bluuebunny/crossref_metadata_2025 huggingface dataset:
Target users’ acceptance of a pharmacist-led prescribing service for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV)
Authors: MacDonald Calum B. , Murphy Andrea L. , Isenor Jennifer E. , Ramsey Tasha D. , Furlotte Kirk , Smith Alesha J. , Bishop Andrea , Kelly Deborah V. , Woodill Lisa , Booker Connor , Wilby Kyle John
Published: June 2023

Background:

Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a highly effective way to reduce virus transmission. There have been increasing calls to improve access to PrEP in Canada. One way to improve access is by having more prescribers available. The objective of this study was to determine target users’ acceptance of a PrEP-prescribing service by pharmacists in Nova Scotia.

Methods:

A triangulation, mixed-methods study was conducted consisting of an online survey and qualitative interviews underpinned by the Theoretical Framework of Acceptability (TFA) constructs (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy). Participants were those eligible for PrEP in Nova Scotia (men who have sex with men or transgender women, persons who inject drugs and HIV-negative individuals in serodiscordant relationships). Descriptive statistics and ordinal logistic regression were used to analyze survey data. Interview data were deductively coded according to each TFA construct and then inductively coded to determine themes within each construct.

Results:

A total of 148 responses were captured by the survey, and 15 participants were interviewed. Participants supported pharmacists’ prescribing PrEP across all TFA constructs from both survey and interview data. Identified concerns related to pharmacists’ abilities to order and view lab results, pharmacists’ knowledge and skills for sexual health and the potential for experiencing stigma within pharmacy settings.

Conclusion:

A pharmacist-led PrEP-prescribing service is acceptable to eligible populations in Nova Scotia. The feasibility of PrEP prescribing by pharmacists should be pursued as an intervention to increase access to PrEP.
Research ethics committee members’ perspectives on paediatric research: a qualitative interview study
Authors: Norberg Wieslander Kajsa , Höglund Anna T , Frygner-Holm Sara , Godskesen Tove
Published: June 2023

Research ethics committees (RECs) have a crucial role in protecting children in research. However, studies on REC members’ perspectives on paediatric research are scarce. We conducted a qualitative study to explore Swedish scientific REC members’ perspectives on ethical aspects in applications involving children with severe health conditions. The REC members considered promoting participation, protecting children and regulatory adherence to be central aspects. The results underscored the importance of not neglecting ill children’s rights to adapted information and participation. REC members supported a contextual and holistic approach to vulnerability and risk, which considers the child’s and parents’ psychological wellbeing and the child’s integrity, both short and long term. The ethical complexity of paediatric research requires continuous ethical competence development within RECs.
Mechanical thrombectomy with intra-arterial thrombolysis versus mechanical thrombectomy alone in patients with acute ischemic stroke: A systematic review and meta-analysis
Authors: Qureshi Adnan I , Lodhi Abdullah , Akhtar Iqra N , Ma Xiaoyu , Kherani Danish , Kwok Chun Shing , Ford Daniel E , Hanley Daniel F , Hassan Ameer E , Nguyen Thanh N , Spiotta Alejandro M , Zaidi Syed F
Published: June 2023

Background:

There is conflicting evidence as to whether intra-arterial thrombolysis (IAT) adds benefit in patients with acute stroke who undergo mechanical thrombectomy (MT).

Methods:

We conducted a systematic review to identify studies that evaluate IAT in patients with acute stroke who undergo MT. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until February 2023. Statistical pooling with random effects meta-analysis was undertaken to evaluate odds of functional independence, mortality, and near-complete or complete angiographic recanalization with IAT compared to no IAT.

Results:

A total of 18 studies were included (3 matched, 14 unmatched, and 1 randomized). The odds ratio (OR) for functional independence (modified Rankin Scale: 0–2) at 90 days was 1.14 (95% confidence interval (CI): 0.95–1.37, p = 0.17, 16 studies involving 7572 patients) with IAT with moderate between-study heterogeneity (I2 = 38.1%). The OR for functional independence with IAT was 1.28 (95% CI: 0.92–1.78, p = 0.15) in studies that were either matched or randomized and 1.24 (95% CI: 0.97–1.58, p = 0.08) in studies with the highest quality score. IAT was associated with higher odds of near-complete or complete angiographic recanalization (OR: 1.65, 95% CI: 1.03–2.65, p = 0.04) in studies that were either matched or of randomized comparisons.

Conclusion:

Although the odds of functional independence appeared to be higher with IAT and MT compared with MT alone, none of the results were statistically significant. A prominent effect of the design and quality of the studies was observed on the association between IAT and functional independence at 90 days.
Rationale and design of phase II clinical trial of dual inhibition with ramucirumab and erlotinib in EGFR exon 19 deletion-positive treatment-naïve non-small cell lung cancer with high PD-L1 expression (SPIRAL-3D study)
Authors: Kawachi Hayato , Yamada Tadaaki , Yoshimura Akihiro , Morimoto Kenji , Iwasaku Masahiro , Tokuda Shinsaku , Kim Young Hak , Shimose Takayuki , Takayama Koichi
Published: June 2023

Background:

Osimertinib is a standard treatment option for epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). However, osimertinib monotherapy yields poor clinical outcomes in some patients, necessitating the development of novel treatment strategies. In addition, several studies have suggested that high programmed cell death-ligand 1 (PD-L1) expression is associated with poor progression-free survival (PFS) for osimertinib monotherapy in patients with advanced NSCLC harboring EGFR mutations.

Objective:

To evaluate the clinical efficacy of erlotinib plus ramucirumab for EGFR exon 19 deletion-positive treatment-naïve NSCLC with high PD-L1 expression.

Design:

A single-arm, prospective, open-label, phase II study

Methods and Analysis:

Patients with treatment-naïve EGFR exon 19 deletion-positive NSCLC with high PD-L1 expression and a performance status of 0–2 will receive combination therapy with erlotinib plus ramucirumab until evidence of disease progression or development of unacceptable toxicity. High PD-L1 expression is defined as a tumor proportion score of 50% or higher, as determined by PD-L1 immunohistochemistry 22C3 pharmDx testing. The Kaplan–Meier method and the Brookmeyer and Crowley method with the arcsine square-root transformation will be used with PFS as the primary endpoint. The secondary endpoints include overall response rate, disease control rate, overall survival, and safety. A total of 25 patients will be enrolled.

Ethics:

The study has been approved by the Clinical Research Review Board, Kyoto Prefectural University of Medicine, Kyoto, Japan, and written informed consent will be obtained from all patients.

Discussion:

To the best of our knowledge, this is the first clinical trial to focus on PD-L1 expression in EGFR mutation-positive NSCLC. If the primary end point is met, combination therapy with erlotinib and ramucirumab could become a potential treatment option for this clinical population.

Trial Registration:

This trial was registered with the Japan Registry for Clinical Trials on 12 January 2023 (jRCTs 051220149).
Slow-motion smartphone video improves interobserver reliability of gait assessment in ambulatory cerebral palsy
Authors: Brodke Dane J , Makaroff Katherine , Kelly Enda G , Silva Mauricio , Thompson Rachel M
Published: June 2023

Purpose:

Structured visual gait assessment is essential for the evaluation of pediatric patients with neuromuscular conditions. The purpose of this study was to evaluate the benefit of slow-motion video recorded on a standard smartphone to augment visual gait assessment.

Methods:

Coronal and sagittal plane videos of the gait of five pediatric subjects were recorded on a smartphone, including four subjects with ambulatory cerebral palsy and one subject without gait pathology. Twenty-one video scorers were recruited and randomized to evaluate slow-motion or normal-speed videos utilizing the Edinburgh Visual Gait Score. The slow-motion group (N = 11) evaluated the videos at one-eighth speed, and the normal-speed group (N = 10) evaluated the same videos at normal speed. Interrater reliabilities were determined by calculating intraclass correlation coefficients for each group as a whole, for each Edinburgh Visual Gait Score item, and after stratification by evaluator experience level.

Results:

The slow-motion group exhibited an intraclass correlation coefficient of 0.65 (95% confidence interval: 0.58–0.73), whereas the normal-speed group exhibited an intraclass correlation coefficient of 0.57 (95% confidence interval: 0.49–0.65). For less-experienced scorers, intraclass correlation coefficients of 0.62 (95% confidence interval: 0.53–0.71) and 0.50 (95% confidence interval: 0.40–0.59) were calculated for slow motion and normal speed, respectively. For more-experienced scorers, intraclass correlation coefficients of 0.69 (95% confidence interval: 0.61–0.76) and 0.67 (95% confidence interval: 0.58–0.75) were calculated for slow motion and normal speed, respectively.

Conclusions:

Visual gait assessment is enhanced by the use of slow-motion smartphone video, a tool widely available throughout the world with no marginal cost.

Level of evidence:

level I, randomized study.
Preoperative Opioid Therapy Correlated With Increased Rate of Complications in Foot and Ankle Surgery
Authors: Shrake Kevin , Newton William , Hoch Caroline , Galasso Annemarie , Scott Daniel J. , Gross Christopher E.
Published: June 2023

Background

The purpose of this study is to determine whether patients with a history of preoperative opioid use will have an increased likelihood of postoperative opioid use and complications after undergoing forefoot, hindfoot, or ankle surgery.

Methods

A retrospective review was conducted on forefoot, hindfoot, and ankle surgeries between 2015 and 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. A total of 326 patients (356 feet) were included with a mean follow-up up of 2.12 (range, 1.00-4.98) years. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (eg, Foot and Ankle Outcome Score), and opioid exposure.

Results

There were significantly more complications among opioid exposed patients than opioid naïve ones (exposed = 29.41%, naïve = 9.62%; P = .044). Preoperative opioid exposure significantly correlated with postoperative opioid exposure (90-day: r = .903, p < .001; 180-day: r = .805, p < .001), and increased hospital length of stay (r = .263, p = .029). Furthermore, body mass index was a significant predictor of postoperative opioid exposure (90-day: r = .262, p = .013; 180-day: r = .217, p = .021), as was concomitant mental illness (90-day: r = .225, p = .035).

Conclusion

Patients with preoperative opioid exposure have significantly more complications and increased postoperative opioid exposure after foot and ankle surgery.

Levels of Evidence:

Level III: Retrospective cohort study
Intravascular Lymphoma as a Cause of Recurrent Strokes – Case Report and Review of the Literature
Authors: Zhao Charlie Weige , Fan Tracey H. , Denize Thomas , Coraini Alba , Kraft Andrew , Kumar Anusha M. , Gao Lucy G. , Lorenzo Mayra E. , Duncan Lyn M. , Camargo Faye Erica C. , Lin David J.
Published: June 2023

Background

Intravascular lymphoma is an uncommon cause of ischemic strokes. Because of its rarity and atypical pattern, most diagnoses are made post-mortem.

Case study

We present a case of a 68-year-old male with multiple cardiovascular risk factors and recent SARS-CoV-2 infection who presented with recurrent strokes. Because of his stroke risk factors, he was initially managed with a sequentially escalating antithrombotic regimen. A malignant process was low on the differential at this point given his lack of systemic symptoms. When he continued to have new strokes despite these measures, including a spinal cord infarct, a broad workup was sent including for hypercoagulable states, vasculitis, and intravascular lymphoma. Eventually, a skin biopsy of a cherry angioma returned positive for lymphoma cells. He was treated with methotrexate followed by chemotherapy and rituximab. Unfortunately, he did not improve and was made comfort measures only by his family.

Conclusion

This case illustrates the importance of considering intravascular lymphoma as a potential etiology of recurrent strokes, as early diagnosis and treatment are important for preventing irreversible neurological damage.
Abstraction Allows Susceptibility to the Perspective of Others: The Case of Decreased Public Self-Awareness Due to Concrete Thinking
Authors: Hansen Jochim , Neumeier Nicole , Höller Magdalena
Published: June 2023

The ability to process information abstractly functions to traverse psychological distance and expand one’s mental horizons. Therefore, abstract (vs. concrete) thinking may expand (vs. contract) one’s social scope. Accordingly, it was hypothesized that concrete (vs. abstract) processing makes one less (vs. more) susceptible to the perspective of others, attenuating (vs. increasing) public—but not private—self-awareness. Four studies (total N = 708) tested this idea. In a pilot study, a positive correlation between abstraction and public (but not private) self-awareness was found. In Studies 1a, 1b, and 2, manipulated concrete (vs. abstract) thinking reduced public self-awareness but not private self-awareness. Study 1b additionally indicated that public self-awareness was reduced by concrete thinking rather than increased by abstract thinking. Study 2 also investigated the effect of abstraction on social anxiety and embarrassment. It was demonstrated that concrete (relative abstract) thinking indirectly reduced social anxiety and embarrassment via public self-awareness. Implications of the findings are discussed.
Modified black phosphorus quantum dots promotes spinal cord injury repair by targeting the AKT signaling pathway
Authors: Xie Dong-Mei , Sun Chuanwei , Tu Qingqiang , Li Suyi , Zhang Yu , Mei Xifan , Li Yuanlong
Published: June 2023

Spinal cord injury (SCI) is a serious refractory disease of the central nervous system (CNS), which mostly caused by high-energy trauma. Existing interventions such as hormone shock and surgery are insufficient options, which relate to the secondary inflammation and neuronal dysfunction. Hydrogel with neuron-protective behaviors attracts tremendous attention, and black phosphorus quantum dots (BPQDs) encapsulating with Epigallocatechin-3-gallate (EGCG) hydrogels (E@BP) is designed for inflammatory modulation and SCI treatment in this study. E@BP displays good stability, biocompatibility and safety profiles. E@BP incubation alleviates lipopolysaccharide (LPS)-induced inflammation of primary neurons and enhances neuronal regeneration in vitro. Furthermore, E@BP reconstructs structural versus functional integrity of spinal cord tracts, which promotes recovery of motor neuron function in SCI rats after transplantation. Importantly, E@BP restarts the cell cycle and induces nerve regeneration. Moreover, E@BP diminishes local inflammation of SCI tissues, characterized by reducing accumulation of astrocyte, microglia, macrophages, and oligodendrocytes. Indeed, a common underlying mechanism of E@BP regulating neural regenerative and inflammatory responses is to promote the phosphorylation of key proteins related to AKT signaling pathway. Together, E@BP probably repairs SCI by reducing inflammation and promoting neuronal regeneration via the AKT signaling pathway.
Assessing adverse drug reaction reports for antidiabetic medications approved by the food and drug administration between 2012 and 2017: a pharmacovigilance study
Authors: Stottlemyer Britney A. , McDermott Michael C. , Minogue Mackenzie R. , Gray Matthew P. , Boyce Richard D. , Kane-Gill Sandra L.
Published: June 2023

Objective:

Between 2012 and 2017, the U.S. Food and Drug Administration (FDA) approved 10 antidiabetic indicated therapies. Due to the limited literature on voluntarily reported safety outcomes for recently approved antidiabetic drugs, this study investigated adverse drug reactions (ADRs) reported in the FDA Adverse Event Reporting System (FAERS).

Research Design and Methods:

A disproportionality analysis of spontaneously reported ADRs was conducted. FAERS reports from January 1, 2012 to March 31, 2022 were compiled, allowing a 5-year buffer following drug approval in 2017. Reporting odds ratios were calculated for the top 10 ADRs, comparing new diabetic agents to the other approved drugs in their therapeutic class.

Results:

127,525 reports were identified for newly approved antidiabetic medications listed as the primary suspect (PS). For sodium-glucose co-transporter-2 (SGLT-2) inhibitors, the odds of blood glucose increased, nausea, and dizziness being reported was greater for empagliflozin. Dapagliflozin was associated with greater reports of weight decreased. Canagliflozin was found to have a disproportionally higher number of reports for diabetic ketoacidosis, toe amputation, acute kidney injury, fungal infections, and osteomyelitis. Assessing glucagon-like peptide-1 (GLP-1) receptor agonists, dulaglutide and semaglutide were associated with greater reports of gastrointestinal adverse drug reactions. Exenatide was disproportionally associated with injection site reactions and pancreatic carcinoma reports.

Conclusion:

Pharmacovigilance studies utilizing a large publicly available dataset allow an essential opportunity to evaluate the safety profile of antidiabetic drugs utilized in clinical practice. Additional research is needed to evaluate these reported safety concerns for recently approved antidiabetic medications to determine causality.
The Impact of Combined Warm and Cold Ischemia Time on Post-transplant Outcomes
Authors: Foley Martha E. , Vinson Amanda J. , Skinner Thomas A. A. , Kiberd Bryce A. , Tennankore Karthik K.
Published: June 2023

Background:

Prolonged warm ischemia time (WIT) and cold ischemia time (CIT) are independently associated with post-transplant graft failure; their combined impact has not been previously studied. We explored the effect of combined WIT/CIT on all-cause graft failure following kidney transplantation.

Methods:

The Scientific Registry of Transplant Recipients was used to identify kidney transplant recipients from January 2000 to March 2015 (after which WIT was no longer separately reported), and patients were followed until September 2017. A combined WIT/CIT variable (excluding extreme values) was separately derived for live and deceased donor recipients using cubic splines; for live donor recipients, the reference group was WIT 10 to <23 minutes and CIT >0 to <0.42 hours, and for deceased donor recipients the WIT was 10 to <25 minutes and CIT 1 to <7.75 hours. The adjusted association between combined WIT/CIT and all-cause graft failure (including death) was analyzed using Cox regression. Secondary outcomes included delayed graft function (DGF).

Results:

A total of 137 125 recipients were included. For live donor recipients, patients with prolonged WIT/CIT (60 to ≤120 minutes/3.04 to ≤24 hours) had the highest adjusted hazard ratio (HR) for graft failure (HR = 1.61, 95% confidence interval [CI] = 1.14-2.29 relative to the reference group). For deceased donor recipients, a WIT/CIT of 63 to ≤120 minutes/28 to ≤48 hours was associated with an adjusted HR of 1.35 (95% CI = 1.16-1.58). Prolonged WIT/CIT was also associated with DGF for both groups although the impact was more driven by CIT.

Conclusions:

Combined WIT/CIT is associated with graft loss following transplantation. Acknowledging that these are separate variables with different determinants, we emphasize the importance of capturing WIT and CIT independently. Furthermore, efforts to reduce WIT and CIT should be prioritized.
Social media use, uncertainty, and negative affect in times of pandemic crisis
Authors: Wu Yun , An Zihao , Lin Yi , Zhang Jingyue , Jing Bo , Peng Kaiping
Published: June 2023

Objective

A common assertion in the social media literature is that passive media use undermines affective wellbeing, and active media use enhances it. The present study investigated the effects of social media use on negative affective wellbeing during pandemic crises and examined the mechanism underlying these effects through perceived uncertainty.

Methods

Three studies were conducted during the Delta variant phase in the post-peak period of the COVID-19 pandemic in China. Participants were recruited from the medium-high-risk infection areas in late August 2021. Study 1 used a cross-sectional survey to explore the relationships between social media use, uncertainty, and negative affect during the pandemic crisis. Study 2 employed a repeated-measures experiment to demonstrate how social media use and (un)certainty impact negative affect. Study 3 utilized a one-week experience sampling design to examine the role of uncertainty in the relationship between social media use and negative affect in real life.

Results

Despite some inconsistencies regarding social media use's direct effect on negative affect, across the three studies, perceived uncertainty was critical in linking pandemic-related social media use to individuals’ negative affect, particularly for passive use.

Conclusions

The relationships between social media use and affective wellbeing are complex and dynamic. While the perception of uncertainty provided an underlying mechanism that links social media use to individuals’ affective wellbeing, this mechanism may be further moderated by individual-level factors. More research is needed as we seek to understand how social media use impacts affective wellbeing in uncertain contexts.
Assessment of eHealth literacy to reduce financial toxicity and improve shared decision-making in cancer patients: A cross-sectional study
Authors: Xu Richard Huan , Wang Ling-ling , Zhou Ling-ming , Wong Eliza Lai-yi , Wang Dong
Published: June 2023

Objectives

This study aimed to investigate the associations between eHealth literacy, preferences for financial decision-making, and financial toxicity (FT) in a sample of Chinese cancer patients.

Methods

Eligible cancer patients were invited to participate in a cross-sectional survey from January to April 2021. Three measures (eHealth literacy scale, control preference scale, and COST) were used to analyze patients’ eHealth literacy, decisional preferences, and FT, respectively. Wilcoxon signed-rank test and Kruskal–Wallis H test assessed the differences between population subgroups. Binary logistic and multivariate linear regression models were used to assess the relationships between eHealth literacy, decisional preferences, and FT.

Results

A total of 590 cancer patients completed the questionnaire. We found that high FT was associated with poor ECOG performance, severe cancer stage, and longer cancer duration. Patients who preferred to adopt collaborative attitude toward decision-making showed a significantly higher eHealth literacy. However, there was an inverse relationship between eHealth literacy and a patient-driven attitude toward decision-making in female cancer patients. Regression analysis indicated that patients who were highly educated and actively employed might report a higher eHealth literacy. A significant relationship was found between high eHealth literacy and low FT. However, this relationship became insignificant when the background characteristics of cancer patients were taken into account.

Conclusions

A relationship between enhanced eHealth literacy, preference for collaborative decision-making, and low risk of FT is identified.

Practical implication

Interventions to improve patients’ ability to use quality and reliable web-based information on cancer care should be encouraged.
Determination of the tibial axis using the tibial anterior border for total knee arthroplasty
Authors: Kim Sung-Gon , Arita Hitoshi , Kobayashi Keiji , Uchino Sayuri , Sakamoto Yuko , Nozawa Masahiko
Published: June 2023

Purpose: We investigated whether the anterior border of the tibia is parallel to the tibial axis, and which position of the anterior border should be used as a landmark of the tibial axis in total knee arthroplasty. Methods: Ninety-one patients prior to total knee arthroplasty were evaluated. Electrocardiogram electrodes were placed along the anterior border at 5 cm (A), 10 cm (B), and 15 cm (C) distal to the tibial tuberosity, and an anteroposterior X-ray image was taken. The angles of the AC, AB, and BC lines on the tibial bone axis line were measured. Results: The mean angles of the AC, AB, and BC lines to the tibial bone axis line were, respectively, 1.09, 2.22, and −0.02. The percentages within −3° to +3° were 86.8, 64.8, and 92.3, respectively. Conclusions: A line connecting a point 10–15 cm distal to the tibial tuberosity can serve as a reference line for total knee arthroplasty.
Exploring the Determinants of Investment Behavior: Evidence from Agrarian Investor Class of India
Authors: Manocha Shilpa , Bhullar Pritpal Singh , Gupta Pradeep Kumar
Published: June 2023

The current research aims to identify the factors that influence the investment behavior of the agrarian investor class, an untapped potential segment for the investment market, in India. The study observes the antecedents of investment behavior and intention. Thus, the present study analyses the responses of 400 agrarian rural respondents. Data from a well-structured questionnaire administered to the study’s target participants were analyzed using structural equation modeling. The results observed the utmost influence of financial self-efficacy in establishing the agrarian rural investors’ attitude and has least influence in determining personality traits and financial knowledge, which ultimately determine the investment intention of investors. Further, social influence has the least effect on how agrarian rural people think and act. The findings demonstrate that investment intention is the leading factor in cementing the investment behavior of agrarian rural investors. This article claims its distinctiveness by adding important insights to the literature of the investment behavior and intention for the Indian agrarian investor class.
Spherocytosis in Newborn Secondary to Novel Heterozygous Mutation in SPTB Gene: Case Report
Authors: Varadi Daphna , Caplan Benjamin , Scarano Maria , Ahmed Rafat
Published: June 2023

This case report describes a novel mutation of the SPTB gene as a potential pathogenic cause of spherocytosis. A 3-week-old male presented with clinical and laboratory signs consistent with hemolytic spherocytosis, including jaundice, hyperbilirubinemia, anemia, reticulocytosis, negative Coombs test, no ABO or Rh incompatibility, and a peripheral blood smear notable for numerous spherocytes. His laboratory work demonstrated persistent anemia despite daily folate prompting next-generation sequencing which revealed a novel mutation in the SPTB gene resulting in a nonfunctioning protein product. Correlation of the genetic finding with clinical presentation may help guide management for this and future patients.
Nursing Student and Faculty Narratives During COVID-19 Pandemic: Challenges and Recommendations From a Canadian Perspective
Authors: Orazietti Brenda , Peniston Sandra , Mohammed Zubaida , Demelie Hermila , Duldulao Jemina Frances , Rao Misbah
Published: June 2023

Introduction

Worldwide, COVID-19 affected nursing students’ and faculty's mental and physical health. The final clinical placement for fourth-year nursing students during the third wave of COVID-19 in Toronto, Canada, included direct patient care without vaccination eligibility. Students’ experiences during the pandemic and faculty exposure to teaching and supporting them provide unique reflective opportunities.

Objective

To examine the lived experiences of nursing students and faculty during the third wave of the COVID-19 pandemic.

Methods

The study used a qualitative phenomenological design with thematic analysis. A voluntary response sample of 80 participants shared their narratives of working and teaching during January to May 2021. An optional interview guide offered open-ended questions requiring reflection. The study was conducted in a nursing school in Toronto, Canada during fourth-year baccalaureate students final clinical placement settings.

Results

A total of 77 fourth-year baccalaureate nursing students and three faculty members participated. Thematic analysis of nursing student narratives identified four main themes: (i) fear and anxiety of COVID-19 during clinical practice; (ii) impact on students’ learning environments; (iii) intrinsic and extrinsic factors that enabled students to persevere; and (iv) how to deal with future pandemics. Thematic analysis of faculty narratives identified three main themes: (i) the importance of preparatory work; (ii) psychological and physical manifestations of supporting students; and (iii) the resilience of students and faculty.

Conclusion

Future disease outbreaks and other large-scale health events will require nurse educators to understand and plan strategies for both themselves and students practicing in high-risk clinical settings. Nursing schools should rethink all fourth-year students’ experiences, perceptions, and feelings to minimize their susceptibility to physical and psychological distress.
Magnitude, Indications, and Factors Associated With Operative Vaginal Delivery Among Mothers Who Gave Birth at Adama Hospital Medical College, Ethiopia, 2022
Authors: Tadesse Workinesh Ketema , Bekele Nardos Tilahun , Negussie Yohannes Mekuria , Getahun Mihiret Shawel , Gurara Abenet Menene , Beyen Teresa Kisi
Published: June 2023

Introduction

Operative vaginal deliveries are a method of dealing with issues that arise during the second stage of labor with the use of vacuum device or forceps. The decision to use an instrument to deliver the fetus weighs the maternal, fetal, and neonatal consequences of the procedure against the alternative option of cesarean birth. However, evidence on operative vaginal delivery is limited in Ethiopia in general and in the study area in particular.

Objectives

This study aimed to assess the magnitude, indications, and factors associated with operative vaginal delivery among mothers who gave birth at Adama Hospital Medical College, Ethiopia.

Methods

A facility-based cross-sectional study was conducted among a sample of 440 mothers who gave birth from 1 to 30 June 2022. A systematic random sampling technique was used to select the study participants. Data were collected using an interviewer-administered structured questionnaire. The data were entered into EPI INFO version 7 and exported to SPSS version 25 for analysis. Bivariate logistic regression analysis was used to identify candidate variables at p < .25 and multivariable logistic regression analysis was used to identify the independent predictors of operative vaginal delivery at p < .05 with 95% confidence intervals (CIs).

Results

The magnitude of operative vaginal delivery was 14.8% (95% CI: 10.8, 18.8). Rural residence (adjusted odds ratio (AOR), 2.09; 95% CI: 2.01, 7.41), maternal age 25–34 (AOR, 4.95; 95% CI: 1.62, 9.2), being primigravida (AOR: 3.5, 95% CI: 1.26, 9.98), gestational age ≥42 weeks (3.09; 95% CI: 1.38, 6.9), and antenatal care (ANC) follow-ups <4 times (AOR:3.9; 95% CI: 1.09, 9.45) were significantly associated with operative vaginal delivery.

Conclusion

The magnitude of operative vaginal delivery in the study area was relatively low. Rural residence, maternal age 25 to 34, primigravida, gestational age ≥42 weeks, and ANC follow-ups <4 times were independent determinants of operative vaginal delivery. Thus, health education programs and other multidisciplinary strategies are required to encourage mothers to have regular ANC follow-ups.
Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute
Authors: Marciano Gerard F. , Ferlauto Harrison R. , Confino Jamie , Kelly Meghan , Surace Michele F. , Vulcano Ettore
Published: June 2023

Background:

Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion.

Methods:

Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired t tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively.

Results:

Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively ( P < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively ( P < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications.

Conclusion:

We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications.

Level of Evidence:

Level IV, case series.
Thromboembolic Events During Weightbearing vs Nonweightbearing Accelerated Rehabilitation Protocols for Complete Achilles Tendon Ruptures
Authors: Lee Conrad , Haarer Francesca , Titheradge Rachel , Iliopoulos Efthymios
Published: June 2023

Background:

Achilles tendon rupture can be treated nonoperatively with functional rehabilitation. However, prolonged immobilization has associated risk of venous thromboembolism (VTE). Early weightbearing may reduce VTE risk, and this was introduced to our rehabilitation protocol. We investigated the prevalence of symptomatic VTE events before and after the introduction of the early weightbearing protocol.

Methods:

Adults with ultrasonography-confirmed complete tendo-Achilles ruptures between January 2017 and June 2020 were included. Preprotocol, patients were instructed to not weightbear for 4 weeks. In 2018, immediate weightbearing was introduced to the treatment protocol. All patients in both cohorts were given low-molecular-weight heparin for 4 weeks. Patients with symptomatic VTE events were investigated with duplex ultrasonographic scan or chest computed tomography. Two independent anonymized examiners collected data from electronic records. Rates of symptomatic VTEs were compared.

Results:

A total of 296 patients were included. Sixty-nine patients were managed with the nonweightbearing protocol, and 227 patients were managed with the early-weightbearing protocol. Two patients in each group developed deep vein thrombosis and 1 developed pulmonary embolism in the early-weightbearing group. Rates of VTEs were lower in the early-weightbearing group (1.3% vs 2.9%) but did not reach statistical significance ( P = .33).

Conclusion:

In this cohort we found that symptomatic VTE after nonoperatively treated Achilles tendon rupture was uncommon. We did not demonstrate a reduction in symptomatic VTE between our early weightbearing and nonweightbearing rehabilitation protocols. We believe a larger study may help clarify whether early weightbearing is beneficial in VTE reduction.

Level of Evidence:

Level III, retrospective cohort study.
Beyond the Mean: Can We Improve the Predictive Power of Psychometric Scales?
Authors: Nielsen Yngwie Asbjørn , Thielmann Isabel , Pfattheicher Stefan
Published: June 2023

Two participants completing a psychometric scale may leave wildly different responses yet attain the same mean score. Moreover, the mean score often does not represent the bulk of participants’ responses, which may be skewed, kurtotic, or bimodal. Even so, researchers in psychological science often aggregate item scores using an unweighted mean or a sum score, thereby neglecting a substantial amount of information. In the present contribution, we explore whether other summary statistics of a scale (e.g., the standard deviation, the median, or the kurtosis) can capture and leverage some of this neglected information to improve prediction of a broad range of outcome measures: life satisfaction, mental health, self-esteem, counterproductive work behavior, and social value orientation. Overall, across 32 psychometric scales and three data sets (total N = 8,376), we show that the mean is the strongest predictor of all five outcomes considered, with little to no additional variance explained by other summary statistics. These results provide justification for the current practice of relying on the mean score but hopefully inspire future research to explore the predictive power of other summary statistics for relevant outcomes. For this purpose, we provide a tutorial and example code for R.
Maritime sovereignty, the territorialization of islands and the integration of fishermen in colonial Tunisia (La Galite (لطة ǧālaṭ))
Authors: Vermeren Hugo
Published: June 2023

To whom do small islands belong? What role do they play in the processes of colonization and maritime territorialization? In what way does the exploitation of their resources contribute to making them central to power and sovereignty conflicts? This article considers the colonization of the Maghreb from the perspective of island spaces as ‘land-sea regimes’. It focuses on an archipelago located off the coast of Tabarka, on the maritime border of Algeria and Tunisia. Frequented for centuries by fishermen exploiting the coral in the region, the Galite became a geostrategic place in the 19th century for coastal security, maritime trade and fishing. The study of the fishermen’s families who settled there from the 1870s onwards, their networks and their relations with the authorities, invites us to reconsider the history of the colonization of North Africa from the sea and the islands.
Hybrid islands: Some reflections on the intersection between Island Studies and environmental history
Authors: Grancher Romain
Published: June 2023

Islands have fascinated environmental historians, but looking at the field as a whole, this attraction has not resulted in attempts at synthesis or strong theoretical propositions. Moreover, it has not necessarily enabled a departure from reductive and continentalist conceptions of the islands, such as that old established idea of island environments as “continents in miniature.” Thus, if islands currently represent one of the most important sites for Anthropocene thinking, it is first of all thanks to the research that some social scientists, mainly geographers, have developed under the banner of Island Studies, a new interdisciplinary field that has come of age during the 2000s. This introductive essay argues that the links between the environmental history of the islands and Island Studies are still very loose and should be strengthened for their mutual benefit. For this, it draws on the articles brought together in this special issue and offers insights on three main problems that all provide a good illustration of the fundamental ambivalence of islands: their limits, their isolation, and their vulnerability.
Intravital imaging of three different microvascular beds in SARS-CoV-2–infected mice
Authors: Castanheira Fernanda V. S. , Nguyen Rita , Willson Michelle , Davoli-Ferreira Marcela , David Bruna A. , Kelly Margaret M. , Lee Woo-Yong , Kratofil Rachel M. , Zhang Wen X. , Bui-Marinos Maxwell , Corcoran Jennifer A. , Kubes Paul
Published: June 2023

Severe acute respiratory syndrome coronavirus–2 (SARS-CoV-2) enters the respiratory tract, where it infects the alveoli epithelial lining. However, patients have sequelae that extend well beyond the alveoli into the pulmonary vasculature and, perhaps, beyond to the brain and other organs. Because of the dynamic events within blood vessels, histology does not report platelet and neutrophil behavior. Because of the rapid nontranscriptional response of these cells, neither single-cell RNA sequencing nor proteomics report robustly on their critical behaviors. We used intravital microscopy in level-3 containment to examine the pathogenesis of SARS-CoV-2 within 3 organs in mice expressing human angiotensin converting enzyme 2 (ACE-2) ubiquitously (CAG-AC-70) or on epithelium (K18-promoter). Using a neon-green SARS-CoV-2, we observed both the epithelium and endothelium infected in AC70 mice but only the epithelium in K18 mice. There were increased neutrophils in the microcirculation but not in the alveoli of the lungs of AC70 mice. Platelets formed large aggregates in the pulmonary capillaries. Despite only neurons being infected within the brain, profound neutrophil adhesion forming the nidus of large platelet aggregates were observed in the cerebral microcirculation, with many nonperfused microvessels. Neutrophils breached the brain endothelial layer associated with a significant disruption of the blood-brain-barrier. Despite ubiquitous ACE-2 expression, CAG-AC-70 mice had very small increases in blood cytokine, no increase in thrombin, no infected circulating cells, and no liver involvement suggesting limited systemic effects. In summary, our imaging of SARS-CoV-2–infected mice gave direct evidence that there is a significant perturbation locally in the lung and brain microcirculation induced by local viral infection leading to increased local inflammation and thrombosis in these organs.
Homocysteine promotes atherosclerosis through macrophage pyroptosis via endoplasmic reticulum stress and calcium disorder
Authors: Zhang Shan , Lv Ying , Luo Xing , Weng Xiuzhu , Qi Jinyu , Bai Xiaoxuan , Zhao Chen , Zeng Ming , Bao Xiaoyi , Dai Xinyu , Zhang Ying , Chen Yuwu , Liu Minghao , Hu Sining , Li Ji , Jia Haibo
Published: June 2023

Background

Elevated plasma homocysteine levels, known as hyperhomocysteinemia, have been identified as an independent risk factor for atherosclerosis and related cardiovascular diseases. Macrophage pyroptosis-mediated inflammation is crucial in the development of atherosclerosis, but the underlying mechanisms remain unclear.

Methods

A hyperhomocysteinemia atherosclerotic model with ApoE−/− mice fed with a high-methionine diet was constructed to investigate the role of plasma homocysteine in atherosclerosis. THP-1-derived macrophages were used to investigate the mechanisms by which Hcy regulates pyroptosis.

Results

We found that hyperhomocysteinemia resulted in larger atherosclerotic plaques and more secretion of inflammatory cytokines, while these effects were attenuated in Caspase-1 knockdown mice. Likewise, in vitro experiments demonstrated that treatment of macrophages with homocysteine resulted in NLRP3 inflammasome activation and pyroptosis, as evidenced by cleavage of Caspase-1, production of downstream IL-1β, elevation of lactate dehydrogenase activity, and extensive propidium iodide-positive staining of cells. These were all inhibited by Caspase-1 inhibitor. In addition, excessive generation of reactive oxygen species was associated with mitochondrial dysfunction, characterized by loss of mitochondrial membrane potential and ATP synthesis. Moreover, further experiments revealed that homocysteine induced endoplasmic reticulum stress, enhanced communication between the endoplasmic reticulum and mitochondria, and consequently contributed to calcium disorder. Furthermore, the endoplasmic reticulum stress inhibitor, 4PBA, the calcium chelator, BAPTA, and calcium channel inhibitor, 2-APB significantly improved macrophage pyroptosis.

Conclusion

Homocysteine accelerates atherosclerosis progression by enhancing macrophages pyroptosis via promoting endoplasmic reticulum stress, endoplasmic reticulum-mitochondria coupling, and disturbing of calcium disorder.
Improved intravenous lentiviral gene therapy based on endothelial-specific promoter-driven factor VIII expression for hemophilia A
Authors: Gong Jie , Yang Rui , Zhou Min , Chang Lung-Ji
Published: June 2023

Background

Hemophilia A (HA) is an X-linked monogenic disorder caused by deficiency of the factor VIII (FVIII) gene in the intrinsic coagulation cascade. The current protein replacement therapy (PRT) of HA has many limitations including short term effectiveness, high cost, and life-time treatment requirement. Gene therapy has become a promising treatment for HA. Orthotopic functional FVIII biosynthesis is critical to its coagulation activities.

Methods

To investigate targeted FVIII expression, we developed a series of advanced lentiviral vectors (LVs) carrying either a universal promoter (EF1α) or a variety of tissue-specific promoters, including endothelial-specific (VEC), endothelial and epithelial-specific (KDR), and megakaryocyte-specific (Gp and ITGA) promoters.

Results

To examine tissue specificity, the expression of a B-domain deleted human F8 (F8BDD) gene was tested in human endothelial and megakaryocytic cell lines. Functional assays demonstrated FVIII activities of LV-VEC-F8BDD and LV-ITGA-F8BDD in the therapeutic range in transduced endothelial and megakaryocytic cells, respectively. In F8 knockout mice (F8 KO mice, F8null mice), intravenous (iv) injection of LVs illustrated different degrees of phenotypic correction as well as anti-FVIII immune response for the different vectors. The iv delivery of LV-VEC-F8BDD and LV-Gp-F8BDD achieved 80% and 15% therapeutic FVIII activities over 180 days, respectively. Different from the other LV constructs, the LV-VEC-F8BDD displayed a low FVIII inhibitory response in the treated F8null mice.

Conclusions

The LV-VEC-F8BDD exhibited high LV packaging and delivery efficiencies, with endothelial specificity and low immunogenicity in the F8null mice, thus has a great potential for clinical applications.
Integrative multi-omics approach for identifying molecular signatures and pathways and deriving and validating molecular scores for COVID-19 severity and status
Authors: Lipman Danika , Safo Sandra E. , Chekouo Thierry
Published: June 2023

Background

There is still more to learn about the pathobiology of COVID-19. A multi-omic approach offers a holistic view to better understand the mechanisms of COVID-19. We used state-of-the-art statistical learning methods to integrate genomics, metabolomics, proteomics, and lipidomics data obtained from 123 patients experiencing COVID-19 or COVID-19-like symptoms for the purpose of identifying molecular signatures and corresponding pathways associated with the disease.

Results

We constructed and validated molecular scores and evaluated their utility beyond clinical factors known to impact disease status and severity. We identified inflammation- and immune response-related pathways, and other pathways, providing insights into possible consequences of the disease.

Conclusions

The molecular scores we derived were strongly associated with disease status and severity and can be used to identify individuals at a higher risk for developing severe disease. These findings have the potential to provide further, and needed, insights into why certain individuals develop worse outcomes.