bluuebunny/crossref_metadata_2025 huggingface dataset:
Retinal blood flow velocities in infants with retinopathy of prematurity after intravitreal administration of bevacizumab
Authors: Mohr Franziska H , Fischer Hendrik S , Czernik Christoph , Müller Bert , Bührer Christoph
Published: May 2023

Background/Objectives

Progression of retinopathy of prematurity (ROP) is associated with increased retinal blood flow velocities. We investigated changes of central retinal arterial and venous blood flow after intravitreal administration of bevacizumab.

Subjects/Methods

Prospective observational study using serial ultrasound Doppler imaging in preterm infants with bevacizumab-treated ROP. Eyes were examined 1 [0–2] days before injection (median [interquartile range]), and at three time points after injection (1 [1–2] days, 6 [3–8] days, and 17 [9–28] days). Preterm infants with ROP stage 2 displaying spontaneous regression served as controls.

Results

In 21 eyes of 12 infants with bevacizumab-treated ROP, peak arterial systolic velocity declined from 13.6 [11.0-16.3] cm/s prior to intravitreal bevacizumab to 11.2 [9.4–13.9] cm/s, 10.6 [9.2–13.3] cm/s and 9.3 [8.2–11.0] cm/s at discharge ( p  =  .002). There was also a decline of the arterial velocity time integral (from 3.1 [2.3–3.9] cm to 2.9 [2.4–3.5], 2.7 [2.3–3.2] cm and 2.2 [2.0–2.7], p  =  .021) and mean velocity in the central retinal vein (from 4.5 [3.6–5.8] cm/s to 3.7 [2.6–4.1] cm/s, 3.5 [3.0–4.3] cm/s, and 3.2 [2.8–4.6] cm/s, p  =  .012). Arterial end-diastolic velocity and resistance index remained unchanged. Blood flow velocities in bevacizumab-treated eyes examined before injection were significantly higher than those measured in untreated eyes that ultimately showed spontaneous regression of ROP. Sequential examinations in these controls did not reveal any declines of retinal blood flow velocities.

Conclusion

Increased retinal arterial and venous blood flow velocities in infants with threshold ROP decline following intravitreal bevacizumab injection.
Comparison of MRI T2-lesion evolution in pediatric MOGAD, NMOSD, and MS
Authors: Redenbaugh Vyanka , Chia Nicholas H , Cacciaguerra Laura , McCombe Jennifer A , Tillema Jan-Mendelt , Chen John J , Lopez Chiriboga A Sebastian , Sechi Elia , Hacohen Yael , Pittock Sean J , Flanagan Eoin P
Published: May 2023

Background:

Magnetic resonance imaging (MRI) T2-lesions resolve more often in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) than aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS) in adults but few studies analyzed children.

Objective:

The main objective of this study is to investigate MRI T2-lesion evolution in pediatric MOGAD, AQP4 + NMOSD, and MS.

Methods:

Inclusion criteria were as follows: (1) first clinical attack; (2) abnormal MRI (⩽6 weeks); (3) follow-up MRI beyond 6 months without relapses in that region; and (4) age < 18 years. An index T2-lesion (symptomatic/largest) was identified, and T2-lesion resolution or persistence on follow-up MRI was determined.

Results:

We included 56 patients (MOGAD, 21; AQP4 + NMOSD, 8; MS, 27) with 69 attacks. Index T2-lesion resolution was more frequent in MOGAD (brain 9 of 15 [60%]; spine 8 of 12 [67%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]) and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Resolution of all T2-lesions occurred more often in MOGAD (brain 6 of 15 [40%]; spine 7 of 12 [58%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]), and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Reductions in median index T2-lesion area were greater in MOGAD (brain, 305 mm; spine, 23 mm) than MS (brain, 42 mm [ p<0.001]; spine, 10 mm [ p<0.001]) without differing from AQP4 + NMOSD (brain, 133 mm [ p=0.42]; spine, 19.5 mm [ p=0.69]).

Conclusion:

In children, MRI T2-lesions resolved more often in MOGAD than AQP4 + NMOSD and MS which is similar to adults suggesting these differences are related to pathogenesis rather than age.
Friction, wear, and characterization of magnesium composite for automotive brake pad material
Authors: B Praveenkumar , S Darius Gnanaraj , Prabhu T Ram
Published: May 2023

Magnesium metal matrix composites for lightweight brake pad applications are developed in this study. The composites are fabricated by using the powder metallurgy process. The addition of 0.5 wt.% to 2 wt.% Y2O3 (Rare Earth Oxide) used as a reinforcement to the AZ31 Mg composite is investigated. Density, hardness, and tribometer tests are carried out according to the ASTM standards. The friction and wear test of magnesium composites is tested against the grey cast iron disc. FESEM analysis shows the microstructure and morphology of worn surfaces. The elemental mapping result depicts that the elements of Mg, Al, Zn, Y, and O are uniformly distributed in the composite. X-ray diffraction analysis shows the compounds of Y2O3, MgO, ZnO, and Al2O4 are present on the worn surface of AZ31 + 2 wt.% Y2O3 composite. The outcome of the experiment reveals that increasing the proportion of yttrium oxide increases the magnesium composite's density and decreases the porosity. AZ31 + 2 wt.% Y2O3 composite exhibits the highest hardness of 122HV, a stable coefficient of friction, and a lower wear rate compared to AZ31 + 0 wt.% Y2O3 composite.
Comparing overlapping data distributions using visualization
Authors: Newburger Eric , Elmqvist Niklas
Published: May 2023

We present results from a preregistered and crowdsourced user study where we asked members of the general population to determine whether two samples represented using different forms of data visualizations are drawn from the same or different populations. Such a task reduces to assessing whether the overlap between the two visualized samples is large enough to suggest similar or different origins. When using idealized normal curves fitted on the samples, it is essentially a graphical formulation of the classic Student’s t-test. However, we speculate that using more sophisticated visual representations, such as bar histograms, Wilkinson dot plots, strip plots, or Tukey boxplots will both allow people to be more accurate at this task as well as better understand its meaning. In other words, the purpose of our study is to explore which visualization best scaffolds novices in making graphical inferences about data. However, our results indicate that the more abstracted idealized bell curve representation of the task yields more accuracy.
Towards Earthly politics in education: Going beyond national, global and planetary environmental imaginaries
Authors: Millei Zsuzsa , Lappalainen Sirpa
Published: May 2023

Early childhood/educational environmental imaginations transmit national, global and planetary views of the world through texts, visual representations and material objects. These representations produce politics, including nationalism and globalism, and play a part in policy making as well as in how children learn to view and relate to the world. Education, however, needs a new political attractor during anthropogenic climate change that differently orients political engagement with the world for education. In this article, we think with the four political attractors Latour describes: the national, global, planetary and Earth, and Cobb’s notion of the child’s primary relatedness to the world. We explore children’s environmental imagination in their drawings and associated stories to highlight the kinds of politics present in their views promoted by current imaginations. Then, we spin these stories further with speculative experiences our own relation with the world with Latour’s ideas and point to a new political object the Earth and Earthly politics for education.
Do labels matter? Implications of ongoing symptomatic chronic illnesses labeled as conventional diagnoses vs. functional somatic syndromes
Authors: Smith Ashley , Lange Lori J.
Published: May 2023

Objective

A consideration of chronic illness according to illness labels that are medically understood as opposed to being outside of medical understanding may reveal unique differences in how individuals understand their illness and how such lay understandings relate to health-related quality of life. Study aims are framed according to the commonsense model of self-regulation with a focus on characterizing illness representations according to chronic illness diagnosis type.

Methods

Individuals suffering from symptomatic chronic illnesses ( n  =  192) completed measures of illness representations, coping, and general health. Participants were categorized into one of two groups based on reported diagnosis/symptoms: (a) conventional diagnosis (CD) or (b) functional somatic syndrome (FSS).

Results

FSS participants reported lower illness coherence and greater illness identity than CD participants. Overall, illness coherence predicted negative coping which mediated the relationship between illness coherence and general health.

Conclusions

Minimal differences were found in illness representations across FSS and CD groups with distinctions found only for illness coherence and identity. Illness coherence stands out as particularly important for coping and health-related quality of life for individuals with ongoing symptoms. Healthcare professionals should work carefully with chronically ill populations to address potential impacts of illness coherence, especially among FSS patients.
Deception and informed consent in studies with incognito simulated standardized patients: empirical experiences and a case study from South Africa
Authors: Daniels Benjamin , Boffa Jody , Kwan Ada , Moyo Sizulu
Published: May 2023

Simulated standardized patients (SPs) are trained individuals who pose incognito as people seeking treatment in a health care setting. With the method’s increasing use and popularity, we propose some standards to adapt the method to contextual considerations of feasibility, and we discuss current issues with the SP method and the experience of consent and ethical research in international SP studies. Since a foundational discussion of the research ethics of the method was published in 2012, a growing number of studies have implemented this method to collect data on the quality of care in a variety of settings around the world. We draw from that experience to provide empirical foundations for a popular approach to ethical approval of such studies in the United States and Canada, which has been to obtain a waiver of informed consent from the health care providers who are the subjects of the research. However, the majority of studies to date have evaluated quality of care outside the U.S., requiring additional ethical consideration when partnering with international institutions. We discuss these considerations in the context of a case study from a completed SP study in South Africa, where informed consent is constitutionally protected.
Special issue: Foreign terrorist fighters: Enhancing the synergies between the EU’s internal and external strategies
Authors: Bounjoua Ali
Published: May 2023

This introduction aims to serve as a reminder of the main steps in the EU’s growing involvement in the topic, showing that there has been a gradual impact on both the EU’s internal and external policies. It also aims to highlight, in particular, two grey areas in law that have an impact on EU policy in the field. On the one hand, a clear and precise definition of the concept of FTF in international law and European law is missing. This absence blurs the line between FTFs and broader or related concepts, such as foreign fighters. It goes without saying that these two questions are particularly acute in the current context of the war in Ukraine and in the context of a growing involvement of the EU institutions in the field of core international crimes and international criminal justice. To conclude, the structure of the special issue entitled “Foreign terrorist fighters: Enhancing the synergies between the EU’s internal and external strategies” will be presented.
Pseudomembranous conjunctivitis caused by Escherichia coli in a newborn
Authors: Thadasina Meenal , Lim Peter Paul , Takhar Jaskirat , Kuper-Sasse Margaret , Zhang David
Published: May 2023

Pseudomembranous conjunctivitis, caused by inflammation of the conjunctiva, is characterized by conjunctival injection, mucopurulent discharge, and formation of a thin membrane overlying the conjunctiva. This is often caused by a viral or bacterial infection. This case report discusses pseudomembranous conjunctivitis from Escherichia coli in a newborn infant which, to our knowledge, has not been reported in relevant literature. This infection was likely transmitted perinatally given that the mother of the infant had blood cultures growing E. coli with the same susceptibilities as the newborn. In addition, we discuss relevant literature on the subject including etiologies, management, and complications of pseudomembranous conjunctivitis.
Infertility caused by an unnoticed intrauterine contraception device: Case series
Authors: Gure Tadesse
Published: May 2023

Infertility is one of the reproductive health issues that affects 10%–15% of couples. There are different factors causing infertility: male factors, female factors, and combinations of them. Knowing the causes of infertility is very important for treatment, and looking for them starts with a simple physical examination and progresses to invasive diagnostic procedures. Although it is rare, there are reports of unnoticed and forgotten intrauterine contraceptive devices causing infertility in different parts of the world. This is a case series of three women who had 3–5 years of infertility consultations and were discovered to have an unnoticed intrauterine contraceptive device. All of them had intrauterine contraceptive devices inserted years before they came to the clinic for an infertility work-up and were unaware of that. These intrauterine contraceptive devices were inserted at different health institutions without any counselling, consent, or information given to the women. The purpose of this case series is to remind health care providers that they should provide counselling, ensure that she understands the type, advantages, and disadvantages of contraception, and that her choices are based on voluntary, informed decision-making before providing any type of contraception to any woman.
Real-world integration of the protocol for responding to and assessing patients’ assets, risks, and experiences tool to assess social determinants of health in the electronic medical record at an academic medical center
Authors: Howell Carrie R , Bradley Heather , Zhang Li , Cleveland John D , Long Dustin , Horton Trudi , Krantz Olivia , Mugavero Michael J , Williams Winter L , Amerson Alesha , Cherrington Andrea L
Published: May 2023

Objective

To describe the real-world deployment of a tool, the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), to assess social determinants of health (SDoH) in an electronic medical record (EMR).

Methods

We employed the collection of the PRAPARE tool in the EMR of a large academic health system in the ambulatory clinic and emergency department setting. After integration, we evaluated SDoH prevalence, levels of missingness, and data anomalies to inform ongoing collection. We summarized responses using descriptive statistics and hand-reviewed data text fields and patterns in the data. Data on patients who were administered with the PRAPARE from February to December 2020 were extracted from the EMR. Patients missing ≥ 12 PRAPARE questions were excluded. Social risks were screened using the PRAPARE. Information on demographics, admittance status, and health coverage were extracted from the EMR.

Results

Assessments with N = 6531 were completed (mean age 54 years, female (58.6%), 43.8% Black). Missingness ranged from 0.4% (race) to 20.8% (income). Approximately 6% of patients were homeless; 8% reported housing insecurity; 1.4% reported food needs; 14.6% had healthcare needs; 8.4% needed utility assistance; and 5% lacked transportation related to medical care. Emergency department patients reported significantly higher proportions of suboptimal SDoH.

Conclusions

Integrating the PRAPARE assessment in the EMR provides valuable information on SDoH amenable to intervention, and strategies are needed to increase accurate data collection and to improve the use of data in the clinical encounter.
The “N+10 Rule” to Avoid Graft-Tunnel Mismatch in Bone–Patellar Tendon–Bone ACL Reconstruction Using Independent Femoral Tunnel Drilling
Authors: Graf Ryan M. , Dart Scott E. , MacLean Ian S. , Barras Laurel A. , Moran Thomas E. , Werner Brian C. , Gwathmey F. Winston , Diduch David R. , Miller Mark D.
Published: May 2023

Background:

Graft-tunnel mismatch (GTM) is a common problem in anterior cruciate ligament (ACL) reconstruction (ACLR) using bone–patellar tendon–bone (BPTB) grafts.

Hypothesis:

Application of the “N+10 rule” in endoscopic ACLR with BPTB grafts will result in acceptable tibial tunnel length (TTL), minimizing GTM.

Study Design:

Controlled laboratory study.

Methods:

Endoscopic BPTB ACLR was conducted on the paired knees of 10 cadaveric specimens using 2 independent femoral tunnel drilling techniques—accessory anteromedial portal and flexible reamer. The graft bone blocks were trimmed to 10 × 20 mm, and the intertendinous distance (represented by “N”) between the bone blocks was measured. The N+10 rule was used to set the angle of the ACL tibial tunnel guide to the appropriate number of degrees for drilling. The amount of excursion or recession of the tibial bone plug in relation to the anterior tibial cortical aperture was measured in both flexion and extension. A GTM threshold of ±7.5 mm was set based on prior studies.

Results:

The mean BPTB ACL intertendinous distance was 47.5 ± 5.5 mm. The mean measured intra-articular distance was 27.2 ± 3 mm. Using the N+10 rule, the mean total (flexion plus extension) GTM was 4.3 ± 3.2 mm (GTM in flexion, 4.9 ± 3.6 mm; GTM in extension, 3.8 ± 3.5 mm). In 18 of 20 (90%) cadaveric knees, the mean total GTM fell within the ±7.5-mm threshold. When comparing the actual measured TTL to the calculated TTL, there was a mean difference of 5.4 ± 3.9 mm. When comparing femoral tunnel drilling techniques, the total GTM for the accessory anteromedial portal technique was 2.1 ± 3.7 mm, while the total GTM for the flexible reamer technique was 3.6 ± 5.4 mm ( P = .5).

Conclusion:

The N+10 rule resulted in an acceptable mean GTM in both flexion and extension. The mean difference between the measured versus calculated TTL using the N+10 rule was also acceptable.

Clinical Relevance:

The N+10 rule is a simple and effective intraoperative strategy for achieving desired TTL regardless of patient-specific factors to avoid excessive GTM in endoscopic BPTB ACLR using independent femoral tunnel drilling.
Outcomes and Survivorship 5 Years After Arthroscopic Rotator Cuff Repair in Active Patients 70 Years and Older
Authors: Horan Marilee P. , Hanson Jared A. , Rakowski Dylan R. , Patel Ravi B. , Vidal Leslie B. , Millett Peter J.
Published: May 2023

Background:

Rotator cuff tears are common in the elderly population and are associated with increased pain, decreased function, and decreased enjoyment of recreational activities.

Purpose:

To evaluate clinical outcomes at a minimum of 5 years after arthroscopic repair of full-thickness rotator cuff tears in recreational athletes aged ≥70 years at the time of surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included were recreational athletes aged ≥70 years who underwent arthroscopic rotator cuff repair (RCR) from December 2005 to January 2016. Patient and surgery characteristics were collected prospectively and retrospectively reviewed. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health survey (SF-12) questionnaire (Physical Component Summary and Mental Component Summary), and patient satisfaction. Kaplan Meier survivorship analysis was performed, with failure defined as revision RCR or retear on magnetic resonance imaging (MRI).

Results:

Overall, 71 shoulders (n = 67 patients [44 men, 23 women]; mean age, 73.4 years [range, 70.1-81.3 years]) were included in this study. Follow-up data was obtained for 65 of the 69 available shoulders (94%) at a mean of 7.8 years (range, 5-15.3 years). Mean age at follow-up was 81.2 years (range, 75.7-91.0). One RCR was revised after a traumatic accident, and another had a symptomatic, MRI-confirmed retear. One patient had lysis of adhesions for stiffness 3 months postoperatively. All PRO scores improved from pre- to postoperatively—ASES, from 55.3 to 93.6; SANE, from 62 to 89.6; QuickDASH, from 32.9 to 7.3; and SF-12 Physical Component Summary, from 43.3 to 53 ( P < .001 for all)—and the median satisfaction score was 10 out of 10. Postoperatively, 63% of the patients returned to their original fitness program and 33% of patients modified their recreational activity. Survivorship analysis showed a 98% survival rate at 5 years and a 92% rate at 10 years.

Conclusion:

Sustained improvement in function, reduced pain, and return to activities was seen after arthroscopic RCR in active patients ≥70 years old. Despite one-third of patients modifying their recreational activity, the cohort reported high levels of satisfaction and general health.
A Preliminary Exploration of the Impact of Aged Care Reforms on the Governance of Two Australian Residential Care Facilities
Authors: Monro Cathy , Mackenzie Lynette , duToit Sanetta , O’Loughlin Kate , Low Lee-Fay
Published: May 2023

Objectives: Australia’s ongoing aged care reforms have re-focused service provisions from a provider-driven policy approach to a consumer-directed care focus and redirected residential care subsidies. This study aimed (i) to identify the experiences and perceptions of people involved in the governance of residential care facilities about their management of changes due to new accreditation requirements and funding mechanisms, and (ii) to describe their strategic responses to aged care reform changes. Methods: A qualitative description design used interviews exploring perspectives of Board Chairs, Board Directors, and Chief Executive Officers of two NSW-based residential care organizations. Thematic analysis was conducted of interview transcripts. Results: Four key themes emerged from the data: (1) Business strategies and challenges under reform conditions including the need for business diversification and new approaches, (2) costs incurred by the reforms such as compliance with accreditation requirements, (3) workforce demands: for example maintaining staffing levels and training needs, and (4) expectations about maintaining quality of care. Discussion: Changes were necessary in business models for facilities to remain sustainable, meet staffing needs, and continue to provide services in a complex, changing fiscal environment. These included generating revenue streams other than government subsidies, better clarity about government support and establishing partnerships.
In-Depth Ethical Analysis of the COVID-19 Vaccine Rollout for Migrant Workers in the Gulf Countries
Authors: Alahmad Barrak , AlMekhled Dawoud , Busalacchi Katie , Wang Wei-Chen
Published: May 2023

During the initial COVID-19 vaccine rollout, supplies were scarce, necessitating rationing. Gulf countries, hosting millions of migrant workers, prioritized nationals over migrants for vaccination. As it turned out, many migrant workers found themselves waiting behind nationals to get vaccinated for COVID-19. Here, we discuss the public health ethical concerns surrounding this approach and call for fair and inclusive vaccine allocation policies. First, we examine global justice through the lens of statism, where distributive justice applies only to sovereign state members, and cosmopolitanism, advocating equal justice distribution for all humans. We propose a cooperativist perspective, suggesting that new justice obligations can arise between people beyond national ties. In cases of mutually beneficial cooperation, such as migrant workers contributing to a nation's economy, equal concern for all parties is required. Second, the principle of reciprocity further supports this stance, as migrants significantly contribute to host countries’ societies and economies. Additional ethical principles—equity, utilitarianism, solidarity, and nondiscrimination—are essentially violated when excluding non-nationals in vaccine distribution. Finally, we argue that prioritizing nationals over migrants is not only ethically indefensible, but it also fails to ensure full protection for nationals and hampers efforts to curb COVID-19 community spread.
Drug mechanism enrichment analysis improves prioritization of therapeutics for repurposing
Authors: Garana Belinda B. , Joly James H. , Delfarah Alireza , Hong Hyunjun , Graham Nicholas A.
Published: May 2023

Background

There is a pressing need for improved methods to identify effective therapeutics for diseases. Many computational approaches have been developed to repurpose existing drugs to meet this need. However, these tools often output long lists of candidate drugs that are difficult to interpret, and individual drug candidates may suffer from unknown off-target effects. We reasoned that an approach which aggregates information from multiple drugs that share a common mechanism of action (MOA) would increase on-target signal compared to evaluating drugs on an individual basis. In this study, we present drug mechanism enrichment analysis (DMEA), an adaptation of gene set enrichment analysis (GSEA), which groups drugs with shared MOAs to improve the prioritization of drug repurposing candidates.

Results

First, we tested DMEA on simulated data and showed that it can sensitively and robustly identify an enriched drug MOA. Next, we used DMEA on three types of rank-ordered drug lists: (1) perturbagen signatures based on gene expression data, (2) drug sensitivity scores based on high-throughput cancer cell line screening, and (3) molecular classification scores of intrinsic and acquired drug resistance. In each case, DMEA detected the expected MOA as well as other relevant MOAs. Furthermore, the rankings of MOAs generated by DMEA were better than the original single-drug rankings in all tested data sets. Finally, in a drug discovery experiment, we identified potential senescence-inducing and senolytic drug MOAs for primary human mammary epithelial cells and then experimentally validated the senolytic effects of EGFR inhibitors.

Conclusions

DMEA is a versatile bioinformatic tool that can improve the prioritization of candidates for drug repurposing. By grouping drugs with a shared MOA, DMEA increases on-target signal and reduces off-target effects compared to analysis of individual drugs. DMEA is publicly available as both a web application and an R package athttps://belindabgarana.github.io/DMEA.
Systematic review on the current state of disaster preparation Simulation Exercises (SimEx)
Authors: Mahdi Syed Sarosh , Jafri Hafsa Abrar , Allana Raheel , Battineni Gopi , Khawaja Mariam , Sakina Syeda , Agha Daniyal , Rehman Kiran , Amenta Francesco
Published: May 2023

Introduction

The simulation exercise (SimEx) simulates an emergency in which an elaboration or description of the response is applied. The purpose of these exercises is to validate and improve plans, procedures, and systems for responding to all hazards. The purpose of this study was to review disaster preparation exercises conducted by various national, non-government, and academic institutions.

Methodology

Several databases, including PubMed (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), BioMed Central, and Google Scholar, were used to review the literature. Information was retrieved using Medical Subject Headings (MeSH) and documents were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). To assess the quality of the selected articles, the Newcastle-Ottawa Scale (NOS) technique was utilized.

Results

A total of 29 papers were selected for final review based on PRISMA guidelines and the NOS quality assessment. Studies have shown that many forms of SimEx commonly used in disaster management including tabletop exercises, functional exercises, and full-scale exercises have their benefits and limitations. There is no doubt that SimEx is an excellent tool for improving disaster planning and response. It is still necessary to give SimEx programs a more rigorous evaluation and to standardize the processes more thoroughly.

Conclusions

Drills and training can be improved for disaster management, which will enable medical professionals to face the challenges of disaster management in the 21st century.
MSMpred: interactive modelling and prediction of individual evolution via multistate models
Authors: Garmendia Bergés Leire , Cortés Martínez Jordi , Gómez Melis Guadalupe ,   DIVINE project
Published: May 2023

Background

Modelling the course of a disease regarding severe events and identifying prognostic factors is of great clinical relevance. Multistate models (MSM) can be used to describe diseases or processes that change over time using different states and the transitions between them. Specifically, they are useful to analyse a disease with an increasing degree of severity, that may precede death. The complexity of these models changes depending on the number of states and transitions taken into account. Due to that, a web tool has been developed making easier to work with those models.

Results

MSMpred is a web tool created with the shiny package that has two main features: 1) to allow to fit a MSM from specific data; 2) to predict the clinical evolution for a given subject. To fit the model, the data to be analysed must be upload in a prespecified format. Then, the user has to define the states and transitions as well as the covariates (e.g., age or gender) involved in each transition. From this information, the app returns histograms or barplots, as appropriate, to represent the distributions of the selected covariates and boxplots to show the patient’ length of stay (for uncensored data) in each state. To make predictions, the values of selected covariates from a new subject at baseline has to be provided. From these inputs, the app provides some indicators of the subject’s evolution such as the probability of 30-day death or the most likely state at a fixed time. Furthermore, visual representations (e.g., the stacked transition probabilities plot) are given to make predictions more understandable.

Conclusions

MSMpred is an intuitive and visual app that eases the work of biostatisticians and facilitates to the medical personnel the interpretation of MSMs.
Developing patient-refined colorectal cancer screening materials: application of a virtual community engagement approach
Authors: Gautom Priyanka , Escaron Anne L. , Garcia Joanna , Thompson Jamie H. , Rivelli Jennifer S. , Ruiz Esmeralda , Torres-Ozadali Evelyn , Richardson Dawn M. , Coronado Gloria D.
Published: May 2023

Introduction

In partnership with a federally qualified health center (FQHC), an adapted virtual version of boot camp translation (BCT) was used to elicit input from Spanish-speaking Latino patients and staff to develop messaging and patient education materials for follow-up colonoscopy after abnormal fecal testing. We describe how we adapted an existing in-person BCT process to be delivered virtually and present evaluations from participants on the virtual format.

Methods

Three virtual BCT sessions were facilitated by bilingual staff and conducted via Zoom. These sessions included introductions and discussions on colorectal cancer (CRC), CRC screening, and gathered feedback from participants on draft materials. Ten adults were recruited from the FQHC. A research team member from the FQHC served as the point of contact (POC) for all participants and offered Zoom introductory sessions and/or technology support before and during the sessions. Following the third session, participants were invited to complete an evaluation form about their virtual BCT experience. Using a 5-point Likert Scale (where 5 = strongly agree), questions focused on session utility, group comfort level, session pacing, and overall sense of accomplishment.

Results

Average scores ranged from 4.3 to 5.0 indicating strong support towards the virtual BCT sessions. Additionally, our study emphasized the importance of a POC to provide technical support to participants throughout the process. Using this approach, we successfully incorporated feedback from participants to design culturally relevant materials to promote follow-up colonoscopy.

Conclusion

We recommend ongoing public health emphasis on the use of virtual platforms for community engaged work.
Clinicodemographic correlates of psychotic features in bipolar disorder – a multicenter study in China
Authors: Zhang Zhi-Fang , Huang Juan , Zhu Xue-Quan , Yu Xin , Yang Hai-Chen , Xu Xiu-Feng , Fang Yi-Ru , Tan Qing-Rong , Li Hui-Chun , Wang Gang , Zhang Ling
Published: May 2023

Background

Psychotic symptoms are prevalent in patients with bipolar disorder (BD). However, nearly all previous studies on differences in sociodemographic and clinical factors between patients with (BD P +) and without (BD P-) psychotic symptoms were conducted in Western populations, and limited information is known in China.

Method

A total of 555 patients with BD from seven centers across China were recruited. A standardized procedure was used to collect patients’ sociodemographic and clinical characteristics. The patients were divided into BD P + or BD P- groups based on the presence of lifetime psychotic symptoms. Mann–Whitney U test or chi-square test was used to analyze differences in sociodemographic and clinical factors between patients with BD P + and BD P-. Multiple logistic regression analysis was conducted to explore factors that were independently correlated with psychotic symptoms in BD. All the above analyses were re-conducted after the patients were divided into BD I and BD II group according to their types of diagnosis.

Results

A total of 35 patients refused to participate, and the remaining 520 patients were included in the analyses. Compared with patients with BD P-, those with BD P + were more likely to be diagnosed with BD I and mania/hypomania/mixed polarity in the first mood episode. Moreover, they were more likely to be misdiagnosed as schizophrenia than major depressive disorder, were hospitalized more often, used antidepressants less frequently, and used more antipsychotics and mood stabilizers. Multivariate analyses revealed that diagnosis of BD I, more frequent misdiagnosis as schizophrenia and other mental disorders, less frequent misdiagnosis as major depressive disorder, more frequent lifetime suicidal behavior, more frequent hospitalizations, less frequent use of antidepressants, more frequent use of antipsychotics and mood stabilizers were independently correlated with psychotic symptoms in BD. After dividing the patients into BD I and BD II groups, we observed notable differences in sociodemographic and clinical factors, as well as clinicodemographic correlates of psychotic features between the two groups.

Conclusions

Differences in clinical factors between patients with BD P + and BD P- showed cross-cultural consistency, but results on the clinicodemographic correlates of psychotic features were not. Notable differences between patients with BD I and BD II were found. Future work exploring the psychotic features of BD needs to take types of diagnosis and cultural differences into consideration.

Trial registration

This study was first registered on the website of the ClinicalTrials.gov (https://clinicaltrials.gov/) on 18/01/2013. Its registration number is NCT01770704.
A community health worker and mobile health app intervention to improve adherence to HIV medication among persons with HIV: the CHAMPS study protocol
Authors: Wood Olivia R. , Schnall Rebecca , Kay Emma S. , Jia Haomiao , Abua Joseph A. , Nichols Tyler K. , Olender Susan A. , Mugavero Michael J. , Batey D. Scott
Published: May 2023

Background

Persons with HIV (PWH) can now achieve a near-normal life expectancy due to antiretroviral therapy (ART). Despite widespread availability of ART in the United States (US), many of the country’s approximate 1.1 million PWH are not achieving viral suppression due to poor ART adherence. Viral suppression rates are particularly low in Alabama (AL, 62%) and New York City (NYC, 67%). There is mixed evidence on the efficacy of community health workers (CHW) and mHealth interventions for improving ART adherence and viral suppression in PWH thus, we sought to combine these interventions and test the efficacy for improving health outcomes in PWH.

Methods

The CHAMPS study is a two-arm randomized controlled trial among 300 PWH with suboptimal primary care appointment adherence (n = 150 in AL and 150 in NYC) over the course of 12 months. Participants are randomly assigned to CHAMPS (intervention) or a standard-of-care (control) arm. Participants in the intervention arm are given a CleverCap pill bottle that syncs to the WiseApp to track medication adherence, reminds users to take their medication at a set time, and enables communication with CHW. All participants complete baseline, 6-month, and 12-month follow-up visits where surveys are administered and, CD4 and HIV-1 viral load are obtained through blood draw.

Discussion

Maintaining ART adherence has significant implications in HIV management and transmission. mHealth technologies have been shown to optimize the provision of health services, produce positive changes in health behavior, and significantly improve health outcomes. CHW interventions also provide personal support to PWH. The combination of these strategies may provide the necessary intensity to increase ART adherence and clinic attendance among PWH at highest risk for low engagement. Delivering care remotely enables CHW to contact, assess, and support numerous participants throughout the day, reducing burden on CHW and potentially improving intervention durability for PWH. The adoption of the WiseApp coupled with community health worker sessions in the CHAMPS study has the potential to improve HIV health outcomes, and will add to the growing knowledge of mHealth and CHW efforts to improve PWH medication adherence and viral suppression.

Trial registration

This trial was registered with Clinicaltrials.gov (NCT04562649) on 9/24/20.
Managing disabled workers due to occupational accidents in Indonesia: a case study on return to work program
Authors: Kurnianto Arie Arizandi , Khatatbeh Haitham , Prémusz Viktória , Nemeskéri Zsolt , Ágoston István
Published: May 2023

Background

Limited research and studies prove the usefulness of case management for persons with disabilities, which helps disabled employees recover their dignity through medical vocational, and psychological rehabilitation in underdeveloped countries’ Return To Work (RTW) programs.

Methods

This qualitative case study design involved semi structured interviews with case managers as the primary data source, supplemented by secondary data from BPJS Ketenagakerjaan. Data analysis utilized QDA Miner Lite and Python with ArcGIS integration for descriptive visualization.

Results

The RTW program of BPJS Ketenagakerjaan has already adopted ILO’s fundamental suggestion, which creates two central themes: internal aspects that are essential to the RTW framework and external variables that impact RTW practice. The key themes produce six main pieces to discuss further: personal skill, personal literacy, providers, guidelines, authorities, and stakeholder support.

Conclusion

Return to Work Program benefits companies, and the implementation of a career development service or a partnership with non-governmental organizations guarantees that disabled employees who cannot return to work with their former employers are still in the global economy.
Comparing oral case presentation formats on internal medicine inpatient rounds: a survey study
Authors: Appold Brendan , Saint Sanjay , Ratz David , Gupta Ashwin
Published: May 2023

Background

Oral case presentations – structured verbal reports of clinical cases – are fundamental to patient care and learner education. Despite their continued importance in a modernized medical landscape, their structure has remained largely unchanged since the 1960s, based on the traditional Subjective, Objective, Assessment, Plan (SOAP) format developed for medical records. We developed a problem-based alternative known as Events, Assessment, Plan (EAP) to understand the perceived efficacy of EAP compared to SOAP among learners.

Methods

We surveyed (Qualtrics, via email) all third- and fourth-year medical students and internal medicine residents at a large, academic, tertiary care hospital and associated Veterans Affairs medical center. The primary outcome was trainee preference in oral case presentation format. The secondary outcome was comparing EAP and SOAP on 10 functionality domains assessed via a 5-point Likert scale. We used descriptive statistics (proportion and mean) to describe the results.

Results

The response rate was 21% (118/563). Of the 59 respondents with exposure to both the EAP and SOAP formats, 69% (n = 41) preferred the EAP format as compared to 19% (n = 11) who preferred SOAP (p < 0.001). EAP outperformed SOAP in 8 out of 10 of the domains assessed, including advancing patient care, learning from patients, and time efficiency.

Conclusions

Our findings suggest that trainees prefer the EAP format over SOAP and that EAP may facilitate clearer and more efficient communication on rounds, which in turn may enhance patient care and learner education. A broader, multi-center study of the EAP oral case presentation will help to better understand preferences, outcomes, and barriers to implementation.
Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study
Authors: Pokharel Alpha , Kiriya Junko , Shibanuma Akira , Silwal Ram Chandra , Jimba Masamine
Published: May 2023

Introduction

Respectful maternity care is an approach that involves respecting women’s belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the early phase of pandemic.

Methods

A cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association.

Results

The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic.

Conclusions

While a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.
Validation and optimization of the French Generic Adherence for Chronic Diseases Profile (GACID-P) using classical test and item response theory
Authors: Rotonda Christine , Guillemin F. , Conroy T , Alleyrat C. , Lefevre B. , Soudant M. , Tarquinio C.
Published: May 2023

Background

The Generic Adherence for Chronic Diseases Profile is a French generic scale (GACID-P) developed to measure adherence in several disease areas such as cardiology, rheumatology, diabetes, cancer and infectiology.

Method

We aimed to study the measurement invariance of the Generic Adherence for Chronic Diseases Profile by an item response model, optimize the new instrument version from item response model and qualitative content analyses results, and validate the instrument. The metric properties of the optimized version were studied according to classical test theory and item response model analysis.

Results

A sample of 397 patients consulting at two French hospitals (in diabetes, cardiology, rheumatology, cancerology and infectiology) and in four private practices was recruited; 314 (79%) patients also completed the questionnaire 15 days later. Factor analyses revealed four dimensions: “Forgetting to take medication”, “Intention to comply with treatment”, “Limitation of risk-related consumer habits” and “Healthy lifestyle”. The item response model and content analyses optimized these four dimensions, regrouping 32 items in four dimensions of 25 items, including one item conditioned on tobacco use. The psychometric properties and scale calibration were satisfactory. One score per dimension was calculated as the sum of the items for the dimensions “Forgetting to take medication” and “Intention to comply with treatment” and as a weighted score according to the item response model analysis for the two other dimensions because of differential item functioning found for two items.

Conclusion

Four adherence profile scores were obtained. The instrument validity was documented by a theoretical approach and content analysis. The Generic Adherence for Chronic Diseases Profile is now available for research targeting adherence in a broad perspective.