bluuebunny/crossref_metadata_2025 huggingface dataset:
The “Nested” Power of TNCs: Smallholders’ Biggest Challenge
Authors: Scherrer Christoph
Published: July 2021

The plight of smallholder farmers vis-à-vis their highly concentrated input providers and distributors is well known. This article highlights the embeddedness of dyadic power relations within broader economic, political, and social institutions governing the relations between transnational corporations (TNCs) and smallholders. It provides a Gramscian gaze into the deep roots of TNCs in the neoliberal historic bloc and argues that challenging the power of the TNCs requires a comprehensive strategy that goes much beyond the capacity of smallholders. It requires a broad-based popular movement crossing the North-South divide.
Bone Staples Provide Favorable Primary Stability in Cortical Fixation of Tendon Grafts for Medial Collateral Ligament Reconstruction: A Biomechanical Study
Authors: Glasbrenner Johannes , Deichsel Adrian , Raschke Michael J. , Briese Thorben , Frank Andre , Herbort Mirco , Herbst Elmar , Kittl Christoph
Published: July 2021

Background:

The use of the interference screw (IFS) for the cortical fixation of tendon grafts in knee ligament reconstruction may lead to converging tunnels in the multiligament reconstruction setting. It is unknown whether alternative techniques using modern suture anchor (SA) or bone staple (BS) fixation provide sufficient primary stability.

Purpose:

To assess the primary stability of cortical fixation of tendon grafts for medial collateral ligament (MCL) reconstruction using modern SA and BS methods in comparison with IFS fixation.

Study Design:

Controlled laboratory study.

Methods:

Cortical tendon graft fixation was performed in a porcine knee model at the tibial insertion area of the MCL using 3 different techniques: IFS (n = 10), SA (n = 10), and BS (n = 10). Specimens were mounted in a materials testing machine, and cyclic loading for 1000 cycles at up to 100 N was applied to the tendon graft, followed by load-to-failure testing. Statistical analysis was performed using 1-way analysis of variance.

Results:

There were no statistical differences in elongation during cyclic loading or peak failure load during load-to-failure testing between BS (mean ± standard deviation: 3.4 ± 1.0 mm and 376 ± 120 N, respectively) and IFS fixation (3.9 ± 1.2 mm and 313 ± 99.5 N, respectively). SA fixation was found to have significantly more elongation during cyclic loading (6.4 ± 0.9 mm; P < .0001) compared with BS and IFS fixation and lower peak failure load during ultimate failure testing (228 ± 49.0 N; P < .01) compared with BS fixation.

Conclusion:

BS and IFS fixation provided comparable primary stability in the cortical fixation of tendon grafts in MCL reconstruction, whereas a single SA fixation led to increased elongation with physiologic loads. However, load to failure of all 3 fixation techniques exceeded the loads expected to occur in the native MCL.

Clinical Relevance:

The use of BS as a reliable alternative to IFS fixation for peripheral ligament reconstruction in knee surgery can help to avoid the conflict of converging tunnels.
Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis
Authors: Torkian Pooya , Golzarian Jafar , Chalian Majid , Clayton Alexander , Rahimi-Dehgolan Shahram , Tabibian Elnaz , Talaie Reza
Published: July 2021

Background:

Genicular artery embolization (GAE) is an innovative technique that has been investigated as a supplementary treatment method for chronic pain secondary to knee osteoarthritis (OA).

Purpose:

To evaluate the current evidence on the effectiveness and safety of GAE for OA-related knee pain.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic literature search was conducted in the PubMed, Web of Science, EMBASE, and Scopus databases to identify studies related to knee OA treated with GAE. Treatment agents were categorized as Embozene, imipenem/cilastatin, resorbable microspheres, and polyvinyl alcohol. The main outcomes were the mean difference (MD) in pre- and postembolization pain based on the visual analog scale (VAS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as changes in the need for pain medication. Random- and fixed-effects models were applied for data analysis.

Results:

Of 379 initially inspected publications, 11 (N = 225 patients; 268 knees) were included in the final review. The quality of the studies was fair in 8 and poor in 3—categorized according to the National Institutes of Health quality assessment tool. Overall, 119, 72, 13, and 21 patients were treated with imipenem/cilastatin, Embozene, resorbable microspheres, and polyvinyl alcohol, respectively. Symptomatic improvement was reported in all studies. The pooled effect size, characterized by MD, showed a significant improvement in the VAS and WOMAC pain scores, with better functional status after GAE. Pre- versus postembolization MDs in VAS scores ranged from 32 within the first week to 58 after a 2-year follow-up (equivalent to 54% and 80% improvement, respectively). There was a similar trend in the overall WOMAC scores, with MDs ranging from 28.4 to 36.8 (about 58% and 85% improvement, respectively). GAE resulted in a decreased need for pain medication for knee OA, with a 27%, 65%, and 73% decline in the number of patients who used opioids, nonsteroidal anti-inflammatory drugs, and intra-articular hyaluronic acid injection, respectively ( P < .00001 for all). No significant difference between embolic agents was seen with regard to post-GAE pain reduction. No severe or life-threatening complications were reported.

Conclusion:

OA treated by GAE using different embolic particles can be considered generally safe, with good efficacy and no reported serious complications.
New insights into self-initiated work design: the role of job crafting, self-undermining and five types of job satisfaction for employee’s health and work ability
Authors: Döbler Antonia-Sophie , Emmermacher André , Richter-Killenberg Stefanie , Nowak Joshua , Wegge Jürgen
Published: July 2021

The present study provides evidence for the important role of job crafting and self-undermining behaviors at work, two new concepts that were recently integrated into the well-known job demands-resources (JD-R) theory (Bakker and Demerouti, 2017). We investigate how these behaviors are associated with work engagement, emotional exhaustion, and work ability as a long-term indicator of employee’s well-being. Furthermore, we examine the moderating role of personal resources in the stress-strain process by comparing groups of employees representing the five types of job satisfaction defined by Bruggemann (1974). Data was collected in a cross-sectional study within a German DAX company’s manufacturing plant from 1145 blue- and white-collar workers. Results of structural equation modeling provided, as expected, support for an indirect effect of job demands and job resources on emotional exhaustion and work engagement through job crafting and self-undermining. Work ability, on the other hand, was mainly affected by emotional exhaustion, but not by work engagement. Most important, we found significant differences between path coefficients across the five types of job satisfaction indicating that these types represent important constellations of personal resources and job demands that should be considered both for analyzing stress at work and for offering tailored stress interventions in organizations.
Thirteen-week nose-only inhalation exposures of propylene glycol aerosols in Sprague Dawley rats with a lung systems toxicology analysis
Authors: Langston T , Randazzo J , Kogel U , Hoeng J , Martin F , Titz B , Guedj E , Schneider T , Prabhakar B , Zhang J , Oldham M , Lee KM
Published: July 2021

The objectives of this study were to increase PG exposure above concentrations tested by Suber et al. and use systems toxicology analysis of lung tissue to understand molecular events. Sprague Dawley rats were exposed to filtered air (sham), propylene glycol/water (PG/W; 90:10) or a propylene glycol/vegetable glycerin/water (PG/VG/W; 50:40:10) reference. The reference group was added at the high dose to observe any changes that might be associated with a carrier more in line with e-vapor products. Macroscopic examinations and terminal organ weights revealed no observations associated with exposure to PG/W or reference. Food consumption and body weights were unaffected by PG/W or reference when compared to sham. No exposure related alterations were observed in serum chemistry, hematology, coagulation, urinalysis or BALF cytology and clinical chemistry. Although clinical observations of dried red material around the nose in the high dose PG/W group were reported, histopathology showed no nasal hemorrhaging which was previously reported by Suber et al. Non-adverse PG/W and reference related findings of minimal mucous cell hyperplasia were noted in nasal cavity section II. No other exposure-related findings were noted in the primary or recovery necropsies. A systems toxicology analysis on lung tissue showed no statistically significant differentially expressed transcripts or proteins compared to the sham group. The endpoints measured from the PG/W high dose group did not differ significantly from those in the more common carrier PG/VG/W. As anticipated, exposure to PG aerosols was slightly irritating but well tolerated. Accordingly, the highest PG exposure (5 mg/L, 6 hrs/day) was regarded as the NOAEC, corresponding to a PG delivered dose of 1,152 mg/kg/day in rats.
Toying With Engineering: Teaching Engineers to Be Entrepreneurial by Developing a Toy
Authors: Bakrania Smitesh
Published: July 2021

Most engineering design projects focus primarily on the engineering fundamentals. Studying the business case or manufacturability of a design is often left for other courses, if at all. To address this gap, an existing mechanical engineering course project was modified by embedding the interdependent entrepreneurial dimensions. In the past, junior engineering students developed a reciprocating air engines over two semesters. The modified project extended the engineering fundamentals into an entrepreneurial venture. To accomplish this, students were asked to propose an air engine toy for middle schoolers. The proposed toy had to be assembled, provide a learning opportunity, and demonstrate utility. The students had to ensure the product appealed to those interested in the STEM fields. The students, working in groups, created renders of the final product, assembly instructions, and a guided worksheet for the kids to explore the underlying engineering concept. The groups produced a website with a video pitching their toy concepts. This case study exemplifies how any engineering endeavor can be modified to capture a more holistic simulation of the profession.
Exploring the applicability of the robotic seal PARO to support caring for older persons with dementia within the home context
Authors: Inoue Kaoru , Wada Kazuyoshi , Shibata Takanori
Published: July 2021

Objective:

To (1) examine the potentiality of using the robot PARO to mediate care provided by the family and (2) identify problems when utilizing PARO in the home context.

Methods:

Family members of 7 households were asked to use PARO for at least three times per week, over 1 to 3 months. Research data, including standardized assessments, interviews, and observations, were collected at initial and subsequent monthly visits. Collected data were analyzed through descriptive statistics and inductive thematic content analysis.

Results:

Out of the seven participants, five responded positively to PARO, thereby achieving their goals of improving activity engagement, relaxation, a respite from supervision, and improved mood. A positive initial interaction with PARO showed continued interest to it. Participants were observed to communicate with caregivers and relate to PARO.

Discussion:

The application of PARO at home is possibly influenced by the persons’ initial level of interest toward PARO. It is crucial to perform careful observation and assessment before deciding to use PARO within the home context to support the life of older persons with dementia.
The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review
Authors: Kudesia Prtha , Salimarouny Banafsheh , Stanley Meagan , Fortin Martin , Stewart Moira , Terry Amanda , Ryan Bridget L
Published: July 2021

Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
Study on the activating effects of biochar composites on formaldehyde
Authors: Qiu Hua , Zhu Yaochan , Ding Xiaoming , Wang Qiang
Published: July 2021

Formaldehyde is ubiquitous and harmful to human body. In this study, biochar graphene and composites are prepared by hydrothermal method. According to the material properties of formaldehyde, biochar composites are used to catalyze the two ends of electrode to promote the activation reaction of formaldehyde. By analyzing the characteristics of Fourier transform infrared spectrum image, it is found that the biochar composite Cu(OH)2/C is more conducive to activate formaldehyde, which effectively improves the conductivity of the material and provides a reference for studying the effects of biochar composites on formaldehyde.
The rescue of F508del-CFTR by elexacaftor/tezacaftor/ivacaftor (Trikafta) in human airway epithelial cells is underestimated due to the presence of ivacaftor
Authors: Becq Frédéric , Mirval Sandra , Carrez Thomas , Lévêque Manuella , Billet Arnaud , Coraux Christelle , Sage Edouard , Cantereau Anne
Published: July 2021

Trikafta, currently the leading therapeutic in cystic fibrosis (CF), has demonstrated a real clinical benefit. This treatment is the triple combination therapy of two folding correctors elexacaftor/tezacaftor (VX445/VX661) plus the gating potentiator ivacaftor (VX770). In this study, our aim was to compare the properties of F508del-CFTR in cells treated with either lumacaftor (VX809), tezacaftor, elexacaftor, elexacaftor/tezacaftor with or without ivacaftor. We studied F508del-CFTR function, maturation and membrane localisation by Ussing chamber and whole-cell patch-clamp recordings, Western blot and immunolocalisation experiments. With human primary airway epithelial cells and the cell lines CFBE and BHK expressing F508del, we found that, whereas the combination elexacaftor/tezacaftor/ivacaftor was efficient in rescuing F508del-CFTR abnormal maturation, apical membrane location and function, the presence of ivacaftor limits these effects. The basal F508del-CFTR short-circuit current was significantly increased by elexacaftor/tezacaftor/ivacaftor and elexacaftor/tezacaftor compared to other correctors and nontreated cells, an effect dependent on ivacaftor and cAMP. These results suggest that the level of the basal F508del-CFTR current might be a marker for correction efficacy in CF cells. When cells were treated with ivacaftor combined to any correctors, the F508del-CFTR current was unresponsive to the subsequently acute addition of ivacaftor, unlike the CFTR (cystic fibrosis transmembrane conductance regulator) potentiators genistein and Cact-A1 which increased elexacaftor/tezacaftor/ivacaftor and elexacaftor/tezacaftor-corrected F508del-CFTR currents. These findings show that ivacaftor reduces the correction efficacy of Trikafta. Thus, combining elexacaftor/tezacaftor with a different potentiator might improve the therapeutic efficacy for treating CF patients.
Artificial intelligence in computed tomography for quantifying lung changes in the era of CFTR modulators
Authors: Dournes Gael , Hall Chase S. , Willmering Matthew M. , Brody Alan S. , Macey Julie , Bui Stephanie , Denis de Senneville Baudouin , Berger Patrick , Laurent François , Benlala Ilyes , Woods Jason C.
Published: July 2021

Background

Chest computed tomography (CT) remains the imaging standard for demonstrating cystic fibrosis (CF) airway structural diseasein vivo. However, visual scoring systems as an outcome measure are time consuming, require training and lack high reproducibility. Our objective was to validate a fully automated artificial intelligence (AI)-driven scoring system of CF lung disease severity.

Methods

Data were retrospectively collected in three CF reference centres, between 2008 and 2020, in 184 patients aged 4–54 years. An algorithm using three 2D convolutional neural networks was trained with 78 patients’ CT scans (23 530 CT slices) for the semantic labelling of bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus and collapse/consolidation. 36 patients’ CT scans (11 435 CT slices) were used for testingversusground-truth labels. The method's clinical validity was assessed in an independent group of 70 patients with or without lumacaftor/ivacaftor treatment (n=10 and n=60, respectively) with repeat examinations. Similarity and reproducibility were assessed using the Dice coefficient, correlations using the Spearman test, and paired comparisons using the Wilcoxon rank test.

Results

The overall pixelwise similarity of AI-drivenversusground-truth labels was good (Dice 0.71). All AI-driven volumetric quantifications had moderate to very good correlations to a visual imaging scoring (p<0.001) and fair to good correlations to forced expiratory volume in 1 s % predicted at pulmonary function tests (p<0.001). Significant decreases in peribronchial thickening (p=0.005), bronchial mucus (p=0.005) and bronchiolar mucus (p=0.007) volumes were measured in patients with lumacaftor/ivacaftor. Conversely, bronchiectasis (p=0.002) and peribronchial thickening (p=0.008) volumes increased in patients without lumacaftor/ivacaftor. The reproducibility was almost perfect (Dice >0.99).

Conclusion

AI allows fully automated volumetric quantification of CF-related modifications over an entire lung. The novel scoring system could provide a robust disease outcome in the era of effective CF transmembrane conductance regulator modulator therapy.
Predicting the risk of respiratory distress in newborns with congenital pulmonary malformations
Authors: Delacourt Christophe , Bertille Nathalie , Salomon Laurent J. , Rahshenas Makan , Benachi Alexandra , Bonnard Arnaud , Choupeaux Laure , Fouquet Virginie , Goua Valérie , Hameury Frédéric , Hervieux Erik , Jouannic Jean-Marie , Khen-Dunlop Naziha , Le Bouar Gwenaelle , Massardier Jérôme , Roditis Léa , Rosenblatt Jonathan , Sartor Agnès , Thong-Vanh Catherine , Lelong Nathalie , Khoshnood Babak
Published: July 2021

Objectives

Most children with prenatally diagnosed congenital pulmonary malformations (CPMs) are asymptomatic at birth. We aimed to develop a parsimonious prognostic model for predicting the risk of neonatal respiratory distress (NRD) in preterm and term infants with CPM, based on the prenatal attributes of the malformation.

Methods

MALFPULM is a prospective population-based nationally representative cohort including 436 pregnant women. The main predictive variable was the CPM volume ratio (CVR) measured at diagnosis (CVR first) and the highest CVR measured (CVR max). Separate models were estimated for preterm and term infants and were validated by bootstrapping.

Results

In total, 67 of the 383 neonates studied (17%) had NRD. For infants born at term (>37 weeks, n=351), the most parsimonious model included CVR max as the only predictive variable (receiver operating characteristic (ROC) curve area: 0.70±0.04, negative predictive value: 0.91). The probability of NRD increased linearly with increasing CVR max and remained below 10% for CVR max <0.4. In preterm infants (n=32), both CVR max and gestational age were important predictors of the risk of NRD (ROC: 0.85±0.07). Models based on CVR first had a similar predictive ability.

Conclusions

Predictive models based exclusively on CVR measurements had a high negative predictive value in infants born at term. Our study results could contribute to the individualised general risk assessment to guide decisions about the need for newborns with prenatally diagnosed CPM to be delivered at specialised centres.
Effect of exacerbation history on clinical response to dupilumab in moderate-to-severe uncontrolled asthma
Authors: Corren Jonathan , Katelaris Constance H. , Castro Mario , Maspero Jorge F. , Ford Linda B. , Halpin David M.G. , Rice Megan S. , Radwan Amr , Deniz Yamo , Rowe Paul J. , Teper Ariel , Djandji Michel
Published: July 2021

Background

The phase 3 LIBERTY ASTHMA QUEST study (ClinicalTrials.gov:NCT02414854) in patients with uncontrolled, moderate-to-severe asthma has demonstrated the efficacy and safety of dupilumab 200 and 300 mg every 2 weeksversusplacebo. Thispost hocanalysis assessed the effect of dupilumab on efficacy outcomes and asthma control across a range of historical exacerbation rates in patients with type 2-high asthma.

Methods

Annualised severe exacerbation rates over the 52-week treatment period, pre-bronchodilator forced expiratory volume in 1 s (FEV1) at weeks 12 and 52, and the five-item Asthma Control Questionnaire (ACQ-5) score at weeks 24 and 52 were assessed in patients with ≥1, ≥2 or ≥3 exacerbations in the previous year. Subgroups were stratified by baseline blood eosinophils ≥150 or ≥300 cells·μL−1or baseline exhaled nitric oxide fraction ≥25 ppb and baseline inhaled corticosteroid (ICS) dose.

Results

Across all type 2-high subgroups, dupilumabversusplacebo significantly reduced severe exacerbations by 54–90%, with greater improvements in patients with more exacerbations prior to study initiation. Similarly, improvements in FEV1(least squares (LS) mean differenceversusplacebo: ≥1 exacerbations, 0.15–0.25 L; ≥2 exacerbations, 0.12–0.32 L; ≥3 exacerbations, 0.09–0.38 L; majority p<0.05) and ACQ-5 score (LS mean difference range: ≥1 exacerbations, −0.30 to −0.57; ≥2 exacerbations, −0.29 to −0.56; ≥3 exacerbations, −0.43 to −0.61; all p<0.05) were observed, irrespective of prior exacerbation history, across all subgroups.

Conclusions

Dupilumab significantly reduced severe exacerbations and improved FEV1and asthma control in patients with elevated type 2 biomarkers irrespective of exacerbation history and baseline ICS dose.
A randomised trial of a web-based physical activity self-management intervention in COPD
Authors: Robinson Stephanie A. , Cooper J. Allen , Goldstein Rebekah L. , Polak Madeline , Cruz Rivera Paola N. , Gagnon David R. , Samuelson Amber , Moore Sheila , Kadri Reema , Richardson Caroline R. , Moy Marilyn L.
Published: July 2021

Improving exercise capacity is a primary objective in COPD. Declines in exercise capacity result in reduced physical activity and health-related quality of life (HRQoL). Self-management interventions can teach patients skills and behaviours to manage their disease. Technology-mediated interventions have the potential to provide easily accessible support for disease self-management. We evaluated the effectiveness of a web-based self-management intervention, focused on physical activity promotion, on exercise capacity in COPD. This 6-month randomised controlled trial (NCT02099799) enrolled 153 persons with COPD at two US sites (VABoston, n=108; VABirmingham, n=45). Participants were allocated (1:1) to the web-based self-management intervention (physical activity promotion through personalised, progressive step-count goals, feedback, online COPD-related education and social supportviaan online community) or usual care. The primary outcome was exercise capacity (6-min walk distance (6 MWD)). Secondary outcomes included physical activity (daily steps per day), HRQoL (St. George's Respiratory Questionnaire Total Score), dyspnoea, COPD-related knowledge and social support. Change in step-count goals reflected intervention engagement. Participants' mean age was 69 (sd=7), and mean forced expiratory volume in 1 s % predicted was 61% (sd=21%). Change in 6MWD did not differ between groups. Intervention participants improved their mean daily step counts by 1312 more than those in the usual care group (p<0.001). Groups did not differ on other secondary outcomes. VABirmingham participants were significantly more engaged with the intervention, although site did not modify the effect of the intervention on 6MWD or secondary outcomes. The intervention did not improve exercise capacity but improved physical activity at 6 months. Additional intervention modifications are needed to optimise its COPD self-management capabilities.
Impact of the COVID-19 pandemic on the behaviour and health status of patients with COPD: results from the German COPD cohort COSYCONET
Authors: Kahnert Kathrin , Lutter Johanna I. , Welte Tobias , Alter Peter , Behr Jürgen , Herth Felix , Kauczor Hans-Ulrich , Söhler Sandra , Pfeifer Michael , Watz Henrik , Vogelmeier Claus F. , Bals Robert , Jörres Rudolf A. , Trudzinski Franziska C.
Published: July 2021

Background:

Infection control measures for coronavirus disease 2019 (COVID-19) might have affected management and clinical state of patients with COPD. We analysed to which extent this common notion is fact-based.

Methods:

Patients of the COSYCONET cohort were contacted with three recurring surveys (COVID1, 2 and 3 at 0, 3 and 6 months, respectively). The questionnaires comprised behaviour, clinical and functional state, and medical treatment. The responses to the questionnaires were compared amongst themselves and with pre-COVID information from the last visit of COSYCONET.

Results:

Overall, 594 patients were contacted and 375 patients (58% males, forced expiratory volume in 1 s (FEV1) 61±22% predicted) provided valid data in COVID1 and COVID2. Five patients reported infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most patients – except for patients with higher education – reported compliance with recommended protective measures, whereby compliance to hygiene, contact and access to physicians slightly improved between COVID1 and COVID2. Also, patients obtained more information from physicians than from public media. In the majority of cases, the personal physician could not be substituted by remote consultation. Over time, symptoms slightly increased and self-assessed physical capacity decreased. Results of COVID3 were similar. Women and patients with more exacerbations and dyspnoea avoided medical consultations, whereas Global Initiative for Chronic Obstructive Lung Disease (GOLD) D patients were more amenable to tele-consultation.

Conclusion:

In well-characterised COPD patients, we observed on average slight deteriorations of clinical state during the period of COVID-19 restrictions, with high and partially increasing adherence to protective measures. The data suggest that in particular, women and GOLD D patients should be actively contacted by physicians to identify deteriorations.
Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting
Authors: Sykes Dominic L. , Crooks Michael G. , Thu Thu Khaing , Brown Oliver I. , Tyrer Theodore J.P. , Rennardson Jodie , Littlefield Catherine , Faruqi Shoaib
Published: July 2021

Background

Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) pneumonia. Limited data are available for patients treated with noninvasive respiratory support outside of the intensive care setting.

Methods

In this single-centre observational study we observed the characteristics, physiological observations, laboratory tests and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with noninvasive respiratory support outside of the intensive care setting.

Results

We report the outcomes of 140 patients (mean±sdage: 71.2±11.1, 65% male (n=91)) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1versus74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2versus4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.

Conclusions

CPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.
A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension
Authors: Boon Gudula J.A.M. , van den Hout Wilbert B. , Barco Stefano , Bogaard Harm Jan , Delcroix Marion , Huisman Menno V. , Konstantinides Stavros V. , Meijboom Lilian J. , Nossent Esther J. , Symersky Petr , Noordegraaf Anton Vonk , Klok Frederikus A.
Published: July 2021

Background

Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds 1 year, contributing to higher mortality. Health economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life-years (QALYs) and healthcare costs.

Material and methods

A Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC – VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens.

Results

For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at EUR 117 100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs. The associated cost increase was EUR 44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost–utility ratio of EUR 21 900/QALY.

Conclusion

Our constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health economic standards, additional costs remain below the deemed acceptable limit of EUR 50 000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.
Propofol attenuates lung ischemia/reperfusion injury though the involvement of the MALAT1/microRNA-144/GSK3β axis
Authors: Zhang Jian-Ping , Zhang Wei-Jing , Yang Miao , Fang Hua
Published: July 2021

Background

Propofol, an intravenous anesthetic, was proven to protect against lung ischemia/reperfusion (I/R) injury. However, the detailed mechanism of Propofol in lung I/R injury is still elusive. This study was designed to explore the therapeutic effects of Propofol, both in vivo and in vitro, on lung I/R injury and the underlying mechanisms related to metastasis-associated lung adenocarcinoma transcript 1 (MALAT1)/microRNA-144 (miR-144)/glycogen synthase kinase-3β (GSK3β).

Methods

C57BL/6 mice were used to establish a lung I/R injury model while pulmonary microvascular endothelial cells (PMVECs) were constructed as hypoxia/reperfusion (H/R) cellular model, both of which were performed with Propofol treatment. Gain- or loss-of-function approaches were subsequently employed, followed by observation of cell apoptosis in lung tissues and evaluation of proliferative and apoptotic capabilities in H/R cells. Meanwhile, the inflammatory factors, autophagosomes, and autophagy-related proteins were measured.

Results

Our experimental data revealed that Propofol treatment could decrease the elevated expression of MALAT1 following I/R injury or H/R induction, indicating its protection against lung I/R injury. Additionally, overexpressing MALAT1 or GSK3β promoted the activation of autophagosomes, proinflammatory factor release, and cell apoptosis, suggesting that overexpressing MALAT1 or GSK3β may reverse the protective effects of Propofol against lung I/R injury. MALAT1 was identified to negatively regulate miR-144 to upregulate the GSK3β expression.

Conclusion

Overall, our study demonstrated that Propofol played a protective role in lung I/R injury by suppressing autophagy and decreasing release of inflammatory factors, with the possible involvement of the MALAT1/miR-144/GSK3β axis.
The impact of training healthcare professionals’ communication skills on the clinical care of diabetes and hypertension: a systematic review and meta-analysis
Authors: Yao Mi , Zhou Xue-ying , Xu Zhi-jie , Lehman Richard , Haroon Shamil , Jackson Dawn , Cheng Kar Keung
Published: July 2021

Background

Diabetes and hypertension care require effective communication between healthcare professionals and patients. Training programs may improve the communication skills of healthcare professionals but no systematic review has examined their effectiveness at improving clinical outcomes and patient experience in the context of diabetes and hypertension care.

Methods

We conducted a systematic review of randomized controlled trials to summarize the effectiveness of any type of communication skills training for healthcare professionals to improve diabetes and/or hypertension care compared to no training or usual care. We searched Medline, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception to August 2020 without language restrictions. Data on the country, type of healthcare setting, type of healthcare professionals, population, intervention, comparison, primary outcomes of glycated hemoglobin (HbA1c) and blood pressure, and secondary outcomes of quality of life, patient experience and understanding, medication adherence and patient-doctor relationship were extracted for each included study. Risk of bias of included studies was assessed by Cochrane risk of bias tool.

Results

7011 abstracts were identified, and 19 studies met the inclusion criteria. These included a total of 21,762 patients and 785 health professionals. 13 trials investigated the effect of communication skills training in diabetes management and 6 trials in hypertension. 10 trials were at a low risk and 9 trials were at a high risk of bias. Training included motivational interviewing, patient centred care communication, cardiovascular disease risk communication, shared decision making, cultural competency training and psychological skill training. The trials found no significant effects on HbA1c (n = 4501, pooled mean difference -0.02 mmol/mol, 95% CI -0.10 to 0.05), systolic blood pressure (n = 2505, pooled mean difference -2.61 mmHg, 95% CI -9.19 to 3.97), or diastolic blood pressure (n = 2440, pooled mean difference -0.06 mmHg, 95% CI -3.65 to 2.45). There was uncertainty in whether training was effective at improving secondary outcomes.

Conclusion

The communication skills training interventions for healthcare professionals identified in this systematic review did not improve HbA1c, BP or other relevant outcomes in patients with diabetes and hypertension. Further research is needed to methodically co-produce and evaluate communication skills training for chronic disease management with healthcare professionals and patients.
A novel immune-related gene pair prognostic signature for predicting overall survival in bladder cancer
Authors: Fu Yang , Sun Shanshan , Bi Jianbin , Kong Chuize , Yin Lei
Published: July 2021

Background

Bladder cancer (BC) is the ninth most common malignant tumor. We constructed a risk signature using immune-related gene pairs (IRGPs) to predict the prognosis of BC patients.

Methods

The mRNA transcriptome, simple nucleotide variation and clinical data of BC patients were downloaded from The Cancer Genome Atlas (TCGA) database (TCGA-BLCA). The mRNA transcriptome and clinical data were also extracted from Gene Expression Omnibus (GEO) datasets (GSE31684). A risk signature was built based on the IRGPs. The ability of the signature to predict prognosis was analyzed with survival curves and Cox regression. The relationships between immunological parameters [immune cell infiltration, immune checkpoints, tumor microenvironment (TME) and tumor mutation burden (TMB)] and the risk score were investigated. Finally, gene set enrichment analysis (GSEA) was used to explore molecular mechanisms underlying the risk score.

Results

The risk signature utilized 30 selected IRGPs. The prognosis of the high-risk group was significantly worse than that of the low-risk group. We used the GSE31684 dataset to validate the signature. Close relationships were found between the risk score and immunological parameters. Finally, GSEA showed that gene sets related to the extracellular matrix (ECM), stromal cells and epithelial-mesenchymal transition (EMT) were enriched in the high-risk group. In the low-risk group, we found a number of immune-related pathways in the enriched pathways and biofunctions.

Conclusions

We used a new tool, IRGPs, to build a risk signature to predict the prognosis of BC. By evaluating immune parameters and molecular mechanisms, we gained a better understanding of the mechanisms underlying the risk signature. This signature can also be used as a tool to predict the effect of immunotherapy in patients with BC.
Serum matrix metalloproteinase-13 as a diagnostic biomarker for cutaneous squamous cell carcinoma
Authors: Wang Hui , Li Hong , Yan Qingtao , Gao Sumei , Gao Jianfang , Wang Zhenhua , Sun Yi
Published: July 2021

Background

A significant proportion of newly diagnosed patients with cutaneous squamous cell carcinoma (cSCC) have metastasis and eventually die of the disease, necessitating the exploration of novel biomarkers for early detection of cSCC aggressiveness, risk assessment and monitoring. Matrix metalloproteinase-13 (MMP-13) has been implicated in cSCC pathogenesis. Serum MMP-13 levels have been shown to predict survival in patients with esophageal SCC, but their diagnostic value for cSCC has not been explored.

Methods

We conducted a case-control study to examine serum MMP-13 as a biomarker for cSCC. Patients with cSCC undergoing surgical resection and health controls undergoing plastic surgery were recruited. ELISA for measurement of serum MMP-13 and immunohistochemistry for detection of tissue MMP-13 were performed, and the results were compared between the case and the control group, and among different patient groups. ROC curve analysis was performed to determine the diagnostic value of serum MMP-13 levels.

Results

The ratio of male to female, and the age between the case (n = 77) and the control group (n = 50) were not significantly different. Patients had significantly higher serum MMP-13 levels than healthy controls. Subjects with stage 3 cSCC had markedly higher serum MMP-13 levels than those with stage 1 and stage 2 cSCC. Patients with invasive cSCC had remarkably higher serum MMP-13 than those with cSCC in situ. Post-surgery serum MMP-13 measurement was done in 12 patients, and a significant MMP-13 decrease was observed after removal of cSCC. Tumor tissues had a remarkably higher level of MMP-13 than control tissues. Serum MMP-13 predicted the presence of invasive cSCC with an AUC of 0.87 (95% CI [0.78 to 0.95]) for sensitivity and specificity of 81.7 and 82.4%, respectively for a cut-off value of 290 pg/mL. Serum MMP-13 predicted lymph node involvement with an AUC of 0.94 (95% CI [0.88 to 0.99]) for sensitivity and specificity of 93.8 and 88.5%, respectively for a cut-off value of 430 pg/mL.

Conclusion

Serum MMP-13 might serve as a valuable biomarker for early detection of cSCC invasiveness and monitoring of cSCC progression.
Fear and depression during the COVID-19 outbreak in Cameroon: a nation-wide observational study
Authors: Siewe Fodjo Joseph Nelson , Ngarka Leonard , Njamnshi Wepnyu Y. , Nfor Leonard N. , Mengnjo Michel K. , Mendo Edwige Laure , Angwafor Samuel A. , Atchou Basseguin Jonas Guy , Nkouonlack Cyrille , Njit Edith N. , Ahidjo Nene , Chokote Eric S. , Dema Fidèle , Fonsah Julius Y. , Tatah Godwin Y. , Palmer Nancy , Seke Etet Paul F. , Palmer Dennis , Nsagha Dickson S. , Etya’ale Daniel E. , Perrig Stephen , Sztajzel Roman , Annoni Jean-Marie , Zoung-Kanyi Bissek Anne-Cécile , Leke Rose G. F. , Abena Ondoa Obama Marie-Thérèse , Nkengasong John N. , Colebunders Robert , Njamnshi Alfred K.
Published: July 2021

Background

The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak.

Methods

An online survey was conducted in Cameroon from June–December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time.

Results

Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53–3.21;p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34;p <  0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression.

Conclusion

Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians.
Demographics, politics, and health factors predict mask wearing during the COVID-19 pandemic: a cross-sectional study
Authors: Cunningham George B. , Nite Calvin
Published: July 2021

Background

Wearing a protective face covering can reduce the spread of COVID-19, but Americans’ compliance with wearing a mask is uneven. The purpose of this study is to examine the association between health determinants (Health Behaviors, Clinical Care, Social and Economic Conditions, and the Physical Environment) and mask wearing at the county level.

Methods

Data were collected from publicly available sources, including the County Health Rankings and theNew York Times. The dependent variable was the percent of county residents who reported frequently or always wearing a mask when in public. County demographics and voting patterns served as controls. Two-levels random effects regression models were used to examine the study hypotheses.

Results

Results indicate that, after considering the effects of the controls, Health Behaviors were positively associated with mask wearing, the Physical Environment held a negative association, and Clinical Care and Social and Behavioral Factors were unrelated.

Conclusions

Results indicate that patterns of healthy behaviors can help predict compliance with public health mandates that can help reduce the spread of COVID-19. From an instutitional theory perspective, the data suggest counties develop collective values and norms around health. Thus, public health officials can seek to alter governance structures and normative behaviors to improve healthy behaviors.
Barriers and facilitators experienced by osteopaths in implementing a biopsychosocial (BPS) framework of care when managing people with musculoskeletal pain – a mixed methods systematic review
Authors: Sampath Kesava Kovanur , Darlow Ben , Tumilty Steve , Shillito Warwick , Hanses Melissa , Devan Hemakumar , Thomson Oliver P.
Published: July 2021

Background

Clinical practice guidelines commonly recommend adopting a biopsychosocial (BPS) framework by practitioners managing musculoskeletal pain. However, it remains unclear how osteopaths implement a BPS framework in the management of musculoskeletal pain. Hence, the objective of this review was to systematically appraise the literature on the current practices, barriers and facilitators experienced by osteopaths in implementing a BPS framework of care when managing people with musculoskeletal pain.

Methods

The following electronic databases from January 2005 to August 2020 were searched: PubMed, CINAHL, Science Direct, Google Scholar, ProQuest Central and SCOPUS. Two independent reviewers reviewed the articles retrieved from the databases to assess for eligibility. Any studies (quantitative, qualitative and mixed methods) that investigated the use or application of the BPS approach in osteopathic practice were included in the review. The critical appraisal skills program (CASP) checklist was used to appraise the qualitative studies and the Mixed Methods Appraisal Tool (MMAT) was used to appraise quantitative or mixed methods studies. Advanced convergent meta-integration was used to synthesise data from quantitative, qualitative and mixed methods studies.

Results

A total of 6 studies (two quantitative, three qualitative and one mixed methods) were included in the final review. While two key concepts (current practice and embracing a BPS approach) were generated using advanced meta-integration synthesis, two concepts (barriers and enablers) were informed from qualitative only data.

Discussion

Our review finding showed that current osteopathic practice occurs within in the biomedical model of care. Although, osteopaths are aware of the theoretical underpinnings of the BPS model and identified the need to embrace it, various barriers exist that may prevent osteopaths from implementing the BPS model in clinical practice. Ongoing education and/or workshops may be necessary to enable osteopaths to implement a BPS approach.