes’ PROCESS macro, unveiling a mediated moderation model. The findings reveal that self-regulation does not directly predict phishing susceptibility. However, information processing, whether systematic or heuristic, significantly impacts phishing susceptibility. Additionally, information processing serves as a mediator, connecting self-regulation to phishing susceptibility. Notably, the interaction between systematic information processing and financial knowledge emerged as a significant determinant of phishing susceptibility. By establishing a comprehensive mediated moderation model, this study provides invaluable insights for individuals and organizations seeking to bolster their defenses against phishing attacks. Furthermore, it emphasizes the vital role of financial knowledge and employees’ heuristic information processing in mitigating cyber threats. This research serves as a crucial scientific contribution, offering compelling evidence that proactive management of contributing factors can effectively mitigate the escalating threats posed by phishing attacks.
Examining Determinants of Regional Inflation Heterogeneity — A Robust Panel Data Analysis
Authors: Abbas Syed Jaffar , Arshed Noman
Published: December 2023

This study examines the impact of different factors on inflation in six regions of the world between 2002 and 2021, analyzing variables such as control of corruption, political stability, broad money growth, GDP growth, and imports to exports ratio. This study seeks to investigate the crucial factors that cause inflation and their significance in different regions. The feasible generalized least square (FGLS) results indicate that the determinants of inflation vary in different regions, but broad money growth consistently increases inflation across all six regions, while control of corruption and political stability reduce inflation in most regions. The study has business implications for political stability and its contribution to inflation control. This should be taken into account when making investment choices by businesses operating in politically insecure regions. The study also highlights how crucial it is to control the growth of broad money and comprehend how GDP growth and inflation are related. Policymakers should establish effective inflation control measures that take into consideration the unique elements driving inflation in their region.

JEL Classification: E31, P24, P44
Status of Borstal Schools in India
Authors: Mukundan K. P. Asha
Published: December 2023

The Borstal system evolved through the Gladstone Committee Report (1895), England, which propagated differential correctional philosophy for adolescent offenders. The philosophy focused on rehabilitation and corrections through training in industrial trades followed by an intensive aftercare programme. The success of Borstal schools was credited to the synergy between legislature, institution and aftercare mechanisms. Borstal schools in India were influenced and modelled in this line. This article studies and compares the existing Borstal Acts in India. National Crime Record Bureau data (2020 and 2021) suggest that Borstals were functional in only 8 out of 29 states, and its occupancy rate was not optimal. This article raises concerns over the decline in the number and use of Borstal schools and tries to understand the reasons for the same. It advocates for the need to revive Borstal schools in the spirit of corrections for young adults against the backdrop of changes in adult and juvenile justice legislation.
Evolution of Seronegative Inflammatory Myositis to Dermatomyositis With Characteristic Cutaneous Features: A Case Report
Authors: Jevtic Dorde , Dharmah Umaima , Bahar Moghaddam
Published: December 2023

Dermatomyositis (DM) is a rare inflammatory myopathy with an incidence of 9.63 per 1 000 000 people and typically presents with skin rash and muscle weakness. We report a case of DM that presented with proximal muscle weakness, normal creatine phosphokinase (CPK), negative myositis antibody panel, and non-specific histopathological findings on muscle biopsy, without initial skin involvement. A 67-year-old male presented with subacute bilateral proximal lower-extremity weakness and weight loss of 20 pounds over 3 months. Laboratory investigation was significant for elevated erythrocyte sedimentation rate, C-reactive protein, CPK, and aldolase, with negative myositis-specific antibodies. Femur magnetic resonance imaging revealed subcutaneous, fascial, and muscle edema throughout quadriceps and gluteal muscles. Muscle biopsy showed myofiber atrophy with perivascular and endomysial T-lymphocytes and histiocytes, as well as scattered necrotic myofibers. He was diagnosed with inflammatory myositis and started on prednisone and monthly IVIG infusions. At 2-month follow-up, he reported new rashes on the extensor surfaces of the hands consistent with Gottron’s papules, mechanic’s hands, and livedo reticularis of feet and arms. Cases of DM that present with myopathy and later develop skin changes are rare. Our patient had several months of progressive proximal muscle weakness, and skin changes occurred after he was started on treatment. Laboratory findings include elevated CPK, aldolase, and myositis-specific auto-antibodies. Muscle biopsy helps in diagnosis; however, findings may be nonspecific—as was the case in our patient. Corticosteroids are first-line treatment. Long-term follow-up studies are necessary to better understand the incidence of late-onset development of typical skin findings.
Transformed Testicular Teratoma to Embryonic-Type Neuroectodermal Tumor With Metastasis to Mediastinum
Authors: Siegenthaler Alanna , Niforatos Stephanie , Loon Taylor , Brady Amy , Sandhu Michael , Kravtsov Oleksandr , Akhtar Komal
Published: December 2023

Testicular teratomas may present in both prepubertal and adult men; however, the prognosis differs greatly between these 2 populations. In children, teratomas (prepubertal type) most often occur before the age of 4, are generally seen in their pure form, and behave in a benign fashion. In adults (postpubertal type), teratomas are usually part of a mixed germ cell tumor, and they have the potential to be found at metastatic sites, especially following chemotherapy for non-teratomatous germ cell tumor. Analyses of metastases from germ cell tumors and teratomas from the same patient have demonstrated a high degree of concordance in the observed genetic abnormalities. In rare cases, testicular teratoma can transform into a malignant germ cell tumor. One such type of transformation is into a primitive neuroectodermal tumor. These tumors are malignant and often metastasize to the retroperitoneum but may also metastasize to other sites. A multimodal treatment approach is needed, including surgery and adjuvant chemotherapy. We describe a rare case of malignant transformation of a testicular teratoma into a primitive neuroectodermal tumor with metastasis to the mediastinum. The patient was treated with radical orchiectomy, retroperitoneal lymph node dissection, and adjuvant vincristine, adriamycin, and cyclofosfamide alternating with ifosfamide and etoposide (VAC/IE therapy).
HCV Genotype Distribution and Clinical Characteristics of HCV Mono-Infected and HCV/HIV Co-Infected Patients in Liangshan Prefecture, Sichuan Province, China
Authors: Cao Bianchuan , Liu Mei , Jiang Tao , Yu Qinghua , Yuan Tianru , Ding Ping , Zhou Xian , Huang Yongmao , Zou Yongsheng , Huang Fuli
Published: December 2023

Objective: The present study aimed to characterize the genotype distribution and clinical characteristics of HCV monoinfected and HCV/HIV coinfected patients in the Liangshan Prefecture, Sichuan Province, China. Methods: All the patients were divided into HCV monoinfection and HCV/HIV coinfection groups according to whether they were complicated with HIV infection. The data from the two groups were collected. Results: In this study, HCV genotype 3 was the most common genotype in both groups, while HCV genotype 6 was significantly higher in the coinfection group than in the monoinfection group ( p = 0.046). The white blood cell count, total bilirubin level, and HCV RNA were significantly higher in the HCV monoinfection group than that in the HCV/HIV coinfection group ( p = 0.031; p < 0.001; p = 0.027, respectively). Conclusion: HCV prevalence was high in HIV-positive patients in the Liangshan Prefecture. Thus, incorporating screening and management of HCV monoinfection and HCV/HIV coinfection is needed in local region programs.
Patient safety near misses – Still missing opportunities to learn
Authors: Woodier Nick , Burnett Charlotte , Sampson Paul , Moppett Iain
Published: December 2023

Objectives

A patient safety near miss is a safety event that had the potential to cause harm, but did not reach the patient. For over 20 years healthcare has been exhorted to learn from patient safety near misses to support improvements in patient safety. The belief is that, by addressing the factors that contribute to patient safety near misses, harmful incidents will be avoided. However, there seems to have been little progress made to learn from patient safety near misses. This study aimed to explore why there has been limited progress, and how best patient safety near misses may be learned from.

Methods

A qualitative case study was undertaken to explore the learning from patient safety near misses in different National Health Service contexts. Semi-structured interviews were conducted with patient safety leads in secondary care, primary care, and regional/national bodies. Interviews were recorded, transcribed, and thematically analysed.

Results

Seventeen interviews were undertaken across the National Health Service, with further data collected from policy, guidance, field notes, and research memos. Thematic analysis identified the following: variations in safety event schema; limited processes for patient safety near misses; unsupportive reporting contexts; and assumed, but non-evidenced improvements in patient safety. Participants also shared their thoughts on how learning from patient safety near misses could be improved.

Conclusion

A lack of progress has been made to learn from patient safety near misses in the National Health Service. This is contributed to by a lack of agreement about what is and how best to learn from a patient safety near miss. The learning value of patient safety near misses lies in the focus they place on controls to hazards, but they should not be learned from in isolation.
Impacts of social restrictions on mental health and health behaviours of individuals with multimorbidity during Covid-19 pandemic
Authors: Chauvin Valérie , Villarino Resti Tito H , Bernard Paquito , Yazbek Hanan , Kern Laurence , Hokayem Marie , Mattar Lama , Kotbagi Gayatri , Rizk Melissa , Morvan Yannick , Baillot Aurélie , Romain Ahmed Jérôme
Published: December 2023

Background

Social restrictions and their possible impact on lifestyle make people with multimorbidity (≥2 co-existing chronic conditions) more vulnerable to poor perceived mental health and health behaviours modifications during the COVID-19 pandemic.

Objective

To understand the mental health status and health behaviour modifications among individuals with multimorbidity during different levels of COVID-19 social restrictions.

Methods

Longitudinal multinational cohort study consisting of two online questionnaires with its first wave taken place while social restrictions were imposed (May 2020), and its second wave with less social restrictions in place (November 2020). Including 559 participants (wave 1) and 147 participants from wave 1 (wave 2) with an average age of 34.30±12.35 and 36.21±13.07 years old. Mostly females living in Canada, France, India and Lebanon.

Results

The prevalence of multimorbidity was 27.68% (wave 1) and 35.37% (wave 2). While social restrictions were imposed, people with multimorbidity were 2 to 3 times more likely to experience psychological distress, depressive symptoms, increased stress or isolation than those without multimorbidity. Health behaviours were also modified during this period with people with multimorbidity being more likely to reduce their physical activity and increased their fruit and vegetable consumption. In wave 2, regardless of multimorbidity status, sexual desire continuously decreased while stress and psychological distress increased.

Conclusion

Mental health and health behaviours modifications occurred while social restrictions were imposed and people with multimorbidity were more severely impacted than those without multimorbidity, indicating a need for a more adapted approach of care during socially restrictive periods for this population.
Contending With Precarity: Health and Multi-Sectoral Supports for Migrant Agricultural Workers in Southern Ontario
Authors: Susana Caxaj C. , George Glynis , Borrelli Erika , Frost Linda
Published: December 2023

Research has long-documented how Canada’s temporary foreign worker programs (TFWP) foster workers' precarity through their status as non-citizens and living and working conditions, ultimately, impacting their health. While studies point to limited supports and services for workers, their role in reinforcing or alleviating the precarious conditions that migrant agricultural workers experience remains largely unexplored. This paper draws on interviews with 35 service providers in three migrant-intensive regions in southwestern Ontario, to explore how service providers describe and construct support. We explore the barriers workers face in accessing services, challenges providers experience in supporting workers, and strategies employed to surmount these barriers. We argue that this multiregional analysis is important to illuminate how support shapes and is shaped by the larger structural context, namely common features of Canada’s TFWP. A more comprehensive understanding of support moreover, provides direction for sustainable interventions that can promote the health and wellbeing of this population.
Review of Thromboelastography (TEG): Medical and Surgical Applications
Authors: Whitton TP , Healy WJ
Published: December 2023

Thromboelastography (TEG) is a laboratory assay utilized to evaluate hemostatic properties of blood, identify coagulopathy, and guide blood product administration. While the clinical use of TEG started in the care of surgical patients, the assay has now been incorporated more routinely in the care of the medical patient as well. In this review, we explore the evolution of TEG from the historical perspective of its inception to the current state of the art of the assay. The TEG procedure and its measurements are illustrated along with a table that summarizes recommendations from across the medical and surgical literature. After each section, we review salient learning points to provide the busy clinician with information that can be immediately integrated at the bedside. We conclude with a series of summary questions to check for comprehension and direct the reader to additional resources to improve their knowledge of TEG.
Hybrid Methodologies: The Evolution and Future of Scientific Training in a Post-Pandemic World
Authors: Evans Kevin D. , Bradbury Peter , Bloom Isaiah W.
Published: December 2023

As the world tackled the COVID-19 pandemic, nearly all research institutions underwent significant change, shifting from an in-person to an online landscape, resulting in several benefits and drawbacks to their research laboratories. The pandemic shut down most research efforts, and methods such as online Zoom meetings were required to keep most elements of the research and training going. In the post-COVID period, anxieties about health and safety resulted in difficulty in recruiting participants for clinical studies, and the emphasis on following health standards and guidelines (e.g., social distancing, personal protective equipment) required flexibility in research training processes. This symposium incorporates satisfaction rates and anecdotal evidence from individuals experiencing in-person and virtual research training throughout the pandemic to examine the changes and effects COVID-19 had on laboratory research. Nine traits of a high-quality research training environment (RTE), proposed in a study by Gelso et al, provide context for the subjective claims made and assist in categorizing certain traits. Both modes of research training carry benefits and drawbacks. The increase in collaboration and communication in an online space promoted several of the nine traits of an RTE. However, qualitative feedback from students suggests that the lack of training incorporating the direct operation of equipment, holding a transducer, and direct interaction was detrimental to new laboratory members and their research training. Flexibility and a combination of in-person and online training are likely necessary for an effective research environment in a post-COVID world.
Atraumatic Splenic Rupture in a Neonate: A Case Report
Authors: Satapathy Madhusmita
Published: December 2023

Idiopathic atraumatic splenic rupture (ASR) is rare, especially in neonates and can result in the spontaneous hemorrhage of the organ, abdominal distension, and hemoperitoneum. This condition can be fatal without prompt diagnosis and surgical intervention. The pathophysiology of ASR is difficult to understand due to its rarity; however, retrospective reviews have found an association with neoplasm, infection, inflammatory diseases, and anticoagulant drugs. Therefore, it is essential to report this rare occurrence. This case report involves a 2-day-old neonate born to a mother with chronic hypertension, chorioamnionitis, and a carrier of cystic fibrosis. An abdominal sonogram followed by contrast-enhanced computed tomography (CT) revealed hemoperitoneum with possible active bleeding and lack of definite visualization of the spleen. During emergency laparotomy, the attempt to preserve the organ was unsuccessful, requiring splenectomy. The neonate recovered well from the procedure and was discharged on the 18th day of life.
How have we measured trial outcomes of asthma attack treatment? A systematic review
Authors: Howell Imran , Howell Aleksandra , Ramakrishnan Sanjay , Bafadhel Mona , Pavord Ian
Published: December 2023

Background

Asthma attacks are a common problem for people with asthma and are responsible for significant healthcare costs. There is interest in a precision medicine approach to treatment. However, the choice of trial outcome measures for asthma attack treatment is hampered by the absence of a consensus on suitability. We carried out a systematic review to understand the characteristics of outcome measures used in randomised controlled trials of asthma attack treatment. Have randomised controlled trials of asthma attack treatment measured outcomes that are useful to patients and healthcare providers?

Methods

The protocol was registered on PROSPERO (CRD42022311479). We searched for randomised controlled trials comparing treatments for adults with asthma attacks, published in English between 1972 and 2022 on MEDLINE, Embase and Cochrane Library databases. We recorded the outcome measures and study characteristics.

Results

We identified 208 eligible randomised controlled trials from 35 countries. Trials ranged from 12 to 1109 participants, with a median of 60. The most common settings were the emergency department (n=165) and hospital admission (n=33). Only 128 studies had primary and secondary outcomes defined clearly. In those that did, 73% of primary outcomes measured change in lung function or other physiological parameters over a short period (usually <24 h). Patient-reported and healthcare utilisation outcomes were the primary outcome in 27%.

Conclusions

Outcomes in randomised controlled trials of asthma attack treatment focus on short-term changes in lung function and may not capture patient-centred and economically important longer-term measures. More work is needed to investigate patient and other stakeholder preferences on core outcome sets.
Overnight desaturation in interstitial lung diseases: links to pulmonary vasculopathy and mortality
Authors: Margaritopoulos George A. , Proklou Athanasia , Trachalaki Athina , Badenes Bonet Diana , Kokosi Maria , Kouranos Vasilis , Chua Felix , George Peter M. , Renzoni Elisabetta A. , Devaraj Anand , Desai Sujal , Nicholson Andrew G. , Antoniou Katerina M. , Wells Athol U.
Published: December 2023

Background

Overnight desaturation predicts poor prognosis across interstitial lung diseases (ILDs). The aim of the present study was to investigate whether nocturnal desaturation is associated with pulmonary vasculopathy and mortality.

Methods

A retrospective single centre study of 397 new ILD patients was carried out including patients with idiopathic pulmonary fibrosis (IPF) (n=107) and patients with non-IPF fibrotic ILD (n=290). This is the largest study to date of the effect of significant nocturnal desaturation (SND) (≥10% of total sleep time with oxygen saturation ≤90% measured by pulse oximetry).

Results

The prevalence of SND was 28/107 (26.2%) in IPF and 80/290 (27.6%) in non-IPF ILD. The prevalence of SND was higher in non-IPF ILDs than in IPF (p=0.025) in multivariate analysis. SND was associated with noninvasive markers of pulmonary hypertension (PH): tricuspid regurgitation velocity (TRV) (p<0.0001), brain natriuretic peptide (p<0.007), carbon monoxide transfer coefficient (p<0.0001), A–a gradient (p<0.0001), desaturation >4% in 6-min walking test (p<0.03) and pulmonary artery diameter (p<0.005). SND was independently associated with high echocardiographic PH probability in the entire cohort (OR 2.865, 95% CI 1.486–5.522, p<0.002) and in non-IPF fibrotic ILD (OR 3.492, 95% CI 1.597–7.636, p<0.002) in multivariate analysis. In multivariate analysis, SND was associated with mortality in the entire cohort (OR 1.734, 95% CI 1.202–2.499, p=0.003) and in IPF (OR 1.908, 95% CI 1.120–3.251, p=0.017) and non-IPF fibrotic ILD (OR 1.663, 95% CI 1.000–2.819, p=0.041). Separate models with exclusion of each one of the diagnostic subgroups showed that no subgroup was responsible for this finding in non-IPF ILDs. SND was a stronger marker of 5-year mortality than markers of PH.

Conclusion

SND was associated with high echocardiographic probability and mortality and was a stronger predictor of mortality in IPF and non-IPF ILDs grouped together to power the study.
Bronchial reactivity and asthma at school age after early-life metapneumovirus infection
Authors: Myklebust Åsne , Rae Simpson Melanie , Valand Jonas , Stenhaug Langaas Vibeke , Jartti Tuomas , Døllner Henrik , Risnes Kari
Published: December 2023

Background

The association between early-life lower respiratory tract infection (LRTI) and asthma is well established. Knowledge about bronchial hyperresponsiveness (BHR) and asthma after metapneumovirus (MPV) LRTI is scarce. The aim of this study was to assess BHR and current asthma in school-aged children after hospital admission for early-life LRTI with MPV, and to compare with more well-known viruses, rhinovirus (RV) and respiratory syncytial virus (RSV), and with controls.

Methods

A cohort consisting of children admitted for LRTI and controls was followed-up at school age with a clinical research assessment and lung function tests, including a methacholine provocation test. Current asthma was defined based on objective variable airway obstruction and clinical symptoms. BHR and asthma were compared according to viral groups.

Results

135 children (median age 9.3 years) were included (16 MPV, 34 RV, 51 RSV, 13 mixed infections and 21 controls). Compared with controls there was increased BHR after MPV and RV LRTI (provocative dose causing a 20% fall in forced expiratory volume in 1 s and dose–response slope; p<0.05). Using Kaplan–Meier statistics, BHR was increased for MPV compared with both controls and RSV (p=0.02 and p=0.01). The proportion of children with current asthma at follow-up was higher in the LRTI children compared with the controls (46% versus 24%; p=0.06). Among children who had undergone MPV and RV infection, 50% fulfilled the asthma criteria compared with 43% in the RSV group (p=0.37).

Conclusion

We found increased BHR and a high prevalence of asthma in school-aged children after early-life MPV infection, and findings were similar to RV, and less to RSV, compared with controls.
The impact of clinical pharmacists’ medication reconciliation upon patients’ admission to reduce medication discrepancies in the emergency department: a prospective quasi-interventional study
Authors: Shaker Heba Othman , Sabry Ahmed Abdel Fattah , Salah Asmaa , Ragab Gilan Mohamed , Sedik Nahla Ahmed , Ali Zahraa , Magdy Doha , Alkafafy Asmaa Mohamed
Published: December 2023

Background

The role of the clinical pharmacist in medication reconciliation is well established. Upon patients’ admission, the reconciliation service mainly focuses on achieving an accurate and full drug history. This will achieve the best treatment plan and reduce medication discrepancies.

Upon the recent implementation of clinical pharmacy services in the emergency department at Alexandria Main University Hospital, medication reconciliation was one of the most important duties that needed to be focused on.

We hypothesized that clinical pharmacists are able to achieve patients’ drug history lists with higher accuracy than emergency physicians.

Results

A total number of 161 patients were included. Age was 58.59 ± (13.78) years, number of comorbidities was 2.39 ± (1.22) and number of home medications was 4.51 ± (2.72). Clinical pharmacists’ fulfillment of patients’ drug history was significantly more accurate than the emergency physicians (75.16% and 50.3% of the total number of revised patients’ profiles respectively). The clinical pharmacists could put a written copy of the accurate patients’ drug history list in only 50.93% of the revised patients’ profiles. Five hundred eighty-five medication discrepancies were detected which represent an average of 3.63 discrepancies/medication sheet. Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for medication reconciliation and the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index were used to categorize discrepancies. Categories A, B, and C represented (66.5%), while categories D, E, and F represented (33.5%) of the total discrepancies. There was a significant direct relationship between the total number of discrepancies and both the number of comorbidities and the number of drugs administered before hospital admission.

Conclusion

The clinical pharmacists are the main members of the emergency health care team. One of their fundamental services is medication reconciliation. The establishment of a complete drug history list and physicians’ discussion about the current treatment plan can obviously detect and reduce medication errors.

Trial registration

NCT04395443. Registered 16 May 2020.
Machine learning-based donor permission extraction from informed consent documents
Authors: Zhang Meng , Sankaranarayanapillai Madhuri , Du Jingcheng , Xiang Yang , Manion Frank J. , Harris Marcelline R. , Stansbury Cooper , Pham Huy Anh , Tao Cui
Published: December 2023

Background

With more clinical trials are offering optional participation in the collection of bio-specimens for biobanking comes the increasing complexity of requirements of informed consent forms. The aim of this study is to develop an automatic natural language processing (NLP) tool to annotate informed consent documents to promote biorepository data regulation, sharing, and decision support. We collected informed consent documents from several publicly available sources, then manually annotated them, covering sentences containing permission information about the sharing of either bio-specimens or donor data, or conducting genetic research or future research using bio-specimens or donor data.

Results

We evaluated a variety of machine learning algorithms including random forest (RF) and support vector machine (SVM) for the automatic identification of these sentences. 120 informed consent documents containing 29,204 sentences were annotated, of which 1250 sentences (4.28%) provide answers to a permission question. A support vector machine (SVM) model achieved a F-1 score of 0.95 on classifying the sentences when using a gold standard, which is a prefiltered corpus containing all relevant sentences.

Conclusions

This study provides the feasibility of using machine learning tools to classify permission-related sentences in informed consent documents.
Integrated metabolome and transcriptome analyses of anthocyanin biosynthesis reveal key candidate genes involved in colour variation of Scutellaria baicalensis flowers
Authors: Guo Fengdan , Guan Renwei , Sun Xinru , Zhang Cuicui , Shan Chenggang , Liu Mengyu , Cui Ning , Wang Ping , Lin Huibin
Published: December 2023

Background

Bright flower colour assists plants attract insects to complete pollination and provides distinct ornamental values. In some medicinal plants, diverse flower colour variations usually imply differences in active ingredients. Compared to the common bluish purple of Scutellaria baicalensis flower (SB), the natural variants present rose red (SR) and white (SW) flowers were screened out under the same growing conditions in the genuine producing area Shandong Province, China. However, the mechanism of flower colour variation in S. baicalensis was remain unclear. In the present study, we conducted integrated transcriptome and metabolome analyses to uncover the metabolic difference and regulation mechanism in three S. baicalensis flowers.

Results

The results showed that 9 anthocyanins were identified. Among which, 4 delphinidin-based anthocyanins were only detected in SB, 4 cyanidin-based anthocyanins (without cyanidin-3-O-glucoside) mainly accumulated in SR, and no anthocyanin but high level of flavanone, naringenin, was detected in SW. The gene expression profile indicated that the key structural genes in the flavonoid and anthocyanin biosynthesis pathway differentially expressed in flowers with different colours. Compared to SB, the down-regulated expression of F3’5’H, ANS, and 3GT gene in SR might influence the anthocyanin composition. Especially the InDel site with deletion of 7 nucleotides (AATAGAG) in F3’5’H in SR might be the determinant for lack of delphinidin-based anthocyanins in rose red flowers. In SW, the lower expression levels of DFR and two F3H genes might reduce the anthocyanin accumulation. Notably the SNP site of G > A mutation in the splicing site of DFR in SW might block anthocyanin biosynthesis from flavanones and thus cause white flowers. In addition, several key transcription factors, including MYB, bHLH, and NAC, which highly correlated with structural gene expression and anthocyanin contents were also identified.

Conclusions

These results provide clues to uncover the molecular regulatory mechanism of flower colour variation in S. baicalensis and promote novel insights into understanding the anthocyanin biosynthesis and regulation.
Genome-wide analysis of long noncoding RNAs in response to salt stress in Nicotiana tabacum
Authors: Li Zefeng , Zhou Huina , Xu Guoyun , Zhang Peipei , Zhai Niu , Zheng Qingxia , Liu Pingping , Jin Lifeng , Bai Ge , Zhang Hui
Published: December 2023

Background

Long noncoding RNAs (lncRNAs) have been shown to play important roles in the response of plants to various abiotic stresses, including drought, heat and salt stress. However, the identification and characterization of genome-wide salt-responsive lncRNAs in tobacco (Nicotiana tabacum L.) have been limited. Therefore, this study aimed to identify tobacco lncRNAs in roots and leaves in response to different durations of salt stress treatment.

Results

A total of 5,831 lncRNAs were discovered, with 2,428 classified as differentially expressed lncRNAs (DElncRNAs) in response to salt stress. Among these, only 214 DElncRNAs were shared between the 2,147 DElncRNAs in roots and the 495 DElncRNAs in leaves. KEGG pathway enrichment analysis revealed that these DElncRNAs were primarily associated with pathways involved in starch and sucrose metabolism in roots and cysteine and methionine metabolism pathway in leaves. Furthermore, weighted gene co-expression network analysis (WGCNA) identified 15 co-expression modules, with four modules strongly linked to salt stress across different treatment durations (MEsalmon, MElightgreen, MEgreenyellow and MEdarkred). Additionally, an lncRNA-miRNA-mRNA network was constructed, incorporating several known salt-associated miRNAs such as miR156, miR169 and miR396.

Conclusions

This study enhances our understanding of the role of lncRNAs in the response of tobacco to salt stress. It provides valuable information on co-expression networks of lncRNA and mRNAs, as well as networks of lncRNAs-miRNAs-mRNAs. These findings identify important candidate lncRNAs that warrant further investigation in the study of plant-environment interactions.
"We are still tired": staff and administrators’ experiences during the COVID-19 pandemic within California residential care facilities for older adults
Authors: Bahr Kaitlin O. , Bhavsar Grishma P. , Zhao David
Published: December 2023

Background

Extensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic.

Methods

An electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators’ confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale.

Results

A total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities’ ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic.

Conclusions

Findings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.