bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of core components and implementation strategies for a Conservative Kidney Management Pathway across a complex, multisector healthcare system in Canada using World Cafés and the Theoretical Domains Framework
Authors: Davison Sara , Steinke Vanessa , Wasylynuk Betty Ann , Holroyd-Leduc Jayna
Published: May 2022

Objective

Develop a Conservative Kidney Management (CKM) Pathway for patients unlikely to benefit from dialysis. We sought to determine (1) core components of care and (2) implementation strategies across a multisector healthcare system.

Design

We used the Knowledge to Action Cycle and the Theoretical Domains Framework to identify barriers and facilitators to CKM. Activities included a current state assessment, World Cafés, interviews, focus groups and readiness for change assessments.

Setting

A provincial initiative in Alberta, Canada.

Participants

282 participants were purposively selected to reflect those involved in the care of patients receiving CKM. This included policy-makers, multidisciplinary healthcare professionals, patients and their family.

Main outcome measures

Theoretical domains linked to pathway content and implementation strategies.

Results

Environmental context and resources, social/professional role and identity, knowledge and social influences were the most influential behaviour change domains identified. The most effective strategies for facilitating behaviour change were identified to be education, training, environmental restructuring and modelling. Core components of care were determined to be guidelines for treating symptoms and disease complications consistent with the philosophy of CKM, timely communication of the choice for CKM, coordination with community services, crisis planning, advance care planning and tools to enhance patients’ capacity for self-management and shared decision-making. This resulted in development of Alberta’s CKM Pathway, an interactive, digital, decision-support tool consisting of: (1) a patient decision aid; (2) a patient/family portal; and (3) a healthcare professional portal, where all resources can be freely accessed.

Conclusions

The pathway was codesigned by patients and healthcare professionals and involves tailor-made combinations of tools to address unique patient needs and system-community circumstances. Most of the strategies are adaptable to local context and are likely translatable to the implementation of sustainable CKM in other national and international jurisdictions.
Developing and validating a prognostic prediction model for patients with chronic kidney disease stages 3–5 based on disease conditions and intervention methods: a retrospective cohort study in China
Authors: Zhang Min , Lei Nuo , Zhang Xian-Long , Xu Yanmin , Chen Hui-Fen , Fu Li-Zhe , Tang Fang , Liu Xusheng , Wu Yifan
Published: May 2022

Objectives

To develop and validate a nomogram model to predict chronic kidney disease (CKD) stages 3–5 prognosis.

Design

A retrospective cohort study. We used univariate and multivariate Cox regression analysis to select the relevant predictors. To select the best model, we evaluated the prediction models’ accuracy by concordance index (C-index), calibration curve, net reclassification index (NRI) and integrated discrimination improvement (IDI). We evaluated the clinical utility by decision curve analysis.

Setting

Chronic Disease Management (CDM) Clinic in the Nephrology Department at the Guangdong Provincial Hospital of Chinese Medicine.

Participants

Patients with CKD stages 3–5 in the derivation and validation cohorts were 459 and 326, respectively.

Primary outcome measure

Renal replacement therapy (haemodialysis, peritoneal dialysis, renal transplantation) or death.

Results

We built four models. Age, estimated glomerular filtration rate and urine protein constituted the most basic model A. Haemoglobin, serum uric acid, cardiovascular disease, primary disease, CDM adherence and predictors in model A constituted model B. Oral medications and predictors in model A constituted model C. All the predictors constituted model D. Model B performed well in both discrimination and calibration (C-index: derivation cohort: 0.881, validation cohort: 0.886). Compared with model A, model B showed significant improvement in the net reclassification and integrated discrimination (model A vs model B: NRI: 1 year: 0.339 (−0.011 to 0.672) and 2 years: 0.314 (0.079 to 0.574); IDI: 1 year: 0.066 (0.010 to 0.127), p<0.001 and 2 years: 0.063 (0.008 to 0.106), p<0.001). There was no significant improvement between NRI and IDI among models B, C and D. Therefore, we selected model B as the optimal model.

Conclusions

We constructed a prediction model to predict the prognosis of patients with CKD stages 3–5 in the first and second year. Applying this model to clinical practice may guide clinical decision-making. Also, this model needs to be externally validated in the future.

Trial registration number

ChiCTR1900024633 (http://www.chictr.org.cn).
ACT Transition from Hospital to Home Orthopaedic Survey: a cross-sectional survey of unplanned 30-day readmissions for patients having total hip arthroplasty
Authors: Yeung Sybil , Perriman Diana , Chhabra Madhur , Phillips Christine , Parkinson Anne , Glasgow Nicholas , Douglas Kirsty A , Cox Darlene , Smith Paul , Desborough Jane
Published: May 2022

Objectives

The aim of this study was to identify patient, hospital and transitional factors associated with unplanned 30-day readmissions in patients who had a total hip arthroplasty (THA).

Design

A cross-sectional survey was performed. All patients attending a 6-week follow-up after a THA in the Australian Capital Territory (ACT) at four public and private clinics in the ACT from 1 February 2018 to 31 January 2019, were invited to complete an ACT Transition from Hospital to Home Orthopaedic Survey.

Participants

Within the ACT, 431 patients over the age of 16 attending their 6-week post-surgery consultation following a THA entered and completed the survey (response rate 77%).

Primary outcome measure

The primary outcome measure was self-reported readmissions for any reason within 30 days of discharge after a THA. Multiple logistic regression was used to estimate ORs of factors associated with unplanned 30-day readmissions.

Results

Of the 431 participants (representing 40% of all THAs conducted in the ACT during the study period), 27 (6%) were readmitted within 30 days of discharge. After controlling for age and sex, patients who did not feel rested on discharge were more likely to be readmitted within 30 days than those who felt rested on discharge (OR=5.75, 95% CI: (2.13 to 15.55), p=0.001). There was no association between post-hospital syndrome (ie, in-hospital experiences of pain, sleep and diet) overall and readmission. Patients who suffered peripheral vascular disease (PVD) were significantly more likely to have an unplanned 30-day readmission (OR=16.9, 95% CI: (3.06 to 93.53), p=0.001). There was no significant difference between private and public patient readmissions

Conclusions

Hospitals should develop strategies that maximise rest and sleep during patients’ hospital stay. Diagnosis and optimum treatment of pre-existing PVD prior to THA should also be a priority to minimise the odds of subsequent unplanned readmissions.
Implementation and staff understanding of shared decision-making in the context of recovery-oriented care across US Veterans Health Administration (VHA) inpatient mental healthcare units: a mixed-methods evaluation
Authors: Eliacin Johanne , Carter Jessica , Bass Emily , Flanagan Mindy , Salyers Michelle P , McGuire Alan
Published: May 2022

Objectives

To examine the understanding and practice of shared decision-making (SDM) within the context of recovery-oriented care across Veterans Health Administration (VHA) inpatient mental healthcare units.

Design

VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient Scale (RAIN). Scores on the RAIN item for medication SDM were used to rank each site from lowest to highest. The top 7 and bottom 8 sites (n=15) were selected for additional analyses using a mixed-methods approach, involving qualitative interviews, observation notes and quantitative data.

Setting

34 VHA inpatient mental health units located in every geographical region of the USA.

Participants

55 treatment team members.

Results

Our results identified an overarching theme of ‘power-sharing’ that describes participants’ conceptualisation and practice of medication decision-making. Three levels of power sharing emerged from both interview and observational data: (1)No power sharing:patients are excluded from treatment decisions; (2)Limited power sharing:patients are informed of treatment decisions but have limited influence on the decision-making process; and (3)Shared-power:patients and providers work collaboratively and contribute to medication decisions. Comparing interview to observational data, only observational data indicating those themes differentiate top from bottom scoring sites on the RAIN SDM item scores. All but one top scoring sites indicated shared power medication decision processes, whereas bottom sites reflected mostly no power sharing. Additionally, our findings highlight three key factors that facilitate the implementation of SDM: inclusion of veteran in treatment teams, patient education and respect for patient autonomy.

Conclusions

Implementation of SDM appears feasible in acute inpatient mental health units. Although most participants were well informed about SDM, that knowledge did not always translate into practice, which supports the need for ongoing implementation support for SDM. Additional contextual factors underscore the value of patients’ self-determination as a guiding principle for SDM, highlighting the role of a supporting, empowering and autonomy-generating environment.
Three-arm randomised controlled trial of an m-health app and digital engagement strategy for improving treatment adherence and reducing suicidal ideation in young people: study protocol
Authors: McGillivray Lauren , Gan Daniel Z Q , Wong Quincy , Han Jin , Hetrick Sarah , Christensen Helen , Torok Michelle
Published: May 2022

Introduction

Youth suicidal ideation and behaviour is concerning due to its widespread prevalence, morbidity and potentially fatal consequences. Digital mental health interventions have been found to improve access to low-cost and high-quality support for a range of mental health issues, yet there are few digital interventions available for suicide prevention in young people. In addition, no studies have examined how digital engagement strategies may impact the engagement and efficacy of digital interventions in suicide prevention. The current protocol describes a three-arm parallel randomised controlled trial. A therapeutic smartphone application (‘LifeBuoy’; intervention condition) will be tested against a condition that consists of the LifeBuoy application plus access to a digital engagement strategy (‘LifeBuoy+engagement’; intervention condition) to determine whether the addition of the digital strategy improves app engagement metrics. To establish the efficacy of the LifeBuoy application, both of these intervention conditions will be tested against an attention-matched control condition (a placebo app).

Methods and analysis

669 young Australians aged 17–24 years who have experienced suicidal ideation in the past 30 days will be recruited by Facebook advertisement. The primary outcomes will be suicidal ideation severity and level of app engagement. Primary analyses will use an intention-to-treat approach and compare changes from baseline to 30-day, 60-day and 120-day follow-up time points relative to the control group using mixed-effect modelling. A subset of participants in the intervention groups will be interviewed on their experience with the app and engagement strategy. Qualitative data will be analysed using an inductive approach, independent of a theoretical confirmative method to identify the group themes.

Ethics and dissemination

The study has been approved by the University of New South Wales Human Research Ethics Committee (HC210400). The results of the trial will be disseminated via peer-reviewed publications in scientific journals and conferences.

Trial registration number

ACTRN12621001247864.
Cohort profile: Colombian Cohort for the Early Prediction of Preterm Birth (COLPRET): early prediction of preterm birth based on personal medical history, clinical characteristics, vaginal microbiome, biophysical characteristics of the cervix and maternal serum biochemical markers
Authors: Becerra-Mojica Carlos Hernan , Parra-Saavedra Miguel Antonio , Diaz-Martinez Luis Alfonso , Martinez-Portilla Raigam Jafet , Rincon Orozco Bladimiro
Published: May 2022

Purpose

Preterm birth (PTB) is a public health issue. Interventions to prolong the length of gestation have not achieved the expected results, as the selection of population at risk of PTB is still a challenge. Cervical length (CL) is the most accepted biomarker, however in the best scenario the CL identifies half of the patients. It is unlikely that a single measure identifies all pregnant women who will deliver before 37 weeks of gestation, considering the multiple pathways theory. We planned this cohort to study the link between the vaginal microbiome, the proteome, metabolome candidates, characteristics of the cervix and the PTB.

Participants

Pregnant women in the first trimester of a singleton pregnancy are invited to participate in the study. We are collecting biological samples, including vaginal fluid and blood from every patient, also performing ultrasound measurement that includes Consistency Cervical Index (CCI) and CL. The main outcome is the delivery of a neonate before 37 weeks of gestation.

Findings to date

We have recruited 244 pregnant women. They all have measurements of the CL and CCI. A vaginal sample for microbiome analysis has been collected in the 244 patients. Most of them agreed to blood collection, 216 (89%). By August 2021, 100 participants had already delivered. Eleven participants (11 %) had a spontaneous PTB.

Future plans

A reference value chart for the first trimester CCI will be created. We will gather information regarding the feasibility, reproducibility and limitations of CCI. Proteomic and metabolomic analyses will be done to identify the best candidates, and we will validate their use as predictors. Finally, we plan to integrate clinical data, ultrasound measurements and biological profiles into an algorithm to obtain a multidimensional biomarker to identify the individual risk for PTB.
Rationale and design of a multicentre, 12-week, randomised, double-blind, placebo-controlled, parallel-group, investigator-initiated trial to investigate the efficacy and safety of elobixibat for chronic constipation
Authors: Tanaka Kosuke , Kessoku Takaomi , Yamamoto Atsushi , Takahashi Kota , Kasai Yuki , Ozaki Anna , Iwaki Michihiro , Kobayashi Takashi , Yoshihara Tsutomu , Misawa Noboru , Kato Takayuki , Arimoto Jun , Fuyuki Akiko , Sakai Eiji , Higurashi Takuma , Chiba Hideyuki , Hosono Kunihiro , Yoneda Masato , Iwasaki Tomoyuki , Kurihashi Takeo , Nakatogawa Machiko , Suzuki Ayao , Taguri Masataka , Oyamada Shunsuke , Ariyoshi Keisuke , Kobayashi Noritoshi , Ichikawa Yasushi , Nakajima Atsushi
Published: May 2022

Introduction

Chronic constipation (CC) is a functional disorder that negatively impacts the quality of life of patients. This is a protocol for a multicentre, 12-week, randomised, double-blind, placebo-controlled study to test the efficacy and safety of elobixibat (EXB) versus placebo in patients with CC.

Methods and analysis

This will be a multicentre, double-blind, placebo-control, randomised controlled trial. A total of 100 adult patients with CC, diagnosed based on Rome IV criteria, who fulfil the inclusion/exclusion criteria will be enrolled. The patients will be randomly assigned to receive EXB (10 mg) or placebo treatment (n=50 per group). Blood tests and stool sampling will be performed 12 weeks following initiation of treatment and questionnaires will be issued to participants. The primary outcome will be the change in complete spontaneous bowel movements after 12 weeks of administration. The secondary outcomes will include the change in Japanese Patient Assessment of Constipation Quality of Life and absolute serum and faecal bile acid.

Ethics and dissemination

Ethics approval has been obtained from Yokohama City University Certified Institutional Review Board before participant enrolment. The results of this study will be submitted for publication in international peer-reviewed journals and the key findings will be presented at international scientific conferences.

Protocol version

V.3.0, 15 June 2021.

Trial registration number

ClinicalTrials.gov (number NCT04784780).
Effects of respiratory physiotherapy in patients with amyotrophic lateral sclerosis: protocol for a systematic review of randomised controlled trials
Authors: Pondofe Karen , Marcelino Ana Aline , Ribeiro Tatiana Souza , Torres-Castro Rodrigo , Vera-Uribe Roberto , Fregonezi Guilherme AF , Resqueti Vanessa R
Published: May 2022

Introduction

Respiratory muscle weakness and ventilatory failure are common complications in patients with amyotrophic lateral sclerosis (ALS) and may lead to death. Respiratory physiotherapy may improve lung function in this population. This study aims to investigate the effects of respiratory physiotherapy on lung function, cough efficacy and functional status of patients with ALS.

Methods and analysis

A protocol was published on the International prospective register of systematic reviews (PROSPERO). The research will cover randomised controlled trials, with no language or publication date restriction, available in the following databases: MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science and Physiotherapy Evidence Database. The research question will be answered using a search strategy adapted for each database. Searches in databases will be conducted from January 2021 to December 2022. Two authors using the Cochrane risk of bias tool for randomised trials V.2 and Grading of Recommendations, Assessment, Development and Evaluations, respectively, will assess risk of bias and quality of evidence independently. According to the results obtained, data will be reported as a meta-analysis or a narrative report.

Ethics and dissemination

No previous ethical approval is required for this publication since data used are already published. Results of this review will be disclosed via peer-reviewed publications and conference presentations.

PROSPERO registration number

CRD42021251842.
Assessing the cumulative effect of long-term training load on the risk of injury in team sports
Authors: Bache-Mathiesen Lena Kristin , Andersen Thor Einar , Dalen-Lorentsen Torstein , Clarsen Benjamin , Fagerland Morten Wang
Published: May 2022

Objectives

Determine how to assess the cumulative effect of training load on the risk of injury or health problems in team sports.

Methods

First, we performed a simulation based on a Norwegian Premier League male football dataset (n players=36). Training load was sampled from daily session rating of perceived exertion (sRPE). Different scenarios of the effect of sRPE on injury risk and the effect of relative sRPE on injury risk were simulated. These scenarios assumed that the probability of injury was the result of training load exposures over the previous 4 weeks. We compared seven different methods of modelling training load in their ability to model the simulated relationship. We then used the most accurate method, the distributed lag non-linear model (DLNM), to analyse data from Norwegian youth elite handball players (no. of players=205, no. of health problems=471) to illustrate how assessing the cumulative effect of training load can be done in practice.

Results

DLNM was the only method that accurately modelled the simulated relationships between training load and injury risk. In the handball example, DLNM could show the cumulative effect of training load and how much training load affected health problem risk depending on the distance in time since the training load exposure.

Conclusion

DLNM can be used to assess the cumulative effect of training load on injury risk.
Physical activity in older adults with metastatic gastrointestinal cancer: a pilot and feasibility study
Authors: Brown Justin C , Brighton Elizabeth , Campbell Nancy , McCleary Nadine J , Abrams Thomas A , Cleary James M , Enzinger Peter C , Ng Kimmie , Rubinson Douglas , Wolpin Brian M , Yurgelun Matthew B , Meyerhardt Jeffrey A
Published: May 2022

Objectives

This study determined the feasibility of delivering a 12-week structured physical activity programme during chemotherapy to older adults recently diagnosed with metastatic gastrointestinal (GI) cancer.

Methods

This study used a single-cohort design. Older adults (aged ≥65 years) diagnosed with metastatic oesophageal, gastric, pancreatic or colorectal cancer who planned to initiate chemotherapy were enrolled. The physical activity programme included a combination of aerobic, flexibility, strength and balance modalities delivered by a certified cancer exercise trainer during chemotherapy infusion appointments, then translated and sustained at home by participants. The co-primary endpoints included: (1) accrual of 20 participants in 12 months and (2) physical activity adherence of ≥50%.

Results

Between March and October 2018, 29 participants were screened, and 20 were enrolled within 12 months (recruitment rate: 69% (90% CI: 55% to 83%); p<0.001), meeting the first co-primary endpoint. The median age of participants was 73.3 years (IQR: 69.3–77.2). At week 12, 67% (90% CI: 48% to 85%) of participants adhered to ≥50% of the prescribed physical activity (p=0.079 (statistically significant)), meeting the second co-primary endpoint. From baseline to week 12, accelerometer-measured light-intensity and moderate-intensity to vigorous-intensity physical activity increased by 307.4 (95% CI: 152.6 to 462.2; p<0.001) and 25.0 min per week (95% CI: 9.9 to 40.1; p=0.001), respectively. There were no serious or unexpected adverse events. The median overall survival was 16.2 months (8.4–22.4).

Conclusion

These results establish the feasibility of a larger scale randomised controlled trial that enrols older adults with metastatic GI cancer and delivers a structured physical activity programme during chemotherapy.

Trial registration number

NCT03331406.
Debridement of diabetic foot ulcers: public health and clinical implications – a systematic review, meta-analysis, and meta-regression
Authors: Dayya David , O'Neill Owen , Habib Nusrat , Moore Joanna , Iyer Kartik , Huedo-Medina Tania B
Published: May 2022

Background

Diabetic foot ulceration (DFU) has devastating complications and a lifetime occurrence of 15%–34%. Debridement of DFU is regarded as an intervention that accelerates ulcer healing and may reduce complications including amputations, infections, and poor quality of life (QoL), which have serious public health and clinical implications. A systematic review (SR) of SRs and of randomized controlled trials (RCTs) with meta-analyses (MAs) on debridement of DFU that synthesizes all human experimental evidence is warranted.

Objectives

Are debridement methods in DFU beneficial over other forms and standard gauze dressings (control condition) in these outcomes?

Study eligibility criteria

All SRs/MAs/RCTs comparing debridement methods for DFU with alternative methods of debridement and with control.

Data sources

Cochrane Wounds Group Specialized Register, Cochrane Central Register of Controlled Trials (Cochrane Library), Ovid MEDLINE, PubMed, EMBASE, EBSCO, CINAHL, and Web of Science.

Participants and interventions

Adults with type 1/2 diabetes with DFU and any debridement method compared with alternative debridement methods or control.

Main Outcomes

Amputation rates, wound infections, QoL, proportion of ulcers healed, time to complete healing, ulcer recurrence, and treatment cost.

Study selection and analysis

Data extraction/synthesis by two independent reviewers pooled using a random-effects model with sensitivity analysis.

Results

10 SRs were retrieved and reported qualitatively. Six SRs included MAs. This SR included 30 studies, with 2654 participants, using 19 debridement combinations. The debridement methods were compared with findings pooled into MAs. Meta-regression (MR) did not identify significant predictors/moderators of outcomes.

Limitations

The studies may have been under-powered. The inclusion/exclusion criteria varied and the increased risk of bias contributed to low-quality evidence.

Discussion/Conclusion

Weak evidence exists that debridement methods are superior to other forms of debridement or control in DFU.

Implications

Researchers should follow standardized reporting guidelines (Consolidated Standards of Reporting Trials). Clinicians/investigators could use the findings from this SR/MA/MR in guiding patient-individualized decision making and designing future RCTs.
Perplexity as a provocation: revisiting the role of metaphor as a ‘place holder’ for the potential of COVID-19 antibodies
Authors: Rosengarten Marsha
Published: May 2022

This article revisits long-standing critiques of the role of metaphor in immunological discourse. Drawing on Alfred North Whitehead’s speculative philosophy of organism, I focus on the use of metaphor to explain the process by which COVID-19 vaccine research is able to generate protective antibodies, the challenge of autoimmune disease and dengue fever antibodies. I suggest that metaphors are provoked by the perplexity that arises from presupposing that distinct morphological substances are the first order of reality. I conclude that rather than seeing metaphors as typically skewing conceptions of the body, as has been previously argued, those of memory, recognition and misrecognition may be instructive of a body in transition. Indeed, a process of transition that shows degrees of creativity. When gesturing towards the processual nature of infection and immunity, metaphors invite new modes of shared thinking across the disciplinary divide.
Bioresorbable flow diverters for the treatment of intracranial aneurysms: review of current literature and future directions
Authors: Oliver Alexander A , Carlson Kent D , Bilgin Cem , Arturo Larco Jorge L , Kadirvel Ramanathan , Guillory Roger J , Dragomir Daescu Dan , Kallmes David F
Published: May 2022

The use of flow diverters is a rapidly growing endovascular approach for the treatment of intracranial aneurysms. All FDA-approved flow diverters are composed of nitinol or cobalt-chromium, which will remain in the patient for the duration of their life. Bioresorbable flow diverters have been proposed by several independent investigators as the next generation of flow diverting devices. These devices aim to serve their transient function of occluding and healing the aneurysm prior to being safely resorbed by the body, eliminating complications associated with the permanent presence of conventional flow diverters. Theoretical advantages of bioresorbable flow diverters include (1) reduction in device-induced thrombosis; (2) reduction in chronic inflammation and device-induced stenosis; (3) reduction in side branch occlusion; (4) restoration of physiological vasomotor function; (5) reduction in imaging artifacts; and (6) use in pediatric applications. Advances made in the similar bioresorbable coronary stenting field highlight some of these advantages and demonstrate the feasibility and safety of bioresorbable endovascular devices in the clinic. The current work aims to review the progress of bioresorbable flow diverters, identify opportunities for further investigation, and ultimately stimulate the advancement of this technology.
Comparing the effects of peripheral nerve block and general anesthesia with general anesthesia alone on postoperative delirium and complications in elderly patients: a retrospective cohort study using a nationwide database
Authors: Yoshimura Manabu , Shiramoto Hiroko , Koga Mami , Yoshimatsu Aya , Morimoto Yasuhiro
Published: May 2022

Introduction

The difference between the effects of peripheral nerve block (PNB) with general anesthesia (GA) and GA alone on the patients’ postoperative clinical outcomes remains unknown. We assessed whether there is a difference in postoperative delirium and composite morbidity between patients receiving GA with PNB and GA alone using a national clinical database in Japan.

Methods

We compared the outcomes of patients receiving GA with PNB and GA alone from April 2016 to October 2019. The primary outcome was postoperative delirium, defined as a status requiring newly prescribed antipsychotic drugs or that given the code of a reimbursable disease after the surgery date. The secondary outcome was morbidity incidence as the occurrence of at least one of any of the following life-threatening complications. We conducted propensity score-matched analyses using covariates for patients who underwent any surgical procedure. We used instrumental variables and restricted the definition of postoperative delirium and subgroup for sensitivity analyses.

Results

Of 653,759 patients, 90,358 received GA-PNB and 563,401 received only GA. After 1:4 propensity score matching, 89,754 patients were included in the GA-PNB and 359,015 in the GA. The adjusted ORs for postoperative delirium and composite morbidity were 0.96 (95% CIs 0.94 to 0.99; p<0.01), 0.80 (95% CIs 0.76 to 0.83; p<0.001), respectively, for the GA-PNB concerning the GA. For sensitivity analyses, findings were also consistent with instrumental variables and subgroup analyses.

Discussion

This retrospective, nationwide cohort study demonstrated that GA-PNB was associated with a small reduction in the likelihood of postoperative delirium and a moderate reduction in the likelihood of composite morbidity.
Fermion propagator diagonalization and eigenvalue problem
Authors: Dolzhikov D. A. , Kaloshin A. E. , Lomov V. P.
Published: May 2022

In this paper, we discuss diagonalization of propagator for system of mixing fermions on the base of the eigenvalue problem. The similarity transformation converting matrix propagator into the diagonal form is obtained, which is a necessary element at renormalization of fermion mixing matrix. The suggested diagonalization has simple algebraic properties for on-mass-shell fermions.
PRÜFER ANALYSIS OF PERIODIC SINGULAR STURM–LIOUVILLE PROBLEM WITH PIECEWISE CHARACTERISTIC
Authors: ÇETIN MEHMET AKIF , KABLAN ABDULLAH , MANAFOV MANAF DZH
Published: May 2022

Prüfer transformation is more effective and flexible in studying the spectral analysis of boundary value problem than using the classical methods in operator theory. The goal of this paper is to study Prüfer approach to spectral analysis of periodic Sturm–Liouville problem with transmission condition. Since we are dealing with a singular problem, the characteristic function we obtained is a piecewise function. At the end of the study, the existence of eigenvalues of investigated problem by using Prüfer transformation is given.
SkillBot: Identifying Risky Content for Children in Alexa Skills
Authors: Le Tu , Huang Danny Yuxing , Apthorpe Noah , Tian Yuan
Published: May 2022

Many households include children who use voice personal assistants (VPA) such as Amazon Alexa. Children benefit from the rich functionalities of VPAs and third-party apps but are also exposed to new risks in the VPA ecosystem. In this article, we first investigate “risky” child-directed voice apps that contain inappropriate content or ask for personal information through voice interactions. We build SkillBot—a natural language processing-based system to automatically interact with VPA apps and analyze the resulting conversations. We find 28 risky child-directed apps and maintain a growing dataset of 31,966 non-overlapping app behaviors collected from 3,434 Alexa apps. Our findings suggest that although child-directed VPA apps are subject to stricter policy requirements and more intensive vetting, children remain vulnerable to inappropriate content and privacy violations. We then conduct a user study showing that parents are concerned about the identified risky apps. Many parents do not believe that these apps are available and designed for families/kids, although these apps are actually published in Amazon’s “Kids” product category. We also find that parents often neglect basic precautions, such as enabling parental controls on Alexa devices. Finally, we identify a novel risk in the VPA ecosystem: confounding utterances or voice commands shared by multiple apps that may cause a user to interact with a different app than intended. We identify 4,487 confounding utterances, including 581 shared by child-directed and non-child-directed apps. We find that 27% of these confounding utterances prioritize invoking a non-child-directed app over a child-directed app. This indicates that children are at real risk of accidentally invoking non-child-directed apps due to confounding utterances.
Inhaled silica nanoparticles cause chronic kidney disease in rats
Authors: Sasai Fumihiko , Rogers Keegan L. , Orlicky David J. , Stem Arthur , Schaeffer Joshua , Garcia Gabriela , Fox Jacob , Ray Matthew S. , Butler-Dawson Jaime , Gonzalez-Quiroz Marvin , Leiva Ricardo , Taduri Gangadhar , Anutrakululchai Sirirat , Venugopal Vidhya , Madero Magdalena , Glaser Jason , Wijkstrom Julia , Wernerson Annika , Brown Jared M. , Johnson Richard J. , Roncal-Jimenez Carlos A.
Published: May 2022

Inhalation of silica nanoparticles (SiNPs) released during the burning of sugarcane has been postulated to have a role in chronic kidney disease of unknown etiology (CKDu). We administered 200- and 300-nm amorphous SiNPs to rats by aspiration and observed kidney damage with tubular injury and inflammation that persisted even after stopping the SiNP exposure. These findings support the hypothesis that human exposure to SiNPs found in sugarcane ash could have a participatory role CKDu.
Evolution of the diagnostic value of “the sugar of the blood”: hitting the sweet spot to identify alterations in glucose dynamics
Authors: Magkos Faidon , Reeds Dominic N. , Mittendorfer Bettina
Published: May 2022

In this paper, we provide an overview of the evolution of the definition of hyperglycemia during the past century and the alterations in glucose dynamics that cause fasting and postprandial hyperglycemia. We discuss how extensive mechanistic, physiological research into the factors and pathways that regulate the appearance of glucose in the circulation and its uptake and metabolism by tissues and organs has contributed knowledge that has advanced our understanding of different types of hyperglycemia, namely prediabetes and diabetes and their subtypes (impaired fasting plasma glucose, impaired glucose tolerance, combined impaired fasting plasma glucose, impaired glucose tolerance, type 1 diabetes, type 2 diabetes, gestational diabetes mellitus), their relationships with medical complications, and how to prevent and treat hyperglycemia.
Diosgenin: An Updated Pharmacological Review and Therapeutic Perspectives
Authors: Semwal Prabhakar , Painuli Sakshi , Abu-Izneid Tareq , Rauf Abdur , Sharma Anshu , Daştan Sevgi Durna , Kumar Manoj , Alshehri Mohammed M. , Taheri Yasaman , Das Rajib , Mitra Saikat , Emran Talha Bin , Sharifi-Rad Javad , Calina Daniela , Cho William C.
Published: May 2022

Plants including Rhizoma polgonati, Smilax china, and Trigonella foenum-graecum contain a lot of diosgenin, a steroidal sapogenin. This bioactive phytochemical has shown high potential and interest in the treatment of various disorders such as cancer, diabetes, arthritis, asthma, and cardiovascular disease, in addition to being an important starting material for the preparation of several steroidal drugs in the pharmaceutical industry. This review aims to provide an overview of the in vitro, in vivo, and clinical studies reporting the diosgenin’s pharmacological effects and to discuss the safety issues. Preclinical studies have shown promising effects on cancer, neuroprotection, atherosclerosis, asthma, bone health, and other pathologies. Clinical investigations have demonstrated diosgenin’s nontoxic nature and promising benefits on cognitive function and menopause. However, further well-designed clinical trials are needed to address the other effects seen in preclinical studies, as well as a better knowledge of the diosgenin’s safety profile.
COlchicine to Prevent PeriprocEdural Myocardial Injury in Percutaneous Coronary Intervention (COPE-PCI): Coronary Microvascular Physiology Pilot Substudy
Authors: Cole Justin , Htun Nay , Lew Robert , Freilich Mark , Quinn Stephen , Layland Jamie
Published: May 2022

Aim. In this randomized pilot trial, we aimed to assess the anti-inflammatory effect of preprocedural colchicine on coronary microvascular physiology measurements before and after PCI. Methods. Patients undergoing PCI for stable angina (SA) or non-ST-elevation myocardial infarction (NSTEMI) were randomized to oral colchicine or placebo, 6- to 24-hours before the procedure. Strict prespecified inclusion/exclusion criteria were set to ensure all patients were given the study medication, had a PCI, and had pre- and post-PCI culprit vessel invasive coronary physiology measurements. Fractional flow reserve (FFR), Index of Microvascular Resistance (IMR), Coronary Flow Reserve (CFR), and Resistive Reserve Ratio (RRR) were measured immediately before and after PCI. CMVD was defined as any one of post-PCI IMR >32 or CFR <2 or RRR <2. High-sensitive-(hs)-troponin-I, hsCRP, and leucocyte count were measured before and 24 hours after PCI. Results. A total of 50 patients were randomized and met the strict prespecified inclusion/exclusion criteria: 24-colchicine and 26-placebo. Pre-PCI coronary physiology measurements, hs-troponin-I, and hsCRP were similar between groups. Although numerically lower in patients given colchicine, the proportion of patients who developed CMVD was not significantly different between groups (colchicine: 10 (42%) vs placebo: 16 (62%),

p
=
0.16

). Colchicine patients had higher post-PCI CFR and RRR vs placebo (respectively: 3.25 vs 2.00,

p
=
0.03

& 4.25 vs 2.75,

p
<
0.01

). Neutrophil count was lower after PCI in the colchicine arm

p
=
0.02

, and hsCRP post-PCI remained low in both treatment arms (1.0 mg/L vs 1.7 mg/L,

p
=
0.97

). Patients randomized to colchicine had significantly less PCI-related absolute hs-troponin-I change (46 ng/L vs 152 ng/L,

p
=
0.01

). Conclusion. In this pilot randomized substudy, colchicine given 6 to 24 hours before PCI did not statistically impact the post-PCI CMVD definition used in this study, yet it did improve post-PCI RRR and CFR measurements, with less procedure-related troponin release and less inflammation.
Main Characteristics of Underwater Supersonic Gas Jet Flows
Authors: Nan Huang , Zhi-Hua Chen , Zheng-Lun Wang
Published: May 2022

Underwater supersonic gas jet flows are sophisticated physical phenomena that widely exist in underwater propulsion, such as underwater rocket, high-speed torpedo, and water-piercing missile launcher (WPML). The present study aims to explore the characteristics of underwater supersonic jets. This research carries out two-dimensional and three-dimensional underwater jet experiments and establishes an improved spherical bubble model to study the transient and steady-state characteristics of the underwater supersonic jet. The simulation results show that the entrainment strength and anti-interference ability are the main factors affecting the transient characteristics of underwater supersonic jets. The experimental results show that the jet angle increases with increasing pressure and the increased rate of the jet angle decreases with increasing pressure. The jet pulsation exists in the entire experimental pressure range from 0.4 MPa to 6.5 MPa. The frequency of back-attack increases first and then decreases with increasing pressure in the chamber. The frequency peak appears at 0.8 MPa, which is 5.96 Hz.
Comparative Metabolic Characterization of Extraintestinal Pathogenic Escherichia coli Blood Isolates from Saudi Arabia
Authors: Alangari Abdulaziz , Jaffal Ahmad Abu , Alyousef Abdulaziz M. , Alyousef Abdullah A.
Published: May 2022

Background. The prevalence of bloodstream infections caused by extraintestinal pathogenic Escherichia coli (ExPEC) has increased substantially. E. coli ST131 is one of the dominant ExPEC clones among E. coli bacteremia population. Metabolism can trigger the pathogenesis of some bacterial isolates, and here we evaluated and compared the metabolic traits of E. coli bacteremia isolates including β-lactamase (BL)/extended-spectrum β-lactamase (ESBL)-positive and ESBL-negative isolates and ST131 and non-ST131 isolates. Methods. The metabolic profiles of thirty E. coli isolates, obtained from blood samples for hospitalized individuals at a tertiary healthcare facility in Riyadh, were determined using HiMedia carbohydrate test strips. The difference in the utilization ability between isolate groups was then statistically assessed. Results. Our data found that non-BL/ESBL producers were of low metabolic capacity compared with ESBL-positive isolates although the difference remained insignificant. Higher levels of utilization for some carbohydrates, such as fructose and trehalose, were detected among ST131 isolates when compared with non-ST131, and ST131 was also significantly associated with metabolizing rhamnose. The mean bio-score of both isolate groups was insignificant. We showed no link between metabolism and antimicrobial susceptibility profiles among tested blood isolates. Conclusion. ST131 blood isolates were slightly higher in their carbohydrate utilization activity than non-ST131. More importantly, ST131 isolates were significantly capable of metabolizing rhamnose. Future research should focus on the factors that might drive the success of major ExPEC clones such as ST131.
Analysis of the Effect of Artificial Intelligence on Role Cognition in the Education System
Authors: Zhu Jianjian , Ren Chuming
Published: May 2022

Taking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses the questionnaire survey method to analyze the effect of artificial intelligence (AI) on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. The questionnaire design has a total of 34 question classified into 6 role cognition items, with a 5-level score; a total of 1012 questionnaires were distributed, and 978 were recovered with a recovery rate of 96.64%, in which 957 were valid questionnaires with an effective rate of 97.85%. The study results show that the learning of AI-assisted courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activity methods. Therefore, the effect of AI on role cognition in the education system needs to be systematically analyzed from the aspects of function realization form, resource presentation method, supporting hardware form, teacher-student interaction method, and representation method of works. As connecters, teacher’s role cognition is limited by the degree of understanding learners, the amount of resources, and data processing capabilities, but the advantage is that they can flexibly monitor and adjust. AI technology is flexible and diverse, it functions in learning and teaching activities in a variety of ways, and there is no agreement on the terminology to describe its role in role recognition. The results of this paper provide a reference for further researches on the effect of AI on role cognition in the education system.
An In Vitro Study on the Shear Bond Strength of Feldspathic Porcelain to Nickel Chromium Alloy and Cobalt Chromium Alloy after Various Surface Treatments
Authors: Kamath Vignesh , Kamath Mayuri , Bhargava Abhinav , Shetty Thilak , Rodrigues Shobha J. , Pai Umesh Y. , Saldanha Sharon , Mahesh M. , Hegde Puneeth , Bajantri Prashant , Mukherjee Sandipan , Sales Ann
Published: May 2022

Background. To evaluate and compare the shear bond strength of feldspathic porcelain to four distinctively surface-treated Ni-Cr and Co-Cr alloys and to assess the impact of oxidation-heat treatment on porcelain to base metal alloy bond strength. Methods. 40 specimens each of nickel-chromium alloy and cobalt-chromium alloy were cast. A total of four groups of specimens were created. Group I was surface-treated by sandblasting with 50 μm alumina particles, Group II was surface-treated by sandblasting with 110 μm alumina particles, Group III and Group IV were surface-treated with 250 μm alumina particles. In Group IV, after sandblasting initially with 250 μm alumina particles, the alloys were subjected to oxidation and resandblasting with 250 μm alumina particles. Each of the specimen was coated with opaque and body porcelain and fired to a total thickness of 2 mm porcelain. A universal measuring machine was used to assess shear bond strength at a crosshead speed of 0.5 mm/min. Results. Two-way ANOVA followed by Tukey’s post hoc test was used to assess the significant difference within the groups. Unpaired t-test was used for the intergroup comparison of the obtained data. The study showed that the size of the air abrasion particles used for sandblasting significantly influenced the porcelain to metal surface bond strength, with

p

value <0.001. The bond strength values of the two alloys tested showed no major variations. Result also showed that oxidation influences the metal-ceramic bond strength. Conclusions. The bond strength of the metal-ceramic interface is influenced by the alloy’s surface treatment. The oxidation process impacts the bond strength of the metal-ceramic system.
Research on Digital Teaching of Creative Writing in the Context of Computer Big Data
Authors: Yang Xiaoci
Published: May 2022

This paper is aimed at examining the effects of digital teaching on reconstructing creative writing skills and to judge the bettering of creativity and writing skills after accepting digital technology. Based on this paper, creativity and writing skills are the most required elements of creative writing. Fluency, flexibility, originality, and elaboration are the major constructs of creativity. From the contribution of Torrance, we find these constructs of creativity. Narrative and linguistics are the major components in writing skills to evaluate the pupils. Concept and background come under the narrative components as subscales. Likewise, content, the structure of grammar, punctuation, and spelling are considered as subscales in linguistic components. Digital teaching methods and traditional teaching methods are used for this research. We are using a nonequivalent comparison-group design for this research. The rubric is a scoring guide used to evaluate performance. We used this scoring guide to access the improvement of pupils. In total, 58 participants were selected from a primary school. 28 participants were selected from the section A class and 30 pupils from the section B class. In creativity, after the digital teaching, the experimental group is greater than the control group; therefore, the digital teaching method improves the pupils’ creativity level. In writing skill, after digital teaching, the experimental group is better than the control group; therefore, the digital teaching method increases the pupils’ writing skill. We proposed a SVM-based Chaotic Grasshopper Optimization algorithm for digital teaching of creative writing in the context of big data. The comparative analysis result shows that the SVM-Chaotic Grasshopper Optimization method accuracy rate is higher than the other three methods’ accuracy rate. The SVM-CGO method execution time (second) speed is fast when compared with that of the other methods. Thus, we have analyzed the effects of digital teaching and evaluated the improvement in creativity and writing skills after utilizing digital tools.