bluuebunny/crossref_metadata_2025 huggingface dataset:
Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic
Authors: Asadi Neda , Salmani Fatemeh , Asgari Narges , Salmani Mahin
Published: May 2022

Introduction

Most ICU nurses feel overwhelmed by the variety of alarms at the same time. Therefore, nurses experience very stressful situations in relation to many responsibilities and care demands. This stressful condition has recently been exacerbated by COVID-19 and potentially endangers patient safety. The aim of this study was to investigate the alarm fatigue and moral distress of ICU nurses in COVID-19 crisis.

Method

This is a descriptive-analytical cross-sectional study (April-May 2021). Sampling was done by convenience among ICU nurses affiliated to Isfahan University of Medical Sciences, Iran. Data were collected using Nurses’ alarm fatigue and the moral distress scale (MDS). Data were analyzed using ANOVA, independent t-test and multivariate logistic regression.

Result

The results showed that the mean score of alarm fatigue was moderate)19.08 ± 6.26 (and moral distress was low (33.80 ± 11.60). The results showed that there was a significant relationship between alarm fatigue and related training courses)P = .012(.So that, alarm fatigue in nurses who were trained in working with ventilators and alarm settings was significantly less than other nurses. Also, a significant relationship was found between moral distress and marital status(P = .001) and Shift type(P = .01). On the other hand, the risk of alarm fatigue was higher in participants who have a PhD. The results showed that no significant correlation was found between alarm fatigue and moral distress (r = 0.111, P = 0.195).

Conclusion

It is suggested that practical training courses on alarm management be included in the curriculum and the ICU nurses should have practical training before starting work in the ICU and on an annual basis. In order to protect nurses and ensure quality care of patients, nurse managers should reduce the number of rotating shifts of ICU nurses.
The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients
Authors: Guo Fengbao , Qin Yan , Fu Hailong , Xu Feng
Published: May 2022

Objectives

To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the length of stay (LOS) and prognosis of patients in the resuscitation area.

Methods

A retrospective analysis of case data of patients in the resuscitation area during the early stages of the COVID-19 pandemic (January 15, 2020– January 14, 2021) was performed and compared with the pre-COVID-19 period (January 15, 2019 – January 14, 2020) in the First Affiliated Hospital of Soochow University. The patients’ information, including age, sex, length of stay, and death, was collected. The Wilcoxon Rank sum test was performed to compare the LOS difference between the two periods. Fisher's Exact test and Chi-Squared test were used to analyze the prognosis of patients. The LOS and prognosis in different departments of the resuscitation area (emergency internal medicine, emergency surgery, emergency neurology, and other departments) were further analyzed.

Results

Of the total 8278 patients, 4159 (50.24%) were enrolled in the COVID-19 pandemic period group, and 4119 (49.76%) were enrolled pre-COVID-19 period group. The length of stay was prolonged significantly in the COVID-19 period compared with the pre-COVID-19 period (13h VS 9.8h,p< 0.001). The LOS in the COVID-19 period was prolonged in both emergency internal medicine (15.3h VS 11.3h,p< 0.001) and emergency surgery (8.7h VS 4.9h,p< 0.001) but not in emergency neurology or other emergency departments. There was no significant difference in mortality between the two cohorts (4.8% VS 5.3%,p= 0.341).

Conclusion

The COVID-19 pandemic was associated with a significant increase in the length of resuscitation area stay, which may lead to resuscitation area crowding. The influence of the COVID-19 pandemic on patients of different departments was variable. There was no significant impact on the LOS of emergency neurology. According to different departments of the resuscitation area, the COVID-19 pandemic didn’t significantly impact the prognosis of patients.
Patient satisfaction with health care at a tertiary hospital in Northern Malawi: results from a triangulated cross-sectional study
Authors: Sinyiza Frank Watson , Kaseka Paul Uchizi , Chisale Master Rodgers Okapi , Chimbatata Chikondi Sharon , Mbakaya Balwani Chingatichifwe , Kamudumuli Pocha Samuel , Wu Tsung-Shu Joseph , Kayira Alfred Bornwell
Published: May 2022

Background

In 2016 the Malawi government embarked on several interrelated health sector reforms aimed at improving the quality of health services at all levels of care and attain Universal Health Coverage by 2030. Patient satisfaction with services is an important proxy measure of quality. We assessed patient satisfaction at a tertiary hospital in Northern Malawi to understand the current state.

Methods

We conducted exit interviews with patients aged ≥ 18 years using a 28 statement interviewer administered questionnaire. Patients were asked to express their level of agreement to each statement on a five-point Likert scale – strongly disagree to strongly agree, corresponding to scores of 1 to 5. Overall patient satisfaction was calculated by summing up the scores and dividing the sum by the number of statements. Mean score > 3 constituted satisfaction while mean score ≤ 3 constituted dissatisfaction. A χ2 test was used to assess the association between overall patient satisfaction and demographic variables, visit type and clinic consulted at alpha 0.05. Patient self-rated satisfaction was determined from a single statement that asked patients to rate their satisfaction with services on a five-point Likert scale. We also asked patients to mention aspects of hospital care that they did not like. Responses were summarized into major issues which are presented according to frequencies.

Results

Overall patient satisfaction was 8.4% (95% CI: 5.2 − 12.9%). Self-rated patient satisfaction was 8.9% (95% CI: 5.5 − 13.4%). There was no significant association between overall patient satisfaction and all predictor variables assessed. Patients raised six major issues that dampened their health care seeking experience, including health workers reporting late to work, doctors not listening to patients concerns and neither examining them properly nor explaining the diagnosis, shortage of medicines, diagnostics and medical equipment, unprofessional conduct of health workers, poor sanitation and cleanliness, and health worker behaviour of favouring relatives and friends over other patients.

Conclusions

We found very low levels of patient satisfaction, suggesting that quality of services in the public health sector is still poor. It is, therefore, critical to accelerate and innovate the Ministry of Health’s quality improvement initiatives to attain Malawi’s health goals.
Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies
Authors: Guo Na , Zhu Ying , Tian Dandan , Zhao Yating , Zhang Chenguang , Mu Changqing , Han Chen , Zhu Ruixia , Liu Xu
Published: May 2022

Background

Stroke is one of the major challenges for the global healthcare system, which makes it necessary to explore the relationship between various modifiable factors and stroke risk. Recently, numerous meta-analyses of prospective observational studies have reported that dietary factors played a key role in the occurrence of stroke. However, the conclusions of previous studies have remained controversial and unclear. Accordingly, we conducted an umbrella review synthesizing and recalculating available evidence to assess the certainty of the associations between dietary factors and stroke.

Methods

Relevant meta-analyses examining the associations between dietary factors and stroke were searched in PubMed and Embase databases up to September 1, 2021. For each eligible meta-analysis, two independent reviewers appraised the methodologic quality using the AMSTAR 2 criteria and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals, heterogeneity between studies, and small-study effects. Moreover, we further assessed the associations between dietary factors and ischemic stroke as well as hemorrhagic stroke. Lastly, a set of pre-specified criteria was applied to qualitatively evaluate the epidemiological credibility of each dietary factor.

Results

Overall, our umbrella review included 122 qualified meta-analyses for qualitative synthesis, involving 71 dietary factors related to food groups, foods, macronutrients, and micronutrients. Using the AMSTAR 2 criteria, 5 studies were assessed as high quality, 4 studies as moderate quality, and 113 studies as low or critically low quality. We identified 34 dietary factors associated with stroke occurrence, 25 dietary factors related to ischemic stroke, and 11 factors related to hemorrhagic stroke. Among them, high/moderate certainty epidemiological evidence demonstrated an inverse association between intake of fruits (RR: 0.90) and vegetables (RR: 0.92) and stroke incidence, but a detrimental association between red meat (RR: 1.12), especially processed red meat consumption (RR:1.17), and stroke incidence. Besides, the evidence of high/moderate certainty suggested that the intake of processed meat, fruits, coffee, tea, magnesium, and dietary fiber was associated with ischemic stroke risk, while consumption of tea, fruits, and vegetables was relevant to hemorrhagic stroke susceptibility.

Conclusions

Our study has reported that several dietary factors have a significant impact on stroke risk and offered a new insight into the relationship between dietary modification and stroke occurrence. Our results may provide an effective strategy for stroke prevention.
MiR-135a-5p suppresses trophoblast proliferative, migratory, invasive, and angiogenic activity in the context of unexplained spontaneous abortion
Authors: Lu Yebin , Zhang Xiaoli , Li Xueyu , Deng Lingjie , Wei Changqiang , Yang Dongmei , Tan Xuemei , Pan Weicheng , Pang Lihong
Published: May 2022

Background

Spontaneous abortions (SA) is amongst the most common complications associated with pregnancy in humans, and the underlying causes cannot be identified in roughly half of SA cases. We found miR-135a-5p to be significantly upregulated in SA-associated villus tissues, yet the function it plays in this context has yet to be clarified. This study explored the function of miR-135a-5p and its potential as a biomarker for unexplained SA.

Method

RT-qPCR was employed for appraising miR-135a-5p expression within villus tissues with its clinical diagnostic values being assessed using ROC curves. The effects of miR-135a-5p in HTR-8/SVneo cells were analyzed via wound healing, Transwell, flow cytometry, EdU, CCK-8, and tube formation assays. Moreover, protein expression was examined via Western blotting, and interactions between miR-135a-5p and PTPN1 were explored through RIP-PCR, bioinformatics analyses and luciferase reporter assays.

Results

Relative to normal pregnancy (NP), villus tissue samples from pregnancies that ended in unexplained sporadic miscarriage (USM) or unexplained recurrent SA (URSA) exhibited miR-135a-5p upregulation. When this miRNA was overexpressed in HTR-8/SVneo cells, their migration, proliferation, and cell cycle progression were suppressed, as were their tube forming and invasive activities. miR-135a-5p over-expression also downregulated the protein level of cyclins, PTPN1, MMP2 and MMP9. In RIP-PCR assays, the Ago2 protein exhibited significant miR-135a-5p and PTPN1 mRNA enrichment, and dual-luciferase reporter assays indicated PTPN1 to be a bona fide miR-135a-5p target gene within HTR-8/SVneo cells.

Conclusion

miR-135a-5p may suppress trophoblast migratory, invasive, proliferative, and angiogenic activity via targeting PTPN1, and it may thus offer value as a biomarker for unexplained SA.
Agomelatine rescues lipopolysaccharide-induced neural injury and depression-like behaviors via suppression of the Gαi-2-PKA-ASK1 signaling pathway
Authors: Lan Tian , Wu Yuhan , Zhang Yulei , Li Shuhan , Zhu Zhanpeng , Wang Liyan , Mao Xueqin , Li Ye , Fan Cuiqin , Wang Wenjing , Yu Shu Yan
Published: May 2022

Background

Agomelatine has been shown to be effective in the treatment of depression, but the molecular mechanisms underlying its antidepressant effects have yet to be elucidated. Identification of these molecular mechanisms would not only offer new insights into the basis for depression but also provide the foundation for the development of novel treatments for this disorder.

Methods

Intraperitoneal injection of LPS was used to induce depression-like behaviors in rats. The interactions of the 5-HT2C reporter and Gαi-2 were verified by immunoprecipitation or immunofluorescence assay. Inflammatory related proteins, autophagy related proteins and apoptosis markers were verified by immunoblotting or immunofluorescence assay. Finally, electron microscopy analysis was used to observe the synapse and ultrastructural pathology.

Results

Here, we found that the capacity for agomelatine to ameliorate depression and anxiety in a lipopolysaccharide (LPS)-induced rat model of depression was associated with an alleviation of neuroinflammation, abnormal autophagy and neuronal apoptosis as well as the promotion of neurogenesis in the hippocampal dentate gyrus (DG) region of these rats. We also found that the 5-HT2C receptor is coupled with G alphai (2) (Gαi-2) protein within hippocampal neurons and, agomelatine, acting as a 5-HT2C receptor antagonist, can up-regulate activity of the Gαi-2-cAMP-PKA pathway. Such events then suppress activation of the apoptosis signal-regulating kinase 1 (ASK1) pathway, a member of the mitogen-activated protein kinase (MAPK) family involved in pathological processes of many diseases.

Conclusion

Taken together, these results suggest that agomelatine plays a neuroprotective role in regulating neuroinflammation, autophagy disorder and apoptosis in this LPS-induced rat model of depression, effects which are associated with the display of antidepressant behaviors. These findings provide evidence for some of the potential mechanisms for the antidepressant effects of agomelatine.

Graphical Abstract
Parkinson's disease peripheral immune biomarker profile: a multicentre, cross-sectional and longitudinal study
Authors: Li Yuanyuan , Yang Yan , Zhao Aonan , Luo Ningdi , Niu Mengyue , Kang Wenyan , Xie Anmu , Lu Hong , Chen Lei , Liu Jun
Published: May 2022

Background

Inflammations play crucial role in the pathogenesis of Parkinson’s disease (PD), however, their possible value in the diagnosis or tracking of the progress of PD is still limited, because of discordant results in the literature and a lack of information regarding its reproducibility. Thus, overall longitudinal and cross-sectional studies are needed. This multicentre study was designed to investigate the association between multiple peripheral immune biomarkers and the development and progression of PD.

Methods

This was a longitudinal and multicentre study. First, we measured the levels of five typical cytokines and five focused chemokines in 76 PD patients and 76 healthy controls (HCs) in a discovery cohort. Then, a validation cohort of 80 PD and 80 HC participants was recruited from four multicentre locations. In addition, a prospective follow-up of early-stage PD patients was performed with significant biomarkers. Finally, we performed further verification in an exploratory set of patients with idiopathic REM sleep behaviour disorder (iRBD).

Results

In the discovery set, CXCL12, CX3CL1 and IL-8 levels were significantly higher in PD patients than in HCs (p < 0.05). The receiver-operating characteristic (ROC) curve for a combination of these three biomarkers produced a high area under the curve (AUC) of 0.89 (p < 0.001). Moreover, four biomarkers (the previous three and CCL15) were significantly associated with PD in the discovery and validation cohorts. Furthermore, in the prospective follow-up cohort, CX3CL1 levels were associated with motor progression after a mean interval of 43 months. In addition, CX3CL1 and IL-8 levels were higher in iRBD patients than in HCs.

Conclusion

We showed a correlation between a profile of four peripheral immune biomarkers and PD development and progression. Our findings may provide a basis whereby PD patients with abnormal inflammatory profiles can be identified and receive timely therapeutic interventions.
Sexually transmitted infection screening to prevent adverse birth and newborn outcomes: study protocol for a randomized-controlled hybrid-effectiveness trial
Authors: Medina-Marino Andrew , Cleary Susan , Muzny Christina A. , Taylor Christopher , Tamhane Ashutosh , Ngwepe Phuti , Bezuidenhout Charl , Facente Shelley N. , Mlisana Koleka , Peters Remco P. H. , Klausner Jeffrey D.
Published: May 2022

Background

Sexually transmitted infections (STIs) during pregnancy are associated with adverse birth outcomes, including preterm birth, low birth weight, perinatal death, and congenital infections such as increased mother-to-child HIV transmission. Prevalence of STIs among pregnant women in South Africa remains high, with most women being asymptomatic for their infection(s). Unfortunately, most STIs remain undetected and untreated due to standard practice syndromic management in accordance with World Health Organization (WHO) guidelines. Although lab-based and point-of-care molecular tests are available, optimal screening strategies during pregnancy, their health impact, and cost-effectiveness are unknown.

Methods

We will implement a 3-arm (1:1:1) type-1 hybrid effectiveness-implementation randomized-controlled trial (RCT). We will enroll 2500 pregnant women attending their first antenatal care (ANC) visit for their current pregnancy at participating health facilities in Buffalo City Metro District, Eastern Cape Province, South Africa. Participants allocated to arms 1 and 2 (intervention) will receive GeneXpert® point-of-care diagnostic testing for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis, with same-day treatment for detected infection(s). Arm 1 will additionally receive a test-of-cure 3 weeks post-treatment, while Arm 2 will receive a repeat test at 30–34 weeks’ gestation. Those allocated to Arm 3 will receive syndromic management (standard-of-care). The RE-AIM framework will be used to guide collection of implementation indicators to inform potential future scale up. Primary outcome measures include (1) frequency of adverse birth outcomes among study arms, defined by a composite measure of low birth weight and pre-term delivery, and (2) change in STI prevalence between baseline and birth outcome among intervention arms and compared to standard-of-care. Estimates and comparative costs of the different screening strategies relative to standard-of-care and the costs of managing adverse birth outcomes will be calculated. Cost-effectiveness will be assessed per STI and disability-adjusted life year averted.

Discussion

This trial is the first RCT designed to identify optimal, cost-effective screening strategies that decrease the burden of STIs during pregnancy and reduce adverse birth outcomes. Demonstrating the impact of diagnostic screening and treatment, compared to syndromic management, on birth outcomes will provide critical evidence to inform changes to WHO guidelines for syndromic management of STIs during pregnancy.

Trial registration

ClinicalTrials.gov NCT04446611. Registered on 25 June 2020.
Human tumor necrosis factor alpha affects the egg-laying dynamics and glucose metabolism of Schistosoma mansoni adult worms in vitro
Authors: Lopes-Junior Ednilson Hilário , Bertevello Claudio Romero , de Oliveira Silveira Gilbert , Guedes Camila Banca , Rodrigues Gratchela Dutra , Ribeiro Viviane Sousa , Amaral Murilo Sena , Kanamura Cristina Takami , Pinto Pedro Luiz Silva , Krüger Rodrigo Ferreira , Verjovski-Almeida Sergio , Oliveira Katia Cristina
Published: May 2022

Several studies have described the effects of human tumor necrosis factor alpha (hTNF-α) on Schistosoma mansoni. hTNF-α affects the worm’s development, metabolism, egg-laying, gene expression and protein phosphorylation. The available data on the influence of hTNF-α on egg-laying in S. mansoni are controversial, but understanding the mechanism of egg-laying regulation in this species is essential in combating schistosomiasis. We characterized the effects of in vitro treatment of S. mansoni adult worms with different doses of hTNF-α (5, 20 and 40 ng/ml) for 5 days. We explored the effects on egg-laying rate, glucose levels, ATP metabolism, and messenger RNA (mRNA) expression levels of lactate dehydrogenase, glucose transporters and the parasite gene which acts as an hTNF-α receptor, SmTNFR. hTNF-α influenced egg-laying in a time- and dose-dependent manner: at a dose of 40 ng/ml, egg-laying increased on day 2 and decreased on days 3 and 4; at 20 ng/ml, egg-laying decreased on day 3; while at 5 ng/ml, egg-laying decreased on day 4. The total number of eggs produced was not affected by the different treatments, but the egg-laying dynamics were: the median egg-laying time decreased significantly with treatment, and egg developmental stages and size were also affected. At 5 and 20 ng/ml hTNF-α, lactate production diminished on day 3 up to day 5, while glucose uptake increased on day 5. At 40 ng/ml, glucose uptake diminished on day 1 up to day 3, while ATP accumulation was detected on day 5. No significant changes in mRNA expression were detected in any of the treatments. We found that crosstalk involving hTNF-α and parasite signaling plays a role in the fine-scale regulation of the worm’s metabolism and physiology, and points to new strategies for disease control.

Graphical abstract
Structural comparisons reveal diverse binding modes between nucleosome assembly proteins and histones
Authors: Gill Jasmita , Kumar Anuj , Sharma Amit
Published: May 2022

Nucleosome assembly proteins (NAPs) are histone chaperones that play a central role in facilitating chromatin assembly/disassembly which is of fundamental importance for DNA replication, gene expression regulation, and progression through the cell cycle. In vitro, NAPs bind to the core histones H2A, H2B, H3, H4 and possibly to H1. The NAP family contains well-characterized and dedicated histone chaperone domain called the NAP domain, and the NAP–histone interactions are key to deciphering chromatin assembly. Our comparative structural analysis of the three three-dimensional structures of NAPs from S. cerevisiae, C. elegans, and A. thaliana in complex with the histone H2A–H2B dimer reveals distinct and diverse binding of NAPs with histones. The three NAPs employ distinct surfaces for recognizing the H2A–H2B dimer and vice versa. Though histones are highly conserved across species they display diverse footprints on NAPs. Our analysis indicates that understanding of NAPs and their interaction with histone H2A–H2B remains sparse. Due to divergent knowledge from the current structures analyzed here, investigations into the dynamic nature of NAP–histone interactions are warranted.
Diversity and communities of culturable endophytic fungi from the root holoparasite Balanophora polyandra Griff. and their antibacterial and antioxidant activities
Authors: Wu Chunyin , Wang Wei , Wang Xiaoqing , Shahid Hamza , Yang Yuting , Wang Yangwen , Wang Shengkun , Shan Tijiang
Published: May 2022

Purpose

Balanophora polyandra Griff. is a holoparasitic medicinal plant that produces compounds with antibacterial and antioxidant activities. Plant endophytic fungi are an abundant reservoir of bioactive metabolites for medicinal exploitation, and an increasing number of novel bioactive compounds are being isolated from endophytic fungi. The present study investigated the diversity of culturable endophytic fungi from the roots of holoparasite B. polyandra to explore active strains and metabolites. In addition, the antibacterial and antioxidant activities of 22 strains cultured from B. polyandra were also evaluated.

Methods

The endophytic fungi were identified according to their colony morphology and ITS-5.8S rDNA sequencing. TLC-MTT-Bioautography assays and DPPH radical scavenging assays were employed to assess the antibacterial and antioxidant activities of ethyl acetate extracts of the endophytic fungi.

Results

One hundred and twenty-five endophytic strains were isolated from the roots of B. polyandra, including 70 from female samples and 55 from male samples. Of them, twenty-two distinct isolates representing 15 genera and 22 species based on their ITS-rDNA genomic sequence were successfully identified from female and male samples of B. polyandra. The genus Calonectria was the most prevalent genus, with a CF% of 18.3, followed by the genera Clonostachys and Botryosphaeria, with CF% values of 13.4 and 10.0, respectively. Interestingly, the fungal extracts exhibited broad-spectrum antibacterial activities against gram-positive and gram-negative bacteria, as well as potential antioxidant activities with IC50 values ranging from 0.45 to 6.90 mg/mL. Among them, endophytes Bpf-10 (Diaporthe sp.) and Bpf-11 (Botryosphaeria sp.) showed the strongest biological activities and more abundant secondary metabolites.

Conclusions

This study reported the diversity of endophytic fungi from the roots of B. polyandra and the antibacterial and antioxidant activities of the crude extracts for the first time. The results revealed that B. polyandra contains diverse culturable endophytic fungi that potentially produce natural antibacterial and antioxidant compounds with great value to the agriculture and pharmaceutical industries.
Primary retroperitoneal hydatid cyst with intraperitoneal rupture: a case report
Authors: Fourati Kais , Tlili Ahmed , Masmoudi Abderrahmen , Laabidi Taher , Ben Ameur Hazem , Boujelben Salah
Published: May 2022

Background

Hydatid disease is endemic in Mediterranean countries and most commonly occurs in the liver followed by the lung. A primary localization in the retroperitoneum is extremely rare.

Case presentation

We report the case of a 29-year-old Tunisian patient presenting with progressive left flank pain and skin urticaria. On abdominal ultrasonography and computed tomography scan, a ruptured retroperitoneal hydatid cyst was diagnosed, which was confirmed by positive hydatid serology. The treatment consisted of resection of protruding dome. The evolution was favorable. No local recurrence was detected during postoperative follow-up.

Conclusions

Primary retroperitoneal hydatid cyst is extremely rare and has uncommon presentation, but we should learn the keys to its diagnosis. In endemic regions, high suspicion for this disease is justified regardless of localization.
Efficacy and safety of AYUSH-64 as standalone or adjunct to standard care in COVID-19: a structured summary of protocol for a systematic review
Authors: Rai Amit Kumar , Ahmad Azeem , Mundada Pallavi , Kumar V Krishna , Yadav Babita , Khanduri Shruti , Chandrasekhararao Bhogavalli , Srikanth Narayanam
Published: May 2022

Trial registration

Registered with PROSPERO (CRD42021267844) dated 14.07.2021.
Experimental investigation of E-beam effect on the electric field distribution in cross-linked polyethylene/ZnO nanocomposites for medium-voltage cables simulated by COMSOL Multiphysics
Authors: Sharshir A. I. , Fayek S. A. , Abd El-Gawad Amal. F. , Farahat M. A. , Ismail M. I. , Ghobashy Mohamed Mohamady
Published: May 2022

This study investigated the electric field distribution of underground cable insulation in cross-linked polyethylene/zinc oxide (XLPE/ ZnO) nanoparticles (NPs) for medium-voltage (MV) cables. The ZnO NPs that were obtained by three methods of preparation were classified using transmission electron microscopy (TEM). The obtained ZnO NPs were semi-spheres with sizes of 35–55 nm on TEM images. XLPE/ ZnO films with various ZnO NP weight contents (i.e., 0, 1, 3, and 5%) were exposed to varied dosages of 3-MeV electron beam (EB); 0 kGy, 15 kGy, 20 kGy, and 25 kGy. The optimum film XLPE/ 5-ZnO, which has ZnO NP content (5 wt%), irradiated at 25 kGy, according to alternating current (AC)/ DC conductivity (AC: 1 × 10−4 S/m; DC: 12.44 × 10−2 S/m) in minimum relative permittivity (2.24), was obtained. COMSOL Multiphysics was used to simulate the electric field distribution within an MV cable of 25-kGy XLPE/ 5-ZnO insulation. The maximum uniform electric field was found in the middle of the 25-kGy XLPE/5-ZnO film sample, rather than at the top or bottom, which might be attributed to the significantly low relative permittivity of the new 25-kGy XLPE/5-ZnO film cable.
Effect of rinse-off hair conditioner containing argan oil or camellia oil on the recovery of hair damaged by bleaching
Authors: Lee Si Hyun , Ahn Cheunsoon
Published: May 2022

Effect of hair conditioner formulated with Argan oil or Camellia oil was investigated on the protection of hair damaged by bleaching. Six different rinse-off type hair conditioners were made with the basic ingredients of hair conditioner and one of the following conditioning agent; Argan oil (AO), Camellia oil (CO), Palmitic acid (PA), Stearic acid (SA), Oleic acid (OA), and Linoleic acid (LA). L*, a*, b* color values and tensile strength, elongation were measured, and the amount of protein leak was examined using the Bradford Protein Assay. Statistical significance was tested using the SPSS statistical software. Although both AO and CO were effective in protecting the tensile properties of bleached hair, significant effects were observed with AO in enhancing the tensile strength and retaining the color of bleached hair. This might be due possibly to the difference in the composition of four major fatty acids in Argan oil and Camellia oil.
Patient-reported outcomes and medical device evaluation: from conception to implementation
Authors: Webber Christina M. , Caldwell Brittany , Bocell Fraser D. , Saha Anindita , Tarver Michelle E.
Published: May 2022

Background

The insights gleaned from patient-reported outcomes (PROs) have implications across the healthcare ecosystem, from clinical investigations to evaluate the safety and effectiveness of medical devices to clinical care and reimbursement decisions. The U.S. Food and Drug Administration’s (FDA) Center for Devices and Radiological Health (CDRH) hosted a public meeting in September 2020 discussing how PROs can be used in medical device evaluation throughout the total product life cycle, as well as methods for developing and modifying PRO instruments to ensure they are fit-for-purpose. This commentary presents key points of discussion from the meeting, providing insight into the increased interest in PRO data to support medical product development while also exploring future opportunities of incorporating PRO data throughout healthcare.

Main Body.

Thoughtful use of fit-for-purpose PRO instruments to integrate the patient’s voice into clinical care paradigms, medical device development, regulatory decisions, and reimbursement and coverage decisions were emphasized throughout the meeting. Existing PRO instruments may be used if the context of use is appropriate. Modifications to an existing PRO instrument may also be explored to ensure the instrument is fit-for-purpose in a new context of use. Development of a novel PRO instrument may be necessary to capture attributes in a new patient population or application. Multi-stakeholder collaborations, of which patients are a key component, create efficiencies in the development and modification of PRO instruments.

Conclusion

Continued multi-stakeholder collaborations bringing together researchers, clinicians, patients, regulators, and payers are critical to further advance the inclusion of the patient voice incorporating PRO instruments throughout the healthcare ecosystem in an efficient manner that is least burdensome to patients.
A combination of two or more unhealthy lifestyle factors is associated with impaired physical and mental health in patients with spondyloarthritis: a cross-sectional study
Authors: Mogard Elisabeth , Bremander Ann , Haglund Emma
Published: May 2022

Background

There is increasing knowledge of how individual lifestyle factors affect patients with spondyloarthritis, while studies exploring the combination of unhealthy lifestyle factors are lacking. Thus, our aim was to study the frequency of two or more unhealthy lifestyle factors and their associations with physical and mental health in patients with spondyloarthritis (SpA).

Methods

A population-based postal survey involving questions on lifestyle factors was completed by 1793 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA), and undifferentiated spondyloarthritis (USpA). Self-reported physical activity, body mass index, and tobacco use were respectively dichotomized as “healthy” or “unhealthy”, summarized for each patient and stratified into four groups (0–3; 0 = no unhealthy lifestyle factors). Group comparisons were performed with Chi-squared tests, and associations with physical and mental health outcomes were performed with analysis of covariance and logistic regression analysis.

Results

Out of 1426 patients (52% women) with complete information for all studied lifestyle factors, 43% reported ≥ two unhealthy lifestyle factors—more frequently patients with PsA (48%) than AS (39%) or USpA (38%)—and with no difference between women and men (p = 0.399). Two or more unhealthy lifestyle factors were associated with worse health-related quality of life, disease activity, physical function, pain, fatigue, anxiety, and depression, adjusted for age and SpA-subgroup. If an unhealthy level of physical activity was one of the two unhealthy lifestyle factors, patients reported worse health outcomes.

Conclusion

Reporting two or more unhealthy lifestyle factors were associated with worse physical and mental health in patients with SpA. This highlights the need to screen for a combination of unhealthy lifestyle factors and offer individualized coordinated interventions, and tailored coaching to support behavioral change, in order to promote sustainable health.
Deprimary reverse time migration angle gathers with a stabilized Poynting vector
Authors: Yang Kai , Dong Xingpeng , Wang Xiaoyi , Zhang Jianfeng
Published: May 2022

Deprimary reverse time migration (RTM) mitigates the problem of low-wavenumber noise and false events in conventional RTM, and the generation of high-quality angle-domain common-image gathers or angle gathers during deprimary RTM greatly extends its further applications in velocity model updating and subsurface parameter inversion. Poynting-vector-based methods are the most efficient approach to extract angle gathers from RTM or deprimary RTM. However, the instability problem of Poynting-vector-based methods seriously degrades the quality of the generated angle gathers. The instability problem arises from the oscillatory nature of the Poynting vector. To overcome this issue, we propose a novel approach by harnessing the extra simulated Hilbert transformed wavefield in deprimary RTM. Our approach consists of adding the conventional Poynting vector with an ancillary one derived from the Hilbert transformed wavefield, which allows us to eliminate the oscillatory nature of the conventional Poynting vector and obtain a stable algorithm to extract high-quality angle gathers from RTM or deprimary RTM. By using numerical examples with two synthetic data sets and a field data set from the deepwater Gulf of Mexico, we prove the effectiveness of our method in generating high-quality angle gathers.
Predictors and Real-World Use of Prostate-Specific Radioligand Therapy: PSMA and Beyond
Authors: Gafita Andrei , Marcus Charles , Kostos Louise , Schuster David M. , Calais Jeremie , Hofman Michael S.
Published: May 2022

PSMA is a transmembrane protein that is markedly overexpressed in prostate cancer, making it an excellent target for imaging and treating patients with prostate cancer. Several small molecule inhibitors and antibodies of PSMA have been radiolabeled for use as therapeutic agents and are currently under clinical investigation. PSMA-based radionuclide therapy is a promising therapeutic option for men with metastatic prostate cancer. The phase II TheraP study demonstrated superior efficacy, lower side effects, and improved patient-reported outcomes compared with cabazitaxel. The phase III VISION study demonstrated that radionuclide therapy with β-emitter 177Lu-PSMA-617 can prolong survival and improve quality of life when offered in addition to standard-of-care therapy in men with PSMA-positive metastatic castration-resistant prostate cancer whose disease had progressed with conventional treatments. Nevertheless, up to 30% of patients have inherent resistance to PSMA-based radionuclide therapy, and acquired resistance is inevitable. Hence, strategies to increase the efficacy of PSMA-based radionuclide therapy have been under clinical investigation. These include better patient selection; increased radiation damage delivery via dosimetry-based administered dose or use of α-emitters instead of β-emitters; or using combinatorial approaches to overcome radioresistance mechanisms (innate or acquired), such as with novel hormonal agents, PARP inhibitors, or immunotherapy.
Prospective Comparative Effectiveness Trial of Multidisciplinary Lung Cancer Care Within a Community-Based Health Care System
Authors: Smeltzer Matthew P. , Ray Meredith A. , Faris Nicholas R. , Meadows-Taylor Meghan B. , Rugless Fedoria , Berryman Courtney , Jackson Bianca , Fehnel Carrie , Pacheco Alicia , McHugh Laura , Robbins Edward T. , Ward Kenneth D. , Klesges Lisa M. , Osarogiagbon Raymond U.
Published: May 2022

PURPOSE:

Multidisciplinary lung cancer care is assumed to improve care delivery by increasing transparency, objectivity, and shared decision making; however, there is a lack of high-level evidence demonstrating its benefits, especially in community-based health care systems. We used implementation and team science principles to establish a colocated multidisciplinary lung cancer clinic in a large community-based health care system and evaluated patient experience and outcomes within and outside this clinic.

METHODS:

We conducted a prospective frequency-matched comparative effectiveness study (ClinicalTrials.gov identifier: NCT02123797 ) evaluating the thoroughness of lung cancer staging, receipt of stage-appropriate treatment, and survival between patients receiving care in the multidisciplinary clinic and those receiving usual serial care. Target enrollment was 150 patients on the multidisciplinary arm and 300 on the serial care arm. We frequency-matched patients by clinical stage, performance status, insurance type, race, and age.

RESULTS:

A total of 526 patients were enrolled: 178 on the multidisciplinary arm and 348 on the serial care arm. After adjusting for other factors, multidisciplinary patients had significantly higher odds (odds ratio [OR]: 2.3 [95% CI, 1.5 to 3.4]) of trimodality staging compared with serial care. Patients on the multidisciplinary arm also had higher odds of receiving invasive stage confirmation (OR: 2.0 [95% CI, 1.4 to 3.1]) and mediastinal stage confirmation (OR: 1.9 [95% CI, 1.3 to 2.8]). Additionally, patients receiving multidisciplinary care were significantly more likely to receive stage-appropriate treatment (OR: 1.8 [95% CI, 1.1 to 3.0]). We found no significant difference in overall or progression-free survival between study arms.

CONCLUSION:

The multidisciplinary clinic delivered significant improvements in evidence-based quality care on multiple levels. Even in the absence of a demonstrable survival benefit, these findings provide a strong rationale for recommending this model of care.
The ultra-low lattice thermal conductivity dominated by the quartic anharmonicity in Bi-based binary compounds A3Bi (A = K, Rb)
Authors: Wang Weiqiang , Wang Xichang , Zhao Yinchang , Meng Sheng , Dai Zhenhong
Published: May 2022

In this article, by using self-consistent phonon (SCP) theory, compressed sensing (CS) technology and Boltzmann transport equation (BTE), we studied the role of quartic anharmonicity in the lattice dynamics and thermal transport characteristics of Bi-based binary compounds A3Bi (A = K, Rb), with a particular focus on unraveling the impacts of quartic anharmonicity on lattice thermal conductivity

. By analyzing the phonon dispersion curve and the phonon density of states, we found that the strong quartic anharmonicity, which is mainly caused by the alkali metal atoms A1 in A3Bi (A = K, Rb), hardens the vibration frequency of the low-lying phonon branch and ensures the lattice dynamic stability. Through the relaxation time approximation of the Boltzmann transport equation, the calculated

considering the three-phonon (3ph) and four-phonon (4ph) scattering process shows an ultra-low value. In addition, we also conducted a detailed analysis of the normalized lattice thermal conductivity, phonon group velocity, phonon scattering rate, and scattering phase space, revealing that the extremely low

in A3Bi is mainly due to its relatively strong 4ph scattering process. Our research proves the existence of strong quartic anharmonicity in A3Bi, and we have studied in detail the influence of 3ph and 4ph scattering processes on the thermal transport properties of A3Bi, which has never been reported before.
Survival Prediction After Neurosurgical Resection of Brain Metastases: A Machine Learning Approach
Authors: Hulsbergen Alexander F. C. , Lo Yu Tung , Awakimjan Ilia , Kavouridis Vasileios K. , Phillips John G. , Smith Timothy R. , Verhoeff Joost J. C. , Yu Kun-Hsing , Broekman Marike L. D. , Arnaout Omar
Published: May 2022

BACKGROUND:

Current prognostic models for brain metastases (BMs) have been constructed and validated almost entirely with data from patients receiving up-front radiotherapy, leaving uncertainty about surgical patients.

OBJECTIVE:

To build and validate a model predicting 6-month survival after BM resection using different machine learning algorithms.

METHODS:

An institutional database of 1062 patients who underwent resection for BM was split into an 80:20 training and testing set. Seven different machine learning algorithms were trained and assessed for performance; an established prognostic model for patients with BM undergoing radiotherapy, the diagnosis-specific graded prognostic assessment, was also evaluated. Model performance was assessed using area under the curve (AUC) and calibration.

RESULTS:

The logistic regression showed the best performance with an AUC of 0.71 in the hold-out test set, a calibration slope of 0.76, and a calibration intercept of 0.03. The diagnosis-specific graded prognostic assessment had an AUC of 0.66. Patients were stratified into regular-risk, high-risk and very high-risk groups for death at 6 months; these strata strongly predicted both 6-month and longitudinal overall survival (P < .0005). The model was implemented into a web application that can be accessed through http://brainmets.morethanml.com.

CONCLUSION:

We developed and internally validated a prediction model that accurately predicts 6-month survival after neurosurgical resection for BM and allows for meaningful risk stratification. Future efforts should focus on external validation of our model.
midline represses Dpp signaling and target gene expression in Drosophila ventral leg development
Authors: Phillips Lindsay A. , Atienza Markle L. , Ryu Jae-Ryeon , Svendsen Pia C. , Kelemen Lynn K. , Brook William J.
Published: May 2022

Ventral leg patterning in Drosophila is controlled by the expression of the redundant T-box Transcription factors midline (mid) and H15. Here, we show that mid represses the Dpp-activated gene Daughters against decapentaplegic (Dad) through a consensus T-box binding element (TBE) site in the minimal enhancer, Dad13. Mutating the Dad13 DNA sequence results in an increased and broadening of Dad expression. We also demonstrate that the engrailed-homology-1 domain of Mid is critical for regulating the levels of phospho-Mad, a transducer of Dpp-signaling. However, we find that mid does not affect all Dpp-target genes as we demonstrate that brinker (brk) expression is unresponsive to mid. This study further illuminates the interplay between mechanisms involved in determination of cellular fate and the varied roles of mid.
A kinase translocation reporter reveals real-time dynamics of ERK activity in Drosophila
Authors: Yuen Alice C. , Prasad Anadika R. , Fernandes Vilaiwan M. , Amoyel Marc
Published: May 2022

Extracellular signal-regulated kinase (ERK) lies downstream of a core signalling cascade that controls all aspects of development and adult homeostasis. Recent developments have led to new tools to image and manipulate the pathway. However, visualising ERK activity in vivo with high temporal resolution remains a challenge in Drosophila. We adapted a kinase translocation reporter (KTR) for use in Drosophila, which shuttles out of the nucleus when phosphorylated by ERK. We show that ERK-KTR faithfully reports endogenous ERK signalling activity in developing and adult tissues, and that it responds to genetic perturbations upstream of ERK. Using ERK-KTR in time-lapse imaging, we made two novel observations: firstly, sustained hyperactivation of ERK by expression of dominant-active epidermal growth factor receptor raised the overall level but did not alter the kinetics of ERK activity; secondly, the direction of migration of retinal basal glia correlated with their ERK activity levels, suggesting an explanation for the heterogeneity in ERK activity observed in fixed tissue. Our results show that KTR technology can be applied in Drosophila to monitor ERK activity in real-time and suggest that this modular tool can be further adapted to study other kinases.

This article has an associated First Person interview with the first author of the paper.
Synovial joint cavitation initiates with microcavities in interzone and is coupled to skeletal flexion and elongation in developing mouse embryo limbs
Authors: Kim Minwook , Koyama Eiki , Saunders Cheri M. , Querido William , Pleshko Nancy , Pacifici Maurizio
Published: May 2022

The synovial cavity and its fluid are essential for joint function and lubrication, but their developmental biology remains largely obscure. Here, we analyzed E12.5 to E18.5 mouse embryo hindlimbs and discovered that cavitation initiates around E15.0 with emergence of multiple, discrete, µm-wide tissue discontinuities we term microcavities in interzone, evolving into a single joint-wide cavity within 12 h in knees and within 72-84 h in interphalangeal joints. The microcavities were circumscribed by cells as revealed by mTmG imaging and exhibited a carbohydrate and protein content based on infrared spectral imaging at micro and nanoscale. Accounting for differing cavitation kinetics, we found that the growing femur and tibia anlagen progressively flexed at the knee over time, with peak angulation around E15.5 exactly when the full knee cavity consolidated; however, interphalangeal joint geometry changed minimally over time. Indeed, cavitating knee interzone cells were elongated along the flexion angle axis and displayed oblong nuclei, but these traits were marginal in interphalangeal cells. Conditional Gdf5Cre-driven ablation of Has2 – responsible for production of the joint fluid component hyaluronic acid (HA) – delayed the cavitation process. Our data reveal that cavitation is a stepwise process, brought about by sequential action of microcavities, skeletal flexion and elongation, and HA accumulation.

This article has an associated First Person interview with the first author of the paper.