bluuebunny/crossref_metadata_2025 huggingface dataset:
Transient ischemic attack events and incident cardiovascular and non-cardiovascular complications: Observations from a large diversified multimorbid cohort
Authors: Lip Gregory YH , Genaidy Ash , Estes Cara , McKay Deborah , Falks Tina
Published: December 2022

Background:

Transient ischemic attack (TIA) is a strong signal prompting the incidence of future cardiovascular and non-cardiovascular complications, in light of recent debate on the so-called “stroke-heart syndrome.” We aimed to investigate the relation of TIAs to incident clinical events.

Methods:

Patients were drawn from three health plans with a wide spectrum of age groups and a wide mix of socio-economic/disability status. Two TIA cohorts in a retrospective design were used to achieve the study specific aims: (i) to investigate the incidence of TIA and associated cardiovascular and non-cardiovascular complications within 30 and 90 days from the onset of incident TIA events; and (ii) to examine the potential risk factors for developing incident TIA events in the general population with/without a history of prior stroke.

Results:

The incident TIA cohort consisted of 53,716 patients with an average age of 64.2 years (SD 15.2) and 46.1% male. Following TIA, the incidence proportions of ischemic stroke within 30 and 90 days were 2.7% and 3.8%, respectively, and for incident acute coronary syndrome being 0.94 and 1.84, respectively. Ventricular arrhythmia had proportions of 1.2 and 2.14, respectively within 30 and 90 days, with acute heart failure having values of 0.49 and 0.923. About 45% or more of the cardiovascular and non-cardiovascular complications occurred in the first 30 days following the incident TIA cases. About one-third of the recurrent TIA cases followed the incident TIA cases within a span of 30 days. Amongst comorbidities with stroke in the comorbid history, prior stroke provided the strongest risk factor in terms of odds ratio (OR = 8.34, 95% CI 7.21–9.66) for incident TIA events. Age was strongly associated with incident TIA events. Without a prior history of stroke (ischemic stroke/transient ischemic attack/thrombo-embolic events), valvular disease was the strongest risk factor from among the comorbidities (OR-1.87, 95% CI 1.51–2.32). Age also provided strong associations with incident TIA events.

Conclusions:

Following a TIA, there was a high risk of stroke, acute coronary syndrome, ventricular arrhythmia, acute heart failure, and non-cardiovascular complications.
Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement
Authors: Ratnasamy Philip P. , Gouzoulis Michael J. , Kammien Alexander J. , Oh Irvin , Grauer Jonathan N.
Published: December 2022

Background:

Physical therapy (PT) following total ankle replacement (TAR) is often considered, but guidelines for its use are not standardized. Although patient factors may dictate recommendations, this retrospective cohort study aims to characterize baseline utilization practices to set the stage for establishing generalizable recommendations.

Methods:

TAR patients were identified from the 2010-2019 M91 Ortho PearlDiver data set based on administrative coding. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients’ surgery was performed (Midwest, Northeast, South, West), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of home or outpatient PT utilization in the 90 days following TAR were identified. Inpatient PT was not captured. Univariate and multivariate logistic regression analyses allowed identification of predictive factors for PT utilization.

Results:

Of 5412 TAR patients identified, postoperative PT services were used by 2453 (45.3%). Most PT was outpatient (38.3% of the study population) compared to home (4.1% of the study population). Weekly utilization of PT was greatest in the first week following surgery (17.7% of PT visits) and thereafter followed a roughly bell-shaped curve, with utilization greatest at 7 weeks following surgery (14.9% of PT visits). Independent predictors of PT utilization following TAR included having surgery performed in the Midwest (relative to the South, OR 1.37, P < .0001), Northeast (OR 1.20, P = .0217), or West (OR 1.26, P < .0021) and having commercial (relative to Medicare, OR 1.87, P < .0001) or Medicaid insurance (OR 1.46, P = .0239).

Conclusion:

Of 5412 TAR patients, 42.5% used PT within 90 days of surgery. PT utilization was highest in the first and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAR, PT care pathways may be better defined.

Level of Evidence:

Level III, retrospective cohort study.
PROMoting the use of studies within a trial (PROMETHEUS): Results and experiences from a large programme to evaluate the routine embedding of recruitment and retention strategies within randomised controlled trials routinely
Authors: Doherty Laura , Parker Adwoa , Arundel Catherine , Clark Laura , Coleman Elizabeth , Hewitt Catherine , Beard David , Bower Peter , Brocklehurst Paul , Cooper Cindy , Culliford Lucy , Devane Declan , Emsley Richard , Eldridge Sandra , Galvin Sandra , Gillies Katie , Montgomery Alan , Sutton Chris , Treweek Shaun , Torgerson David
Published: December 2022

Aim

PROMoting THE USE of Studies Within A Trial (PROMETHEUS) aimed to improve the evidence base for recruiting and retaining participants in Randomised Controlled Trials (RCTs) by pump-priming and facilitating the start of at least 25 Studies Within A Trial (SWATs) testing recruitment or retention interventions.

Methods

Ten Clinical Trials Units (CTUs) and one Primary Care Research Centre formed a network to conduct randomised SWATs of recruitment and/or retention strategies. We identified promising recruitment and retention interventions from various sources, which were reviewed by patient and public (PPI) partners to generate an initial priority list of seven recruitment and eight retention interventions. Host trial teams could apply for funding of up to £5000 and receive support from the PROMETHEUS team to design, implement, and report SWATs. We additionally tested the feasibility of undertaking coordinated SWATs across multiple host trials simultaneously.

Results

PROMETHEUS funded 42 SWATs, embedded within 31 host trials, across 12 CTUs. The SWAT cost per SWAT was £3535. Of the 42 SWATs, 12 tested the same SWAT in multiple trials ( simultaneous SWAT design) and eight tested a factorial SWAT design. PROMETHEUS will add 18% and 79% more SWATs to the Cochrane systematic review of recruitment strategies and the Cochrane review of retention strategies respectively.

Conclusion

The PROMETHEUS programme substantially increased the evidence base for both recruitment and retention strategies within RCTs. Future research should adopt a systematic approach to identifying and targeting gaps in the evidence base and focus on translating SWAT evidence into recruitment and retention practice.
Metabolism in acute myeloid leukemia: mechanistic insights and therapeutic targets
Authors: Mishra Sushanta Kumar , Millman Scott E. , Zhang Lingbo
Published: December 2022

Metabolic rewiring and cellular reprogramming are trademarks of neoplastic initiation and progression in acute myeloid leukemia (AML). Metabolic alteration in leukemic cells is often genotype specific, with associated changes in epigenetic and functional factors resulting in the downstream upregulation or facilitation of oncogenic pathways. Targeting abnormal or disease-sustaining metabolic activities in AML provides a wide range of therapeutic opportunities, ideally with enhanced therapeutic windows and robust clinical efficacy. This review highlights the dysregulation of amino acid, nucleotide, lipid, and carbohydrate metabolism in AML; explores the role of key vitamins and enzymes that regulate these processes; and provides an overview of metabolism-directed therapies currently in use or development.
Identifying and appraising outcome measures for severe asthma: a systematic review
Authors: Rattu Anna , Khaleva Ekaterina , Brightling Chris , Dahlén Sven-Erik , Bossios Apostolos , Fleming Louise , Chung Kian Fan , Melén Erik , Djukanovic Ratko , Chaudhuri Rekha , Exley Andrew , Koppelman Gerard H. , Bourdin Arnaud , Rusconi Franca , Porsbjerg Celeste , Coleman Courtney , Williams Clare , Nielsen Hanna , Davin Elizabeth , Taverner Phil , Romagosa Vilarnau Sofia , Roberts Graham
Published: December 2022

Background

Valid outcome measures are imperative to evaluate treatment response, yet the suitability of existing end-points for severe asthma is unclear. This review aimed to identify outcome measures for severe asthma and appraise the quality of their measurement properties.

Methods

A literature search was performed to identify “candidate” outcome measures published between 2018 and 2020. A modified Delphi exercise was conducted to select “key” outcome measures within healthcare professional, patient, pharmaceutical and regulatory stakeholder groups. Initial validation studies for “key” measures were rated against modified quality criteria from COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evidence was discussed at multi-stakeholder meetings to ratify “priority” outcome measures. Subsequently, four bibliographic databases were searched from inception to 20 July 2020 to identify development and validation studies for these end-points. Two reviewers screened records, extracted data, assessed their methodological quality and graded the evidence according to COSMIN.

Results

96 outcome measures were identified as “candidates”, 55 as “key” and 24 as “priority” for severe asthma, including clinical, healthcare utilisation, quality of life, asthma control and composite. 32 studies reported measurement properties of 17 “priority” end-points from the latter three domains. Only the Severe Asthma Questionnaire and Childhood Asthma Control Test were developed with input from severe asthma patients. The certainty of evidence was “low” to “very low” for most “priority” end-points across all measurement properties and none fulfilled all quality standards.

Conclusions

Only two outcome measures had robust developmental data for severe asthma. This review informed development of core outcome measures sets for severe asthma.
Cytokines as prognostic biomarkers in pulmonary arterial hypertension
Authors: Boucly Athénaïs , Tu Ly , Guignabert Christophe , Rhodes Christopher , De Groote Pascal , Prévot Grégoire , Bergot Emmanuel , Bourdin Arnaud , Beurnier Antoine , Roche Anne , Jevnikar Mitja , Jaïs Xavier , Montani David , Wilkins Martin R. , Humbert Marc , Sitbon Olivier , Savale Laurent
Published: December 2022

Background

Risk stratification and assessment of disease progression in patients with pulmonary arterial hypertension (PAH) are challenged by the lack of accurate disease-specific and prognostic biomarkers. To date, brain natriuretic peptide (BNP) and/or its N-terminal fragment (NT-proBNP) are the only markers for right ventricular dysfunction used in clinical practice, in association with echocardiographic and invasive haemodynamic variables to predict outcome in patients with PAH.

Methods

This study was designed to identify an easily measurable biomarker panel in the serum of 80 well-phenotyped PAH patients with idiopathic, heritable or drug-induced PAH at baseline and at first follow-up. The prognostic value of identified cytokines of interest was secondly analysed in an external validation cohort of 125 PAH patients.

Results

Among the 20 biomarkers studied with the multiplex Ella platform, we identified a three-biomarker panel composed of β-NGF, CXCL9 and TRAIL that were independently associated with prognosis both at the time of PAH diagnosis and at the first follow-up after initiation of PAH therapy. β-NGF and CXCL9 were predictors of death or transplantation, whereas high levels of TRAIL were associated with a better prognosis. Furthermore, the prognostic value of the three cytokines was more powerful for predicting survival than usual non-invasive variables (New York Heart Association Functional Class, 6-min walk distance and BNP/NT-proBNP). The results were validated in a fully independent external validation cohort.

Conclusion

The monitoring of β-NGF, CXCL9 and TRAIL levels in serum should be considered in the management and treatment of patients with PAH to objectively guide therapeutic options.
RIPK1 kinase-dependent inflammation and cell death contribute to the pathogenesis of COPD
Authors: Van Eeckhoutte Hannelore P. , Donovan Chantal , Kim Richard Y. , Conlon Thomas M. , Ansari Meshal , Khan Haroon , Jayaraman Ranjith , Hansbro Nicole G. , Dondelinger Yves , Delanghe Tom , Beal Allison M. , Geddes Brad , Bertin John , Vanden Berghe Tom , De Volder Joyceline , Maes Tania , Vandenabeele Peter , Vanaudenaerde Bart M. , Deforce Dieter , Škevin Sonja , Van Nieuwerburgh Filip , Verhamme Fien M. , Joos Guy F. , Idrees Sobia , Schiller Herbert B. , Yildirim Ali Önder , Faiz Alen , Bertrand Mathieu J.M. , Brusselle Guy G. , Hansbro Philip M. , Bracke Ken R.
Published: December 2022

Background

Receptor-interacting protein kinase 1 (RIPK1) is a key mediator of regulated cell death (including apoptosis and necroptosis) and inflammation, both drivers of COPD pathogenesis. We aimed to define the contribution of RIPK1 kinase-dependent cell death and inflammation in the pathogenesis of COPD.

Methods

We assessedRIPK1expression in single-cell RNA sequencing (RNA-seq) data from human and mouse lungs, and validated RIPK1 levels in lung tissue of COPD patientsviaimmunohistochemistry. Next, we assessed the consequences of genetic and pharmacological inhibition of RIPK1 kinase activity in experimental COPD, usingRipk1S25D/S25Dkinase-deficient mice and the RIPK1 kinase inhibitor GSK′547.

Results

RIPK1expression increased in alveolar type 1 (AT1), AT2, ciliated and neuroendocrine cells in human COPD. RIPK1 protein levels were significantly increased in airway epithelium of COPD patients compared with never-smokers and smokers without airflow limitation. In mice, exposure to cigarette smoke (CS) increasedRipk1expression similarly in AT2 cells, and further in alveolar macrophages and T-cells. Genetic and/or pharmacological inhibition of RIPK1 kinase activity significantly attenuated airway inflammation upon acute and subacute CS exposure, as well as airway remodelling, emphysema, and apoptotic and necroptotic cell death upon chronic CS exposure. Similarly, pharmacological RIPK1 kinase inhibition significantly attenuated elastase-induced emphysema and lung function decline. Finally, RNA-seq on lung tissue of CS-exposed mice revealed downregulation of cell death and inflammatory pathways upon pharmacological RIPK1 kinase inhibition.

Conclusions

RIPK1 kinase inhibition is protective in experimental models of COPD and may represent a novel promising therapeutic approach.
A prospective study of pulmonary outcomes and chest computed tomography in the first year after COVID-19
Authors: Lerum Tøri Vigeland , Meltzer Carin , Rodriguez Jezabel Riverio , Aaløkken Trond Mogens , Brønstad Eivind , Aarli Bernt B. , Aarberg-Lund Kristine Marie , Durheim Michael T. , Ashraf Haseem , Einvik Gunnar , Skjønsberg Ole Henning , Stavem Knut
Published: December 2022

COVID-19 primarily affects the respiratory system. We aimed to evaluate how pulmonary outcomes develop after COVID-19 by assessing participants from the first pandemic wave prospectively 3 and 12 months following hospital discharge.

Pulmonary outcomes included self-reported dyspnoea assessed with the modified Medical Research Council dyspnoea scale, 6-min walk distance (6MWD), spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), body plethysmography and chest computed tomography (CT). Chest CT was repeated at 12 months in participants with pathological findings at 3 months. The World Health Organization (WHO) ordinal scale for clinical improvement defined disease severity in the acute phase.

Of 262 included COVID-19 patients, 245 (94%) and 222 (90%) participants attended the 3- and 12-month follow-up, respectively. Self-reported dyspnoea and 6MWD remained unchanged between the two time points, whileDLCOand total lung capacity improved (0.28 mmol·min−1·kPa−1, 95% CI 0.12–0.44, and 0.13 L, 95% CI 0.02–0.24, respectively). The prevalence of fibrotic-like findings on chest CT at 3 and 12 months in those with follow-up chest CT was unaltered. Those with more severe disease had worse dyspnoea,DLCOand total lung capacity values than those with mild disease.

There was an overall positive development of pulmonary outcomes from 3 to 12 months after hospital discharge. The discrepancy between the unaltered prevalence of self-reported dyspnoea and the improvement in pulmonary function underscores the complexity of dyspnoea as a prominent factor of long-COVID. The lack of increase in fibrotic-like findings from 3 to 12 months suggests that SARS-CoV-2 does not induce a progressive fibrotic process in the lungs.
Symptoms are known by their companies: towards association guided disease diagnosis assistant
Authors: Tiwari Abhisek , Saha Tulika , Saha Sriparna , Bhattacharyya Pushpak , Begum Shemim , Dhar Minakshi , Tiwari Sarbajeet
Published: December 2022

Over the last few years, dozens of healthcare surveys have shown a shortage of doctors and an alarming doctor-population ratio. With the motivation of assisting doctors and utilizing their time efficiently, automatic disease diagnosis using artificial intelligence is experiencing an ever-growing demand and popularity. Humans are known by the company they keep; similarly, symptoms also exhibit the association property, i.e., one symptom may strongly suggest another symptom’s existence/non-existence, and their association provides crucial information about the suffering condition. The work investigates the role of symptom association in symptom investigation and disease diagnosis process. We propose and build a virtual assistant called Association guided Symptom Investigation and Diagnosis Assistant (A-SIDA) using hierarchical reinforcement learning. The proposed A-SIDDA converses with patients and extracts signs and symptoms as per patients’ chief complaints and ongoing dialogue context. We infused association-based recommendations and critic into the assistant, which reinforces the assistant for conducting context-aware, symptom-association guided symptom investigation. Following the symptom investigation, the assistant diagnoses a disease based on the extracted signs and symptoms. The assistant then diagnoses a disease based on the extracted signs and symptoms. In addition to diagnosis accuracy, the relevance of inspected symptoms is critical to the usefulness of a diagnosis framework. We also propose a novel evaluation metric called Investigation Relevance Score (IReS), which measures the relevance of symptoms inspected during symptom investigation. The obtained improvements (Diagnosis success rate-5.36%, Dialogue length-1.16, Match rate-2.19%, Disease classifier-6.36%, IReS-0.3501, and Human score-0.66) over state-of-the-art methods firmly establish the crucial role of symptom association that gets uncovered by the virtual agent. Furthermore, we found that the association guided symptom investigation greatly increases human satisfaction, owing to its seamless topic (symptom) transition.
Gut microbiota profiling variated during colorectal cancer development in mouse
Authors: Liu Jingjing , Dong Wei , Zhao Jian , Wu Jing , Xia Jinqiang , Xie Shaofei , Song Xiaofeng
Published: December 2022

Background

The imbalance of intestinal flora may promote the occurrence and development of colorectal cancer, changes of the intestinal flora during the development of colorectal cancer and the mechanism that promotes the colorectal cancer were discovered in this study. Deep sequencing of the microbial 16 s ribosomal RNA gene was used to investigate alterations in feces samples of mice at the early inflammation stage and fully developed stage of colorectal cancer.

Results

According to PCoA analysis and ANOSIM test, we found the intestinal flora had significantly changed in mice with colorectal inflammation or colorectal cancer compared with healthy mice (p < 0.05). Using correlation analysis, we found thatMuribaculaceaeandBacteroidaceaehad strong excluding interactions. The functional changes of the gut microbiota include the up-regulation of the cancers pathway and the down-regulation of the replication and repair pathways.

Conclusion

Our study found the intestinal flora of mice suffering from colorectal inflammation and colorectal cancer has changed significantly, especially the decrease ofMuribaculaceaeand the increase ofBacteroidaceae. We suppose that these two floras may play an important role in development of colorectal cancer.
Health care professionals’ perceptions about atrial fibrillation care in the Brazilian public primary care system: a mixed-methods study
Authors: Paschoal Elisabete , Gooden Tiffany E. , Olmos Rodrigo D. , Lotufo Paulo A. , Benseñor Isabela M. , Manaseki-Holland Semira , Lip Gregory Y. H. , Thomas G. Neil , Jolly Kate , Lancashire Emma , Lane Deirdre A. , Greenfield Sheila , Goulart Alessandra C. ,   on behalf of NIHR Global Health Research Group on Atrial Fibrillation Management, Arasalingam Ajini , Beane Abi , Brocklehurst Peter , Cheng Kar Keung , El-Bouri Wahbi , Feng Mei , Guo Yutao , Guruparan Mahesan , Gusso Gustavo , Haniffa Rashan , Humphreys Lindsey , Jowett Sue , Kodippily Chamira , Kumarendran Balachandran , Li Xuewen , Li Yan-guang , Lobban Trudie , Moore David , Nirantharakumar Krishnarajah , Pirasanth Paskaran , Powsiga Uruthirakumar , Romagnolli Carla , Santos Itamar S. , Shantsila Alena , Sheron Vethanayagan Antony , Shribavan Kanesamoorthy , Szmigin Isabelle , Subaschandren Kumaran , Surenthirakumaran Rajendra , Tai Meihui , Thavarajah Bamini , Toippa Timo , Varella Ana C. , Wang Hao , Wang Jingya , Zhang Hui , Zhong Jiaoyue
Published: December 2022

Background

Atrial fibrillation (AF) negatively impacts health systems worldwide. We aimed to capture perceptions of and barriers and facilitators for AF care in Brazilian primary care units (PCUs) from the perspective of healthcare professionals (HCPs).

Methods

This mixed-methods, cross-sectional study utilised an exploratory sequential design, beginning with the quantitative data collection (up to 18 closed questions) immediately followed by a semi-structured interview. HCPs were recruited from 11 PCUs in the Sao Paulo region and included managers, physicians, pharmacists, nurses and community health agents. Descriptive statistics were used to present findings from the quantitative questionnaire and inductive analysis was used to identify themes from the qualitative data.

Results

One hundred seven HCPs were interviewed between September 2019 and May 2020. Three main themes were identified that encapsulated barriers and facilitators to AF care: access to care (appointments, equipment/tests and medication), HCP and patient roles (HCP/patient relationship and patient adherence) and the role of the organisation/system (infrastructure, training and protocols/guidelines). Findings from the qualitative analysis reinforced the quantitative findings, including a lack of AF-specific training for HCPs, protocols/guidelines on AF management, INR tests in the PCUs, patient knowledge of AF management and novel oral anticoagulants (NOACs) as key barriers to optimal AF care.

Conclusions

Development and implementation of AF-specific training for PCU HCPs are needed in Brazil, along with evidence-based protocols and guidelines, educational programmes for patients, better access to INR tests for patients taking warfarin and availability of NOACs.
Vitamin C alleviates LPS-induced myocardial injury by inhibiting pyroptosis via the ROS-AKT/mTOR signalling pathway
Authors: Zhang Pu , Zang Meirong , Sang Zhenzhen , Wei Yunxia , Yan Yan , Bian Xiaohua , Dong Shimin
Published: December 2022

Background

The efficacy of vitamin C in sepsis remains controversial. Whether vitamin C can alleviate lipopolysaccharide (LPS)-induced myocardial injury by inhibiting pyroptosis has not been studied. This study aimed to evaluate the effects of vitamin C on LPS-induced myocardial injury in vitro.

Methods

H9C2 cells were treated with indicated concentrations of LPS, and the cell viability was then assessed by CCK-8 assay. The levels of lactate dehydrogenase (LDH), CK-MB, IL-18 and IL-1β were examined by enzyme-linked immunosorbent assay (ELISA). The levels of intracellular reactive oxygen species (ROS) were measured using the fluorescent probe dichlorodihydrofluorescein diacetate (DCFH-DA). Western blot assays were conducted to determine the levels of the ROS-associated protein nicotinamide adenine dinucleotide phosphate oxidase 4 (Nox4) and pyroptosis-associated proteins, such as NOD-like receptor (NLR) family pyrin domain containing 3 (NLRP3), caspase-1 and gasdermin D (GSDMD). The AKT inhibitor MK-2206 was then applied to explore the signalling pathway. Finally, H9C2 cells were divided into the control group, LPS group, vitamin C + LPS group, and N-acetyl-l-cysteine (NAC) + LPS group. The intracellular ROS, levels of associated proteins, cell viability, and release of LDH, CK-MB, IL-18 and IL-1β were examined.

Results

LPS decreased cell viability and induced ROS and pyroptosis in H9C2 cells in a dose-dependent manner. Moreover, LPS activated the AKT/mTOR pathway in H9C2 cells. The AKT inhibitor MK-2206 protected H9C2 cells from LPS-induced death by suppressing pyroptosis, without changing intracellular ROS level. Vitamin C significantly inhibited intracellular ROS and cell pyroptosis in LPS-treated H9C2 cells. Moreover, vitamin C suppressed the activation of the AKT/mTOR pathway.

Conclusions

Our data suggest that vitamin C alleviates LPS-induced myocardial injury by inhibiting pyroptosis via the ROS-AKT/mTOR signalling pathway and thus provide novel insights into the prevention of sepsis-induced myocardial dysfunction.
Going virtual during the COVID-19 pandemic: adaptation of a mixed-methods dietary behavior study within a community-based participatory research study of African-American adults at risk for cardiovascular disease
Authors: Farmer Nicole , Tuason Ralph Thadeus , Kazmi Narjis , Flynn Sharon , Mitchell Valerie , Middleton Kimberly , Cox Robert , Franklin Kristina , Gordon Talya , Baginski Alyssa , Wallen Gwenyth R.
Published: December 2022

Background

Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic.

Method

The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who previously participated in the DC CHOC community-based studies were contacted to participate in Phase 1. The quantitative part of the mixed-methods included survey data collection.

Results

Due to the pandemic, the mode of data collection for surveys changed from self-administered face-to-face to internet-based. All virtual study procedures were conducted between March and April, 2021. Anticipated benefits of the virtual setting included participant safety during the pandemic, ease of logistics for participants. Anticipated challenges included administration of electronic devices to participants, research team training, and potential threats to established trust related to the privacy and confidentiality of participants.

Conclusion

The transition to a virtual setting for study procedures in a mixed-methods study was conducted successfully in terms of recruitment, retention of participants, and training of research team members. The virtual transition required established and ongoing engagement through the community advisory board and CBPR practices, institutional support through virtual research policies, collaborations with information technology-based teams, and equipment administration for the study.

Trials registration

NCT04305431. Registered on March 12, 2020.
Model selection for survival individualized treatment rules using the jackknife estimator
Authors: Honvoh Gilson D. , Cho Hunyong , Kosorok Michael R.
Published: December 2022

Background

Precision medicine is an emerging field that involves the selection of treatments based on patients’ individual prognostic data. It is formalized through the identification of individualized treatment rules (ITRs) that maximize a clinical outcome. When the type of outcome is time-to-event, the correct handling of censoring is crucial for estimating reliable optimal ITRs.

Methods

We propose a jackknife estimator of the value function to allow for right-censored data for a binary treatment. The jackknife estimator or leave-one-out-cross-validation approach can be used to estimate the value function and select optimal ITRs using existing machine learning methods. We address the issue of censoring in survival data by introducing an inverse probability of censoring weighted (IPCW) adjustment in the expression of the jackknife estimator of the value function. In this paper, we estimate the optimal ITR by using random survival forest (RSF) and Cox proportional hazards model (COX). We use a Z-test to compare the optimal ITRs learned by RSF and COX with the zero-order model (or one-size-fits-all). Through simulation studies, we investigate the asymptotic properties and the performance of our proposed estimator under different censoring rates. We illustrate our proposed method on a phase III clinical trial of non-small cell lung cancer data.

Results

Our simulations show that COX outperforms RSF for small sample sizes. As sample sizes increase, the performance of RSF improves, in particular when the expected log failure time is not linear in the covariates. The estimator is fairly normally distributed across different combinations of simulation scenarios and censoring rates. When applied to a non-small-cell lung cancer data set, our method determines the zero-order model (ZOM) as the best performing model. This finding highlights the possibility that tailoring may not be needed for this cancer data set.

Conclusion

The jackknife approach for estimating the value function in the presence of right-censored data shows satisfactory performance when there is small to moderate censoring. Winsorizing the upper and lower percentiles of the estimated survival weights for computing the IPCWs stabilizes the estimator.
General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers
Authors: Kühl Anja , Hering Christian , Herrmann Wolfram J. , Gangnus Annabell , Kohl Raphael , Steinhagen-Thiessen Elisabeth , Kuhlmey Adelheid , Gellert Paul
Published: December 2022

Background

Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners’ (GP) care during the pandemic in nursing homes is still scarce.

Methods

A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses.

Results

The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1–50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51–100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents.

Conclusion

We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.
Risk factors for the poor prognosis of Benign esophageal perforation: 8-year experience
Authors: Yang Qinyu , Liu Haipeng , Shu Xu , Liu Xiaoming
Published: December 2022

Background

Esophageal perforation (EP) has a high mortality rate and poor prognosis. This single-center retrospective study aims to analyze the related risk factors for benign EP.

Methods

We retrospectively analyzed 135 patients with benign EP admitted to the First Affiliated Hospital of Nanchang University from January 2012 to December 2020. Univariate and multivariate logistic analysis were performed to estimate risk factors for prognosis of esophageal perforation patients.

Results

There were 118 EP patients with foreign body ingestion and 17 patients with nonforeign body ingestion. Fish bones (78/118) were the most common foreign body and most of the nonforeign EPs were caused by spontaneous esophageal rupture (14/17). Foreign body perforations occurred mostly in the upper thoracic segment (70/118) and middle thoracic segment (31/118), and spontaneous esophageal ruptures occurred mostly in the lower thoracic segment (15/17). Fifteen patients (11.1%) died during hospitalization or within one month of discharge. Multivariable logistic regression analysis showed that high white blood cell (WBC) levels [odds ratio (OR) = 2.229, 95% confidential interval (CI): 0.776–6.403, P = 0.025], chest or mediastinal emphysema (OR = 7.609, 95% CI: 2.418–23.946, P = 0.001), and time to treatment > 72 h (OR = 3.407, 95% CI: 0.674–17.233, P = 0.018) were independent risk factors for poor prognosis.

Conclusion

Foreign body was the major reason for benign EP. High WBC level, chest or mediastinal emphysema and time to treatment > 72 h were risk factors for poor prognosis.
‘After mealtime is before mealtime’ – an ethnographic exploration of nursing home residents’ practices of dealing with meal requirements
Authors: Stöhr Doreen , Mayer Hanna , Soom Ammann Eva
Published: December 2022

Background

In nursing homes, food is part of the care provided to residents, causing it to be strictly organised within the institutional framework. Moreover, once food has been integrated into the institutional logic, structural and economic aspects regarding organisation of food and eating may dictate individual and social needs, as a theoretical perspective informed by Goffman’s notion of the ‘total social institution’ suggests. This paper describes nursing home residents’ practices of dealing with meal requirements in two Austrian nursing homes, to understand how food integrates into the daily routine and how the institutional setting influences the social and material arrangement of food.

Methods

An ethnographic design was chosen to gain an in-depth understanding. Two urban nursing homes were studied over 21 months (approx. 800 h of participant observation and ethnographic interviews collected). Data analysis took place iteratively, following Grounded Theory strategies.

Results

As the thick descriptions resulting from this procedure show, observing everyday practices of eating in nursing homes reveals complex dimensions of residents being subject to institutional logics, and also demonstrates that residents develop elaborate strategies to deal with the institutional circumstances.

Conclusion

A better understanding of the resulting tensions between the restrictions of living in a formal organisation and the agencies of residents described, may contribute to better understanding the effects of structural constraints and to designing more flexible processes.
Exploring women’s experiences during childbirth in health facilities during COVID-19 pandemic in occupied palestinian territory: a cross-sectional community survey
Authors: ME Abu-Rmeileh Niveen , Wahdan Yasmeen , Mehrtash Hedieh , Hamad Khitam Abu , Awad Arein , Tunçalp Ӧzge
Published: December 2022

Introduction

This study aims to assess the prevalence of mistreatment during childbirth in the occupied Palestinian territory and to explore factors associated with mistreatment.

Methods

A cross-sectional study of women who gave birth in the West Bank and Gaza Strip health facilities. The survey was administered over the phone to women up to 8 weeks post-partum. Data collection took place between July 2020 and March 2021.

Results

A total of 745 women participated in the study, 36·25% were from the Gaza Strip and 63·75% from the West Bank. The prevalence of mistreatment was 18·8% in which women reported any verbal abuse, physical abuse, or stigma or discrimination during childbirth, with verbal abuse as the most common form of mistreatment reported. Physical abuse was more likely to be reported by women with no labour companion with them (OR: 3·11, 95%CI: 1·24 − 7·99). Verbal abuse was more likely to be reported by women with less than three live births (OR: 1·71, 95%CI: 1·06 − 2·76, women with no birth companion (OR: 2·72, 95%CI: 1·36 − 3·80) and more likely to be reported if curtains wre not used (OR: 2·55, 95%CI: 1·33 − 4·88). Women with less education were more likely to report long waiting times or delays in receiving services compared to women with higher education (OR: 1·40, 95%CI: 1·06 − 2·10).

Conclusion

For the first time using the World Health Organisation (WHO) tool in the Eastern Mediterranean region, the study findings, show the occurrence of mistreatment and identify areas to be strengthened to ensure that all women have a respectful childbirth experience within health facilities.
Clinicopathological findings, prognosis, and Epstein–Barr virus infection in rheumatoid arthritis patients with other iatrogenic immunodeficiency-associated T- and NK-cell lymphoproliferative disorders
Authors: Kimura Shoichi , Oshiro Yumi , Iwasaki Hiromi , Kadowaki Masanori , Ogata Masao , Daa Tsutomu , Sakata Toshifumi , Kawauchi Shigeto , Wang Ziyao , Takamatsu Yasushi , Takeshita Morishige
Published: December 2022

Background

Other iatrogenic immunodeficiency-associated (OIIA) T- and natural killer (NK)-cell lymphoproliferative disorders (TNK-LPDs) are rare in patients with rheumatoid arthritis (RA).

Methods

We investigated the clinicopathological characteristics, Epstein–Barr virus (EBV) infection, genetic findings, therapeutic response, and prognostic factors in 21 RA patients with OIIA TNK-LPDs and compared these with those of 39 with OIIA B-cell LPDs (B-LPDs) and 22 with non-OIIA B-LPDs.

Results

Immunohistologically, 11 patients (52%) showed CD4+ T-LPDs, and 7 had a T follicular helper (TFH) phenotype. The other nine patients (43%) showed CD8+ T-LPDs, and the remaining one (5%) had features of CD3+ CD4− CD8− nasal type TNK-cell lymphoma. CD30+, p53+, and CMYC+ atypical lymphocytes were identified in seven (33%), eight (38%), and five (24%) patients, respectively. In situ hybridisation detected EBV-encoded RNA (EBER) + large atypical lymphocytes in five patients (24%). Nine of 17 patients (53%) showed clonal peaks of TCRγ by polymerase chain reaction. Withdrawal of MTX and biologic drugs was effective in 12 patients (57%), and 8 (38%) received chemotherapies. Two patients with TFH+ or EBV+ CD4+ CD30+ large cell peripheral T-cell lymphoma, one with CD8+ systemic anaplastic large cell lymphoma, and two with systemic EBV+ CD8+ T-cell lymphoma of childhood showed a lethal progressive clinical course within 13 months. Moreover, > 500 U/L LDH, large atypical lymphocytes, expression of CD30, p53, and CMYC, and EBER+ atypical lymphocytes were significantly poor prognostic factors for overall survival (p < 0.05). Median interval from RA onset to OIIA TNK-LPDs was 72 months, which was shorter than 166 months in OIIA B-LPDs (p = 0.003). EBV+ atypical and reactive lymphocytes were frequently found in 15 patients with OIIA TNK-LPDs (71%), in 27 with OIIA B-LPDs (69%), and only in 3 with non-OIIA B-LPDs (14%).

Conclusions

OIIA TNK-LPDs occurred in early phase of RA, compared with OIIA B-LPDs, and occasionally showed a lethal progressive clinical course. Detection of OIIA TNK-LPD patients with poor prognostic factors is necessary. EBV infection in immunosuppressed patients due to persistent RA, MTX, and biologic drugs may play a role in forming the tumour microenvironment and lymphomagenesis of TNK-LPDs.
Our Voice in a rural community: empowering Colombian adolescents to advocate for school community well-being through citizen science
Authors: Montes Felipe , Guerra Ana María , Higuera-Mendieta Diana , De La Vega-Taboada Eduardo , King Abby C. , Banchoff Ann , Maturana Augusto César Rodríguez , Sarmiento Olga L.
Published: December 2022

Background

Santa Ana is home to an Afro-descendant rural population of the island of Barú in Cartagena, Colombia. While a popular area for tourism, Santa Ana’s population is affected by multidimensional poverty, precarious work conditions, homelessness, broken streets and sewer systems, limited quality education, and a lack of recreation and sport spaces. While Santa Ana’s Community Action Board aims to unify efforts and resources to solve these problems, the state’s capacity to meet the requirements of the Board is limited.

Methods

We evaluated the relationship between healthy lifestyles and characteristics of Santa Ana’s school using the Our Voice Citizen Science Research Method. This systemic approach combines information and communication technologies with group facilitation to empower adolescents to: 1) collect and discuss data about factors in their local environments that facilitate or hinder well-being within their school community; 2) identify relevant local stakeholders who could help to address the issues identified; and 3) advocate collectively for local improvements to support increased well-being at a community level.

Results

Eleven citizen scientists ages 13 to 17 years from the science club of Institución Educativa Santa Ana were recruited and together conducted 11 walks within the school to collect data about the facilitators and barriers to student well-being. They identified barriers to well-being related to school infrastructure, furniture, bathrooms, and sense of belonging. They then advocated with school stakeholders and reached agreements on concrete actions to address identified barriers, including fostering a culture among students of caring for school property and presenting their findings to the community action board. This methodology allowed the community to realize how students can become agents of change and take collective action when motivated by solution-oriented methodologies such as Our Voice. Project ripple effects, including greater empowerment and participation in collective actions by students, also were observed.

Conclusions

This study underscores the importance of the school’s built environment in the well-being of students in rural areas. The Our Voice method provided the opportunity to inform school-based interventions, and promoted ripple effects that expanded productive dialogue to the community level and generated systemic actions involving actors outside of the school community.
Use of LigaSure vessel sealing system versus conventional axillary dissection in breast cancer patients: a retrospective comparative study
Authors: Wienerroither V. , Hammer R. , Kornprat P. , Schrem H. , Wagner D. , Mischinger H. J. , El-Shabrawi A.
Published: December 2022

Background

In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and—most frequently—seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome.

Methods

A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid.

Results

Seventy one female patients with a median age of 63 (30–83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005).

Conclusion

LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.