bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Tendon Morphology as a Biomarker of Long-term Patient Outcomes After Surgical Repair of Achilles Tendon Rupture: A Prospective Cohort Study
Authors: Saarensilta Annukka , Aufwerber Susanna , Grävare Silbernagel Karin , Ackermann Paul
Published: November 2023

Background:

Patient outcome after acute Achilles tendon rupture (ATR) varies and is difficult to predict. Whether early variations in healing, visualized with ultrasonography, can predict long-term patient outcome is unclear.

Purpose:

To (1) examine the associations of Achilles tendon cross-sectional area (CSA) and elongation (TE) during healing of ATR repair with patient outcomes at 12 months postoperatively and (2) investigate the predictive or diagnostic capacity of the morphological biomarkers.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This study was based on previously collected data from 86 patients who underwent acute standardized ATR repair between 2013 and 2018 and who were included in a prior randomized trial investigating early functional mobilization (EFM). In the EFM group, loading was allowed immediately after surgery, while in the comparison group, loading was allowed first at 2 weeks postoperatively. Achilles tendon CSA and length were measured with ultrasound at 6 weeks, 6 months, and 12 months postoperatively. CSA ratio and absolute difference in the length of the healthy and injured tendons were calculated. Patient-reported outcome was registered with the validated Achilles tendon Total Rupture Score and functional outcome with the heel-rise endurance test at 12 months postoperatively. The limb symmetry index (LSI) was calculated for maximum heel-rise height (HRHmax) and total concentric work. Multiple linear regression adjusted for age was used, and the area under the receiver operating characteristic curve (AUC) was calculated to evaluate predictive capacity.

Results:

A larger CSA ratio at 6 weeks was associated with higher LSI HRHmax at 12 months ( R2, 0.35; P < .001) and exhibited good predictive capacity (AUC, 0.82). More TE at 12 months was associated with lower LSI total concentric work at 12 months ( R2, 0.21; P = .001) and exhibited acceptable predictive capacity (AUC, 0.71).

Conclusion:

Greater Achilles tendon CSA seen on ultrasound 6 weeks after surgical repair had good clinical prediction for long-term functional outcome. TE at 12 months was predictive of inferior functional outcome.

Registration:

NCT02318472 (ClinicalTrials.gov identifier).
The Social Construction of Dementia: Implications for Healthcare Experiences of Caregivers and People Living with Dementia
Authors: Farhana Nusrat , Peckham Allie , Marani Husayn , Roerig Monika , Marchildon Greg
Published: November 2023

Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer's Disease or Alzheimer's Disease-related dementia (AD/ADRD) in five North American jurisdictions. This study analyzed interviews with individuals living with an AD/ADRD and caregivers of individuals living with an AD/ADRD (n = 11). Thematic analysis was conducted to understand how the perception of dementia may have shaped their engagement and experience with healthcare systems. Our analysis resulted in three main themes of care users’ experience: (i) undesirable experience owing to the overarching negative shared understanding and stereotyping of dementia; (ii) dismissal throughout disease progression when seeking health and social care support; and (iii) dehumanization during care interactions. The findings carry critical social and clinical implications, for example, in informing person-centered approaches to care, and communication tools clinicians can use to enhance provider, patient, and caregiver well-being.
Early Initiation of Breastfeeding and Associated Factors Among Women of Reproductive age in Simiyu Region, Tanzania
Authors: Shirima Laura J. , Mlay Henry L. , Mkuwa Serafina , Fabian Agatha , Mushy Stella E. , Ngalesoni Frida N. , Mboya Innocent B. , Manongi Rachel N.
Published: November 2023

Background

Breast milk provides infants with complete nutrition for immune development and protection against childhood diseases and associated mortality. Early initiation of breastfeeding (EIBF) aids in providing colostrum to newborns, providing protection against infection, and improving newborn and infant survival. Although Simiyu reported the lowest prevalence of EIBF in Tanzania, no study has investigated the factors associated with EIBF in this region.

Objective

The study aimed to determine early breastfeeding initiation prevalence and associated factors among women of reproductive age in the Simiyu region.

Methodology

We used data from a cross-sectional study conducted by AMREF Health Africa among 669 women of reproductive age (15–49 years) in the Simiyu region, Tanzania. An interviewer-administered questionnaire collected data on breastfeeding practices (including breastfeeding initiation) among others. A multilevel logistic regression analysis estimated the adjusted odds ratio (OR) and 95% confidence intervals (CI) for factors associated with EIBF.

Results

The mean age of 669 women analyzed was 28.3 years (SD ± 6.8). The prevalence of EIBF was 62.2%, ranging from 52.7% in Bariadi district to 73.3% in Maswa district. Lower odds of EIBF were among women who had a caesarian section (OR = 0.41; 95% CI = 0.17–0.98) and those who gave birth to male children (OR =  0.57; 95%CI = 0.39–0.82) while higher odds of EIBF were among mothers who reported skin-to-skin contact (OR =  2.40; 95%CI = 1.53–3.83) and from Maswa district (OR = 2.73; 95%CI = 1.09–6.89).

Conclusion

The prevalence of EIBF in the Simiyu region remains low (62%) relative to the global target of 70% by 2030 and varies by district. To promote EIBF in the region, good engagement and communication practices between mothers and healthcare providers should be emphasised in educating women about the importance of EIBF. Moreover, the practice of skin-to-skin contact between mother and child should be encouraged immediately after delivery.
Eligible Applicants and Diversity Across Settings in a Regional Family Medicine Residency Network
Authors: Weidner Amanda , Ormsby Molly , Weinhold AJ , Holmes John
Published: November 2023

OBJECTIVES

Residency programs must gather and track data on the diversity of their applicants, interviewees, and matched residents as part of the process of checking for bias in the interview and rank process. As such, the aims of this study were (1) to provide data from a large, regional network of family medicine residencies on who is applying, interviewing, and matching into our programs as a baseline for the family medicine residency community; and (2) to assess potential differences in the gender and racial diversity of the eligible applicants to programs across settings, including in rural and underserved communities.

METHODS

Survey of programs in Alaska, Idaho, Montana, Washington and Wyoming about their applicant pool in the 2020-2021 interview season.

RESULTS

Programs received a median of 100 applications per position, 57 of which were considered eligible. Programs offered 17 interviews per position and 15 of these were completed. Programs in rural and underserved communities did not have fewer eligible applicants per position, nor was there less diversity within that pool of applicants. Most programs are working to increase their program's diversity.

CONCLUSION

On average, the racial and gender diversity of eligible applicants to programs in rural and underserved settings is no different than other programs. What is important in terms of diversity varies across programs, based on community needs and program mission, but having a mechanism to extract and review data and to then be able to assess progress is a place to start.
Re-assessing the Classic Frames: Intersection of Caste, Class and Gender in Neelakuyil
Authors: Mithuna S. M.
Published: November 2023

Neelakuyil, produced in 1954, is among the few Malayalam films that represent how caste category and gender norms affect the lives of the proletariat and upper-class women. The film retains its position as a classic and the foremost among works chosen to historicize Malayalam Cinema. This article argues that the symbiosis of patriarchal power, caste discrimination and economic disparities unveil a complex system of discrimination and manipulation of women’s lives. How Neelakuyil illustrates the impact of such a schema on the mindset of dominant selves and the way in which they have a bearing upon the subaltern lives are negotiated. I adopt a Dalit-feminist perspective within the conceptual framework of intersectionality by focusing on the manner in which the protagonist Neeli’s subjectivity is situated within the narrative discourse. I also attempt to examine the ideologies of ‘progressive thought’ and ‘paternal authority’ embodied in the characters Sankaran Nair and Sreedharan Nair and their ideological significance in relation to persistent caste dynamics.
From Stigmatization to Neo-Buddhist Identity: Reflections on the Changing Identities of the Scheduled Castes of India
Authors: Barman Rup Kumar
Published: November 2023

The Scheduled Caste (SC) communities of India have always been locked down with stigmatized social identities since the very beginning of the caste system. They were categorized with certain administrative identities under colonial rule and branded as ‘Harijans’ (Children of God) by the nationalist leaders. On the other hand, the SC communities themselves had asserted for respectable caste identities, opposed the Brahmanical hegemony, and fought against untouchability. Harijan identity, however, has transformed into Dalit identity in the post-colonial period. In such a context, Navayana Buddhism has appeared as a symbol of dignified identity. This article has highlighted this trend of changing identifiers of the SCs of Indian society.
Engendering Equity in India’s Social Policies: Lessons from COVID-19 and Beyond
Authors: Sanil Akanksha
Published: November 2023

The COVID-19 outbreak inadvertently became a field experiment to test social and economic resilience both within and between societies. Vulnerability to lives and livelihoods exposed as a result made it necessary to adopt a reasonable, well-grounded approach in policy choices to envision an equitable and durable society. Admittedly, it is an appropriate time to revisit the idea of ‘equity’ more aggressively in designing the framework of social policies. This article is an attempt to explore ‘equity’ in India’s social policy architecture—the role, impact and challenges—with an emphasis on initiatives undertaken during COVID-19, especially those targeted to address the needs of marginalized sections. It aims to, first, facilitate an understanding of how social equity as an imperative function for India, shaped its policy responses, especially during the early stages of the pandemic. Second, what is the (im)possibility to develop a ‘National Social Equity Indicator’ for a credible measurement of administrative responses at the appropriate level, which may eventually help improvise future policies.
Respiratory variation in the internal jugular vein does not predict fluid responsiveness in the prone position during adolescent idiopathic scoliosis surgery: a prospective cohort study
Authors: Wu Mimi , Dai Zhao , Liang Ying , Liu Xiaojie , Zheng Xu , Zhang Wei , Bo Jinhua
Published: November 2023

Background

Respiratory variation in the internal jugular vein (IJVV) has not shown promising results in predicting volume responsiveness in ventilated patients with low tidal volume (Vt) in prone position. We aimed to determine whether the baseline respiratory variation in the IJVV value measured by ultrasound might predict fluid responsiveness in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with low Vt.

Methods

According to the fluid responsiveness results, the included patients were divided into two groups: those who responded to volume expansion, denoted the responder group, and those who did not respond, denoted the non-responder group. The primary outcome was determination of the value of baseline IJVV in predicting fluid responsiveness (≥15% increases in stroke volume index (SVI) after 7 ml·kg-1 colloid administration) in patients with AIS undergoing PSF during low Vt ventilation. Secondary outcomes were estimation of the diagnostic performance of pulse pressure variation (PPV), stroke volume variation (SVV), and the combination of IJVV and PPV in predicting fluid responsiveness in this surgical setting. The ability of each parameter to predict fluid responsiveness was assessed using a receiver operating characteristic curve.

Results

Fifty-six patients were included, 36 (64.29%) of whom were deemed fluid responsive. No significant difference in baseline IJVV was found between responders and non-responders (25.89% vs. 23.66%, p = 0.73), and no correlation was detected between baseline IJVV and the increase in SVI after volume expansion (r = 0.14, p = 0.40). A baseline IJVV greater than 32.00%, SVV greater than 14.30%, PPV greater than 11.00%, and a combination of IJVV and PPV greater than 64.00% had utility in identifying fluid responsiveness, with a sensitivity of 33.33%, 77.78%, 55.56%, and 55.56%, respectively, and a specificity of 80.00%, 50.00%, 65.00%, and 65.00%, respectively. The area under the receiver operating characteristic curve for the baseline values of IJVV, SVV, PPV, and the combination of IJVV and PPV was 0.52 (95% CI, 0.38–0.65, p=0.83), 0.54 (95% CI, 0.40–0.67, p=0.67), 0.58 (95% CI, 0.45–0.71, p=0.31), and 0.57 (95% CI, 0.43–0.71, p=0.37), respectively.

Conclusions

Ultrasonic-derived IJVV lacked accuracy in predicting fluid responsiveness in patients with AIS undergoing PSF during low Vt ventilation. In addition, the baseline values of PPV, SVV, and the combination of IJVV and PPV did not predict fluid responsiveness in this surgical setting.

Trail registration

This trial was registered at www.chictr.org (ChiCTR2200064947) on 24/10/2022. All data were collected through chart review.
Supporting family carers in general practice: a scoping review of clinical guidelines and recommendations
Authors: Cronin Mary , McLoughlin Kathy , Foley Tony , McGilloway Sinéad
Published: November 2023

Background

Increasing numbers of family carers are providing informal care in community settings. This creates a number of challenges because family carers are at risk of poor physical and psychological health outcomes, with consequences both for themselves and those for whom they provide care. General Practitioners (GPs), who play a central role in community-based care, are ideally positioned to identify, assess, and signpost carers to supports. However, there is a significant gap in the literature in respect of appropriate guidance and resources to support them in this role.

Methods

A scoping review was undertaken to examine clinical guidelines and recommendations for GPs to support them in their role with family carers. This involved a multidisciplinary team, in line with Arksey & O’Malley’s framework, and entailed searches of ten peer-reviewed databases and grey literature between September-November 2020.

Results

The searches yielded a total of 4,651 English language papers, 35 of which met the criteria for inclusion after removing duplicates, screening titles and abstracts, and performing full-text readings. Ten papers focused on resources/guidelines for GPs, twenty were research papers, three were review papers, one was a framework of quality markers for carer support, and one was an editorial. Data synthesis indicated that nine (90%) of the guidelines included some elements relating to the identification, assessment, and/or signposting of carers. Key strategies for identifying carers suggest that a whole practice approach is optimal, incorporating a role for the GP, practice staff, and for the use of appropriate supporting documentation. Important knowledge gaps were highlighted in respect of appropriate clinical assessment and evidence-based signposting pathways.

Conclusion

Our review addresses a significant gap in the literature by providing an important synthesis of current available evidence on clinical guidelines for GPs in supporting family carers, including strategies for identification, options for assessment and potential referral/signposting routes. However, there is a need for greater transparency of the existing evidence base as well as much more research to evaluate the effectiveness and increase the routine utilisation, of clinical guidelines in primary care.
Molecular diagnosis, phylogenetic analysis, and antifungal susceptibility profiles of Candida species isolated from neutropenic oncological patients
Authors: Hassanpour Parviz , Spotin Adel , Morovati Hamid , Aghebati-Maleki Leili , Raeisi Mortaza , Rezaee Mohammad Ahangarzadeh , Hasani Alka , Aghebati-Maleki Ali , Abdollahzadeh Hossein , Nami Sanam
Published: November 2023

Background

Neutropenia is the most important cause of life-threatening invasive fungal infections (IFIs). Here, we studied the frequency and antifungal susceptibility profiles of Candida species that colonized or caused infections among neutropenic patients with solid or hematological malignancies.

Methods

A total of 362 clinical samples were collected from 138 patients. After initial isolation using a mix of mycological methods, isolates were screened using chromogenic culture media. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was applied for molecular identification. Positive or suspected cases were confirmed using the reference method of sequencing. Antifungal susceptibility testing for voriconazole and caspofungin was carried out using the microbroth dilution method. An in-silico assay was applied for phylogenetic analysis.

Results

Thirty-four Candida strains were isolated. C. albicans (47.06%) and C. glabrata (29.41%) were the most frequent strains. Antifungal treatment reduced the chance of Candida colonization by almost 76% in neutropenic patients (OR: 1.759; 95% CI: 1.349 to 2.390; p value: 0.000). An unusual and non-resistant strain, C. lambica, was reported from the bloodstream of a 56-year-old man with hematologic malignancy (HM). Eight isolates were non-susceptible, and one isolate was resistant to voriconazole. Also, four isolates were non-susceptible to caspofungin.

Conclusion

We can conclude that there is a cause-and-effect relationship between neutropenia, HM background, and Candida species separated from neutropenic patients, which can lead to possible infections. Further and repetitive studies are recommended using different molecular methods for better prediction and management of fungal infections in neutropenic patients.
Comparison of 3 and 4 cycles of neoadjuvant gemcitabine and cisplatin for muscle-invasive bladder cancer: a systematic review and meta-analysis
Authors: Lu Lanpeng , Chen Chaohu , Cheng Hui , Ding Hui , Tian Junqiang , Wang Hanzhang , Wang Zhiping
Published: November 2023

Background

In muscle-invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NAC) combined with radical cystectomy (RC) is critical in reducing disease recurrence, with GC (gemcitabine and cisplatin) being one of the most commonly used NACs. Different GC schedules have been used, but the best neoadjuvant regimen is still unknown. The clinical outcomes of 3 and 4 cycles of neoadjuvant GC are compared in this systematic review and meta-analysis to determine which is best for patients with MIBC.

Methods

We searched PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, WAN FANG DATA, and meeting abstracts to identify relevant studies up to March 2023. Studies that compared 3 and 4 cycles of neoadjuvant GC for MIBC were included. The primary outcomes were pCR, pDS, OS, and CSS. The secondary outcome was recurrence and SAEs.

Results

A total of 3 studies, with 1091 patients, were included in the final analysis. Patients that received 4 cycles of GC had a higher pCR (OR = 0.66; 95% CI, 0.50–0.87; p = 0.003) and pDS (OR = 0.63; 95% CI, 0.48–0.84; p = 0.002) than those who received 3 cycles. Regarding recurrence rate (OR = 1.23; 95% CI, 0.91–1.65; p = 0.18), there were no appreciable differences between the 3 and 4 cycles of GC. Survival parameters such as OS (HR, 1.35; 95% CI, 0.86–2.12; p = 0.19) and CSS (HR, 1.06; 95% CI, 0.82–1.38; p = 0.20) were similar. Only one trial reported on the outcomes of SAEs. And there were no statistically significant differences in thrombocytopenia, infection rate, neutropenic fever, anemia, or decreased renal function between patients. The neutropenia of patients was statistically different (OR = 0.72; 95% CI, 0.52–0.99; p = 0.04).

Conclusion

The 4-cycle GC regimen was superior to the 3-cycle regimen in only the pCR and pDS results. Survival and recurrence rates were similar between the two regimens. In both treatment regimes, the toxicity profile was manageable. However, due to the inherent drawbacks of retrospective research, this should be regarded with caution.
Atovaquone inhibits colorectal cancer metastasis by regulating PDGFRβ/NF-κB signaling pathway
Authors: Liu Bin , Zheng Xin , Li Jiajun , Yao Peng , Guo Peng , Liu Wei , Zhao Gaoping
Published: November 2023

Background

Colorectal cancer is a common malignant tumour. Invasive growth and distant metastasis are the main characteristics of its malignant biological behaviour, and they are also the primary factors leading to death in colon cancer patients. Atovaquone is an antimalarial drug, and its anticancer effect has recently been demonstrated in several cancer models in vitro and in vivo, but it has not been examined in the treatment of colorectal cancer.

Methods

To elucidate the effect of atovaquone on colorectal cancer. We used RNA transcriptome sequencing, RT‒PCR and Western blot experiments to examine the expression of NF-κB (p-P65), EMT-related proteins and related inflammatory factors (IL1B, IL6, CCL20, CCL2, CXCL8, CXCL6, IL6ST, FAS, IL10 and IL1A). The effect of atovaquone on colorectal cancer metastasis was validated using an animal model of lung metastases. We further used transcriptome sequencing, the GCBI bioinformatics database and the STRING database to predict relevant target proteins. Furthermore, pathological sections were collected from relevant cases for immunohistochemical verification.

Results

This study showed that atovaquone could inhibit colorectal cancer metastasis and invasion in vivo and in vitro, inhibit the expression of E-cadherin protein, and promote the protein expression of N-cadherin, vimentin, ZEB1, Snail and Slug. Atovaquone could inhibit EMT by inhibiting NF-κB (p-P65) and related inflammatory factors. Further bioinformatics analysis and verification showed that PDGFRβ was one of the targets of atovaquone.

Conclusion

In summary, atovaquone can inhibit the expression of NF-κB (p-P65) and related inflammatory factors by inhibiting the protein expression of p-PDGFRβ, thereby inhibiting colorectal cancer metastasis. Atovaquone may be a promising drug for the treatment of colorectal cancer metastasis.
Rubella virus-associated uveitis at a tertiary care hospital in Germany between 2013 and 2019
Authors: Hönemann Mario , Scharfenberg Elizabeth , Dietze Nadine , Claus Claudia , Jochmann Claudia , Liebert Uwe Gerd
Published: November 2023

Uveitis is a process of intraocular inflammation that may involve different sections of the uveal tract. Apart from systemic or localized immune-mediated diseases, infections are key players in the etiology of uveitis and entail different treatment strategies. Rubella virus (RuV) is a recognized causative agent for the development of Fuchs uveitis, representing a major cause of virus-associated intraocular inflammation. A cohort of 159 patients diagnosed with different forms of uveitis between 2013 and 2019 was subjected to diagnostic antibody testing of the aqueous or vitreous humor. The diagnostic panel included RuV, cytomegalovirus, herpes simplex virus, varicella-zoster virus, and toxoplasmosis. Within this cohort, 38 RuV-associated uveitis (RAU) patients were identified based on a pathologic Goldman-Witmer coefficient indicative of an underlying RuV infection. With a mean age of 45.9 years, the RAU patients were younger than the non-RAU patients (56.3, p < 0.001). The evaluation of clinical parameters revealed a predominance of anterior uveitis and late sequalae such as cataract and glaucoma among the RAU patients. In 15 of the patients a history of prior RuV infections could be confirmed. The study underlines the importance of long-term surveillance of RuV associated diseases that originate from infections before the introduction of RuV vaccination programs.
School and childcare facility air quality decision-makers’ perspectives on using low-cost sensors for wildfire smoke response
Authors: Stampfer Orly , Farquhar Stephanie , Seto Edmund , Karr Catherine J.
Published: November 2023

Background

During wildfire smoke episodes, school and childcare facility staff and those who support them rely upon air quality data to inform activity decisions. Where ambient regulatory monitor data is sparse, low-cost sensors can help inform local outdoor activity decisions, and provide indoor air quality data. However, there is no established protocol for air quality decision-makers to use sensor data for schools and childcare facilities. To develop practical, effective toolkits to guide the use of sensors in school and childcare settings, it is essential to understand the perspectives of the potential end-users of such toolkit materials.

Methods

We conducted 15 semi-structured interviews with school, childcare, local health jurisdiction, air quality, and school district personnel regarding sensor use for wildfire smoke response. Interviews included sharing PM2.5 data collected at schools during wildfire smoke. Interviews were transcribed and transcripts were coded using a codebook developed both a priori and amended as additional themes emerged.

Results

Three major themes were identified by organizing complementary codes together: (1) Low-cost sensors are useful despite data quality limitations, (2) Low-cost sensor data can inform decision-making to protect children in school and childcare settings, and (3) There are feasibility and public perception-related barriers to using low-cost sensors.

Conclusions

Interview responses provided practical implications for toolkit development, including demonstrating a need for toolkits that allow a variety of sensor preferences. In addition, participants expected to have a wide range of available time for monitoring, budget for sensors, and decision-making types. Finally, interview responses revealed a need for toolkits to address sensor uses outside of activity decisions, especially assessment of ventilation and filtration.
A prediction model for acute respiratory distress syndrome in immunocompetent adults with adenovirus-associated Pneumonia: a multicenter retrospective analysis
Authors: Lin Fengyu , Zhou Qianhui , Li Wen , Xiao Wenchao , Li Sha , Liu Ben , Li Haitao , Cui Yanhui , Lu Rongli , Li Yi , Zhang Yan , Pan Pinhua
Published: November 2023

Background

In recent years, the number of human adenovirus (HAdV)-related pneumonia cases has increased in immunocompetent adults. Acute respiratory distress syndrome (ARDS) in these patients is the predominant cause of HADV-associated fatality rates. This study aimed to identify early risk factors to predict early HAdV-related ARDS.

Methods

Data from immunocompetent adults with HAdV pneumonia between June 2018 and May 2022 in ten tertiary general hospitals in central China was analyzed retrospectively. Patients were categorized into the ARDS group based on the Berlin definition. The prediction model of HAdV-related ARDS was developed using multivariate stepwise logistic regression and visualized using a nomogram.

Results

Of 102 patients with adenovirus pneumonia, 41 (40.2%) developed ARDS. Overall, most patients were male (94.1%), the median age was 38.0 years. Multivariate logistic regression showed that dyspnea, SOFA (Sequential Organ Failure Assessment) score, lactate dehydrogenase (LDH) and mechanical ventilation status were independent risk factors for this development, which has a high mortality rate (41.5%). Incorporating these factors, we established a nomogram with good concordance statistics of 0.904 (95% CI 0.844–0.963) which may help to predict early HAdV-related ARDS.

Conclusion

A nomogram with good accuracy in the early prediction of ARDS in patients with HAdV-associated pneumonia may could contribute to the early management and effective treatment of severe HAdV infection.
Machine learning in the detection of dental cyst, tumor, and abscess lesions
Authors: Kumar Vyshiali Sivaram , Kumar Pradeep R. , Yadalam Pradeep Kumar , Anegundi Raghavendra Vamsi , Shrivastava Deepti , Alfurhud Ahmed Ata , Almaktoom Ibrahem T. , Alftaikhah Sultan Abdulkareem Ali , Alsharari Ahmed Hamoud L , Srivastava Kumar Chandan
Published: November 2023

Background and Objective

Dental panoramic radiographs are utilized in computer-aided image analysis, which detects abnormal tissue masses by analyzing the produced image capacity to recognize patterns of intensity fluctuations. This is done to reduce the need for invasive biopsies for arriving to a diagnosis. The aim of the current study was to examine and compare the accuracy of several texture analysis techniques, such as Grey Level Run Length Matrix (GLRLM), Grey Level Co-occurrence Matrix (GLCM), and wavelet analysis in recognizing dental cyst, tumor, and abscess lesions.

Materials & Methods

The current retrospective study retrieved a total of 172 dental panoramic radiographs with lesion including dental cysts, tumors, or abscess. Radiographs that failed to meet technical criteria for diagnostic quality (such as significant overlap of teeth, a diffuse image, or distortion) were excluded from the sample. The methodology adopted in the study comprised of five stages. At first, the radiographs are improved, and the area of interest was segmented manually. A variety of feature extraction techniques, such GLCM, GLRLM, and the wavelet analysis were used to gather information from the area of interest. Later, the lesions were classified as a cyst, tumor, abscess, or using a support vector machine (SVM) classifier. Eventually, the data was transferred into a Microsoft Excel spreadsheet and statistical package for social sciences (SPSS) (version 21) was used to conduct the statistical analysis. Initially descriptive statistics were computed. For inferential analysis, statistical significance was determined by a p value < 0.05. The sensitivity, specificity, and accuracy were used to find the significant difference between assessed and actual diagnosis.

Results

The findings demonstrate that 98% accuracy was achieved using GLCM, 91% accuracy using Wavelet analysis & 95% accuracy using GLRLM in distinguishing between dental cyst, tumor, and abscess lesions. The area under curve (AUC) number indicates that GLCM achieves a high degree of accuracy. The results achieved excellent accuracy (98%) using GLCM.

Conclusion

The GLCM features can be used for further research. After improving the performance and training, it can support routine histological diagnosis and can assist the clinicians in arriving at accurate and spontaneous treatment plans.
The effect of lavender aroma for anxiety disorder: a study protocol for a multicenter, double-masked, randomized, placebo-controlled clinical trial
Authors: Amitani Haruka , Nishi Ryusei , Sagiyama Kenichiro , Fukumoto Takamasa , Funakoshi Kouta , Takayanagi Naomi , Watanabe Hiroko , Hirose Masayuki , Tagawa Koshiro , Ota Keiko , Ito Yoichi M. , Asakawa Akihiro
Published: November 2023

Background

Anxiety disorder is the most prevalent psychiatric disorder. Benzodiazepines, which are often used for anxiety in patients with anxiety disorder, have various side effects. Lavender, one of the most commonly used essential oils in aromatherapy, has the potential to reduce benzodiazepine use for anxiety disorders.

Methods

This study is a multicenter, double-masked, randomized, placebo-controlled clinical trial. The study will recruit patients aged 20–59 years old with generalized anxiety disorder and panic disorder among anxiety disorders. The bottle containing the test solution (lavender aroma essential oil or distilled water) will be given to the patients. Patients will carry the bottles with them in their daily life and use the drops on tissue paper when anxious. The primary endpoint is the number of times anxiolytics used in 28 days.

Discussion

If the use of benzodiazepines could be reduced by sniffing lavender aroma, which is inexpensive and safe, it would contribute not only to the risks associated with benzodiazepine use but also to the health care economy and could even be added as a standard treatment.

Trial registration

University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000034422 Registered 17 January 2019.
“We just don’t have the resources”: Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa
Authors: Ras Tasleem , Stander Jenkins Louis , Lazarus Colin , van Rensburg Jacques Janse , Cooke Richard , Senkubuge Flavia , N Dlova Abegail , Singaram Veena , Daitz Emma , Buch Eric , Green-Thompson Lionel , Burch Vanessa
Published: November 2023

Background

South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context.

Methods

This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively.

Results

The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA.

Conclusions

Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.
The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals’ views
Authors: Cam Henrik , Wennlöf Björn , Gillespie Ulrika , Franzon Kristin , Nielsen Elisabet I. , Ling Mia , Lindner Karl-Johan , Kempen Thomas Gerardus Hendrik , Kälvemark Sporrong Sofia
Published: November 2023

Background

Hospital discharge of older patients is a high-risk situation in terms of patient safety. Due to the fragmentation of the healthcare system, communication and coordination between stakeholders are required at discharge. The aim of this study was to explore communication in general and medication information transfer in particular at hospital discharge of older patients from the perspective of healthcare professionals (HCPs) across different organisations within the healthcare system.

Methods

We conducted a qualitative study using focus group and individual or group interviews with HCPs (physicians, nurses and pharmacists) across different healthcare organisations in Sweden. Data were collected from September to October 2021. A semi-structured interview guide including questions on current medication communication practices, possible improvements and feedback on suggestions for alternative processes was used. The data were analysed thematically, guided by the systematic text condensation method.

Results

In total, four focus group and three semi-structured interviews were conducted with 23 HCPs. Three main themes were identified: 1) Support systems that help and hinder describes the use of support systems in the discharge process to compensate for the fragmentation of the healthcare system and the impact of these systems on HCPs’ communication; 2) Communication between two separate worlds depicts the difficulties in communication experienced by HCPs in different healthcare organisations and how they cope with them; and 3) The large number of medically complex patients disrupts the communication reveals how the highly pressurised healthcare system impacts on HCPs’ communication at hospital discharge.

Conclusions

Communication at hospital discharge is hindered by the fragmented, highly pressurised healthcare system. HCPs are at risk of moral distress when coping with communication difficulties. Improved communication methods at hospital discharge are needed for the benefit of both patients and HCPs.
Does disease incite a stronger moral appeal than health?
Authors: Hofmann Bjørn
Published: November 2023

Is disease demotion more important than health promotion? The question is crucial for the ethos of medicine and for priority setting in healthcare. When things get tough, where should our attention and resources go: to health or disease? This study investigates two general perspectives on health and disease to address whether there is a stronger moral appeal from people’s disease than from their health. While naturalist conceptions of health and disease are mute on moral appeal, normativist conceptions give diverse answers. Classical utilitarianism provides a symmetrical view of health and disease, according to which we have an equally strong moral appeal to further health as we have to reduce disease. Other normativist positions argue that there is an asymmetry between health and disease providing substantial support for a stronger moral appeal from disease than from health. This has a wide range of radical implications, especially within priority setting. In particular, treatment, palliation, and prevention of disease should have priority to the promotion and enhancement of health.
An exploratory in silico comparison of open-source codon harmonization tools
Authors: Willems Thomas , Hectors Wim , Rombaut Jeltien , De Rop Anne-Sofie , Goegebeur Stijn , Delmulle Tom , De Mol Maarten L. , De Maeseneire Sofie L. , Soetaert Wim K.
Published: November 2023

Background

Not changing the native constitution of genes prior to their expression by a heterologous host can affect the amount of proteins synthesized as well as their folding, hampering their activity and even cell viability. Over the past decades, several strategies have been developed to optimize the translation of heterologous genes by accommodating the difference in codon usage between species. While there have been a handful of studies assessing various codon optimization strategies, to the best of our knowledge, no research has been performed towards the evaluation and comparison of codon harmonization algorithms. To highlight their importance and encourage meaningful discussion, we compared different open-source codon harmonization tools pertaining to their in silico performance, and we investigated the influence of different gene-specific factors.

Results

In total, 27 genes were harmonized with four tools toward two different heterologous hosts. The difference in %MinMax values between the harmonized and the original sequences was calculated (ΔMinMax), and statistical analysis of the obtained results was carried out. It became clear that not all tools perform similarly, and the choice of tool should depend on the intended application. Almost all biological factors under investigation (GC content, RNA secondary structures and choice of heterologous host) had a significant influence on the harmonization results and thus must be taken into account. These findings were substantiated using a validation dataset consisting of 8 strategically chosen genes.

Conclusions

Due to the size of the dataset, no complex models could be developed. However, this initial study showcases significant differences between the results of various codon harmonization tools. Although more elaborate investigation is needed, it is clear that biological factors such as GC content, RNA secondary structures and heterologous hosts must be taken into account when selecting the codon harmonization tool.
The characteristics and the multiple functions of integrin β1 in human cancers
Authors: Sun Li , Guo Shuwei , Xie Yiping , Yao Yongliang
Published: November 2023

Integrins, which consist of two non-covalently linked α and β subunits, play a crucial role in cell–cell adhesion and cell-extracellular matrix (ECM) interactions. Among them, integrin β1 is the most common subunit and has emerged as a key mediator in cancer, influencing various aspects of cancer progression, including cell motility, adhesion, migration, proliferation, differentiation and chemotherapy resistance. However, given the complexity and sometimes contradictory characteristics, targeting integrin β1 for therapeutics has been a challenge. The emerging understanding of the mechanisms regulating by integrin β1 may guide the development of new strategies for anti-cancer therapy. In this review, we summarize the multiple functions of integrin β1 and signaling pathways which underlie the involvement of integrin β1 in several malignant cancers. Our review suggests the possibility of using integrin β1 as a therapeutic target and highlights the need for patient stratification based on expression of different integrin receptors in future clinical studies.
Randomized clinical trial of low dose suramin intravenous infusions for treatment of autism spectrum disorder
Authors: Hough David , Mao Alice R. , Aman Michael , Lozano Reymundo , Smith-Hicks Constance , Martinez-Cerdeno Veronica , Derby Michael , Rome Zachary , Malan Niel , Findling Robert L.
Published: November 2023

Background

There is a critical need for effective treatment of the core symptoms of autism spectrum disorder (ASD). The purinergic antagonist suramin may improve core symptoms through restoration of normal mitochondrial function and reduction of neuro-inflammation via its known antagonism of P2X and P2Y receptors. Nonclinical studies in fragile X knockout mice and the maternal immune activation model support these hypotheses.

Methods

We conducted a 14 week, randomized, double-blind, placebo-controlled proof -of-concept study (N = 52) to test the efficacy and safety of suramin intravenous infusions in boys aged 4–15 years with moderate to severe ASD. The study had 3 treatment arms: 10 mg/kg suramin, 20 mg/kg suramin, and placebo given at baseline, week 4, and week 8. The Aberrant Behavior Checklist of Core Symptoms (ABC-Core) (subscales 2, 3, and 5) was the primary endpoint and the Clinical Global Impressions—Improvement (CGI-I) was a secondary endpoint.

Results

Forty-four subjects completed the study. The 10 mg/kg suramin group showed a greater, but statistically non-significant, numeric improvement (− 12.5 ± 3.18 [mean ± SE]) vs. placebo (− 8.9 ± 2.86) in ABC-Core at Week 14. The 20 mg/kg suramin group did not show improvement over placebo. In exploratory analyses, the 10 mg/kg arm showed greater ABC Core differences from placebo in younger subjects and among those with less severe symptoms. In CGI-I, the 10 mg/kg arm showed a statistically significant improvement from baseline (2.8 ± 0.30 [mean ± SE]) compared to placebo (1.7 ± 0.27) (p = 0.016). The 20 mg/kg arm had a 2.0 ± 0.28 improvement in CGI-I, which was not statistically significant compared to placebo (p = 0.65).

Conclusion

Suramin was generally safe and well tolerated over 14 weeks; most adverse events were mild to moderate in severity.

Trial Registration Registered with the South African Health Authority, registration number DOH-27–0419-6116. ClinicalTrials.Gov registration ID is NCT06058962, last update posted 2023–09-28.
Internet use, cardiometabolic multimorbidity, and death in older adults: a multi-cohort study spanning developing and developed countries
Authors: Ren Ziyang , Xia Shuangbo , Sun Jinfang , Wang Duoduo , Du Yushan , Li Ning , Liu Jufen
Published: November 2023

Background

Internet use is a double-edged sword for older adults’ health. Whether internet use can prevent cardiometabolic diseases and death in older adults remains controversial.

Methods

Four cohorts across China, Mexico, the United States, and Europe were utilized. Internet use was defined using similar questions. Cardiometabolic diseases included diabetes, heart diseases, and stroke, with 2 or more denoting cardiometabolic multimorbidity. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale and Europe-depression scale. The competing risk analysis based on subdistribution hazard regression, random-effects meta-analysis, and mediation analysis were utilized.

Results

A total of 104,422 older adults aged 50 or older were included. Internet users (vs. digital exclusion) were at lower risks of diabetes, stroke, and death, with pooled sHRs (95% CIs) of 0.83 (0.74–0.93), 0.81 (0.71–0.92), and 0.67 (0.52–0.86), respectively, which remained significant in sensitivity analyses. The inverse associations of internet use with new-onset cardiometabolic diseases and death were progressively significant in Mexico, China, the United States, and Europe. For instance, older internet users in Europe were at 14-30% lower cardiometabolic risks and 40% lower risk of death. These associations were partially mediated by reduced depressive symptoms and were more pronounced in those with high socioeconomic status and women. Furthermore, patients with prior cardiometabolic conditions were at about 30% lower risk of death if they used the internet, which was also mediated by reduced depressive symptoms. However, certain cardiometabolic hazards of internet use in those aged < 65 years, with low socioeconomic status, men, and single ones were also observed.

Conclusion

Enhancing internet usage in older adults can reduce depressive symptoms and thus reduce the risks of cardiometabolic diseases and death. The balance of internet use, socioeconomic status, and health literacy should be considered when popularizing the internet in older adults.