bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive evaluation of intrinsic safety of railway facilities and equipment based on improved cloud model-fuzzy Petri net
Authors: Lin Junting , Li Qian , Wang Yang
Published: February 2024

In order to achieve the goal of transforming China into a modernized railway powerhouse, a comprehensive evaluation model of intrinsic safety is constructed in this paper by focussing on the intrinsic safety of railway facilities and equipment. Firstly, the index system for evaluating the intrinsic safety of railway facilities and equipment is divided. Secondly, the fuzzy Petri net (FPN) model for intrinsic safety evaluation is constructed according to the fuzzy generative rules, and the similarity calculation method of the cloud model based on shape and distance is applied to derive the initial state value of the FPN model and carry out the calculation of fuzzy reasoning of the intrinsic safety. Finally, the comprehensive evaluation of intrinsic safety is carried out using the example of railroad facilities and equipment at one China Railway Group bureau’s station section. The results indicate that the intrinsic safety level of the station section falls into Class IV intrinsic safety, exhibiting a few vulnerabilities. However, the risk level is low, aligning with the findings of the actual research. Moreover, the evaluation results based on the FPN, the cloud model’s similarity calculation method and the suggested method are compared and analysed with the findings of the actual research. The comparative results demonstrate the accuracy and scientificity of the proposed method, providing a reference for enhancing the intrinsic safety of railway facilities and equipment.
Improving the Mental Health of Surgical Teams Through Operating Room Design
Authors: Oh Yeinn , Gill Simon , Baek Daehwa , Watral Alexandra , Pulos Bridget , Thompson Bettina , Young Suzanne , Guyer Jean M , McCoy Jessica , Phillips Meshach , Potts Kenneth , Evenson Lindsey , Lim Lisa , Blocker Renaldo
Published: February 2024

Objective:

In this study, we aim to develop and propose an evaluation method for analyzing the design of operating rooms (ORs) from the perspective of surgical teams’ reported experiences and stress levels.

Background:

Stress and burnout of surgical team members can lead to diminished performance and medical errors, which endangers the safety of both the patients and team members. The design and layout of the OR play a critical role in managing such stress.

Methods:

To understand surgical teams’ spatial needs related to their experiences and stress, we administered a survey and in-depth focus group discussions to three surgical teams from the same organization. The identified spatial needs were translated into functional scenarios and spatial metrics, essentially viewing the OR through the perspective of users.

Results:

Our analysis revealed four integral sections—patient flow, room organization, access to facilities/medical equipment/support staff/team members, and staff well-being—identified as critical design factors associated with the experiences and stress levels of the surgical teams in the ORs.

Conclusions:

We expect this method to serve as a tool for evaluating the effect of the design of OR layouts on stress, thereby supporting the well-being and resiliency of surgical teams.
Evaluating drug stability and sterility in single-dose vials when accessed with a closed system transfer device
Authors: Hopkins James N , Waldman Michael , Sahai Raghvendra , Battle Jason
Published: February 2024

Background:

Impact of drug wastage is a legitimate and persistent concern. Financial impact of drug waste is borne by the hospital network, patients, and healthcare systems. Measures to reduce drug wastage may have a positive impact throughout healthcare systems.

Objective:

This study investigated the stability and sterility of single-dose vials when repeatedly accessed with a closed system transfer device. By evaluating the sterility and stability, these results may be used to validate the extension of vial usage and lead to potential drug wastage reduction.

Methods:

Sterility testing was performed in accordance with US Pharmacopeia 71. A closed system transfer device was incorporated into simulated compounding tasks, utilizing growth media. Simulated compounding tasks were performed in the clinical environment, followed by incubation to stimulate growth. Stability testing was performed in accordance with US Pharmacopeia monographs at multiple timepoints post access. Test samples were comparatively tested via high-performance liquid chromatography to freshly opened vials at each timepoint.

Results:

No growth was observed in test samples. Control vials displayed growth, where appropriate. The drugs retained stability, when compared to freshly opened vials at 0, 24, 48, and 72 h, post access.

Conclusions:

This study confirms that closed system transfer devices do not contribute to microbial contamination of drug vials, following the repeated access, for up to 7 days and the tested drugs retained equivalent chemical stability for up to 72 h post access. This study may offer a manner by which a facility may assess single-dose vials’ sterility and stability, following repeated access by a closed system transfer device.
The unexpected results of the peace referendum changed conflict termination preferences in Colombia
Authors: Ramirez-Ruiz Sebastian
Published: February 2024

In October 2016, the Colombian electorate narrowly rejected in a plebiscite the final agreement to end the conflict with the longest-running armed insurgency in the Western Hemisphere, the FARC. The plebiscite’s result provides a unique opportunity to assess dynamics in civil conflict termination preferences. I exploit the unexpected victory of the No vote, observed during the AmericasBarometer fieldwork, to estimate the effect of the uncertainty about the trajectory of the conflict generated by the outcome of the plebiscite. The unexpected defeat of the peace plebiscite did not measurably change the expressed support for the recently rejected agreement. However, it increased the public support for a negotiated rather than military settlement to the conflict, as well as respondents’ willingness to give concessions to FARC members. These findings inform the broader literature on civilian preferences toward civil conflict termination and compromise.
Digital physiotherapy is a satisfactory and effective method to improve the quality of life in Long COVID patients
Authors: Estebanez-Pérez María-José , Pastora-Bernal José-Manuel , Vinolo-Gil María- Jesús , Pastora-Estebanez Pablo , Martín-Valero Rocío
Published: February 2024

Objective

This research aimed to explore Long COVID patient's quality of life, satisfaction and perception with an individualized and customizable digital physiotherapy intervention during a 4-week period.

Methods

A pre-post clinical trial was conducted with 32 Long COVID patients. Quality of life was assessed using the 12-Item Short Form Survey and the European Quality of Life-5 Dimensions questionnaire (EuroQol-5D), while satisfaction and perception were measured using the Telemedicine Satisfaction Questionnaire. Optional open-ended questions were added as qualitative approach. A mixed design method was conducted.

Results

After intervention, a statistically significant improvement ( p < 0.05) was observed in quality of life. The SF-12 questionnaire showed an increase of 4.04 points in the physical component and 6.55 points in the mental component with a small/medium effect size. The EuroQoL-5D questionnaire demonstrated a medium effect size with an increase of 0.87 points. Patient perception indicated high rates of satisfaction and values above the minimal clinically important difference. The qualitative approach revealed several interesting findings.

Conclusion

Participants found the digital intervention satisfactory and effective in improving their quality of life. Suggestions for improvement, such as the inclusion of face-to-face sessions, a chat for immediate contact, sound in breath exercises in the digital program, longer duration and continuity of intervention, were mentioned. Larger sample studies and in-deep qualitative methodologies are needed to draw extrapolable conclusions.

Trial registration

NCT04742946.
Using Narrative Films to Combat HIV-Related Stigma in Western Kenya: An Exploratory Pilot Study of Adolescents Living With HIV and Their Caregivers
Authors: McCoy Brittany M. , McAteer Carole I. , Ashimosi Celestine , Aluoch Josephine , Lewis C. Thomas , Nyandiko Winstone , Vreeman Rachel C.
Published: February 2024

Objective. Interventions that effectively address HIV-related stigma are urgently needed to improve outcomes for adolescents living with HIV (ALHIV). We piloted a series of 4 short narrative films depicting Kenyan ALHIV’s lived experiences of stigma and discrimination with 57 ALHIV and 50 adult caregivers of ALHIV in western Kenya. Methods. Participants completed either pre- and post-viewing questionnaires, including an HIV/AIDS-related stigma and discrimination scale, or participated in post-viewing focus group discussions. Three-month follow-up visits were conducted. Results. Caregivers endorsed significantly greater disagreement with stigmatizing statements on the scale at 3-month follow-up, whereas adolescents had no significant differences in scores. Participants reported they believed the films would have a positive impact on their communities and had led to changes in their own attitudes, beliefs and/or behavior. Conclusion. The HIV Stigma Films may show promise as an intervention to reduce stigmatizing attitudes and beliefs about HIV-infection, especially among caregivers of ALHIV.
Identifying Factors Associated with Discontinuation of Infertility Treatment Prior to Achieving Pregnancy: Results of a Nationwide Survey
Authors: Collura Barbara , Hayward Brooke , Modrzejewski Krysten A , Mottla Gilbert L , Richter Kevin S , Catherino Allison B
Published: February 2024

The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P = .014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P = .004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation.
Competency Framework for Podiatric Medicine Training: A Validation Report Based on an Adapted E-Delphi Across Canada
Authors: Andoulsi Yassin , Hue Olivier , Brousseau Martine , Hill James , Alleyne Joel , Blanchette Virginie
Published: February 2024

OBJECTIVES

Competency-based medical education has been introduced into many health professional curricula. Based on CanMEDs, a framework has recently been developed for podiatric medicine education in Canada. This study aimed to validate the framework through a consensus of various podiatric medicine experts across Canada.

METHODS

An adapted Delphi method was used for content validation. Two structured online questionnaires were used to gather expert opinions and agreement on the roles and core competencies described in the framework previously developed. The validation consensus threshold was set at a minimum of 80% agreement. The summary of comments and suggestions was used to reformulate certain items after the research team reached a consensus.

RESULTS

Out of the 51 experts invited from the Canadian Podiatric Medicine Association, 19 completed the first-round questionnaire (mean podiatric experience = 24.5 years; standard deviation 17.6). After the first round, “Podiatric Expert”, “Communicator” and “Scholar” roles have been modified. After these modifications, a consensus was obtained at the second round completed by 13 experts. Overall, 95% of the experts agreed that the competency framework was relevant even if some indicators would need to be adapted to suit the requirements of each province and territory.

CONCLUSION

This validated framework supports the excellence and the quality of our podiatric educational program. It also promotes the adoption of a uniform education of podiatrists in Canada and worldwide.
Domesticating the Cosmic: Elemental Fire and the Tamil Festival of Lights
Authors: Arumugam Indira
Published: February 2024

This article is about the calendrical, climactic and especially cosmological implications of Karthigai Deepam, an ancient Tamil celebration pivoted around the lighting of lamps that precedes Deepavali, the quintessential, ubiquitous but also comparatively recent festival of lights. Karthigai Deepam signals the end of the rains, intensifying winter chills and winds and shorter days. Juxtaposing festival observances in homes and those in temples, I demonstrate how its overriding concerns with generating light and warmth are part of ritual efforts to defend against elemental and existential threats of darkness and cold. Linking sacred time and mythical events with chronological time and human activities, this calendrical ritual joins together the divine and the mortal. Tracing the movement of fire and its various iterations as it traverses and connects the natural, cosmic, temple and home, this festival, I propose, renders the cosmic intimate and the intimate cosmic. Some rituals not only embody but also put cosmology into dynamic practice.
Socioeconomic Disparities and Emergency Department Visits for Diabetic Retinopathy in California
Authors: Akinyemi Oluwasegun A. , Jones MD Leslie S. , Ochoa Alejandro , Nelson Luke , Weldeslase Terhas A. , Yousuf Salman J.
Published: February 2024

Purpose: To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). Methods: All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018–2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Results: Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; P = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; P < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; P < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; P = .001) compared with private insurance. Conclusions: The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.
Prevalence, Risk Factors and Prognosis of Seizures After Ischemic Stroke
Authors: Moreira Mairla Maracaba , de Andrade João Brainer Clares , Rodriguez Carlos Eduardo Lenis , Araújo Davi Said , Rolim Flávia Paiva , Monteiro Marla Rochana Braga , Frota Norberto Anizio , Lima Fabrício Oliveira , Silva Gisele Sampaio
Published: February 2024

Introduction and objectives

Epileptic seizures (ES) are a recognized complication of stroke, commonly associated with extensive ischemic regions and cortical damage. Despite thorough investigation, reports on the incidence, risk factors, and functional implications of post-stroke ES vary widely in the literature. We aimed to evaluate the predictive factors for post-stroke ES and their effects on the clinical outcome at hospital discharge.

Methods

Patients with acute ischemic stroke (AIS) admitted to our stroke unit from 2015 to 2017 were eligible to this study. A multivariable logistic regression modeling was built to assess associated variables with acute symptomatic seizures (AS). We defined AS as seizures that occurred within the period of hospitalization (stroke unit discharge) without a history of seizures with clinical or electroencephalographic evidence.

Results

Four hundred ninety-two were included in the final analysis. The patients had a mean of 66.7 (±14.4) years; 56% were male. Thirty-eight (7.7%) patients experienced clinical ES in-hospital, with a higher incidence in those with total anterior circulation syndrome. The NIH Stroke Scale score (odds ratio [OR] 1.07, 95% confidence interval [CI], p = .03) and symptomatic hemorrhagic transformation (HT) (OR: 3.53, 95% CI: 1.38–8.99, p = .01) independently predicted ES. We did not find an association between the occurrence of seizures and unfavorable outcomes (Modified Rankin Scale 3–6) at discharge (OR1.26, 95% CI: 0.3–5.32, p = .75). Patients with seizures had a longer hospital stay (18.5 [11–35] vs. 9 [7–14] days).

Conclusions

Patients presenting higher NIH Stroke Scale scores upon admission or experiencing symptomatic HT face an increased risk of in-hospital ES. Nonetheless, acute symptomatic ES following AIS does not independently predict adverse functional outcomes at discharge.
Improving the forecast of fine dust emission and transmission from cattle barns: a comprehensive data package and analysis
Authors: Mostafa Ehab , Paßmann Jessica , Abdellatif Hassan R. S. , Buescher Wolfgang
Published: February 2024

The livestock sector emits harmful gases and bioaerosols, impacting animals, plants, and human health. Ventilation systems in livestock buildings disperse polluted air, affecting nearby air quality depending on the wind patterns and atmospheric stability. Understanding pollutant emission and transmission is crucial for environmental mitigation. This study focuses on fine dust dispersion from dairy cattle buildings. Chemical and microscopic analyses were conducted to identify the cattle barn dust sources. Particle mass emissions were quantified by measuring particle mass concentrations and air volume flow using the tracer gas decay method. Seasonal and daily effects on dust emissions were studied. Remarkably, particle emissions remained below prescribed values in Germany. Additionally, particle transmission, including resuspension and adsorption parameters, was investigated using a developed wind tunnel. Resuspension measurements revealed minimal resuspended particle mass due to low ground wind speeds. Notably, wheat, as a model plant, exhibited high adsorption rates, which increased with particle size. Overall, the findings for resuspension and adsorption parameters provide an initial database for understanding fine dust transmission from cattle barns.
Transcriptomics and metabolomics analysis reveal the dietary copper deficiency and supplementation effects of liver gene expression and metabolite change in grazing sheep
Authors: Jin Xiwei , Meng Lingbo , Qi Zhi , Mi Lan
Published: February 2024

Background

The appropriate mineral nutrients are essential for sheep growth and reproduction. However, traditional grazing sheep often experience mineral nutrient deficiencies, especially copper (Cu), due to inadequate mineral nutrients from natural pastures.

Results

The results indicated that dietary Cu deficiency and supplementation significantly reduced and elevated liver concentration of Cu, respectively (p < 0.05). FOXO3, PLIN1, ACTN2, and GHRHR were identified as critical genes using the weighted gene co-expression network analysis (WGCNA), quantitative real-time polymerase chain reaction (qRT-PCR), and receiver operating characteristic curve (ROC) validation as potential biomarkers for evaluating Cu status in grazing sheep. Combining these critical genes with gene functional enrichment analysis, it was observed that dietary Cu deficiency may impair liver regeneration and compromise ribosomal function. Conversely, dietary Cu supplementation may enhance ribosomal function, promote lipid accumulation, and stimulate growth and metabolism in grazing sheep. Metabolomics analysis indicated that dietary Cu deficiency significantly decreased the abundance of metabolites such as cholic acid (p < 0.05). On the other hand, dietary Cu supplementation significantly increased the abundance of metabolites such as palmitic acid (p < 0.05). Integrative analysis of the transcriptome and metabolome revealed that dietary Cu deficiency may reduce liver lipid metabolism while Cu supplementation may elevate it in grazing sheep.

Conclusions

The Cu content in diets may have an impact on hepatic lipid metabolism in grazing sheep. These findings provide new insights into the consequences of dietary Cu deficiency and supplementation on sheep liver and can provide valuable guidance for herders to rationalize the use of mineral supplements.
Mortality of traumatic chest injury and its predictors across sub-saharan Africa: systematic review and meta-analysis, 2024
Authors: Adal Ousman , Tareke Abiyu Abadi , Bogale Eyob Ketema , Anagaw Tadele Fentabil , Tiruneh Misganaw Guadie , Fenta Eneyew Talie , Endeshaw Destaw , Delie Amare Mebrat
Published: February 2024

Introduction

Globally, chest trauma remain as a prominent contributor to both morbidity and mortality. Notably, patients experiencing blunt chest trauma exhibit a higher mortality rate (11.65%) compared to those with penetrating chest trauma (5.63%).

Aim

This systematic review and meta-analysis aimed to assess the mortality rate and its determinants in cases of traumatic chest injuries.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the data synthesis process. Multiple advanced search methods, encompassing databases such as PubMed, Africa Index Medicus, Scopus, Embase, Science Direct, HINARI, and Google Scholar, were employed. The elimination of duplicate studies occurred using EndNote version X9. Quality assessment utilized the Newcastle-Ottawa Scale, and data extraction adhered to the Joanna Briggs Institute (JBI) format. Evaluation of publication bias was conducted via Egger’s regression test and funnel plot, with additional sensitivity analysis. All studies included in this meta-analysis were observational, ultimately addressing the query, what is the pooled mortality rate of traumatic chest injury and its predictors in sub-Saharan Africa?

Results

Among the 845 identified original articles, 21 published original studies were included in the pooled mortality analysis for patients with chest trauma. The determined mortality rate was nine (95% CI: 6.35–11.65). Predictors contributing to mortality included age over 50 (AOR 3.5; 95% CI: 1.19–10.35), a time interval of 2–6 h between injury and admission (AOR 3.9; 95% CI: 2.04–7.51), injuries associated with the head and neck (AOR 6.28; 95% CI: 3.00–13.15), spinal injuries (AOR 7.86; 95% CI: 3.02–19.51), comorbidities (AOR 5.24; 95% CI: 2.93–9.40), any associated injuries (AOR 7.9; 95% CI: 3.12–18.45), cardiac injuries (AOR 5.02; 95% CI: 2.62–9.68), the need for ICU care (AOR 13.7; 95% CI: 9.59–19.66), and an Injury Severity Score (AOR 3.5; 95% CI: 10.6–11.60).

Conclusion

The aggregated mortality rate for traumatic chest injuries tends to be higher in sub-Saharan Africa. Factors such as age over 50 years, delayed admission (2–6 h), injuries associated with the head, neck, or spine, comorbidities, associated injuries, cardiac injuries, ICU admission, and increased Injury Severity Score were identified as positive predictors. Targeted intervention areas encompass the health sector, infrastructure, municipality, transportation zones, and the broader community.
Association between physical frailty, circadian syndrome and cardiovascular disease among middle-aged and older adults: a longitudinal study
Authors: Zhu Xinhong , Ding Linlin , Zhang Xiaona , Wang Heqing , Chen Ningbo
Published: February 2024

Background

Physical frailty (PF) and circadian syndrome (CircS) are proposed as novel risks for cardiovascular disease (CVD), but little attention is paid to their combined impact on CVD. This study aimed to investigate the association of PF, CircS and CVD in middle-aged and older adults.

Methods

The sample comprised 8512 participants aged at least 45 years from the China Health and Retirement Longitudinal Study (CHARLS) 2011. PF was examined by the physical frailty phenotype scale. CircS was assessed by the components of the International Diabetes Federation (IDF) MetS plus short sleep duration and depression. The cut-off for CircS was set as ≥ 4. CVD was defined as the presence of physician-diagnosed heart disease and/or stroke. A total of 6176 participants without CVD recruited from CHARLS 2011 and were followed up in 2018.

Results

The prevalence of CVD in total populations, neither CircS or PF, PF alone, CircS alone and both CircS and PF were 13.0%, 7.4%, 15.5%, 17.4%, and 30.2%, respectively. CircS was more likely to be PF [OR (95%CI): 2.070 (1.732 ∼ 2.472)] than those without CircS. Both CircS alone [OR (95% CI): 1.954 (1.663 ∼ 2.296)], and coexisting CircS and PF [3.508 (2.739 ∼ 4.494)] were associated with CVD. Longitudinal analysis showed that individuals with both CircS and PF (HR: 1.716, 95%CI: 1.314 ∼ 2.240) and CircS alone [1.520 (1.331 ∼ 1.737)] were more likely to have new onset CVD than neither CircS or PF peers.

Conclusion

PF and CircS together are associated with higher CVD risk, which provided new evidence for a strong relation that warrants attention to assessing PF and CircS and in community to promote healthy aging.
Antibiotic dosing recommendations in critically ill patients receiving new innovative kidney replacement therapy
Authors: Lewis Susan J. , Mueller Bruce A.
Published: February 2024

Background

The Tablo Hemodialysis System is a new innovative kidney replacement therapy (KRT) providing a range of options for critically ill patients with acute kidney injury. The use of various effluent rate and treatment durations/frequencies may clear antibiotics differently than traditional KRT. This Monte Carlo Simulation (MCS) study was to develop antibiotic doses likely to attain therapeutic targets for various KRT combinations.

Methods

Published body weights and pharmacokinetic parameter estimates were used to predict drug exposure for cefepime, ceftazidime, imipenem, meropenem and piperacillin/tazobactam in virtual critically ill patients receiving five KRT regimens. Standard free β-lactam plasma concentration time above minimum inhibitory concentration targets (40–60%fT> MIC and 40–60%fT> MICx4) were used as efficacy targets. MCS assessed the probability of target attainment (PTA) and likelihood of toxicity for various antibiotic dosing strategies. The smallest doses attaining PTA ≥ 90% during 1-week of therapy were considered optimal.

Results

MCS determined β-lactam doses achieving ∼90% PTA in all KRT options. KRT characteristics influenced antibiotic dosing. Cefepime and piperacillin/tazobactam regimens designed for rigorous efficacy targets were likely to exceed toxicity thresholds.

Conclusion

The flexibility offered by new KRT systems can influence β-lactam antibiotic dosing, but doses can be devised to meet therapeutic targets. Further clinical validations are warranted.
Novel drug therapy of acute hepatic failure induced in rats by a combination of tadalafil and Lepidium sativum
Authors: Sabra Mahmoud S. , Mohammed Ahmed A. , Hassanein Khaled M. Ahmed , Ahmed Ahmed A. N. , Hassan Dalia , Abdel-lah Ebtsam S.
Published: February 2024

Background

Hepatocyte death and a systemic inflammatory response are the outcome of a complex chain of events mediated by numerous inflammatory cells and chemical mediators. The point of this study was to find out if tadalafil and/or Lepidium sativum (L. sativum) could help people who have been exposed to carbon tetrachloride (CCL4) and are experiencing acute moderate liver failure. This was especially true when the two were used together.

Method and materials

To cause mild liver failure 24 h before sacrifice, a single oral dosage of CCL4 (2.5 mL/kg b.w.) (50% in olive oil) was utilized. Furthermore, immunohistochemical expression of nuclear factor kappa B (NF-κB) as well as histological abnormalities were performed on liver tissue.

Results

The results showed that tadalafil and/or L. sativum, especially in combination, performed well to cure acute mild liver failure caused by CCL4. This was demonstrated by a decrease in NF-κB expression in the liver tissue and an improvement in organ damage markers observed in the blood and liver tissues. Furthermore, such therapy reduced interleukin1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) levels in the liver tissue. It’s worth noting that the tested combination resulted in greater liver improvement.

Conclusions

According to the findings, tadalafil and L. sativum, particularly in combination, have the ability to protect the liver from the negative effects of CCL4 exposure. Because of its capacity to improve liver function, restore redox equilibrium, and decrease inflammatory mediators, it is a prospective option for mitigating the negative effects of common environmental pollutants such as CCL4.
Physician resilience and perceived quality of care among medical doctors with training in psychosomatic medicine during the COVID-19 pandemic: a quantitative and qualitative analysis
Authors: Fazekas Christian , Zieser Maximilian , Hanfstingl Barbara , Saretzki Janika , Kunschitz Evelyn , Zieser-Stelzhammer Luise , Linder Dennis , Matzer Franziska
Published: February 2024

Background

At an individual level, physician resilience protects against burnout and against its known negative effects on individual physicians, patient safety, and quality of care. However, it remains uncertain whether physician resilience also correlates with maintaining a high level of healthcare quality during crises such as a pandemic. This study aimed to investigate whether higher resilience among physicians, who had received training in resilience-related competences in the past, would be associated with higher quality of care delivered during the COVID-19 pandemic.

Methods

This study enrolled physicians working in family medicine, psychiatry, internal medicine, and other medical specialties, who had obtained at least one of three consecutive diplomas in psychosomatic medicine in the past. Participants completed a quantitative and qualitative anonymous online survey. Resilience was measured using the Connor-Davidson Resilience Scale, and healthcare quality was assessed through single-item quality indicators, including perceived quality of care, professional autonomy, adequate time for patient care, and job satisfaction.

Results

The study included 229 physicians (70 males/159 females) with additional training in psychosomatic medicine, working in family medicine (42.5%), psychiatry (28.1%), internal medicine (7.0%), or other medical specialties (22.4%). Participants represented four intensity levels of training background (level 1 to level 4: 9.2%, 32.3%, 46.3%, and 12.2% of participants). Training background in psychosomatic medicine was positively associated with resilience (B = 0.08, SE = 0.04, p <.05). Resilience and training background independently predicted perceived quality of care, even after controlling for variables such as own health concerns, involvement in the treatment of COVID-19 patients, financial strain, percentage of working hours spent on patient care, age, and gender (resilience: B = 0.33, SE = 0.12, p <.01; training background: B = 0.17, SE = 0.07, p <.05). Both resilience and training background predicted job satisfaction (resilience: B = 0.42, SE = 0.12, p <.001; training background: B = 0.18, SE = 0.07, p <.05), while resilience alone predicted professional autonomy (B = 0.27, SE = 0.12, p <.05). In response to an open question about their resources, resilient physicians more frequently reported applying conscious resilient skills/emotion regulation (p <.05) and personal coping strategies (p <.01) compared to less resilient medical doctors.

Conclusion

Physician resilience appears to play a significant role in the perceived quality of patient care, professional autonomy, and job satisfaction during healthcare crises.
An analysis of the diagnoses and costs of pediatric emergency care visits: a single center study
Authors: Kauppala Annika , Heikkilä Paula , Palmu Sauli
Published: February 2024

Background

Children’s emergency care visits are common, although the costs and reasons for visits vary. This register-based study examines the costs of pediatric emergency care and the diagnoses related to visits made to the Pediatric Emergency Unit at Tampere University Hospital (Tays), Tampere, Finland.

Methods

This retrospective study described pediatric emergency care visits made between September 2018 and December 2019 to a single center in Tampere, Finland. The data were gathered from medical files and from cost-per-patient software and analyzed in groups by age, season, level of treatment in the ED (primary or secondary), and hospitalization, as well as by diagnosis groups.

Results

During the study period, 11,454 visits were made. The total costs were over €3,380,000 ($2,837,758), with a median cost per visit was €260 ($217.90). Higher costs were associated with hospitalization and treatment in secondary care. The most common diagnoses were respiratory tract infections, counseling, other infections, GI symptoms, and other reasons.

Conclusion

Seriously ill children incur the highest costs per visit in pediatric emergency care. Respiratory tract infections are common reasons for emergency care visits, and the reasons why children come to emergency care in Finland are similar to those in other countries.
Sibling species of the major malaria vector Anopheles gambiae display divergent preferences for aquatic breeding sites in southern Nigeria
Authors: Ebhodaghe Faith I. , Sanchez-Vargas Irma , Isaac Clement , Foy Brian D. , Hemming-Schroeder Elizabeth
Published: February 2024

Background

When integrated with insecticide-treated bed nets, larval control of Anopheles mosquitoes could fast-track reductions in the incidence of human malaria. However, larval control interventions may deliver suboptimal outcomes where the preferred breeding places of mosquito vectors are not well known. This study investigated the breeding habitat choices of Anopheles mosquitoes in southern Nigeria. The objective was to identify priority sites for mosquito larval management in selected urban and periurban locations where malaria remains a public health burden. 

Methods

Mosquito larvae were collected in urban and periurban water bodies during the wet-dry season interface in Edo, Delta, and Anambra States. Field-collected larvae were identified based on PCR gel-electrophoresis and amplicon sequencing, while the associations between Anopheles larvae and the properties and locations of water bodies were assessed using a range of statistical methods.

Results

Mosquito breeding sites were either man-made (72.09%) or natural (27.91%) and mostly drainages (48.84%) and puddles (25.58%). Anopheles larvae occurred in drainages, puddles, stream margins, and a concrete well, and were absent in drums, buckets, car tires, and a water-holding iron pan, all of which contained culicine larvae. Wild-caught Anopheles larvae comprised Anopheles coluzzii (80.51%), Anopheles gambiae sensu stricto (s.s.) (11.54%), and Anopheles arabiensis (7.95%); a species-specific PCR confirmed the absence of the invasive urban malaria vector Anopheles stephensi among field-collected larvae. Anopheles arabiensis, An. coluzzii, and An. gambiae s.s. displayed preferences for turbid, lowland, and partially sunlit water bodies, respectively. Furthermore, An. arabiensis preferred breeding sites located outside 500 m of households, whereas An. gambiae s.s. and An. coluzzii had increased detection odds in sites within 500 m of households. Anopheles gambiae s.s. and An. coluzzii were also more likely to be present in natural water bodies; meanwhile, 96.77% of An. arabiensis were in man-made water bodies. Intraspecific genetic variations were little in the dominant vector An. coluzzii, while breeding habitat choices of populations made no statistically significant contributions to these variations.

Conclusion

Sibling malaria vectors in the An. gambiae complex display divergent preferences for aquatic breeding habitats in southern Nigeria. The findings are relevant for planning targeted larval control of An. coluzzii whose increasing evolutionary adaptations to urban ecologies are driving the proliferation of the mosquito, and An. arabiensis whose adults typically evade the effects of treated bed nets due to exophilic tendencies.
The effect of bovine dairy products and their components on the incidence and natural history of infection: a systematic literature review
Authors: Mitchell Meghan , Suh Mina , Hooda Naushin , Bylsma Lauren C. , Cohen Sarah S.
Published: February 2024

Background

Dairy products and their components may impact immune function, although the current evidence base has some research gaps. As part of a larger systematic literature review of dairy products/components (including probiotics, dairy proteins, and dairy fats) and immune function, we identified the available epidemiologic research on the impact of dairy products/components on incidence and natural history of infectious diseases.

Methods

PubMed and Embase databases were systematically searched through May 2022 to identify eligible studies using pre-defined Population, Intervention, Comparator, Outcomes, and Study design criteria. Herein, we focused on describing the impacts of dairy product/component on infectious disease outcomes, including the effect on leukocyte and cytokine response in humans. Risk of bias assessment was performed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.

Results

Among 9,832 studies identified from the larger literature search, 133 relevant publications from 128 studies reported on dairy product/component and infectious disease outcomes. Few studies are available on the impact of non-fermented milk and traditional yogurt on infectious disease. Evidence was identified to suggest milk and yogurt drinks fermented with Lactobacillus strains reduce the risk and burden of common infectious diseases (CIDs), although the findings are mixed and difficult to reconcile due to heterogenous study populations, bacterial strains, and study methods. Few studies are available on the impact of dairy products/components on the natural history of infection, with the available findings indicating probiotics may both improve gastrointestinal symptoms among HIV-infected persons and help eradicate and alleviate the symptoms of Heliobacter (H.) pylori. The available evidence also suggests lactoferrin may reduce the virological burden of COVID-19 and hepatitis C virus. No consistent changes in leukocytes or cytokine production were observed for any type of dairy product or their components, but probiotics appeared to enhance natural killer cell levels/activity and the phagocytic process.

Conclusions

Dairy products, particularly those with added probiotics, may represent an easily accessible nutritional intervention to prevent and improve the course of infectious diseases. This review highlights the need for additional research in this potentially impactful area.

Prospero registration

CRD42022333780.
Rural‒urban disparities in household catastrophic health expenditure in Bangladesh: a multivariate decomposition analysis
Authors: Rahman Taslima , Gasbarro Dominic , Alam Khorshed , Alam Khurshid
Published: February 2024

Background

Rural‒urban disparity in catastrophic healthcare expenditure (CHE) is a well-documented challenge in low- and middle-income countries, including Bangladesh, limiting financial protection and hindering the achievement of the Universal Health Coverage target of the United Nations Sustainable Development Goals. However, the factors driving this divide remain poorly understood. Therefore, this study aims to identify the key determinants of the rural‒urban disparity in CHE incidence in Bangladesh and their changes over time.

Methods

We used nationally representative data from the latest three rounds of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016). CHE incidence among households seeking healthcare was measured using the normative food, housing, and utilities method. To quantify covariate contributions to the rural‒urban CHE gap, we employed the Oaxaca-Blinder multivariate decomposition approach, adapted by Powers et al.for nonlinear response models.

Results

CHE incidence among rural households increased persistently during the study period (2005: 24.85%, 2010: 25.74%, 2016: 27.91%) along with a significant (p-value ≤ 0.01) rural‒urban gap (2005: 9.74%-points, 2010: 13.94%-points, 2016: 12.90%-points). Despite declining over time, substantial proportions of CHE disparities (2005: 87.93%, 2010: 60.44%, 2016: 61.33%) are significantly (p-value ≤ 0.01) attributable to endowment differences between rural and urban households. The leading (three) covariate categories consistently contributing significantly (p-value ≤ 0.01) to the CHE gaps were composition disparities in the lowest consumption quintile (2005: 49.82%, 2010: 36.16%, 2016: 33.61%), highest consumption quintile (2005: 32.35%, 2010: 15.32%, 2016: 18.39%), and exclusive reliance on informal healthcare sources (2005: -36.46%, 2010: -10.17%, 2016: -12.58%). Distinctively, the presence of chronic illnesses in households emerged as a significant factor in 2016 (9.14%,p-value ≤ 0.01), superseding the contributions of composition differences in household heads with no education (4.40%,p-value ≤ 0.01) and secondary or higher education (7.44%,p-value ≤ 0.01), which were the fourth and fifth significant contributors in 2005 and 2010.

Conclusions

Rural‒urban differences in household economic status, educational attainment of household heads, and healthcare sources were the key contributors to the rural‒urban CHE disparity between 2005 and 2016 in Bangladesh, with chronic illness emerging as a significant factor in the latest period. Closing the rural‒urban CHE gap necessitates strategies that carefully address rural‒urban variations in the characteristics identified above.
Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups?
Authors: Tura Bernardo Rangel , da Costa Milene Rangel , Lordello Sylvia , Barros Danillo , Souza Yuri , da Silva Santos Marisa
Published: February 2024

Background

Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low/middle-income countries. This study aimed to investigate whether the EQ-5D-3L instrument can detect differences in HRQOL between groups of different socioeconomic status (SES) in Brazil.

Methods

Data collection occurred during the Brazilian EQ-5D-3L valuation study and included respondents aged 18 to 64 years enrolled in urban areas. SES was aggregated into three categories: “higher” (A and B), “intermediate” (C) and “lower” (D and E). EQ-5D-3L index was calculated considering the Brazilian value set. A mixed-effects regression model was estimated with random effects on individuals and marginal effects on SES, sex, and educational attainment. Odds ratios for the chance of reporting problems for each EQ-5D dimension were estimated by logistic regression.

Results

A total of 9,148 respondents were included in the study. Mean age was 37.80 ± 13.13 years, 47.4% were men and the majority was ranked as classes B or C (38.4% and 50.7%, respectively). Participants in lower SES classes reported increasingly poorer health compared to individuals in higher classes. The mean EQ-5D-3L index decreased as SES deteriorates being significantly higher for classes A and B (0.874 ± 0.14) compared to class C (0.842 ± 0.15) and classes D and E (0.804 ± 0.17) (p < 0.001). The same was observed for the mean EQ-VAS scores (84.0 ± 13.8 in classes A and B, 81.0 ± 17 in class C and 78.3 ± 18.7 in class C [p < 0.001]). The multivariate analysis confirmed that SES is an independent factor that effects EQ-5D-3L index measures. Participants in intermediate and lower SES classes have a statistically significant lower EQ-5D-3L index compared to participants in classes A and B, regardless of age, sex, and educational attainment.

Conclusion

In a Brazilian population sample, the EQ-5D-3L instrument was able to detect important differences between groups with distinct socioeconomic statuses (SES). The EQ-5D-3L is useful for exploring inequities in health.