bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of COVID-19 on stage migration in bladder cancer: A single-centre retrospective comparative cohort analysis
Authors: Haq Kamran , Whyte Eleanor , Poulopoulou Dimitra , Shannon Oliver , Couper Sinclair , Lye Jonathan , Illinca Cristina , Reynolds Martin , Veeratterapillay Rajan , Rai Bhavan Prasad
Published: June 2023

Objectives:

To evaluate whether the COVID-19 pandemic has increased the proportion of patients diagnosed with muscle invasive bladder cancer (MIBC) at first presentation and explore potential causes for this hypothesised stage migration.

Subjects/Patients and Methods:

All patients undergoing first transuretheral resection of bladder tumour (TURBT) between 2 January 2018 and 30 June 2021. The date of the lockdown restrictions was used to divide patients into pre-COVID and COVID cohorts. Data were collated retrospectively from electronic patient records. Variables included demographics data, TNM stage and presentation (emergent/elective). A comparative analysis of the two cohorts was undertaken using the chi-square test to evaluate for statistical significance. A p-value of <0.05 was regarded as significant.

Results:

A total of 1064 patient underwent a TURBT for a suspected bladder cancer in the study period. The number of patients in the pre-COVID and COVID cohorts was 704 and 360, respectively. Mean age was comparable between cohorts (74.7 vs 74.2 ( p = 0.46)) as was sex ratio (F:M (1:2.84 vs 1:2.95) p = 0.80). The proportion of patients with MIBC pre-COVID was 18% compared to 23.6% in the COVID cohort. This represents a 5.6% increase in the prevalence of first presentation MIBC during the COVID era ( p = 0.03 [95% confidence interval (CI) = 0.2–10.4]). The odds of a patient presenting with MIBC was 38% higher during the COVID era versus pre-COVID (odds ratio (OR) [95% CI] = 1.38 [1.01–1.85]). A significantly higher proportion of patients had metastases at presentation in the COVID cohort versus pre-COVID (4.4% vs 2.1% ( p = 0.034)).

Conclusion:

Our data would support the hypothesis that the COVID pandemic has precipitated a stage migration in the presentation of bladder cancer towards muscle invasive disease. This has implications in terms of patient outcomes as well as an increased demand on services to provide radial treatment. Potential reasons for the stage migration are patient-related factors and pathway failure due to widespread service disruption caused by COVID-19.

Level of evidence:

3
Variation in Kidney Transplant Referral Across Chronic Kidney Disease Programs in Ontario, Canada
Authors: Yohanna Seychelle , Naylor Kyla L. , Luo Bin , Dixon Stephanie N. , Bota Sarah E. , Kim S. Joseph , Blake Peter G. , Elliott Lori , Cooper Rebecca , Knoll Gregory A. , Treleaven Darin , Wang Carol , Garg Amit X.
Published: June 2023

Background:

Eligible patients with kidney failure should have equal access to kidney transplantation. Transplant referral is the first crucial step toward receiving a kidney transplant; however, studies suggest substantial variation in the rate of kidney transplant referral across regions. The province of Ontario, Canada, has a public, single-payer health care system with 27 regional chronic kidney disease (CKD) programs. The probability of being referred for kidney transplant may not be equal across CKD programs.

Objective:

To determine whether there is variability in kidney transplant referral rates across Ontario’s CKD programs.

Design:

Population-based cohort study using linked administrative health care databases from January 1, 2013, to November 1, 2016.

Setting:

Twenty-seven regional CKD programs in the province of Ontario, Canada.

Patients:

Patients approaching the need for dialysis (advanced CKD) and patients receiving maintenance dialysis (maximum follow-up: November 1, 2017).

Measurements:

Kidney transplant referral.

Methods:

We calculated the 1-year unadjusted cumulative probability of kidney transplant referral for Ontario’s 27 CKD programs using the complement of Kaplan-Meier estimator. We calculated standardized referral ratios (SRRs) for each CKD program, using expected referrals from a 2-staged Cox proportional hazards model, adjusting for patient characteristics in the first stage. Standardized referral ratios with a value less than 1 were below the provincial average (maximum possible follow-up of 4 years 10 months). In an additional analysis, we grouped CKD programs according to 5 geographic regions.

Results:

Among 8641 patients with advanced CKD, the 1-year cumulative probability of kidney transplant referral ranged from 0.9% (95% confidence interval [CI]: 0.2%-3.7%) to 21.0% (95% CI: 17.5%-25.2%) across the 27 CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.4) to 4.2 (95% CI: 2.1-7.5). Among 6852 patients receiving maintenance dialysis, the 1-year cumulative probability of transplant referral ranged from 6.4% (95% CI: 4.0%-10.2%) to 34.5% (95% CI: 29.5%-40.1%) across CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.3) to 1.8 (95% CI: 1.6-2.1). When we grouped CKD programs according to geographic region, we found that patients residing in Northern regions had a substantially lower 1-year cumulative probability of transplant referral.

Limitations:

Our cumulative probability estimates only captured referrals within the first year of advanced CKD or maintenance dialysis initiation.

Conclusions:

There is marked variability in the probability of kidney transplant referral across CKD programs operating in a publicly funded health care system.
QR code: The global making of an infrastructural gateway
Authors: de Seta Gabriele
Published: June 2023

This article traces the history of machine-readable data encoding standards and argues that the QR code has become an infrastructural gateway. Through the analysis of patents, corporate documents and advertising, ethnographic observations, and interviews with professionals, I describe the global making of the QR code and argue that the convergence of data encoding standards, mobile computing, machine vision algorithms, and platform ecosystems has led to the emergence of a new component of computational infrastructures which functions as a gateway between different actors, systems, and practices. The central section of the article covers seven decades of machine-readable data encoding history across different national and regional contexts: from the invention and popularization of the barcode in the United States, through the QR code’s invention in Japan and its success in East Asia, to its platformization in China. By revisiting this history through concepts drawn from the field of infrastructure studies, I argue that QR codes have become infrastructural gateways and conclude that this concept is useful not only to understand the current role of QR codes but also to identify and follow the emergence and change of other gateways in infrastructures to come.
A 5-Year Analysis of Saudi Arabian Applications to Plastic Surgery Residency Training in Canada
Authors: Samargandi Osama A. , Fadel Zahir T. , AlJaaly Hattan , Al Qurashi Abdullah A. , Samarkandi Osama A. , Saadah Omar I. , Williams Jason
Published: June 2023

Introduction: The goal of this study is to determine factors associated with acceptance into Canadian plastic surgery (PS) residency programs by Saudi Arabian Medical Graduates. Methods: This is a cross-sectional study targeting eligible Saudi Arabian applicants to any Canadian PS residency program between 2017 and 2022. Collected data included demographics, education/licensure, electives in Canada, and letter of reference. The 2 main outcomes analyzed were “invited for an interview” and “offered a residency position.” Results: We reviewed 52 applications. Of these, 18 applicants received an invitation for an interview and 8 were offered a residency training position. Significant variables associated with receiving an invitation for an interview were completing an elective in Canada ( P = .016), having a master's degree ( P = .012), and completion of an English test ( P = .032). The variables most likely to influence receiving a residency position offer are completion of elective training in Canada ( P = .004) and receiving a letter of reference from a Canadian plastic surgeon (95% CI: 0.77 to 76.69: OR: 8.90). Conclusion: Completion of an elective rotation in Canada and obtaining Canadian letters of reference were found to be the most important factors for Saudi Arabian physician applicants to be accepted into a Canadian PS residency program. Other factors that were less critical but improved their chances of being considered include completion of an English assessment test and having a master's degree. This study offers valuable guidance for any Saudi Arabian candidates interested in PS residency in Canada and may aid Canadian programs in their assessment of potential residents.
Immune restoration with ibrutinib plus venetoclax in first-line chronic lymphocytic leukemia: the phase 2 CAPTIVATE study
Authors: Moreno Carol , Solman Isabelle G. , Tam Constantine S. , Grigg Andrew , Scarfò Lydia , Kipps Thomas J. , Srinivasan Srimathi , Mali Raghuveer Singh , Zhou Cathy , Dean James P. , Szafer-Glusman Edith , Choi Michael
Published: June 2023

We evaluated immune cell subsets in patients with chronic lymphocytic leukemia (CLL) who received first-line therapy with 3 cycles of ibrutinib then 13 cycles of ibrutinib plus venetoclax in the minimal residual disease (MRD) cohort of the CAPTIVATE study (NCT02910583). Patients with Confirmed undetectable MRD (uMRD) were randomly assigned to placebo or ibrutinib groups; patients without Confirmed uMRD were randomly assigned to ibrutinib or ibrutinib plus venetoclax groups. We compared immune cell subsets in samples collected at 7 time points with age-matched healthy donors. CLL cells decreased within 3 cycles after venetoclax initiation; from cycle 16 onward, levels were similar to healthy donor levels (HDL; ≤0.8 cells per μL) in patients with Confirmed uMRD and slightly above HDL in patients without Confirmed uMRD. By 4 months after cycle 16, normal B cells had recovered to HDL in patients randomly assigned to placebo. Regardless of randomized treatment, abnormal counts of T cells, classical monocytes, and conventional dendritic cells recovered to HDL within 6 months (median change from baseline −49%, +101%, and +91%, respectively); plasmacytoid dendritic cells recovered by cycle 20 (+598%). Infections generally decreased over time regardless of randomized treatment and were numerically lowest in patients randomly assigned to placebo within 12 months after cycle 16. Sustained elimination of CLL cells and recovery of normal B cells were confirmed in samples from patients treated with fixed-duration ibrutinib plus venetoclax in the GLOW study (NCT03462719). These results demonstrate promising evidence of restoration of normal blood immune composition with ibrutinib plus venetoclax.
Genomic evidence reveals high genetic diversity in a narrowly distributed species and natural hybridization risk with a widespread species in the genus Geodorum
Authors: Zhu Xianliang , Tang Jianmin , Jiang Haidu , Yang Yishan , Chen Zongyou , Zou Rong , Xu Aizhu , Luo Yajin , Deng Zhenhai , Wei Xiao , Chai Shengfeng
Published: June 2023

Background

Understanding genetic diversity is a core issue in conservation genetics. However, previous genetic diversity evaluations of narrowly distributed species have rarely used closely related widespread species as a reference. Furthermore, identifying natural hybridization signals between narrowly and widely distributed sympatric species is of great importance for the development of species conservation programs.

Methods

In this study, population genotyping by sequencing (GBS) was performed for a narrowly distributed species,Geodorum eulophioides(endemic and endangered in Southwest China), and a widespread species,G. densiflorum. A total of 18,490 high-quality single nucleotide polymorphisms (SNPs) were identified at the whole-genome level.

Results

The results showed that the nucleotide diversity and heterozygosity ofG. eulophioideswere significantly higher than those ofG. densiflorum, confirming that narrowly distributed species can still preserve high genetic diversity. Consistent with taxonomic boundaries, all sampled individuals from the two species were divided into two genetic clusters and showed high genetic differentiation between species. However, in a sympatric population, a fewG. eulophioidesindividuals were detected with genetic components fromG. densiflorum, suggesting potential interspecific natural hybridization. This hypothesis was supported by Treemix analysis and hand-hybridization trials. Invasion of the habitat ofG. eulophioidesinvasion byG. densiflorumunder anthropogenic disturbance may be the main factor causing interspecific hybridization.

Conclusions

Therefore, reducing or avoiding habitat disturbance is a key measure to protect theG. eulophioidespopulations. This study provides valuable information for future conservation programs for narrowly distributed species.
Genetic diversity and selection signatures in a gene bank panel of maize inbred lines from Southeast Europe compared with two West European panels
Authors: Galić Vlatko , Anđelković Violeta , Kravić Natalija , Grčić Nikola , Ledenčan Tatjana , Jambrović Antun , Zdunić Zvonimir , Nicolas Stéphane , Charcosset Alain , Šatović Zlatko , Šimić Domagoj
Published: June 2023

Southeast Europe (SEE) is a very important maize-growing region, comparable to the Corn belt region of the United States, with similar dent germplasm (dent by dent hybrids). Historically, this region has undergone several genetic material swaps, following the trends in the US, with one of the most significant swaps related to US aid programs after WWII. The imported accessions used to make double-cross hybrids were also mixed with previously adapted germplasm originating from several more distant OPVs, supporting the transition to single cross-breeding. Many of these materials were deposited at the Maize Gene Bank of the Maize Research Institute Zemun Polje (MRIZP) between the 1960s and 1980s. A part of this Gene Bank (572 inbreds) was genotyped with Affymetrix Axiom Maize Genotyping Array with 616,201 polymorphic variants. Data were merged with two other genotyping datasets with mostly European flint (TUM dataset) and dent (DROPS dataset) germplasm. The final pan-European dataset consisted of 974 inbreds and 460,243 markers. Admixture analysis showed seven ancestral populations representing European flint, B73/B14, Lancaster, B37, Wf9/Oh07, A374, and Iodent pools. Subpanel of inbreds with SEE origin showed a lack of Iodent germplasm, marking its historical context. Several signatures of selection were identified at chromosomes 1, 3, 6, 7, 8, 9, and 10. The regions under selection were mined for protein-coding genes and were used for gene ontology (GO) analysis, showing a highly significant overrepresentation of genes involved in response to stress. Our results suggest the accumulation of favorable allelic diversity, especially in the context of changing climate in the genetic resources of SEE.
Effect of wet-heparinized suction on the quality of mediastinal solid tumor specimens obtained by endoscopic ultrasound-guided fine-needle aspiration: a retrospective study from a single center
Authors: Xu Bo , Lu Qian , Fang Rong , Dai Xiaojuan , Xu Haiyan , Ding Xiangwu , Gui Huawei
Published: June 2023

Background

Mediastinal lesions are diagnosed sometimes by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Wet-heparinized suction technique has been used to improve the quality of abdominal solid tumor samples obtained by EUS-FNA. The aim of the study is to assess the effect of wet-heparinized suction on the quality of mediastinal solid tumor samples and to evaluate the safety of the method.

Methods

The medical records, EUS-FNA records, pathologic data, and follow-up data between the patients who suspected mediastinal lesions with wet-heparinized suction and conventional suction were retrospectively and comparatively analyzed. Adverse events at 48 h and 1 week after EUS-FNA were evaluated.

Results

Wet-heparinized suction contributed to more tissue specimens (P < 0.05), superior tissue integrity (P < 0.05), and a longer length of white tissue core (P < 0.05). In addition, the more complete the tissue bar was, the higher the rate of successful sample (P < 0.05). Moreover, the total length of the white tissue bar at the first puncture was remarkably longer in the Experimental group (P < 0.05). No significant difference in red blood cell contamination in paraffin sections was found between the two groups (P > 0.05). There was no complication after discharge in both groups.

Conclusion

Wet-heparinized suction can improve the quality of mediastinal lesion samples obtained by EUS-FNA and increase the success rate of sampling. In addition, it will not aggravate blood contamination in paraffin sections while ensuring a safe puncture.
Persistent neurological symptoms and elevated intracranial pressures in a previously healthy host with cryptococcal meningitis
Authors: El-Atoum Mohammad , Hargarten Jessica C. , Park Yoon-Dong , Ssebambulidde Kenneth , Ding Li , Chittiboina Prashant , Hammoud Dima A. , Anjum Seher H. , Glassman Seth R. , Merchant Shehzad , Williamson Peter R. , Hu John C.
Published: June 2023

Cryptococcal meningoencephalitis can occur in both previously healthy and immunocompromised hosts. Here, we describe a 55 year-old HIV-negative male with no known prior medical problems, who presented with three months of worsening headaches, confusion, and memory changes without fever. Magnetic resonance imaging of the brain demonstrated bilateral enlargement/enhancement of the choroid plexi, with hydrocephalus, temporal and occipital horn entrapments, as well as marked periventricular transependymal cerebrospinal fluid (CSF) seepage. CSF analysis yielded a lymphocytic pleocytosis and cryptococcal antigen titer of 1:160 but sterile fungal cultures. Despite standard antifungal therapy and CSF drainage, the patient had worsening confusion and persistently elevated intracranial pressures. External ventricular drainage led to improved mental status but only with valve settings at negative values. Ventriculoperitoneal shunt placement could thus not be considered due to a requirement for drainage into the positive pressure venous system. Due to this persistent CSF inflammation and cerebral circulation obstruction, the patient required transfer to the National Institute of Health. He was treated for cryptococcal post-infectious inflammatory response syndrome with pulse-taper corticosteroid therapy, with resultant reductions in CSF pressures along with decreased protein and obstructive material, allowing successful shunt placement. After tapering of corticosteroids, the patient recovered without sequelae. This case highlights (1) the necessity to consider cryptococcal meningitis as a rare cause of neurological deterioration in the absence of fever even in apparently immunocompetent individuals and (2) the potential for obstructive phenomena from inflammatory sequelae and the prompt response to corticosteroid therapy.
Use of Bevacizumab in recurrent glioblastoma: a scoping review and evidence map
Authors: Fu Minjie , Zhou Zhirui , Huang Xiao , Chen Zhenchao , Zhang Licheng , Zhang Jinsen , Hua Wei , Mao Ying
Published: June 2023

Background

Glioblastoma (GBM) is the most malignant primary tumor in the brain, with poor prognosis and limited effective therapies. Although Bevacizumab (BEV) has shown promise in extending progression-free survival (PFS) treating GBM, there is no evidence for its ability to prolong overall survival (OS). Given the uncertainty surrounding BEV treatment strategies, we aimed to provide an evidence map associated with BEV therapy for recurrent GBM (rGBM).

Methods

PubMed, Embase, and the Cochrane Library were searched for the period from January 1, 1970, to March 1, 2022, for studies reporting the prognoses of patients with rGBM receiving BEV. The primary endpoints were overall survival (OS) and quality of life (QoL). The secondary endpoints were PFS, steroid use reduction, and risk of adverse effects. A scoping review and an evidence map were conducted to explore the optimal BEV treatment (including combination regimen, dosage, and window of opportunity).

Results

Patients with rGBM could gain benefits in PFS, palliative, and cognitive advantages from BEV treatment, although the OS benefits could not be verified with high-quality evidence. Furthermore, BEV combined therapy (especially with lomustine and radiotherapy) showed higher efficacy than BEV monotherapy in the survival of patients with rGBM. Specific molecular alterations (IDH mutation status) and clinical features (large tumor burden and double-positive sign) could predict better responses to BEV administration. A low dosage of BEV showed equal efficacy to the recommended dose, but the optimal opportunity window for BEV administration remains unclear.

Conclusions

Although OS benefits from BEV-containing regimens could not be verified in this scoping review, the PFS benefits and side effects control supported BEV application in rGBM. Combining BEV with novel treatments like tumor-treating field (TTF) and administration at first recurrence may optimize the therapeutic efficacy. rGBM with a low apparent diffusion coefficient (ADCL), large tumor burden, or IDH mutation is more likely to benefit from BEV treatment. High-quality studies are warranted to explore the combination modality and identify BEV-response subpopulations to maximize benefits.
Validation of the German Glasgow Sensory Questionnaire and replication of sensory processing differences in students with higher and lower Autism-Spectrum Quotient
Authors: Zeisel Annalena , Thiel Tobias , Gaigg Sebastian B. , Roessner Veit , Ring Melanie
Published: June 2023

Background

The Glasgow Sensory Questionnaire (GSQ) gives insight into sensory processing differences (hypo- and hyper-sensitivity across modalities), which is a clinically defining characteristic of autism spectrum disorder (ASD). Because there is no validated German version of this instrument, this study aimed at validating the German GSQ. Further, a replication of the GSQ’s sensory processing differences was intended.

Methods

University students of Technische Universität or Universitätsklinikum in Dresden, Germany, were recruited via email distribution or the university homepage and 297 German-speaking students completed the online survey, comprising the German GSQ, Autism-Spectrum Quotient (AQ) and Symptom-Checklist (SCL-90). For validation of the German GSQ, confirmatory factor analyses followed by exploratory factor analyses were applied.

Results

The German GSQ has moderate to low validity, good to acceptable reliability, and a different internal structure from the original GSQ. Replicating the sensory processing differences in students with higher and lower AQ was not successful.

Conclusions

Results indicate that the GSQ, developed especially for individuals with ASD, is less informative for the general population if there are not enough individuals with higher AQ scores in the sample.
Fogging to combat dengue: factors influencing stakeholders' attitudes in Malaysia
Authors: Arham Ahmad Firdhaus , Amin Latifah , Mustapa Muhammad Adzran Che , Mahadi Zurina , Yaacob Mashitoh , Wasli Mohamad Muhidin Patahol , Rusly Noor Sharizad
Published: June 2023

Background

Fogging is a conventional technique used to combat Aedes mosquitoes and prevent dengue disease. It is often implemented in outbreak areas or areas harbouring a high density of Aedes mosquitoes. Currently, studies on stakeholders' attitudes towards fogging are still limited in number. Therefore, this study aims to assess Malaysian attitudes, and identify the predicting factors influencing such attitudes.

Methods

A validated instrument was used to interview 399 randomly selected respondents from the public (n = 202, 50.6%) and scientists (n = 197, 49.4%) in the Klang Valley region of Malaysia. The data were analysed using PLS-SEM involving Smart-PLS software.

Results

The results confirmed that stakeholder attitudes toward fogging should be viewed in terms of a multi-dimensional association. The stakeholders surveyed were highly positive with regard to the application of fogging to control dengue but professed moderate concerns as to associated risks. The PLS-SEM analyses demonstrated that the perceived benefit was the most important factor influencing attitudes, followed by trust in key players.

Conclusions

This result provides a good insight from the perspective of education and unravels the underlying fundamentals of stakeholders' attitudes toward the fogging technique. The findings also provide a positive indicator to the responsible parties involved to continue the usage of this technique in conjunction with improvements with regard to its safety aspects, and possibly in combination with other environmental-friendly alternatives in order to achieve a healthy environment without dengue in Malaysia.
Association between internal migration experience and depressive symptoms: analysis of PSID data
Authors: Liao Zi-Xuan , Tan Xiao-Min , Zhao Ying-Ying , Sun Xiao-Cui , Yi Fa-Ling
Published: June 2023

Background

Depression is on the rise globally. Additionally, the United States has a high level of population mobility. The main aim of this study was to provide a reference for improving the mental health of internal migrants by investigating the relationship between internal migration experience and depressive symptoms.

Methods

We analysed data from the Panel Study of Income Dynamics (PSID). We included PSID data from the 2005 to 2019 waves in which all respondents were asked about their internal migration experience and depressive symptoms. This study included 15,023 participants. T tests, chi-square tests, multiple logistic regression methods were performed and fixed effects model.

Results

In the sample, the prevalence of depressive symptoms was 4.42%. The risk of depression in internal migrants was 1.259 times (OR = 1.259, 95% CI = (1.025–1.547, p < 0.05) that of nonmigrants. Internal migration experience was significantly positively associated with female depressive episodes (OR = 1.312, 95% CI = 1.010–1.704, p < 0.05) and increased risk of becoming depressed at a young age (OR = 1.304, 95% CI = 1.010–1.684, p < 0.05). The association between internal migration experience and depressive symptoms was more significant for participants who might move (OR = 1.459, 95% CI = 1.094–1.947, p < 0.05). In addition, different internal migratory causes are associated with depressive symptoms to varying degrees.

Conclusions

Our findings highlight the need for greater policy attention to mental health inequalities between Internal migrants and those who never move away from their hometown in the United States. Our study provides a foundation for further research.
The natural course of incidental ureteral polyp during ureteroscopic surgery: KSER research
Authors: Cho Sung Yong , Oh Kyung-Jin , Jung Wonho , Kim Hyung Joon , Lee Sang Hyub , Lee Joo Yong , Lee Dong Sup
Published: June 2023

Background

The natural course of polypoid lesions in the ureter during ureteroscopic stone surgery was not yet clarified.

Methods

Patient data were collected prospectively from six teaching hospitals between 2019 and 2021. Patients with polypoid lesions in the ureter distal to ureteral stones were included during ureteroscopy. Computed tomography was performed on all enrolled patients three months after the procedure. Follow-up ureteroscopy was performed only if the patient consented, due to the need for general anesthesia and ethical considerations.

Results

Among the 35 patients who were followed up, 14 had fibroepithelial polyps and 21 had inflammatory polyps. Twenty of the followed-up patients underwent ureteroscopy, and nine of them had fibroepithelial polyps. Although fibroepithelial polyps did not disappear in the follow-up ureteroscopy (p = 0.002), the rate of postoperative hydronephrosis was not higher in the fibroepithelial group than in the inflammatory group. Postoperative ureteral stricture and moderate-to-severe hydronephrosis were found to be closely related to the number of resected polyps, regardless of the type of polyp (p = 0.014 and 0.006, respectively).

Conclusion

Fibroepithelial polyps in the ureter may persist after treatment of adjacent ureter stones. However, conservative management may be preferable to active removal of ureteral polyps because fibroepithelial polyps may not contribute to clinically significant hydronephrosis after surgery, and inflammatory polyps disappear spontaneously. Hasty resections of polyps may increase the risk of ureteral stricture.
‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making
Authors: Tan Emmanuel , Ng Wei Ming , Soh Poh Choong , Tan Daniel , Cleland Jennifer
Published: June 2023

Context

Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making?

Methods

This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein’s integrative model of behavioural prediction to underpin secondary data analysis.

Results

Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., “better safe than sorry”); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system).

Discussion

Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.
Dietary non-starch polysaccharides impair immunity to enteric nematode infection
Authors: Valente Angela H. , Jensen Karen M. R. , Myhill Laura J. , Zhu Ling , Mentzel Caroline M. J. , Krych Lukasz , Simonsen Henrik T. , Castro-Mejía Josue L. , Gobbi Alex , Bach Knudsen Knud Erik , Nielsen Dennis S. , Thamsborg Stig M. , Williams Andrew R.
Published: June 2023

Background

The influence of diet on immune function and resistance to enteric infection and disease is becoming ever more established. Highly processed, refined diets can lead to inflammation and gut microbiome dysbiosis, whilst health-promoting dietary components such as phytonutrients and fermentable fibres are thought to promote a healthy microbiome and balanced mucosal immunity. Chicory (Cichorium intybus) is a leafy green vegetable rich in fibres and bioactive compounds that may promote gut health.

Results

Unexpectedly, we here show that incorporation of chicory into semisynthetic AIN93G diets renders mice susceptible to infection with enteric helminths. Mice fed a high level of chicory leaves (10% dry matter) had a more diverse gut microbiota, but a diminished type-2 immune response to infection with the intestinal roundworm Heligmosomoides polygyrus. Furthermore, the chicory-supplemented diet significantly increased burdens of the caecum-dwelling whipworm Trichuris muris, concomitant with a highly skewed type-1 immune environment in caecal tissue. The chicory-supplemented diet was rich in non-starch polysaccharides, particularly uronic acids (the monomeric constituents of pectin). In accordance, mice fed pectin-supplemented AIN93G diets had higher T. muris burdens and reduced IgE production and expression of genes involved in type-2 immunity. Importantly, treatment of pectin-fed mice with exogenous IL-25 restored type-2 responses and was sufficient to allow T. muris expulsion.

Conclusions

Collectively, our data suggest that increasing levels of fermentable, non-starch polysaccharides in refined diets compromises immunity to helminth infection in mice. This diet-infection interaction may inform new strategies for manipulating the gut environment to promote resistance to enteric parasites.
A multicentre, prospective, non-interventional study evaluating the safety of dapagliflozin in patients with type 2 diabetes in routine clinical practice in China (DONATE)
Authors: Guo Lixin , Wang Jing , Li Li , Yuan Lin , Chen Sheng , Wang Hui , Li Tonghuan , Qi Lin , Yang Hong
Published: June 2023

Background

There are few large-scale studies evaluating the safety of the sodium-glucose cotransporter-2 inhibitor, dapagliflozin, in Chinese patients with type 2 diabetes. DONATE, a multicentre, single-arm, prospective, non-interventional study, is the first real-world study evaluating the safety of dapagliflozin in Chinese patients with type 2 diabetes in routine clinical practice.

Methods

Between August 2017 and July 2020, patients with type 2 diabetes who had initiated dapagliflozin therapy and received ≥1 dose were prospectively recruited from 88 hospitals in China. Patients were subsequently followed up for 24 weeks; if patients discontinued dapagliflozin they were followed up for an additional 7 days after treatment discontinuation. The primary outcome was the proportion of patients with adverse events and serious adverse events, particularly key adverse events of special interest (AESI) including urinary tract infection, genital tract infection (typical symptoms with or without microbiological diagnosis) and hypoglycaemia (typical symptoms with or without blood glucose ≤3.9 mmol/L, or blood glucose ≤3.9 mmol/L without symptoms). Exploratory outcomes included the absolute change in metabolic parameters and the proportion of patients with other AESI including volume depletion, abnormal blood electrolytes, polyuria, renal impairment, diabetic ketoacidosis, hepatic impairment and haematuria.

Results

A total of 3000 patients were enrolled, of whom 2990 (99.7%) were included in the safety analysis set. Mean (SD) age was 52.6 (12.0) years, and 65.8% of patients were male. Mean (SD) duration of type 2 diabetes at enrolment was 8.4 (7.1) years. Mean (SD) treatment duration of dapagliflozin was 209.1 (157.6) days. Adverse events were reported in 35.4% (n = 1059) of patients during the 24-week follow-up period. Overall, 9.0% (n = 268) were related to treatment and 6.2% (n = 186) were serious. Urinary tract infection, genital tract infection and hypoglycaemia were reported in 2.3% (n = 70), 1.3% (n = 39) and 1.1% (n = 32) of patients, respectively. The proportion of patients with other AESI was also low: polyuria (0.7%;n = 21), volume depletion (0.3%;n = 9), renal impairment (0.3%;n = 8), hepatic impairment (0.2%;n = 7), haematuria (0.2%;n = 6) and diabetic ketoacidosis (0.1%;n = 2).

Conclusions

This study demonstrated that once-daily dapagliflozin was well tolerated in Chinese patients with type 2 diabetes and the overall safety profile of dapagliflozin in clinical practice in China was consistent with that reported in clinical trials.

Trial registration

ClinicalTrials.gov, NCT03156985. Registered on 16 May, 2017.
The intermediate filament protein nestin serves as a molecular hub for smooth muscle cytoskeletal signaling
Authors: Wang Yinna , Liao Guoning , Wu Yidi , Wang Ruping , Tang Dale D.
Published: June 2023

Background

The recruitment of the actin-regulatory proteins cortactin and profilin-1 (Pfn-1) to the membrane is important for the regulation of actin cytoskeletal reorganization and smooth muscle contraction. Polo-like kinase 1 (Plk1) and the type III intermediate filament protein vimentin are involved in smooth muscle contraction. Regulation of complex cytoskeletal signaling is not entirely elucidated. The aim of this study was to evaluate the role of nestin (a type VI intermediate filament protein) in cytoskeletal signaling in airway smooth muscle.

Methods

Nestin expression in human airway smooth muscle (HASM) was knocked down by specific shRNA or siRNA. The effects of nestin knockdown (KD) on the recruitment of cortactin and Pfn-1, actin polymerization, myosin light chain (MLC) phosphorylation, and contraction were evaluated by cellular and physiological approaches. Moreover, we assessed the effects of non-phosphorylatable nestin mutant on these biological processes.

Results

Nestin KD reduced the recruitment of cortactin and Pfn-1, actin polymerization, and HASM contraction without affecting MLC phosphorylation. Moreover, contractile stimulation enhanced nestin phosphorylation at Thr-315 and the interaction of nestin with Plk1. Nestin KD also diminished phosphorylation of Plk1 and vimentin. The expression of T315A nestin mutant (alanine substitution at Thr-315) reduced the recruitment of cortactin and Pfn-1, actin polymerization, and HASM contraction without affecting MLC phosphorylation. Furthermore, Plk1 KD diminished nestin phosphorylation at this residue.

Conclusions

Nestin is an essential macromolecule that regulates actin cytoskeletal signaling via Plk1 in smooth muscle. Plk1 and nestin form an activation loop during contractile stimulation.
Policymaker perspectives on self-management of disease and disabilities using information and communication technologies
Authors: Gauthier-Beaupré Amélie , Battistini Bruno J. , Kuziemsky Craig , Jutai Jeffrey W.
Published: June 2023

Background

Policies that support health self-management are malleable and highly dependent on various factors that influence governments. Within a world that is shifting toward digitalization due to pressures such as the COVID-19 pandemic and labor shortages, policymaking on older adults’ self-management of chronic diseases and disability using information and communication technologies (ICTs) needs to be better understood. Using the province of Ontario, in Canada, as a case study, the research question was What is the environment that policymakers must navigate through in development and implementation of policies related to older adults’ self-management of disease and disability using information and communication technologies (ICTs)?

Methods

This study used a qualitative approach where public servants from 4 ministries within the government of Ontario were invited to participate in a 1-h, one-on-one, semi-structured interview. The audio-recorded interviews were based on an adapted model of the policy triangle, where the researcher asked questions about the influences from the different sources identified in the model. The interviews were later transcribed and analyzed using a deductive-inductive coding approach.

Results

Ten participants across 4 different Ministries participated in the interviews. Participants shared insights on various aspects of context, process and actors that help shape the current content of policies. The analysis revealed that policies, in the form of programs, services, legislation and regulations, are the result of collaborations and dialogue between different actors and get developed and implemented via a set of complex government processes. In addition, policy actions come from a plethora of sectors which all get influenced by several predictable and unpredictable external pressures.

Conclusions

The environment for policymaking in the government of Ontario regarding older adults’ self-management of disease and disability using ICTs is one that is mostly reactive to external pressures, while organized within a set of complex processes and multi-sectoral collaborations. The present research helped us to understand the complexity of policymaking on the topic and highlights the need for increased foresight and proactive policymaking, regardless of which governments are in-place.
A qualitative analysis of factors influencing the implementation of antiretroviral treatment adherence policy in Ghana: stakeholders perspective
Authors: Abdulai Martha Ali , Mevissen Fraukje E. F. , Marien Veerle , Ruiter Robert A. C. , Owusu-Agyei Seth , Asante Kwaku Poku , Bos Arjan E. R.
Published: June 2023

Background

The Joint United Nations Programme on HIV/AIDS launched the 90-90-90 initiative. Failure to meet the target reflects the difficulties in successfully implementing HIV treatment policy. There are research gaps in exploring personal and external factors influencing HIV treatment in Ghana. To fill this gap, we explored individual and environmental (interpersonal, community and structural) factors influencing stakeholders' HIV treatment policy implementation in Ghana.

Methods

Fifteen qualitative semi-structured in-depth interviews were conducted among representatives in different management positions at hospitals, health directorates, the Ghana AIDS Commission, the National AIDS and STI control program, and the National Association of People Living with HIV.

Results

Using thematic analysis, the findings suggest that individual and environmental factors such as attitude towards policy, awareness of HIV treatment policy, training received on policy implementation, difficulties related to patient factors, alternate sources of HIV care, inefficient policy decision-making, monitoring and evaluation of HIV treatment policy, lack of HIV treatment policy implementation training, poor availability of logistics, policy and guidelines, infrastructure, organization of training, and staff availability may hinder successful HIV treatment policy implementation.

Conclusion

Several individual and environmental (interpersonal, community and structural) factors seem to influence HIV treatment policy implementation. To ensure successful policy implementation stakeholders need to receive training on new policies, availability of sufficient supplies of material resources, inclusive decision-making, receive supportive monitoring of policy implementation, and oversight.
Changes in sodium levels in Australian packaged foods between 2014 and 2019: an interrupted time series analysis of the impact of the Victorian Salt Reduction Partnership’s media advocacy strategy
Authors: Rosewarne Emalie , Santos Joseph Alvin , Di Tanna Gian Luca , Shahid Maria , Grimes Carley , Bolton Kristy A. , Webster Jacqui , Neal Bruce , Woodward Mark , Coyle Daisy , Trieu Kathy
Published: June 2023

Background

The Victorian Salt Reduction Partnership (VSRP) implemented a media advocacy strategy (intervention) to stimulate food manufacturers to reduce sodium levels across targeted Australian packaged foods between 2017 and 2019. This study assessed changes in sodium levels of targeted and non-targeted packaged foods during the intervention (2017 to 2019) compared to before the intervention (2014 to 2016) in Australia.

Methods

Annually collected branded-food composition data from 2014 to 2019 were used. Interrupted time series analyses was conducted to compare the trend in sodium levels in packaged foods during the intervention (2017–2019) to the trend in the pre-intervention period (2014–2016). The difference between these trends was derived to estimate the effect of the intervention.

Results

A total of 90,807 products were included in the analysis, of which 14,743 were targeted by the intervention. The difference in before and during intervention trends between targeted and non-targeted food categories was 2.59 mg/100 g (95% CI: -13.88 to 19.06). There was a difference in the pre-intervention slope (2014, 2015, 2016) and intervention slope (2017, 2018, 2019) for four of 17 targeted food categories. There was a decrease in sodium levels (mg/100 g) in one food category: frozen ready meals (-13.47; 95% CI: -25.40 to -1.53), and an increase in three categories: flat bread (20.46; 95% CI: 9.11 to 31.81), plain dry biscuits (24.53; 95% CI: 5.87 to 43.19), and bacon (44.54; 95% CI: 6.36 to 82.72). For the other 13 targeted categories, the difference in slopes crossed the line of null effect.

Conclusions

The VSRP’s media advocacy strategy did not result in a meaningful reduction in sodium levels of targeted packaged food products during the intervention years compared to trends in sodium levels before the intervention. Our study suggests media advocacy activities highlighting the differences in sodium levels in packaged food products and industry meetings alone are not sufficient to lower average sodium levels in packaged foods in the absence of government leadership and measurable sodium targets.
Comparison of Epstein–Barr virus and Kaposi’s sarcoma-associated herpesvirus viral load in peripheral blood mononuclear cells and oral fluids of HIV-negative individuals aged 3–89 years from Uganda
Authors: Nalwoga Angela , Marshall Vickie , Miley Wendell , Labo Nazzarena , Whitby Denise , Newton Robert , Rochford Rosemary
Published: June 2023

We previously found that age, sex and malaria were associated with KSHV in individuals from Uganda. In this study, we have evaluated these same factors in relation to EBV in the same specimens. Overall, 74% (oral fluids) and 46% (PBMCs) had detectable EBV. This was significantly higher than observed for KSHV (24% oral fluids and 11% PBMCs). Individuals with EBV in PBMCs were more likely to have KSHV in PBMCs (P = 0.011). The peak age for detection of EBV in oral fluids was 3–5 years while that of KSHV was 6–12 years. In PBMCs, there was a bimodal peak age for detection of EBV (at 3–5 years and 66 + years) while for KSHV there was a single peak at 3–5 years. Individuals with malaria had higher levels of EBV in PBMCs compared to malaria-negative individuals (P = 0.002). In summary, our results show that younger age and malaria are associated with higher levels of EBV and KSHV in PBMCs suggesting malaria impacts immunity to both gamma-herpesviruses.