bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors of Challenge-Proven Beta-Lactam Allergy in Children with Immediate and Non-Immediate Mild Cutaneous Reactions
Authors: Sipahi Cimen Sevgi , Hizli Demirkale Zeynep , Yucel Esra , Ozceker Deniz , Suleyman Ayse , Sayili Ugurcan , Tamay Zeynep , Guler Nermin
Published: March 2023

Introduction: Beta-lactam (BL) antibiotics are the most often involved drugs in allergic reactions. Mild cutaneous reactions such as maculopapular exanthema or urticaria are the most common presenting complaints of BL allergy in the pediatric population. However, it can be challenging to distinguish BL-induced allergy from reactions due to infections or other reasons. In this study, we aimed to determine the clinical characteristics and potential risk factors of true BL allergy in children with suspected mild cutaneous reactions to BLs. Methods: We evaluated children who were admitted to our pediatric allergy clinic with suspected BL allergy in between January 2015 and March 2020. Patients with a history suggestive of immediate and non-immediate mild cutaneous reactions were included in the study. The oral challenge test (OCT) with the culprit drug was performed on all patients to confirm the diagnosis. Results: Two hundred fourteen (119 male and 95 female) patients with a median age of 4.9 years were evaluated. BL allergy was confirmed in 10.7% (23) of the patients, according to the OCT results. Most of the proven allergic reactions were of the immediate type (73.9%), and urticaria was the most common presenting complaint (60.8%) in proven BL-allergic patients. The negative predictive value of penicillin-G skin testing was 89.7% for immediate-type penicillin allergy and 93.4% for non-immediate reactions. Also, positive predictive value of penicillin-G skin testing was 50% for immediate and 25% for non-immediate reactions. In the multivariate logistic regression analysis, a history of proven drug allergy (Exp (B): 7.76, 95% CI: 1.88–31.97, p = 0.005) was found to be the risk for BL allergy. Conclusion: This study highlighted that OCTs should be performed to confirm the diagnosis in patients suspected of immediate and non-immediate mild cutaneous reactions to BLs and remove the overestimated “BL allergy” label. In these patients, a history of proven drug allergy might be a risk factor for true BL allergy.
Checklist of Indian mites in the family Laelapidae (Acari: Mesostigmata)
Authors: BANDYOPADHYAY PRITHA , KARMAKAR KRISHNA , HALLIDAY BRUCE
Published: March 2023

Laelapidae Canestrini, 1891 is one of the most diverse mite families in the order Mesostigmata, but the Indian fauna of this family is very poorly known. This paper is a checklist of the known species of Laelapidae recorded from India, with a summary of the available information on the distribution and biology of each species. The known fauna includes 66 species in 21 genera, plus seven species whose generic placement is unresolved and a number of others that lack validly published descriptions.
Venue Shopping in Multiple Streams: Campus Free Speech Policy Adoption in Wisconsin
Authors: Stelbotsky Brian , Fowler Luke
Published: March 2023

Wisconsin’s Campus Free Speech Act provides a distinctive case study to examine the intersection of venue shopping and the multiple streams framework. After some initial traction, entrepreneur ran into roadblocks in the state legislature; then, shifted their attention to the University of Wisconsin Board of Regents, where they were able to take advantage of an open policy window. When these events are considered holistically, they illustrate how manipulating institutional structures and fragmented authorities can help entrepreneurs achieve their goals.
Can psychedelics enhance group psychotherapy? A discussion on the therapeutic factors
Authors: Ponomarenko Polina , Seragnoli Federico , Calder Abigail , Oehen Peter , Hasler Gregor
Published: March 2023

Background:

Despite the growth of psychedelic research, psychedelic-assisted group psychotherapy (PAGP) has received little attention in comparison to individual psychedelic-assisted psychotherapy models.

Methods:

In this article, we aim to discuss the therapeutic potential of PAGP, as well as outline existing models and the challenges of this approach. Using Irvin Yalom’s 11 therapeutic factors of group therapy as a basic framework, we analyse current literature from clinical studies and neurobiological research relative to the topic of PAGP.

Results:

We argue that combining psychedelic substances and group psychotherapy may prove beneficial for increasing group connectedness and interpersonal learning, potentially enhancing prosocial behaviour with direct opportunities to practice newly acquired knowledge about previously maladaptive behavioural patterns. Challenges regarding this approach include a more rigid therapy structure and potential loss of openness from patients, which may be ameliorated by adequate therapeutic training.

Conclusion:

We hope for this article to support clinical research on PAGP by presenting a therapeutic framework and outlining its mechanisms and challenges.
The Bullying in Anaesthesia Registrars Survey (BARS): Does a validated questionnaire improve our understanding of bullying in Australian and New Zealand anaesthesia trainees?
Authors: Garnett Peter BJ , Douglas Scott G , Riley Richard H , Roberts Lindy J
Published: March 2023

Previous studies have established that bullying is a pervasive problem in healthcare. However, most investigations of bullying in anaesthesia use self-labelled survey questions in which respondents’ subjective perceptions of bullying are central in defining prevalence. This study applied the validated revised Negative Acts Questionnaire (NAQ-r) for a more objective assessment of bullying prevalence and types of negative behaviours experienced by anaesthesia trainees in Australia and New Zealand.

An online questionnaire was distributed by the Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network to 990 randomly selected ANZCA trainees. Bullying prevalence was assessed using both a self-labelled survey tool and the NAQ-r, which requires respondents to select from a list of negative acts, with validated cut-offs that define bullying. Sources of bullying, impact on recipients and barriers to reporting were also examined. This design allowed comparison of the two methods for evaluating bullying prevalence.

Twenty-six percent of trainees surveyed completed both bullying survey instruments. Thirty percent of these respondents self-labelled as having experienced bullying in the previous six months, with 8% reporting bullying at least monthly. With the NAQ-r, most respondents (96%) reported experiencing at least one negative act in the prior six months, with 54% reporting these on a monthly basis. The most frequent behaviours described were humiliation and intimidation. Using NAQ-r cut-offs, 36% of respondents experienced occasional bullying and 10% were victims of severe workplace bullying.

The NAQ-r provides a more nuanced and objective insight into bullying faced by ANZCA trainees than do self-labelled surveys. The results of the present study provide a valuable baseline for ongoing assessment.
Managing the Logistics Distribution Performance Using Digitalization in the FMCG Sector
Authors: Chauhan Pradeep , Bangwal Deepak , Kumar Rupesh
Published: March 2023

The logistics performance of fast-moving consumer goods (FMCG) depends profoundly on transportation and warehouse performance, which can be worked on through digitalization. This paper studies the distribution of FMCG and tries to identify inefficiencies in transportation and warehousing operations. The factors leading to inefficiencies in transportation and warehouse performance are identified through a literature review. The goal is to assess the impact of digitalization on composed activities scattering execution. The information was gathered through organized polls from 256 managers and executives in the FMCG area. The information is examined through structural equation modelling with AMOS. The calculated model is formed, and speculations are tried in light of the model. The measuring model’s parameters were assessed for reliability, convergent and discriminant validity. The results of the study indicate the optimization of transport performance and warehousing performance has a positive impact on the logistics distribution performance of FMCG. The partly mediating effect of digitalization is also supported and found to be substantial in enhancing logistics distribution performance.
Experiment and meso-scale modelling on combined effects of strain rate and specimen size on uniaxial-compressive failures of concrete
Authors: Yu Wenxuan , Jin Liu , Du Xiuli
Published: March 2023

This paper presents experimental and meso-scale modelling studies on the combined effects of strain-rate and specimen size on uniaxial compressive failure behaviour of concrete. A series of uniaxial compressive tests and meso-scale simulations were conducted on concrete with various specimen sizes under different strain-rates covering the strain-rate range of seismic load, with special focus on the quantitative contribution of end-friction to compressive strength and its corresponding strain-rate effect as well as size effect. Results indicate that the uniaxial compressive failure with end-friction follows an hourglass failure pattern while that without end-friction exhibits a columnar failure pattern. The end-friction effect can form different confined zone distributions for various sized specimens, which can cause the contribution of end-friction to compressive strength is size dependent as well as enhance the influence of specimen size on static and dynamic strength. The contribution proportion of end-friction to compressive strength is around 20∼25%. Moreover, larger-sized specimen performs a stronger strain-rate effect and the increasing strain-rate can weaken the influence of specimen size on the real compressive strength. The proposed real DIF empirical formula considering the size-dependency (covering the low strain-rate range) can well estimate the strain-rate effect for concrete with different sizes, which can provide a valuable reference for the numerical calculation of dynamic mechanical response and the safety design of concrete structures.
Immigration Policy is Health Policy: News Media Effects on Health Disparities for Latinx Immigrant and Indigenous Groups
Authors: Espinoza-Kulick Mario , Espinoza-Kulick Alex , González Elisa , Takahashi Jodene
Published: March 2023

Legal exclusions and cultural factors reproduce barriers to health care by enforcing boundaries between citizens and immigrants, leading to a range of health risks and disparities for Latinx immigrant and Indigenous communities. This study utilized a mixed-methods examination of news media and ethnographic interviews guided by a decolonial-inspired framework to demonstrate the linkages between policy discourse and health behaviors. Both newspaper articles and interviews with affected stakeholders show how immigrants and their families experience more significant health risks because of policy changes and proposals. Regardless of the political regime, media discourses that promote fear and threat sustain the overall effects of immigration policy enforcement strategies on health. Immigration policy is health policy, and these laws should be evaluated in terms of their impact on public health, in addition to other factors. Furthermore, the news media is a contextual factor for health promotion strategies and a target for health advocates working with immigrant and Indigenous communities.
Dates, Carpets, and Pearl Necklaces: The Case of Anno 1404s Exotic Orientalism
Authors: Buhari Ömer Kemal
Published: March 2023

Since a few decades, digital games have become an area deemed worthy of studying for academics of multifarious fields. Numerous articles and books are being written on the topic of games and culture. Anno 1404 is an economic simulation with a medieval setting that deploys various Orientalist stereotypes. Some scholars, leaning on Said's seminal work Orientalism, have analyzed Orientalist aspects in various digital games. The scope of this article consists of such an analysis of Anno 1404. The game's setting, religious context, view of Muslims, mechanism, narrative, characters, representations, gamescape, geopolitics, and stereotypes are pertinent to this analysis. Anno 1404 proves to carry the characteristics of colonialism, imperialism, and exotic Orientalism.
Cancer Metastases to the Hand: A Systematic Review and Meta-analysis
Authors: Dow Todd , Davis Caitlin , ElAbd Rawan , Lalonde Donald , Williams Jason
Published: March 2023

Background:

Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management.

Methods:

An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival.

Results:

Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months.

Conclusion:

Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.
Field-based upper-body motor variability as determinant of stroke performance in the main tennis strokes
Authors: Ruiz-Malagón Emilio J , Vanrenterghem Jos , Ritacco-Real Maximiliano , González-Fernández Francisco T , Soto-Hermoso Víctor Manuel , Delgado-García Gabriel
Published: March 2023

Performance in tennis relies heavily on the skilful repetition of several types of tennis strokes, yet the role of motor variability has still received little scientific attention – especially at the within subject level. The present study aims to evaluate the role of motor variability depending on the strokes/body segment and the level of expertise. Thirty-five players performed a field test (including first and second serves, forehand and backhand strokes) with four synchronized gyroscopes placed on the trunk, head, upper arm and forearm. Variability was measured based on the coefficient of variation (CV) of the angular velocity peaks per stroke in each body segment. MANOVA revealed greater motor variability in the forehand and backhand than in the serve ( p < 0.001), with head and forearm segments showing the highest variability (CV > 15% in some cases). This result also translated to differences in variability between levels of expertise, with variability being greater among lower level players ( p < 0.02 in all strokes, with Cohen d > 1 in some cases). Summarized, groundstrokes could imply more compensatory kinematic movements to keep the result of the action stable. Motor variability must be considered to evaluate performance, as a reduced motor variability was found in players with higher level of expertise. The compensatory action of the body segments (especially in groundstrokes and in the forearm and head, where the coefficients of variation were high) should be studied in depth because it can help design motor tasks, making them more specific.
Using Space Syntax Analysis to Measure Patient Aggression Risk
Authors: MohammadiGorji Soheyla , Nubani Linda , Bosch Sheila J. , Valipoor Shabboo , McElhinney Sam
Published: March 2023

Objectives:

The present study investigates whether space syntax offers appropriate tools for identifying risks of aggression, interventional opportunities, and environmental design strategies to reduce the risk of Type II violence in emergency departments.

Background:

Although healthcare workers are a relatively small percentage of the U.S. workforce, they sustain almost 75% of workplace assaults. Poor environmental design has been identified as an antecedent to aggression by patients and/or their companions.

Method:

Guided by Rational Choice Theory, Lifestyle Exposure Theory, Routine Activity Theory, and Crime Prevention through Environmental Design (CPTED), the study uses five visibility graph analysis (VGA) measures: visibility, control, controllability, mean visual depth, and occlusivity. Three U.S. hospital-based emergency departments were selected. First, a VGA was performed on all three layouts. A second VGA was performed after excluding unconnected spaces, and a third was performed on key patient and staff areas. Last, a fourth VGA was conducted after performing physical modifications to the three departments.

Results:

Statistical analysis revealed significant differences in VGA measures not only between different layouts but also between the original and modified layouts. Specifically, small changes created by architectural features can affect visual access and exposure as measured by space syntax. Alcove-style spaces in key staff areas are also associated with limited visual control of the local environment. Typically, in smaller zones, central staff workstations afford better control of patient spaces.

Conclusion:

This study shows that space syntax analysis is a useful tool for identifying risks of aggression in hospital spaces and for identifying interventional opportunities.
Relationships Between Psychosocial Factors and Mental Health Among Nurses Working With COVID-19 Patients in Japan
Authors: Ohue Takashi , Togo Eiichi , Ohue Yuka , Mitoku Kazuko
Published: March 2023

Background

Nurses who work with COVID-19 patients may suffer high levels of work-related stress, anxiety, and depressive symptoms. These impacts raise concerns about the deterioration of their mental health during this time.

Objective

This study examines the relationships between psychosocial factors (health, behavior, social, and economic factors) and mental health on among nurses working in a COVID-19 ward in Japan.

Design

A cross-sectional questionnaire-based study design was adopted.

Methods

We randomly selected 41 general hospitals that had over 400 beds. The participants were nurses who cared for COVID-19 patients at five hospitals. The questionnaire was completed by 56 nurses (seven men and 49 women) (response rate 46.6%). The survey asked participants about their basic attributes (gender, age, years of experience). It also included the Japanese version of the Patient Health Questionnaire-9, the Japanese version of the Generalized Anxiety Disorder-7, the Japanese version of the Impact of Event Scale-Revised, and the Maslach Burnout Inventory-General Survey to measure depression, anxiety, trauma experience, and burnout, respectively. To determine psychosocial factors, perception of damage from harmful rumors, nurses’ intention to quit their jobs, working environment changes, and changes in daily life were measured.

Results

Intention to quit was specifically associated with “wanting to continue nursing,” the posttraumatic stress disorder (PTSD) symptom of avoidance, depression, anxiety, and burnout. Nurses who had experienced the impact of harmful rumors in the workplace had high levels of PTSD symptoms, including intrusion, avoidance, and hyperarousal, as well as depression, anxiety disorder, and burnout cynicism. Regarding changes in the working environment, significant differences were confirmed in PTSD symptoms including intrusion, avoidance, and hyperarousal, as well as depression. We also examined the relationship between changes in daily life and mental health. We found that answering affirmatively to “the family income has decreased,” “I’ve had family problems,” and “I cannot do housework” related to mental health disorders among the nurses. Consideration: Psychosocial factors that may have been exacerbated during the COVID-19 pandemic were found to affect nurses’ mental health. Thus, reducing these psychosocial factors and building a mental health support system for nurses is crucial.
The association of patient safety culture with patient satisfaction: The role of the pharmacist's performance
Authors: Alolayyan Main Naser , Hijazi Bushra , Jalaileh Raneen Atef
Published: March 2023

Background and objective

A cross-sectional research, the questionnaire-based study aimed to investigate the association between patient safety culture and patient satisfaction through pharmacist performance, between patient safety culture and pharmacist performance, between pharmacist performance and patient satisfaction, and between patient safety culture and patient satisfaction.

Methods

Pharmacists and pharmacy technicians working in the community pharmacies evaluated the patient safety culture using an online self-administrated questionnaire filled out by participants. The first research questionnaire was adopted from the agency of healthcare research and quality (AHRQ), which was reliable and valid. Pharmacist performance and patient satisfaction were measured by using an online self-completion questionnaire that patients filled out. To measure performance, a previously validated questionnaire was used. For measuring patient satisfaction, The Patient Satisfaction with Pharmacist Clinical Services Questionnaire the final version (PSPSQ 2.0) was used. A total of 204 pharmacists, pharmacy technicians, and 204 patients constitute the research sample.

Results

The results showed that there is a significant association between the patient safety culture and the pharmacist's performance; an insignificant association between the patient safety culture and patient satisfaction; a significant association between the pharmacist’s performance and patient satisfaction; and a pharmacist’s performance mediates the relationship between patient safety culture and patient satisfaction.

Conclusion

The pharmacy sector may effectively reinforce patient safety culture in community pharmacies and enhance pharmacists’ performance to improve the quality of care and increase patient satisfaction.
Genome-wide identification, bioinformatics and expression analysis of HD-Zip gene family in peach
Authors: Wang Zhe , Wu Xuelian , Zhang Binbin , Xiao Yuansong , Guo Jian , Liu Jin , Chen Qiuju , Peng Futian
Published: March 2023

Background

HD-Zips (Homeodomain-Leucine Zippers) are a class of plant-specific transcription factors that play multiple roles in plant growth and development. Although some functions of HD-Zip transcription factor have been reported in several plants, it has not been comprehensively studied in peach, especially during adventitious root formation of peach cuttings.

Results

In this study, 23 HD-Zip genes distributed on 6 chromosomes were identified from the peach (Prunus persica) genome, and named PpHDZ01-23 according to their positions on the chromosomes. These 23 PpHDZ transcription factors all contained a homeomorphism box domain and a leucine zipper domain, were divided into 4 subfamilies(I-IV) according to the evolutionary analysis, and their promoters contained many different cis-acting elements. Spatio-temporal expression pattern showed that these genes were expressed in many tissues with different levels, and they had distinct expression pattern during adventitious root formation and development.

Conclusion

Our results showed the roles of PpHDZs on root formation, which is helpful to better understand the classification and function of peach HD-Zip genes.
Metabolomics reveals arbuscular mycorrhizal fungi-mediated tolerance of walnut to soil drought
Authors: Zou Ying-Ning , Qin Qiu-Yun , Ma Wen-Ya , Zhou Li-Jun , Wu Qiang-Sheng , Xu Yong-Jie , Kuča Kamil , Hashem Abeer , Al-Arjani Al-Bandari Fahad , Almutairi Khalid F. , Abd-Allah Elsayed Fathi
Published: March 2023

Background

Arbuscular mycorrhizal fungi (AMF) have a positive effect on drought tolerance of plants after establishing reciprocal resymbiosis with roots, while the underlying mechanism is not deciphered. Metabolomics can explain the mechanism of plant response to environmental stress by analyzing the changes of all small molecular weight metabolites. The purpose of this study was to use Ultra High Performance Liquid Chromatography Q Exactive Mass Spectrometer to analyze changes in root metabolites of walnut (Juglans regia) after inoculation with an arbuscular mycorrhizal fungus Diversispora spurca under well-watered (WW) and drought stress (DS).

Results

Sixty days of soil drought significantly inhibited root mycorrhizal colonization rate, shoot and root biomass production, and leaf water potential in walnut, while AMF inoculation significantly increased biomass production and leaf water potential, accompanied by a higher increase magnitude under DS versus under WW. A total of 3278 metabolites were identified. Under WW, AMF inoculation up-regulated 172 metabolites and down-regulated 61 metabolites, along with no changes in 1104 metabolites. However, under DS, AMF inoculation up-regulated 49 metabolites and down-regulated 116 metabolites, coupled with no changes in 1172 metabolites. Among them, juglone (a quinone found in walnuts) as the first ranked differential metabolite was up-regulated by AMF under WW but not under DS; 2,3,5-trihydroxy-5–7-dimethoxyflavanone as the first ranked differential metabolite was increased by AMF under DS but not under WW. The KEGG annotation showed a large number of metabolic pathways triggered by AMF, accompanied by different metabolic pathways under WW and DS. Among them, oxidative phosphorylation and phenylalanine metabolism and biosynthesis were triggered by AMF in response to WW and DS, where N-acetyl-L-phenylalanine was induced by AMF to increase under DS, while decreasing under WW.

Conclusion

This study provides new insights into the metabolic mechanisms of mycorrhiza-enhanced drought tolerance in walnuts.
The clinical and epidemiological characteristics of a series of patients living with HIV admitted for COVID-19 in a district hospital
Authors: Mnguni Ayanda Trevor , Schietekat Denzil , Ebrahim Nabilah , Sonday Nawhaal , Boliter Nicholas , Schrueder Neshaad , Gabriels Shiraaz , Sigwadhi Lovemore N. , Zemlin Annalise E. , Chapanduka Zivanai C. , Ngah Veranyuy , Yalew Anteneh , Jalavu Thumeka , Abdullah Ibtisam , Tamuzi Jacques L. , Tembo Yamanya , Davies Mary-Ann , English Rene , Nyasulu Peter S.
Published: March 2023

Background

The coronavirus disease 2019 (COVID-19) pandemic continues to evolve. Globally, COVID-19 continues to strain even the most resilient healthcare systems, with Omicron being the latest variant. We made a thorough search for literature describing the effects of the COVID-19 in a high human immunodeficiency virus (HIV)/tuberculosis (TB) burden district-level hospital setting. We found scanty literature.

Methods

A retrospective observational study was conducted at Khayelitsha District Hospital in Cape Town, South Africa (SA) over the period March 2020–December 2021. We included confirmed COVID-19 cases with HIV infection aged from 18 years and above. Analysis was performed to identify predictors of mortality or hospital discharge among people living with HIV (PLWH). Predictors investigated include CD4 count, antiretroviral therapy (ART), TB, non-communicable diseases, haematological, and biochemical parameters.

Findings

This cohort of PLWH with SARS-CoV-2 infection had a median (IQR) age of 46 (37–54) years, male sex distribution of 29.1%, and a median (IQR) CD4 count of 267 (141–457) cells/mm3. Of 255 patients, 195 (76%) patients were discharged, 60 (24%) patients died. One hundred and sixty-nine patients (88%) were on ART with 73(28%) patients having acquired immunodeficiency syndrome (AIDS). After multivariable analysis, smoking (risk ratio [RR]: 2.86 (1.75–4.69)), neutrophilia [RR]: 1.024 (1.01–1.03), and glycated haemoglobin A1 (HbA1c) [RR]: 1.01 (1.007–1.01) were associated with mortality.

Conclusion

The district hospital had a high COVID-19 mortality rate among PLWH. Easy-to-access biomarkers such as CRP, neutrophilia, and HbA1c may play a significant role in informing clinical management to prevent high mortality due to COVID-19 in PLWH at the district-level hospitals.
ICU infection surveillance can be based on electronic routine data: results of a case study
Authors: Schaumburg Tiffany , Köhler Norbert , Breitenstein Yasmine , Kolbe-Busch Susanne , Hasenclever Dirk , Chaberny Iris F.
Published: March 2023

Background

The surveillance of hospital-acquired infections in Germany is usually conducted via manual chart review; this, however, proves resource intensive and is prone to a certain degree of subjectivity. Documentation based on electronic routine data may present an alternative to manual methods. We compared the data derived via manual chart review to that which was derived from electronic routine data.

Methods

Data used for the analyses was obtained from five of the University of Leipzig Medical Center’s (ULMC) ICUs. Clinical data was collected according to the Protection against Infection Act (IfSG); documentation thereof was carried out in hospital information systems (HIS) as well as in the ICU-KISS module provided by the National Reference Center for the Surveillance of Nosocomial Infections (NRZ). Algorithmically derived data was generated via an algorithm developed in the EFFECT study; ward-movement data was linked with microbiological test results, generating a data set that allows for evaluation as to whether or not an infection was ICU-acquired.

Results

Approximately 75% of MDRO cases and 85% of cases of sepsis/primary bacteremia were classified as ICU-acquired by both manual chart review and EFFECT. Most discrepancies between the manual and algorithmic approaches were due to differentiating definitions regarding the patients’ time at risk for acquiring MDRO/bacteremia.

Conclusions

The concordance between manual chart review and algorithmically generated data was considerable. This study shows that hospital infection surveillance based on electronically generated routine data may be a worthwhile and sustainable alternative to manual chart review.
Multisystem inflammatory syndrome in children associated with Bacille Calmette-Guérin scar: a case presentation
Authors: Kizildag Hilal , Hannavi Kristin Joanna , Gur Rana , Oztarhan Kazim
Published: March 2023

Background

During Coronavirus disease of 2019 (COVID-19) pandemic, the WHO reported a noticeable increase in Kawasaki disease prevalence in countries where Kawasaki disease is rare. This newly seen disease, unlike typical Kawasaki disease, tends to appear at a later age, has prominent gastrointestinal findings, higher rates of myocarditis and coronary artery involvement and a greater need for admission to the intensive care unit (ICU). Induration of the Bacillus Calmette-Guerin (BCG) scar is a rare finding seen in multisystem inflammatory syndrome (MIS-C). This is the second reported case of erythema and induration of the BCG scar in a 1-year-old boy with MIS-C.

Case presentation

The Arabic boy presented with high resistant fever, nausea/vomiting, diarrhea, erythematous lips, and conjunctivitis. He later developed induration of his BCG scar, diffuse rash and desquamation on fingers and toes. He had a history of COVID-19 exposure as his IgG antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive. Based on his clinical findings and repeated lab results, he was diagnosed with MIS-C with Kawasaki features and treated with intravenous immune globulin (IVIG) followed by methylprenisolone and aspirin.

Conclusions

Reaction at the BCG inoculation site is not a diagnostic criteria for Kawasaki, but it is seen clinically in 30-50% of the patients. We report the case of a 1-year-old boy diagnosed with MIS-C presenting with erythema and induration of BCG scar. Further studies are needed to explore this clinical presentation, especially in the countries that have BCG vaccination programs, and to determine the mechanisms of MIS-C.
Failure to diagnose hypochondroplasia by prenatal diagnosis: a case report
Authors: Xie Hua , Chen Yulin , Xiong Fei , Li Jinrong , Yang Fan
Published: March 2023

Background

Hypochondroplasia (HCH) is a common nonlethal skeletal dysplasia caused by pathogenic variations in the fibroblast growth factor receptor 3 (FGFR3) gene, and HCH has similar clinical manifestations with achondroplasia (ACH), which can be screened during the fetal period by prenatal ultrasound testing and diagnosed by genetic testing.

Case presentation

we report the special case of a patient with obvious growth retardation and rhizomelic disproportionate short stature, accompanied by other manifestations, including an enlarged head and short hands at 1 year old. However, several multiple color ultrasound exams identified shortened limbs (< 3rd percentile), an increased biparietal diameter (> 95th percentile) and a low nasal bridge in the fetal period. Due to the high incidence rate of ACH, genetic testing for the hotspot FGFR3 gene c.1138 g > A pathogenic variations was performed immediately in the third trimester. Unfortunately, the definitive diagnosis could not be made before birth due to the negative result of hotspot gene exam. Whole exome sequencing (WES) was performed at 1 year identified FGFR3 gene c.1620C > A variations positivity, and the patient was finally diagnosed as HCH.

Conclusion

Our report extends the understanding of the limitations of prenatal genetic diagnostic testing, especially the hot spot pathogenic variations test should be not the only clinical diagnostic basis. Moreover, this case also emphasizes that further gene analysis for patients with significant conflict between the clinical manifestation and the prenatal genetic panel examination findings should be reconducted timely to spare the family from a delayed diagnosis or a misdiagnosis.
Development and initial evaluation of a behavioural intervention to support weight management for people with serious mental illness: an uncontrolled feasibility and acceptability study
Authors: Lee Charlotte , Waite Felicity , Piernas Carmen , Aveyard Paul
Published: March 2023

Background

The rates of obesity and associated health problems are higher in people with serious mental illness (SMI), such as schizophrenia and bipolar disorder, than the general population. A primary care referral to a behavioural weight management programme can be an effective intervention, but people with SMI have reported barriers to engaging with them and bespoke options are rarely provided in routine practice. It is possible that adjunct support addressing these specific barriers could help. Here we report the development, feasibility and acceptability of an intervention to improve uptake and engagement with a mainstream weight management programme for people with SMI.

Methods

We worked with people with a lived-experience of SMI and used the person-based approach to develop the ‘Weight cHange for people with sErious mEntal iLlness’ (WHEEL) intervention. It comprised a referral to a mainstream weight management programme (WW®) to be attended once a week, in-person or online, for 12-weeks. The adjunct support comprised a one-off, online consultation called Meet Your Mentor and weekly, telephone or email Mentor Check Ins for 12-weeks. We assessed the feasibility of WHEEL through the number of programme and adjunct support sessions that the participants attended. We analysed the acceptability of WHEEL using a thematic analysis of qualitative interviews conducted at baseline and at 12-week follow-up. Our exploratory outcome of clinical effectiveness was self-reported weight at baseline and at end-of-programme.

Results

Twenty participants were assessed for eligibility and 17 enrolled. All 17 participants attended Meet Your Mentor and one was lost to follow-up (94% retention). Nine out of 16 attended ≥50% of the weekly programme sessions and 12/16 attended ≥50% of the weekly check-ins. Participants reported in the interviews that the adjunct support helped to establish and maintain a therapeutic alliance. While some participants valued the in-person sessions, others reported that they preferred the online sessions because it removed a fear of social situations, which was a barrier for some participants. The mean change in self-reported weight was − 4·1 kg (SD: 3·2) at 12-weeks.

Conclusions

A mainstream weight management programme augmented with brief and targeted education and low-intensity check-ins generated sufficient engagement and acceptability to warrant a future trial.
Young people’s explanations for the decline in youth drinking in England
Authors: Whitaker Victoria , Curtis Penny , Fairbrother Hannah , Oldham Melissa , Holmes John
Published: March 2023

Background

Youth alcohol consumption has fallen markedly over the last twenty years in England. This paper explores the drivers of the decline from the perspectives of young people.

Methods

The study used two methods in a convergent triangulation design. We undertook 38 individual or group qualitative interviews with 96 participants in various educational contexts in England. An online survey of 547 young people in England, was also conducted. Participants were aged between 12–19 years. For both data sources, participants were asked why they thought youth alcohol drinking might be in decline. Analysis of interview data was both deductive and inductive, guided by a thematic approach. Content analysis of survey responses further refined these themes and indicated their prevalence within a larger sample.

Results

The research identified eight key themes that young people used to explain the decline in youth drinking: The potential for alcohol-related harm; Contemporary youth cultures and places of socialisation; The affordability of alcohol; Displacement of alcohol by other substances; Access and the regulatory environment; Disputing the decline; Future Orientations; and Parenting and the home environment. Heterogeneity in the experiences and perspectives of different groups of young people was evident, particularly in relation to age, gender, and socio-economic position.

Conclusions

Young people’s explanations for the decline in youth drinking in England aligned well with those generated by researchers and commentators in prior literature. Our findings suggest that changing practices of socialisation, decreased alcohol affordability and changed attitudes toward risk and self-governance may be key explanations.
High variability of COVID-19 case fatality rate in Germany
Authors: Wjst Matthias , Wendtner Clemens
Published: March 2023

Background

During the first wave of the COVID-19 pandemic a high case fatality rate (CFR) was noticed worldwide including also Germany where the first European cases have been observed. The WHO recommended immediate intubation for patients with dyspnoea which has since been revised after reviewing the initial clinical outcome. The objective of this study is to analyze CFR and assess if there is an advantage of a more conservative management of COVID-19 induced hypoxemia.

Methods

PCR confirmed COVID-19 infections and death counts were obtained for all German districts from 27 Jan 2020 until 15 Feb 2021 using official reports of Robert Koch Institute Berlin, Germany. A moving average CFRt was constructed by dividing disease related deaths two weeks after a given index day by the number of infections two weeks prior to that date. In addition to a local comparison also mortality outcomes in other German speaking countries were compared.

Results

The mean CFR is estimated to be 2.92% based on 71.965 fatalities and 2.465.407 cases. There was a large regional scattering of CFRs across the German districts. Differences of the mortality pattern were observed also at state level and preserved across different sex and age groups while being largely independent of case numbers. Although Munich city had higher infection rates, more patients died during the first wave in Hamburg (OR 1.6, 95% CI 1.3–1.9) which was mirrored also by higher death risk at Hamburg intensive care units (OR 2.0, 95% CI 1.3–3.1). While the majority of Munich hospitals favoured a conservative management of hypoxemia including high flow nasal cannula (HFNC), Hamburg hospitals followed a more aggressive scheme of early mechanical ventilation (MV). Austria and Switzerland experienced higher CFRs than Germany during the first wave but after changing their treatment guidelines, both countries experienced lower CFRs during the second wave.

Conclusion

Using retrospective public health data, different case fatality rates have been observed across Germany. A more conservative management of COVID-19 induced Adult Respiratory Distress Syndrome (ARDS) is justified also by epidemiological data.
Resiliency of the Iranian healthcare facilities against the Covid-19 pandemic: challenges and solutions
Authors: Ezzati Farahnaz , Mosadeghrad Ali Mohammad , Jaafaripooyan Ebrahim
Published: March 2023

Background

Health care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions.

Methods

This qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data.

Results

Overall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources.

Conclusion

The Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.
Inflammatory myofibroblastic tumour of the common bile duct: a case report and literature review
Authors: Huang Xiang , Li Guoli , Wang Jinjing , Zheng Hong
Published: March 2023

Introduction

Inflammatory myofibroblastic tumour (IMT) of the common bile duct (CBD) is an extremely rare low-grade malignancy with various biological behaviours and a lack of specific clinical and histopathological features. Preoperative and intraoperative diagnosis are challenging, and a diagnostic delay may increase surgical complexity.

Case presentation

We present the case of a 34-year-old male with no relevant medical history who presented with jaundice of 20 days of evolution. Histology and immunohistochemistry confirmed the diagnosis of an IMT with anaplastic lymphoma kinase (ALK)-1 expression. In addition, a review of the relevant literature revealed 13 published reports of biliary IMTs. The clinical history and histopathological features in these 13 cases were compared with those in our case to provide a comprehensive overview of the clinical manifestations and histopathological features of the disease.

Conclusion

IMT of the CBD is an extremely rare low-grade malignancy that mainly occurs in middle-aged female patients. The main clinical manifestation is monosymptomatic jaundice. The reported tumours originated in the middle and lower segments of the CBD, with an average size of approximately 3.5 cm × 3.0 cm and tumour cells expressing smooth muscle actin (SMA), vimentin and ALK. Abnormal ALK expression and ALK gene rearrangement represent potential histopathological and differential diagnoses. A clear diagnosis by preoperative biopsy and intraoperative frozen section examination is critical and can significantly reduce surgical trauma. The prognosis is good, and very few patients experience recurrence or distant metastasis.
A short peptide exerts neuroprotective effects on cerebral ischemia–reperfusion injury by reducing inflammation via the miR-6328/IKKβ/NF-κB axis
Authors: Li Yilin , Jin Tao , Liu Naixin , Wang Junsong , Qin Zihan , Yin Saige , Zhang Yingxuan , Fu Zhe , Wu Yutong , Wang Yinglei , Liu Yixiang , Yang Meifeng , Pang Ailan , Sun Jun , Wang Ying , Yang Xinwang
Published: March 2023

Background

Despite considerable efforts, ischemic stroke (IS) remains a challenging clinical problem. Therefore, the discovery of effective therapeutic and targeted drugs based on the underlying molecular mechanism is crucial for effective IS treatment.

Methods

A cDNA-encoding peptide was cloned from RNA extracted from Rana limnocharis skin, and the mature amino acid sequence was predicted and synthesized. Hemolysis and acute toxicity of the peptide were tested. Furthermore, its neuroprotective properties were evaluated using a middle cerebral artery occlusion/reperfusion (MCAO/R) model in rats and an oxygen–glucose deprivation/reperfusion (OGD/R) model in neuron-like PC12 cells. The underlying molecular mechanisms were explored using microRNA (miRNA) sequencing, quantitative real-time polymerase chain reaction, dual-luciferase reporter gene assay, and western blotting.

Results

A new peptide (NP1) with an amino acid sequence of ‘FLPAAICLVIKTC’ was identified. NP1 showed no obvious toxicities in vivo and in vitro and was able to cross the blood–brain barrier. Intraperitoneal administration of NP1 (10 nmol/kg) effectively reduced the volume of cerebral infarction and relieved neurological dysfunction in MCAO/R model rats. Moreover, NP1 significantly alleviated the decrease in viability and increase in apoptosis of neuron-like PC12 cells induced by OGD/R. NP1 effectively suppressed inflammation by reducing interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) levels in vitro and in vivo. Furthermore, NP1 up-regulated the expression of miR-6328, which, in turn, down-regulated kappa B kinase β (IKKβ). IKKβ reduced the phosphorylation of nuclear factor-kappa B p65 (NF-κB p65) and inhibitor of NF-κB (I-κB), thereby inhibiting activation of the NF-κB pathway.

Conclusions

The newly discovered non-toxic peptide NP1 (‘FLPAAICLVIKTC’) exerted neuroprotective effects on cerebral ischemia–reperfusion injury by reducing inflammation via the miR-6328/IKKβ/NF-κB axis. Our findings not only provide an exogenous peptide drug candidate and endogenous small nucleic acid drug candidate but also a new drug target for the treatment of IS. This study highlights the importance of peptides in the development of new drugs, elucidation of pathological mechanisms, and discovery of new drug targets.