bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence and Laryngeal Cancer: From Screening to Prognosis: A State of the Art Review
Authors: Bensoussan Yael , Vanstrum Erik B. , Johns Michael M. , Rameau Anaïs
Published: July 2022

Objective

This state of the art review aims to examine contemporary advances in applications of artificial intelligence (AI) to the screening, detection, management, and prognostication of laryngeal cancer (LC).

Data Sources

Four bibliographic databases were searched: PubMed, EMBASE, Cochrane, and IEEE.

Review Methods

A structured review of the current literature (up to January 2022) was performed. Search terms related to topics of AI in LC were identified and queried by 2 independent reviewers. Citations of selected studies and review articles were also evaluated to ensure comprehensiveness.

Conclusions

AI applications in LC have encompassed a variety of data modalities, including radiomics, genomics, acoustics, clinical data, and videomics, to support screening, diagnosis, therapeutic decision making, and prognosis. However, most studies remain at the proof‐of‐concept level, as AI algorithms are trained on single‐institution databases with limited data sets and a single data modality.

Implications for Practice

AI algorithms in LC will need to be trained on large multi‐institutional data sets and integrate multimodal data for optimal performance and clinical utility from screening to prognosis. Out of the data types reviewed, genomics has the most potential to provide generalizable models thanks to available large multi‐institutional open access genomic data sets. Voice acoustic data represent an inexpensive and accurate biomarker, which is easy and noninvasive to capture, offering a unique opportunity for screening and monitoring of LA, especially in low‐resource settings.
Predictors and prognostic significance of persistent fluid overload: A longitudinal study in Chinese peritoneal dialysis patients
Authors: Ng Jack Kit-Chung , Kwan Bonnie Ching-Ha , Chan Gordon Chun-Kau , Chow Kai Ming , Pang Wing Fai , Cheng Phyllis Mei-Shan , Leung Chi Bon , Li Philip Kam-Tao , Szeto Cheuk Chun
Published: July 2022

Background:

Cross-sectional studies showed that fluid overload (FO) measured by bioimpedance spectroscopy (BIS) predicted adverse outcomes in patients on peritoneal dialysis (PD). We aimed to describe the longitudinal change in volume status in Chinese PD patients and determine its relation with clinical outcomes.

Methods:

We performed a single-centre, retrospective analysis of all PD patients who underwent repeated BIS from 2010 to 2015. FO was defined by relative hydration index (RHI; volume of overhydration adjusted by extracellular water >7%). Variability of volume status (VVS) was denoted by the standard deviation of all RHI. The association of time-averaged RHI and VVS on patient and technique survival was explored by a competing risk model.

Results:

A total of 269 patients were followed for a median of 47.1 months. Mean time-averaged RHI was 17.6 ± 10.2%. Multivariable mixed linear regression revealed that RHI was significantly associated with diabetes, time-varying systolic blood pressure, and inversely with time-varying albumin level, lean tissue index and fat tissue index ( p <0.0001 for all). Time-averaged RHI independently predicted patient survival (subdistribution hazard ratio (SHR) 1.05, 95% CI 1.03–1.07, p <0.0001) and technique survival (SHR 1.04, 95% CI 1.02–1.06, p <0.0001), whereas VVS did not. The mortality risk for patients with persistent FO was consistently higher than the corresponding risk estimated from baseline FO of the same extent.

Conclusions:

Persistent FO was a strong predictor of patient and technique failure. Repeated bioimpedance measurements to monitor volume status may provide additional prognostic information in PD patients.
Marginal voices: Exploring presence and participation in interaction in child protection conferences
Authors: Lutman-White Eleanor , Angouri Jo
Published: July 2022

Child protection conferences are key meetings in the social work child protection process in England. They provide the context where decisions are made about how best to safeguard and promote the welfare of children and constitute an important opportunity for social work services to work in partnership with parents; yet there is little research about what happens interactionally in these meetings and particularly about parents’ participation. Using interactional sociolinguistics, we analyse the data from three audio-recorded child protection conferences, focussing on sequences where concerns are raised and responded to, to illuminate how parent involvement is accomplished interactionally. We look specifically at the linguistic and discursive features of turns and the management of the floor, connecting the sequential nature of the account sequences to presence and participation. The analysis shows a contrast between professionals’ participation versus parents’ presence in this asymmetrical event, suggesting a marginalisation of parents’ contributions and a mismatch between the principle of partnership working with parents and practice in this area of child protection social work.
Branching during axial compression histories of solid cylinders of time-dependent materials
Authors: Waas Anthony M , Wineman Alan S
Published: July 2022

This work considers the uniaxial compression of a solid circular cylinder of time-dependent material. Initially, the cylinder undergoes a homogeneous compression history. The purpose is to determine a time when this deformation history can form a new inhomogenous branch. Material time dependence is described by a nonlinear single-integral constitutive equation that relates the stress in the material to its deformation history. A criterion is developed for determining branching times using a Pipkin–Rogers constitutive equation for nonlinear incompressible isotropic viscoelastic solids. For the purpose of numerical examples, material parameters are chosen so that the material acts as a neo-Hookean material in its short-time response and a softer one in its long-time equilibrium response. Examples show that characteristic relaxation times and deformation histories influence the time to branch and the corresponding compressive stretch and compressive force.
Ectopic and impacted maxillary canines: A quality evaluation of online information
Authors: Meade Maurice J , Dreyer Craig W
Published: July 2022

Objective:

To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs).

Design:

A cross-sectional survey on the Internet.

Material and methods:

An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0.

Results:

In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46–10.16; range = 6.7–15.1).

Conclusion:

The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.
Do Ideological Attacks Change How Voters Evaluate Primary Election Candidates?
Authors: Britzman Kylee J. , Kantack Benjamin R.
Published: July 2022

Partisan polarization in the United States has increased the ideological uniformity of the Democratic and Republican parties, and therefore the usefulness of party identification as an indicator of candidates’ ideology. However, candidates – especially during primary elections – often attack their opponents for being insufficiently conservative or progressive, explicitly signaling to voters that they should put less faith in their stereotypes about the party’s ideology when evaluating candidates. To assess the effects of these ideological attacks, we conduct a Dynamic Process Tracing Environment experiment that simulates a primary election campaign. We find mixed evidence that participants, when exposed to an ideological attack ad, lower their ratings of the attacked candidate’s ideological extremity, overall favorability, qualification for office, and trustworthiness. However, we observe no differences between experimental conditions in terms of information search, suggesting that ideological attacks are generally accepted at face value and not independently verified by voters.
Authors Reply: Empathy and Creativity: Dangers of the Methodological Tail Wagging the Conceptual Dog
Authors: Murphy Brett A. , Algoe Sara B.
Published: July 2022

The three commentaries on “Why We Should Reject the Restrictive Isomorphic Matching (RIM) Definition of Empathy” mostly concurred with our critique of that widely adopted definition of empathy. Yet, commenters also raised important questions relating to the clarity and operationalizability of our recommended alternative: returning to a classical conceptualization of empathy as a dynamic, functionally oriented, multi-faceted unfolding process. To help contextualize these issues, we provide an extended analogy between empathy research and creativity research, areas of study which are conceptually linked and have faced similar conceptual and methodological obstacles. In doing so, we highlight the challenge of (a) distilling empathy down to a firm operationalizable definition without (b) losing sight of the general meaning and real-world value of the construct.
The Effectiveness of Superbolus on Postprandial Blood Glucose Management of Pregnant Women With Type 1 Diabetes
Authors: Pintaudi Basilio , Gironi Ilaria , Mion Elena , Di Vieste Giacoma , Meneghini Elena , Disoteo Olga , Pani Arianna , Bonomo Matteo , Bertuzzi Federico
Published: July 2022

Aim:

Pregnancies of women with pregestational diabetes are at risk of after-meal glucose peaks and late after-meal hypoglycemia, particularly at breakfast. We aimed to explore the effectiveness of a specific feature of insulin pump therapy called superbolus in preventing these glucose swings.

Methods:

In this retrospective observational study, we analyzed continuous glucose monitoring data of patients with type 1 diabetes in pregnancy who were advised to use superbolus to manage their breakfast. Some of the postprandial basal insulin delivery was partially reduced and delivered instead as additional insulin bolus on top of a normal bolus. Outcomes of interest were one hour after breakfast glucose levels, the time in glucose range for after breakfast period, the number of late hypoglycemic episodes.

Results:

Overall, 21 consecutive pregnant women with type 1 diabetes (mean age 34.3 ± 5.5 years, mean pregestational body mass index 23.7 ± 4.7 kg/m2, HbA1c levels during pregnancy 6.1 ± 0.6%) were studied. Superbolus reduced after breakfast glucose peaks (one hour after breakfast glucose levels 130 ± 17 mg/dL vs 123 ± 10 mg/dL before and after superbolus use, respectively, P = .01), improved the time in glucose range for after breakfast period (70.4% vs 50.8%, P = .001), and reduced the number of late hypoglycemic episodes (3 [1-5] vs 1 [0-2], P< .0001).

Conclusion:

Superbolus was effective in avoiding after-meal glucose peaks, increased postprandial glucose time in target, without late hypoglycemia occurrence. It represents a valid option for the treatment of pregnant women with type 1 diabetes using insulin pump.
Severe Wernicke’s Encephalopathy Associated with Cortical Ribboning and Intracranial Hemorrhage
Authors: DePolo Daniel , Gillen Stefan , Marden Kyle , Rajagopalan Swarna , Thon Olga R. , Siegler James E. , Thon Jesse M.
Published: July 2022

Wernicke’s encephalopathy (WE) is a neurological emergency that results from thiamine deficiency. It is most commonly associated with chronic alcohol consumption but can result from any cause of impaired thiamine absorption or dietary intake. The classic triad of ophthalmoparesis, ataxia, and altered sensorium is rarely seen in toto, and while certain radiographic findings strongly correlate with the disease, one should have a low threshold to suspect (and promptly treat) patients in order to mitigate the risk of morbidity and mortality. However, atypical presentations can result in delayed or missed diagnoses. In this report, we describe a case of severe non-alcoholic WE associated with atypical brain Magnetic resonance imaging (MRI) manifestations of both cortical diffusion restriction and intracranial hemorrhage, which have previously been associated with poor outcomes. Early treatment with high-dose parenteral thiamine resulted in rapid improvement in ocular motility and reversal of MRI abnormalities, and on long-term follow up, the patient had made a marked functional improvement. This case highlights the importance of recognizing these unusual imaging features of WE in a patient with a compatible clinical syndrome in order to make a timely diagnosis and initiate treatment, as there is potential for a good clinical outcome despite these imaging findings.
Stress Resilience Program for Health Care Professionals During a Pandemic: A Pilot Program
Authors: Croghan Ivana T. , Hurt Ryan T. , Fokken Shawn C. , Fischer Karen M. , Lindeen Stephanie A. , Schroeder Darrell R. , Ganesh Ravindra , Ghosh Karthik , Bausek Nina , Bauer Brent A.
Published: July 2022

Background:

The COVID-19 pandemic has led to increased burnout and staff turnover for health care providers (HCPs). The purpose of this pilot study was to evaluate the safety and acceptability of a Stress Resilience Program (SRP) for reducing perceived stress and improving resilience among HCPs during a pandemic.

Method:

Of the 12 HCPs expressing interest in the study, 10 were enrolled in this study. Participants attended three in-person visits (consent/screen, baseline, and end-of-study). The SRP consisted of education related to resilience enhancement and a breathing device ( BreatherFit®) for combined respiratory muscle training (cRMT). Participants completed 4 weeks of cRMT and applied situational breathing strategies as needed. Outcomes measured were changes in stress (PSS-10), resilience (BRS), depression (PRIME-MD), and sleep (PSQI and Ōura Ring®).

Findings:

The majority of participants were male (60%) and White (60%) with an average age of 39.7 years. Changes from baseline to end-of-treatment indicated a positive trend with significant stress reduction (−3.2 ± 3.9, p = .028) and nonsignificant depression reduction (−0.5 ± 0.7, p = .05). Resilience was high at baseline and continued to stay high during the study with a nonsignificant increase at end-of-study (+0.07 ± 0.7, p = .77). No changes in overall sleep scores were noted. All participants agreed the study was worthwhile, 80% indicated they would repeat the experience, while 90% indicated they would recommend the study to others.

Conclusion/Application to Practice:

Because of its size and portability, SRP is an easily applicable and promising option for reducing stress among HCPs during a high-stress period, such as a pandemic. Larger studies are needed.
High early death rates, treatment resistance, and short survival of Black adolescents and young adults with AML
Authors: Larkin Karilyn T. , Nicolet Deedra , Kelly Benjamin J. , Mrózek Krzysztof , LaHaye Stephanie , Miller Katherine E. , Wijeratne Saranga , Wheeler Gregory , Kohlschmidt Jessica , Blachly James S. , Mims Alice S. , Walker Christopher J. , Oakes Christopher C. , Orwick Shelley , Boateng Isaiah , Buss Jill , Heyrosa Adrienne , Desai Helee , Carroll Andrew J. , Blum William , Powell Bayard L. , Kolitz Jonathan E. , Moore Joseph O. , Mayer Robert J. , Larson Richard A. , Stone Richard M. , Paskett Electra D. , Byrd John C. , Mardis Elaine R. , Eisfeld Ann-Kathrin
Published: July 2022

Survival of patients with acute myeloid leukemia (AML) is inversely associated with age, but the impact of race on outcomes of adolescent and young adult (AYA; range, 18-39 years) patients is unknown. We compared survival of 89 non-Hispanic Black and 566 non-Hispanic White AYA patients with AML treated on frontline Cancer and Leukemia Group B/Alliance for Clinical Trials in Oncology protocols. Samples of 327 patients (50 Black and 277 White) were analyzed via targeted sequencing. Integrated genomic profiling was performed on select longitudinal samples. Black patients had worse outcomes, especially those aged 18 to 29 years, who had a higher early death rate (16% vs 3%; P=.002), lower complete remission rate (66% vs 83%; P=.01), and decreased overall survival (OS; 5-year rates: 22% vs 51%; P<.001) compared with White patients. Survival disparities persisted across cytogenetic groups: Black patients aged 18 to 29 years with non–core-binding factor (CBF)-AML had worse OS than White patients (5-year rates: 12% vs 44%; P<.001), including patients with cytogenetically normal AML (13% vs 50%; P<.003). Genetic features differed, including lower frequencies of normal karyotypes and NPM1 and biallelic CEBPA mutations, and higher frequencies of CBF rearrangements and ASXL1, BCOR, and KRAS mutations in Black patients. Integrated genomic analysis identified both known and novel somatic variants, and relative clonal stability at relapse. Reduced response rates to induction chemotherapy and leukemic clone persistence suggest a need for different treatment intensities and/or modalities in Black AYA patients with AML. Higher early death rates suggest a delay in diagnosis and treatment, calling for systematic changes to patient care.
Quantitative proteomics reveals protein dysregulation during T cell activation in multiple sclerosis patients compared to healthy controls
Authors: Cappelletti Chiara , Eriksson Anna , Brorson Ina Skaara , Leikfoss Ingvild S. , Kråbøl Oda , Høgestøl Einar August , Vitelli Valeria , Mjaavatten Olav , Harbo Hanne F. , Berven Frode , Bos Steffan D. , Berge Tone
Published: July 2022

Background

Multiple sclerosis (MS) is an autoimmune, neurodegenerative disorder with a strong genetic component that acts in a complex interaction with environmental factors for disease development. CD4+ T cells are pivotal players in MS pathogenesis, where peripherally activated T cells migrate to the central nervous system leading to demyelination and axonal degeneration. Through a proteomic approach, we aim at identifying dysregulated pathways in activated T cells from MS patients as compared to healthy controls.

Methods

CD4+ T cells were purified from peripheral blood from MS patients and healthy controls by magnetic separation. Cells were left unstimulated or stimulated in vitro through the TCR and costimulatory CD28 receptor for 24 h prior to sampling. Electrospray liquid chromatography-tandem mass spectrometry was used to measure protein abundances.

Results

Upon T cell activation the abundance of 1801 proteins was changed. Among these proteins, we observed an enrichment of proteins expressed by MS-susceptibility genes. When comparing protein abundances in T cell samples from healthy controls and MS patients, 18 and 33 proteins were differentially expressed in unstimulated and stimulated CD4+ T cells, respectively. Moreover, 353 and 304 proteins were identified as proteins exclusively induced upon T cell activation in healthy controls and MS patients, respectively and dysregulation of the Nur77 pathway was observed only in samples from MS patients.

Conclusions

Our study highlights the importance of CD4+ T cell activation for MS, as proteins that change in abundance upon T cell activation are enriched for proteins encoded by MS susceptibility genes. The results provide evidence for proteomic disturbances in T cell activation in MS, and pinpoint to dysregulation of the Nur77 pathway, a biological pathway known to limit aberrant effector T cell responses.
Later one knows better: the over-reporting of short-time work in firm surveys
Authors: Kagerl Christian , Schierholz Malte , Fitzenberger Bernd
Published: July 2022

Short-time work (STW) in Germany allows for a lot of flexibility in actual usage. Ex ante, firms notify the Employment Agency about the total number of employees eligible, and, up to the total granted, firms can flexibly choose how many employees actually use STW. In firm-level surveys, which provide timely information on STW in Germany, over-reporting of the number of employees on STW is prevalent. This study explores reasons for STW over-reporting based on a high-frequency and low-cost survey initiated during the Covid-19-pandemic (BeCovid) and a low-frequency and high-cost long-running survey (BP). Merging administrative records on actual use of STW, firms that use STW prove more likely to participate in the BeCovid survey. Multi-establishment firms over-report STW because they tend to report STW for all subfirms. The BP uses more interview time and confirms the over-reporting of STW use in the survey month, while—crucially—the over-reporting drops sharply with a few months of retrospection.
Fecal microbiota and their association with heat stress in Bos taurus
Authors: Czech Bartosz , Szyda Joanna , Wang Kai , Luo Hanpeng , Wang Yachun
Published: July 2022

Background

Humans have been influencing climate changes by burning fossil fuels, farming livestock, and cutting down rainforests, which has led to global temperature rise. This problem of global warming affects animals by causing heat stress, which negatively affects their health, biological functions, and reproduction. On the molecular level, it has been proved that heat stress changes the expression level of genes and therefore causes changes in proteome and metabolome. The importance of a microbiome in many studies showed that it is considered as individuals’ “second genome”. Physiological changes caused by heat stress may impact the microbiome composition.

Results

In this study, we identified fecal microbiota associated with heat stress that was quantified by three metrics – rectal temperature, drooling, and respiratory scores represented by their Estimated Breeding Values. We analyzed the microbiota from 136 fecal samples of Chinese Holstein cows through a 16S rRNA gene sequencing approach. Statistical modeling was performed using a negative binomial regression. The analysis revealed the total number of 24 genera and 12 phyla associated with heat stress metrics. Rhizobium and Pseudobutyrivibrio turned out to be the most significant genera, while Acidobacteria and Gemmatimonadetes were the most significant phyla. Phylogenetic analysis revealed that three heat stress indicators quantify different metabolic ways of animals’ reaction to heat stress. Other studies already identified that those genera had significantly increased abundance in mice exposed to stressor-induced changes.

Conclusions

This study provides insights into the analysis of microbiome composition in cattle using heat stress measured as a continuous variable. The bacteria highly associated with heat stress were highlighted and can be used as biomarkers in further microbiological studies.
Establishment of optimized in vitro disinfection protocol of Pistacia vera L. explants mediated a computational approach: multilayer perceptron–multi−objective genetic algorithm
Authors: Gammoudi Najet , Nagaz Kamel , Ferchichi Ali
Published: July 2022

Background

Contamination−free culture is a prerequisite for the success of in vitro − based plant biotechnology. Aseptic initiation is an extremely strenuous stride, particularly in woody species. Meanwhile, over−sterilization is potentially detrimental to plant tissue. The recent rise of machine learning algorithms in plant tissue culture proposes an advanced interpretive tool for the combinational effect of influential factors for such in vitro − based steps.

Results

A multilayer perceptron (MLP) model of artificial neural network (ANN) was implemented with four inputs, three sterilizing chemicals at various concentrations and the immersion time, and two outputs, disinfection efficiency (DE) and negative disinfection effect (NDE), intending to assess twenty−seven disinfection procedures of Pistacia vera L. seeds. Mercury chloride (HgCl2; 0.05–0.2%; 5–15 min) appears the most effective with 100% DE, then hydrogen peroxide (H2O2; 5.25–12.25%; 10–30 min) with 66–100% DE, followed by 27–77% DE for sodium hypochlorite (NaOCl; 0.54–1.26% w/v; 10–30 min). Concurrently, NDE was detected, including chlorosis, hard embryo germination, embryo deformation, and browning tissue, namely, a low repercussion with NaOCl (0–14%), a moderate impact with H2O2 (6–46%), and pronounced damage with HgCl2 (22–100%). Developed ANN showed R values of 0.9658, 0.9653, 0.8937, and 0.9454 for training, validation, testing, and all sets, respectively, which revealed the uprightness of the model. Subsequently, the model was linked to multi−objective genetic algorithm (MOGA) which proposed an optimized combination of 0.56% NaOCl, 12.23% H2O2, and 0.068% HgCl2 for 5.022 min. The validation assay reflects the high utility and accuracy of the model with maximum DE (100%) and lower phytotoxicity (7.1%).

Conclusion

In one more case, machine learning algorithms emphasized their ability to resolve commonly encountered problems. The current successful implementation of MLP–MOGA inspires its application for more complicated plant tissue culture processes.
The value of myocardial work in assessment of ventricular function in patients with non-obstructive hypertrophic cardiomyopathy
Authors: Yang Chenguang , Guo Ying , Wang Xiang , Zhang Ruisheng , Wang Fang , Zhu Huolan
Published: July 2022

Background

To evaluate myocardial work using speckle tracking echocardiography in patients with non-obstructive hypertrophic cardiomyopathy (HCM).

Methods

Fifty patients with HCM and 50 normal controls were included. Left ventricular ejection fraction (LVEF) was quantified using the bi-plane Simpson’s method. Myocardial work parameters, which included global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE), were derived from the 2D strain-pressure loop.

Results

The patient group was older (49.19 ± 14.69 vs. 37.16 ± 7.49 years old) and had a higher body mass index (24.93 ± 3.67 vs. 23.26 ± 3.32 kg/m2) and systolic blood pressure (121.81 ± 16.50 vs. 115.30 ± 11.01 mmHg) (P < 0.05). The mean LVEF in patients was 51%, with 54% of patients had LVEF ≤ 50%. Compared to controls, GWI (946.42 ± 360.64 vs. 1639.72 ± 204.56 mmHg%), GCW (1176.94 ± 373.23 vs. 1960.16 ± 255.72 mmHg%), and GWE (83.96 ± 7.68 vs. 95.26 ± 1.98%) were significantly decreased, while GWW (158.17 ± 82.47 vs. 79.12 ± 40.26 mmHg%) was significantly increased (P < 0.05) in the patient group. In patients, GWE showed a trend of positive correlation with LVEF (r = 0.276, P = 0.06), while GWW had a trend of negative correlation with LVEF (r = − 0.241, P = 0.09). No correlation between myocardial work and LV diastolic function or QRS duration was observed. Maximal wall thickness significantly correlated with all the myocardial work parameters.

Conclusions

Assessing myocardial work adds useful information of LV function in patients with non-obstructive HCM.
Trauma team training in Norwegian hospitals: an observational study
Authors: Bredin Ida Celine , Gaup Hedi Marina Joks , Brattebø Guttorm , Wisborg Torben
Published: July 2022

Background

Traumatic injuries are a leading cause of deaths in Norway, especially among younger males. Trauma-related mortality can be reduced by structural measures, such as organization of a trauma system. Many hospitals in Norway treat few seriously injured patients, one of the reasons for development of the Norwegian trauma system. Since its implementation, there has been continuous improvement of this system, including trauma team training. Regular trauma team training is compulsory, with the aims of compensating for lack of experience and maintaining competence. The purpose of this study was to present an overview of current trauma team training activities in Norway.

Methods

For this observational study, the authors developed an online questionnaire and mailed it to local trauma coordinators from 38 Norwegian hospitals—including four trauma centers and 34 acute hospitals with trauma function. The study was performed during April–June 2020, with a two-month response window. Trauma team training frequency was assessed in four predefined intervals: < 5, 5–9, 10–15 and > 15 times per year. The response rate was 33 of 38, 87%.

Results

All responding hospitals conducted regular trauma team training. The frequency of training increased significantly from 2013 to 2020 (Chi square test, Chi2 8.33, p = 0.04). All hospitals described a quite homogenous approach. The trauma centres trained more frequently as compared to the acute care hospitals (Chi square test, Chi2 8.24, p = 0.04).

Conclusions

All responding hospitals performed regular trauma team training using a homogenous approach, which is in line with previous assessments. We observed a minor improvement in frequency compared to prior assessments. Our findings suggest that Norwegian trauma teams likely maintain their competence through team training. All hospitals followed the current recommendations from the National Trauma Plan.
Application of variance components to the identification of determinants of modern contraceptive use in the Tanzania demographic and health survey data
Authors: Donni Oliva Safari , Bishanga Dunstan Raphael , Mbalawata Isambi Sailon
Published: July 2022

Background

Over time, demographic and health survey (DHS) data remain valuable to examine variables relating to nationally representative population outcomes for low- and middle-income countries. In Tanzania, there are very limited DHS-based studies on the uptake of Modern Contraceptive Use (MCU). Present studies have focused on measurements at the level of individuals, yet research has shown that MCU variations exists at other levels within populations. In this study, we use a variance component modelling approach to explore variation in MCU at primary sampling unit (PSU) and regional levels while considering survey sample weights.

Methods

Using DHS data from 2016–2017 in Tanzania, we study different variance structures and the respective variation on MCU in a sample of 5263 Women of Reproductive Age (WRA) defined as between the ages of 15–49 years. First, a single variance component was used, followed by its extension to a random coefficient model and we tracked changes in the models.

Results

There was an influence of random variations on MCU on the levels of populations much explained by PSU-level clustering than region. On the fixed part, age of a woman, husband education level, desire to have children, and exposure to media and wealth tertiles were important determinants for MCU. Compared to WRA in 15–19 years, the odds of MCU among middle aged women (20–29 and 30–39 years) were 1.94 (95%CI:1.244–3.024) and 2.28 (95%CI:1.372–3.803). Also, increases in media exposure and middle and rich wealth tertiles women led to higher odds for MCU. We also found the presence of random effects influence of wealth tertiles levels on MCU.

Conclusion

This study highlighted the utility of accounting for variance structures in addressing determinants of MCU while using DHS national level data. Apart from MCU, the DHS data have been widely applied to examine other variables pertaining to public health issues. This approach could be considered a better modelling technique for the DHS studies compared to traditional survey approaches, and to guide hierarchical population-based interventions to increase MCU.
Characteristics and perioperative complications of hip fracture in the elderly with acute ischemic stroke: a cross-sectional study
Authors: Zhang Yaqian , Fu Mingming , Guo Junfei , Zhao Yuqi , Wang Zhiqian , Hou Zhiyong
Published: July 2022

Background

Patients with acute ischemic stroke (AIS) after hip fracture in the elderly have worse prognosis. We aimed to describe the characteristics and complications of hip fracture with AIS in the elderly.

Methods

This cross-sectional study selected patients with hip fracture (age ≥65 years) from January 2018 to September 2020. The collected data included age, sex, fracture types, comorbidities. In above screened patients, we further collected cerebral infarction related information of AIS patients. The least absolute shrinkage and selection operator (LASSO) logistic regression was performed to identify the strongest predictors of AIS after hip fracture. Multivariate logistic regression analysis was conducted to find independent risk factors for AIS after hip fracture.

Results

Sixty patients (mean age 79.7 years;female 56.7%) occurred AIS after hip fracture in 1577 cases. The most common infarction type was partial anterior circulation infarction (PACI) (70.0%). The majority of these infarction lesions were single (76.7%) and most infarction lesions(65.0%) were located in the left side. 81.7% of AIS patients had mild (Health stroke scale NIHSS <4) AIS. Older patients with AIS after hip fracture were more frequently complicated by hypertension(73.3%), prior stroke (46.7%), diabetes(35.0%) and were more likely to have hypoproteinemia(68.3%), electrolyte disorders ( 66.7%), anemia (65.0%), deep vein thrombosis (51.6%), pneumonia (46.6%),cardiac complications (45.0%). Combined with hypertension (OR 2.827, 95%CI 1.557-5.131) and male sex(OR 1.865, 95%CI 1.095-3.177) were associated with the increased risk of AIS after hip fracture.

Conclusions

Older patients combined with hypertension are more likely to have AIS after hip fracture. For these patients, early preventions should be administered. AIS patients after hip fracture are prone to have multiple complications under traumatic stress, and we should enhance the management of these patients to reduce the stress and avoid occurrence of complications.
The influence of the COVID-19 pandemic on surgical therapy and care: a cross-sectional study
Authors: Hillebrandt Karl H. , Moosburner Simon , Winter Axel , Nevermann Nora , Raschzok Nathanael , Malinka Thomas , Sauer Igor M. , Schmelzle Moritz , Pratschke Johann , Chopra Sascha
Published: July 2022

Background

Due to the COVID-19 pandemic, an extensive reorganisation of healthcare resources was necessary—with a particular impact on surgical care across all disciplines. However, the direct and indirect consequences of this redistribution of resources on surgical therapy and care are largely unknown.

Methods

We analysed our prospectively collected standardised digital quality management document for all surgical cases in 2020 and compared them to the years 2018 and 2019. Periods with high COVID-19 burdens were compared with the reference periods in 2018 and 2019.

Results

From 2018 to 2020, 10,723 patients underwent surgical treatment at our centres. We observed a decrease in treated patients and a change in the overall patient health status. Patient age and length of hospital stay increased during the COVID-19 pandemic (p = 0.004 and p = 0.002). Furthermore, the distribution of indications for surgical treatment changed in favour of oncological cases and less elective cases such as hernia repairs (p < 0.001). Postoperative thromboembolic and pulmonary complications increased slightly during the COVID-19 pandemic. There were slight differences for postoperative overall complications according to Clavien-Dindo, with a significant increase of postoperative mortality (p = 0.01).

Conclusion

During the COVID-19 pandemic we did not see an increase in the occurrence, or the severity of postoperative complications. Despite a slightly higher rate of mortality and specific complications being more prevalent, the biggest change was in indication for surgery, resulting in a higher proportion of older and sicker patients with corresponding comorbidities. Further research is warranted to analyse how this changed demographic will influence long-term patient care.
Biopsychosocial risk factors of depression during menopause transition in southeast China
Authors: Chu Ketan , Shui Jing , Ma Linjuan , Huang Yizhou , Wu Fan , Wei Fang , Meng Xingjun , Luo Jie , Ruan Fei , Zhou Jianhong
Published: July 2022

Objective

More than 2 billion women are experiencing menopause transition in China and some of them suffered from depression; while the risk factors of depression during menopause transition were still unclearin China. We aimed to investigate the risk factors in mid-life women in Southeast China.

Method

This study included 1748 Chinese women aged 40–65 years-old who visited gynecology outpatient department of Women’s hospital School of Medicine, Zhejiang University during 2010–2018. Demographic information was collected, and the modified Kupperman Menopausal Index (mKMI) and Hamilton Rating Scale for Depression were assessed. Circulating levels of sex hormones were tested. Ordinal logistic regression analysis was performed to identify risk factors for depression.

Results

The prevalence of depression symptoms was 47.43%. The majority of women had mild (38.56%) or moderate depressive symptoms (8.00%); only 0.86% had severe depressive symptoms. Compared with perimenopausal women, postmenopausal women had increased risks of more severe depression. The associations between menopausal syndromes and the intensity of depression were strongly positive (OR 6.69, 95% CI 5.39–8.29). Elder age, higher follicle stimulating hormone levels, lower estradiol levels, and fewer parity were positively related with the intensity of depression. Among postmenopausal women, underweight, mKMI > 14, earlier age at menopause, shorter reproductive period, and longer duration after menopause were risk factors for incresed intensity of depression.

Conclusions

The results demonstrated a high proportion of depression in women complaining of menopause. Menopausal symptoms were strongly related to the intensity of depression. In postmenopausal women, estrogen related events are associated with the intensity of depression. Gynecological endocrinologists in China should consider screening for depression in high-risk women.
“Medicines is all that I can sometimes offer them”: challenges of providing primary diabetes care to persons with disabilities in Tamil Nadu
Authors: Thiagesan Rajeswaran , Soundari Hilaria , Gopichandran Vijayaprasad
Published: July 2022

Background

Persons with disabilities have a higher risk for and poorer outcomes of type 2 diabetes. Primary health care providers face several challenges in providing primary diabetes care for them. This study was conducted to explore the challenges faced by primary health care providers in delivering primary diabetes services to persons with disabilities.

Methods

We performed a qualitative research study by conducting in-depth interviews among 13 primary health care providers including medical officers, staff nurses, community health workers and a physiotherapist. We adopted a descriptive qualitative research approach to data collection and analysis.

Results

Primary health care providers often could only prescribe medications to persons with diabetes by proxy due to poor accessibility of the facilities. They felt that these patients also had poor compliance to treatment. They felt that the lack of standard guidelines for diet and exercise for persons with disabilities prevented them from giving them appropriate advice on the same and even if they did, persons with disabilities would find it very difficult to adopt dietary changes and physical activity as they were dependent on others for even their daily activities. They also felt that they couldn’t perform annual screening tests due to lack of accessibility to higher facilities. Some primary care providers did local innovations such as formation of peer support groups, utilization of resources of other programs to reach out to persons with disabilities and innovative physical activity techniques to care for persons with disabilities. They recommended that there is a need for specific guidelines for management of diabetes among persons with disabilities, treatment of chronic diseases among persons with disabilities must be incentivized and there must be intersectoral coordination between social welfare department and health department to achieve the goal of care for persons with disabilities.

Conclusions

Primary health care providers faced substantial challenges in providing primary diabetes care for persons with disabilities. There is a need for an effective public health policy to address these challenges.
Comparative genomic analysis of Babesia duncani responsible for human babesiosis
Authors: Wang Jinming , Chen Kai , Yang Jifei , Zhang Shangdi , Li Youquan , Liu Guangyuan , Luo Jianxun , Yin Hong , Wang Guangying , Guan Guiquan
Published: July 2022

Background

Human babesiosis, caused by parasites of the genus Babesia, is an emerging and re-emerging tick-borne disease that is mainly transmitted by tick bites and infected blood transfusion. Babesia duncani has caused majority of human babesiosis in Canada; however, limited data are available to correlate its genomic information and biological features.

Results

We generated a B. duncani reference genome using Oxford Nanopore Technology (ONT) and Illumina sequencing technology and uncovered its biological features and phylogenetic relationship with other Apicomplexa parasites. Phylogenetic analyses revealed that B. duncani form a clade distinct from B. microti, Babesia spp. infective to bovine and ovine species, and Theileria spp. infective to bovines. We identified the largest species-specific gene family that could be applied as diagnostic markers for this pathogen. In addition, two gene families show signals of significant expansion and several genes that present signatures of positive selection in B. duncani, suggesting their possible roles in the capability of this parasite to infect humans or tick vectors.

Conclusions

Using ONT sequencing and Illumina sequencing technologies, we provide the first B. duncani reference genome and confirm that B. duncani forms a phylogenetically distinct clade from other Piroplasm parasites. Comparative genomic analyses show that two gene families are significantly expanded in B. duncani and may play important roles in host cell invasion and virulence of B. duncani. Our study provides basic information for further exploring B. duncani features, such as host-parasite and tick-parasite interactions.
Regulatory roles of alternative splicing at Ezh2 gene in mouse oocytes
Authors: Guo Shi-meng , Liu Xing-ping , Tian Qing , Fei Cai-feng , Zhang Yi-ran , Li Zhi-ming , Yin Ying , He Ximiao , Zhou Li-quan
Published: July 2022

Background

Enhancer of zeste homologue 2 (EZH2), the core member of polycomb repressive complex 2 (PRC2), has multiple splicing modes and performs various physiological functions. However, function and mechanism of alternative splicing at Ezh2 exon 3 in reproduction are unknown.

Methods

We generated Ezh2Long and Ezh2Short mouse models with different point mutations at the Ezh2 exon 3 alternative splicing site, and each mutant mouse model expressed either the long or the short isoform of Ezh2. We examined mutant mouse fertility and oocyte development to assess the function of Ezh2 alternative splicing at exon 3 in the reproductive system.

Results

We found that Ezh2Long female mice had normal fertility. However, Ezh2Short female mice had significantly decreased fertility and obstructed oogenesis, with compromised mitochondrial function in Ezh2Short oocytes. Interestingly, increased EZH2 protein abundance and accumulated H3K27me3 were observed in Ezh2Short oocytes.

Conclusions

Our results demonstrate that correct Ezh2 alternative splicing at exon 3 is important for mouse oogenesis.
Protocol for a randomised, assessor‐blinded, parallel group feasibility trial of flat flexible school shoes for adolescents with patellofemoral pain
Authors: Mazzella Natalie , Fox Aaron , Saunders Natalie , Trowell Danielle , Vicenzino Bill , Bonacci Jason
Published: July 2022

Background

There are limited evidence‐based treatment options for adolescents with patellofemoral pain (PFP). Flat, flexible footwear have been shown to reduce patellofemoral joint loading and pain in adults with PFP. The efficacy of this intervention in adolescents with PFP is not established. The primary aim of this study is to determine the feasibility of conducting a large‐scale randomised controlled trial (RCT) of the effect of flat, flexible school footwear, when compared to traditional school footwear, in adolescents with PFP. The secondary aim is to describe changes in self‐reported outcome measures for adolescents with PFP while wearing flat, flexible footwear when compared to traditional school shoes.

Methods

Twenty‐four adolescents with PFP will be recruited from the community. Following baseline assessment, participants will be randomly allocated to receive either (i) flat, flexible school footwear or, (ii) traditional school footwear. Participants will wear the shoe as per school requirements throughout a 12‐week intervention period. Feasibility will be assessed with (i) ≥ 75% adherence to allocated shoe wear of their total weekly school wear time, (ii) a recruitment rate of one participant per fortnight, and (iii) a dropout rate of ≤ 20%. Patient reported outcome measures will describe changes in knee pain, function, quality of life and global rating of change at 6 and 12 weeks. Descriptive statistics will be used for the primary outcomes of feasibility.

Discussion

This study will determine the feasibility of conducting a large scale RCT evaluating the effect of flat, flexible school shoes for adolescents with PFP. A full‐scale study will guide evidence‐based management of adolescent PFP.

Trial registration

Australian New Zealand Clinical Trials Registry reference: ACTRN12621001525875, Date registered: 9th November 2021.
The future of intensive care: delirium should no longer be an issue
Authors: Kotfis Katarzyna , van Diem-Zaal Irene , Williams Roberson Shawniqua , Sietnicki Marek , van den Boogaard Mark , Shehabi Yahya , Ely E. Wesley
Published: July 2022

In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A–F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a ‘home-like’ (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.