bluuebunny/crossref_metadata_2025 huggingface dataset:
Pentoxifylline decreases the activity of the nucleotide-binding oligomerization domain-like receptor protein 3 pathway: potential role for preventing arteriovenous fistula stenosis
Authors: Feng Tao , Ma Zejun , Pan Congqing , Yu Pei
Published: October 2022

Purpose:

This study aimed to determine the effect of pentoxifylline (PTX) on the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome pathway and its role in preventing arteriovenous fistula (AVF) failure.

Methods:

Vein samples were collected from AVF failure patients and from patients who underwent surgical AVF as a control. The expressions of CD34 and NLRP3 in AVF tissues were detected by immunohistochemistry and Western blotting. Arteriovenous fistula rat models were established by the end-to-end anastomosis of the common carotid artery and external jugular vein. The AVF models were divided into the following groups: AVF, AVF + PTX, AVF + uraemia and AVF + uraemia + PTX. Six weeks after surgery, the AVF tissues in each group were collected to detect the expressions of CD34, NLRP3, caspase-1 and interleukin (IL)-1β by immunohistochemistry, Western blotting and real-time polymerase chain reaction.

Results:

The expressions of NLRP3 and CD34 in human AVF failure tissues were significantly higher than those in normal veins ( p < 0.001), indicating that NLRP3 was upregulated in patients with AVF failure. In our animal study, the veins in the AVF + uraemia group exhibited heavy hyperplasia, and the boundary between the media and the adventitia was not clear. However, PTX alleviated this hyperplasia. Compared with the AVF models, the AVF + uraemia models had much higher expressions of NLRP3, caspase-1, IL-1β and CD34 ( p < 0.001). However, PTX had the opposite effect against uraemia on the NLRP3 inflammasome pathway at both the gene and protein levels.

Conclusions:

Our findings provide new insights that show that PTX can decrease the activity of the NLRP3 inflammasome pathway in AVF models. Pentoxifylline has the potential as a drug for preventing intimal hyperplasia and AVF failure.
A comparison between two radiological criteria for verifying tip location of central venous catheters
Authors: Pittiruti Mauro , Bilancia Andrea , Ortiz Miluy Gloria , D’Arrigo Sonia
Published: October 2022

Introduction:

Current guidelines recommend intraprocedural methods—such as Intra-Cavitary ECG (IC-ECG) and echocardiography—for verifying the location of the tip of central venous catheters. Nonetheless, there are clinical conditions which may require to verify tip location by less accurate methods such as Chest X-Ray (CXR). We have compared the feasibility and accuracy of two radiological methods for tip location—the Sweet Spot Criterion (SSC) and the Carina Criterion (CC)—using IC-ECG as reference.

Methods:

In this retrospective multicenter study, we reviewed the radiology databases of three hospitals, examining all CXRs performed on patients after insertion of Peripherally Inserted Central Catheters (PICCs), as long as the tip location had been successfully performed during the procedure by IC-ECG. Tip location was verified using SSC and CC, comparing the two methods in terms of feasibility and accuracy.

Results:

We reviewed the CXR of 1116 PICCs successfully inserted by IC-ECG. CC was not feasible in 0.5% (impossible visualization of the carina) and difficult in 1.5%; in 97.7% of cases, the position of the tip was adequate (1–5 cm below the carina), in 0.6% too high (<1 cm), in 1.2% too low (6–9 cm). On the other hand, because of unclear visualization of radiological landmarks, SSC was not feasible in 0.9% and difficult in 10.5%; though, according to SSC the tip location was always acceptable (in 94.2% the tip was in the middle of the spot, in 2.5% close to the superior border, and in 2.3% close to the inferior border); no tip was visualized outside of the spot.

Conclusion:

CC and SSC were similar in terms of feasibility (99.5% vs 99.1%) and accuracy (98.1% vs 100%), though CC was subjectively perceived to be easier and more rapid to perform.
Minimally invasive peritoneal access: A new approach of catheter placement for peritoneal dialysis
Authors: Chula Domingos Candiota , Riella Miguel Carlos , Portiolli Franco Ricardo , de Alcântara Márcia Tokunaga , Campos Rodrigo Peixoto , Gordon Gina Moreno , Rokukawa Patrícia Emiko , do Nascimento Marcelo Mazza
Published: October 2022

Background:

Catheter implantation techniques for peritoneal dialysis (PD) have advanced significantly in recent years. We aimed to analyze the survival and associated complications of catheters inserted using a new technique that is guided by ultrasound and fluoroscopy and requires minimal tissue dissection. The procedure was performed by nephrologists in the outpatient basis, we compared these results of the minimally invasive insertion with traditional implantation using trocars.

Methods:

A total of 152 PD catheters were placed in 152 patients with stage 5 chronic kidney disease; 62.5% of the patients were men, with a mean age of 56.6 ± 18.5 years. The following two methods were used: minimally invasive insertion (MI group, n = 73) and trocar insertion (T group, n = 79). Patients in both the groups were followed prospectively for 26 months from the date of the first implantation.

Results:

Gender, age, and prevalence of diabetes mellitus were not significantly different between the groups, while the body mass index, presence of obesity, and abdominal scars from previous surgeries were higher in the MI group ( p = 0.021). The incidence of catheter dysfunction was lower in the MI group compared to group T (6.8% vs 20.3%; p = 0.019). Exit site infection was also lower with the new technique (4.1% vs. 18.9%; p = 0.005). Further, the cumulative incidence of peritonitis also reduced with MI ( p = 0.034). Finally, the overall catheter survival at 1 year was 89%, which has been shown as higher in group MI (95% vs 82% in group T; p = 0.025).

Conclusion:

The MI technique for catheter insertion showed low complication rates and excellent catheter survival as compared to traditional implantation methods; thus, it may be an alternative method for PD catheter placement.
Impact of Body Mass Index on 5-Year Survival Rates in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Aoyama Takashi , Notsu Akifumi , Ichimaru Koki , Hayashi Kinuko , Tsuji Masanori , Yoshitsugu Kanako , Fukaya Masafumi , Enami Terukazu , Ikeda Takashi
Published: October 2022

Background:

Cancer survival is associated with body mass index (BMI). However, the impact of patients’ baseline characteristics on allogeneic hematopoietic stem cell transplantation (allo-HSCT) outcomes remains unclear. This study aimed to examine the baseline clinical factors associated with 5-year survival rates in patients undergoing allo-HSCT.

Material and Methods:

This was a retrospective exploratory observational study. Patients (n = 113, 52 women; average age: 55 years) who underwent allo-HSCT at the Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, between January 2008 and March 2015, were included in the present study.

Results:

Patients with low BMI (<18.5 kg/m2) had significantly lower 5-year survival rates than those with normal (18.5-24.9 kg/m2) and high (⩾25.0 kg/m2) BMI. The 5-year survival rate was poorer for patients with sarcopenia (41.5%) than that for those without sarcopenia prior to allo-HSCT ( P = .05). The 5-year survival rate was poorer for patients with geriatric nutritional risk index (GNRI < 98) (34.5%) than that for those without GNRI prior to allo-HSCT ( P < .01).

Conclusions:

Low BMI before allo-HCST pre-treatment was a predictor of 5-year survival rates in this study. Patients undergoing allo-HSCT may require nutritional interventions during pre-treatment to reduce the risk of sarcopenia and GNRI (<98), which affects their survival rates.
Dental Screening Including Panoramic Radiograph for Gorlin-Goltz Syndrome in Patients With Multiple Basal Cell Carcinomas
Authors: Pitak-Arnnop Poramate , Witohendro Levyn Kay , Tangmanee Chatpong , Bhakdinaronk Anonknart , Subbalekha Keskanya , Auychai Prim , Sirintawat Nattapong , Meningaud Jean-Paul , Neff Andreas
Published: October 2022

Purpose

To answer the following clinical research question: “Among patients with multiple basal cell carcinomas (mBCCs), can panoramic radiograph (PaR) facilitate the diagnosis of Gorlin-Goltz syndrome (GGS)?”

Methods

This retrospective study enrolled mBCCs subjects who presented to a German tertiary care center between 1 January 2015 and 31 December 2021. The primary predictor was presence of syndromic mBCCs, and the main outcomes were jaw cysts and odontogenic keratocysts (OKCs). Descriptive, bi- and multivariate statistics, diagnostic test evaluation, and number needed to screen (NNS) were computed at α = 95%.

Results

The sample comprised 527 mBCCs patients (36.1% females; 6.8% GGS; 5.5% OKCs; mean age, 74.5 ± 15.8 years [range, 15-102]). There was a significant association between syndromic mBCCs and jaw cysts ( P < .0001; NNS = 2 [95% CI, CI, 1.1 to 1.4]). In the adjusted logistic model, PaR identified GGS via radiographic diagnosis of jaw cysts in case of 1) age ≤ 35 years, 2) ≥ 5 BCCs, and 3) ≥ 1 high-risk BCCs. Nearly every jaw cyst identified by PaR was OKCs ( P = .01; 95% CI, 3.1 to 3,101.4; NNS = 1.3 [95% CI, .9 to 2]). The post hoc power was 100%.

Conclusions

Dental screening with the use of PaR for mBCCs patients, especially those aged ≤35 years, or with ≥5 BCCs, or ≥1 high-risk BCCs, may be helpful in detection and identification of GGS through recognition of OKCs.
Providing physical education preservice teachers with opportunities to interrogate their conceptions and practices of assessment
Authors: Moura André , MacPhail Ann , Graça Amândio , Batista Paula
Published: October 2022

This study enacted and supported a scaffolding process to improve preservice teachers’ (PSTs') assessment literacy as they experienced school placement. It is crucial to create opportunities that enhance PSTs’ understanding of assessment literacy, helping them to reconsider conceptions previously developed as school students (socialisation experiences) and to gain an appreciation for the benefits assessment affords students in their learning. Assessment literate teachers can enact appropriate assessment practices that can improve students’ learning and the teaching-learning process while providing opportunities for students to regulate their learning. Eight physical education PSTs working with the same university supervisor took part in the study. Data were collected through individual and focus group interviews, post-seminar reflections and testimonial surveys, researcher's field notes, and PSTs’ school placement reports. This study highlighted that supportive, practical and critical participatory approaches are crucial to encourage PSTs to question and change their assessment conceptions, and to improve their assessment literacy. Results also showed that, despite struggling to avoid practicing what they experienced as school students (i.e. socialisation experiences), PSTs can alter their assessment understanding and practices to incorporate assessment for learning principles. Teacher educators are encouraged to consider how they can best acknowledge and address the pre-conceived assessment conceptions PSTs bring into these programmes.
Labour, capital and the struggle over history: Reconstructing Marxist class theory from the standpoint of alienation
Authors: Øversveen Emil , Kelly Conor Andre
Published: October 2022

During the last decade, class analysis has been re-invigorated as a response to increasing economic inequality, social fragmentation and political unrest. Somewhat paradoxically, however, the perspective that has traditionally been most associated with class analysis – Marxism – has largely been absent from these debates. This article reconstructs Marxist class analysis by considering the previously unexplored relationship between social class and alienation. Incorporating insights from alienation theory, we argue, allows for an expanded conception of class that avoids economism while also retaining the distinctness of Marxist theory as compared to other approaches. Our central argument is that Marxist class analysis cannot be reduced to an explanation of economic inequality but must instead be seen as a struggle over the conditions of social development. We conclude by demonstrating the theoretical, empirical and political implications of our analysis and by arguing for a shift in the politics of class from inequality to unfreedom.
Temperature behaviors of an arch bridge through integration of field monitoring and unified numerical simulation
Authors: Xia Qi , Wu Wang-lin , Li Fu-nian , Zhou Xiao-qing , Xu You-lin , Xia Yong
Published: October 2022

Varying temperature may cause a non-uniform temperature distribution of a bridge and lead to excessive movement and stresses of the structure. Traditional thermal analyses of bridges adopt a divide-and-conquer approach, which conducts a simplified 2D or local 3D heat-transfer analysis and then a global 3D structural analysis by inputting the calculated temperature into another bridge model. This process requires considerable manual intervention and is inefficient and may lead to inaccurate results. This study develops a unified approach of heat-transfer and structural analyses for the first time to calculate the temperature distribution and the associated responses of an entire structure by integrating the field monitoring data. The arch footbridge at the Hong Kong Polytechnic University is used as a testbed, and a detailed finite element model (FEM) of the bridge is established. The measured air temperature and solar radiation are used as the thermal boundary conditions. The hemisphere technique is adopted to calculate the view factor between different surfaces of the bridge, which are then used to obtain the solar radiation on all external surfaces in different instants on different dates. The 3D global hear-transfer analysis is conducted to obtain the temperature distribution of the entire bridge. The calculated temperature data of the bridge are then automatically input into the same FEM of the bridge to calculate the temperature-induced bridge responses via the structural analysis. The heat-transfer analysis and structural analysis share the same FEM while using different element types. Therefore, the manual intervention is avoided. The calculated and monitored temperature data and responses show a good agreement. The developed new unified approach enables an automatic and efficient analysis of thermal behaviors of bridges. This approach can be extended to other types of bridges.
Vertical geomediation: The automation and platformization of photogrammetry
Authors: Wilken Rowan , Thomas Julian
Published: October 2022

Photogrammetry is the science of using photographs to make measurements and derive three-dimensional (3D) data about objects or terrain from two-dimensional (2D) imaging. In this article we view photogrammetry through the lens of geomedia studies, arguing two things. First, we suggest the accumulation and concentration of photogrammetric capabilities, technologies and knowledge, from the First World War onwards can be understood as both part of the 20th-century creation of a ‘government machine’, and a crucial element within the longer-run ‘cartographic project’. Through both world wars and the post-war period, aerial photogrammetry emerged as a fundamental capability for government-supported geomedia infrastructure and spatial information capture – what we term an extended geomedia infosphere. Second, we examine the critical dynamics of digitization, automation and platformization. These developments, we argue, have led to a redistribution of photogrammetric capabilities and technologies outside governmental cartography, with implications for platforms and geomedia studies.
Ethical issues in dementia guidelines for people with dementia and informal caregivers in Denmark: A qualitative thematic synthesis
Authors: Schou-Juul Frederik , Nørgaard Signe , Lauridsen Sigurd Mørk Rønbøl
Published: October 2022

Numerous dementia-specific guidelines are offered to support people with dementia and their informal caregivers in dealing with dementia. However, the extent to which such guidelines address ethical issues and provide guidance for dealing with the issues has not yet been assessed. This study investigates the extent to which ethical issues are addressedin those guidelines, which ethical themes are considered and whatrecommendations are offered. We analysed Danish collected via onlinesearch engines and manual contact with relevant governmental, municipal and patient organisations from November 2020 to January 2021. To assess the scope of ethical issues in such guidelines, we devised an analytical framework using Beauchamp and Childress’s four principles of biomedical ethics and a data-processing method inspired by systematic reviews. We collected a total 653 dementia guidelines and screened them using formal inclusion criteria, such as publication year, target group and public availability. The guidelines that satisfied these criteria were screened for content related to ethical issues and recommendations. The guidelines that addressed ethical issues were then coded in NVivo 12 and analysed using thematic text analysis. In total, 59 guidelines satisfied the formal inclusion criteria. Among these guidelines, 15 addressed ethical issues, which fell into four transversal themes: (1) being open about the disease, (2) accepting help, (3) the line between dignified behaviour and overstepping boundaries and (4) decision-making and autonomy. The ethical issues addressed in Danish dementia-specific guidelines were diverse. However, the addressed issues did not represent a comprehensive spectrum of ethical issues as identified in relevant literature, and only a few guidelines contained substantial ethical content. In conclusion, this study indicates that the need for guidance on ethical issues is not being met by dementia-specific guidelines and that further research is required to provide additional ethical guidance that benefits people with dementia and their informal caregivers.
Network governance and effectiveness on renewable energy integration: A comparative case study on power transmission networks in the United States
Authors: Tang Tian , Li Wenhui , Zheng Guimin
Published: October 2022

This paper examines how network structure and coordinating mechanisms in the US power transmission system affect the integration of wind energy through comparative case studies. The two transmission network cases represent two major transmission network governance models in the US power sector. Using archival data from all network participants and interviews with key stakeholders, we find that a centralized transmission network coordinated by an independent network administrative organization (NAO) is more effective in integrating wind power than a less centralized structure. Particularly, the concentration of decision-making authorities is a more substantial determinant than the structural centrality of the core agency. The two cases also highlight that hierarchy, collaboration, and market mechanisms coexist in a transmission network to manage the tension between stability and flexibility. When the network operates in a turbulent environment with great uncertainties, different coordinating mechanisms complement each other to improve system resilience.
Negative Ulnar Variance Lessens DRUJ Instability After DRUJ Disruption: A Biomechanical Analysis
Authors: Huddleston Hailey P. , Kurtzman Joey S. , Deegan Liam , Hayes Westley , Austin Kevin , Carter John , Aibinder William R. , Koehler Steven M.
Published: October 2022

Background:

The purpose of this study was to perform a biomechanical investigation on the effect of ulnar variance (UV) on the stability of the distal radioulnar joint (DRUJ) prior to and after DRUJ sectioning.

Methods:

Ten cadaveric forearm specimens were included in the study and baseline UV was assessed radiographically. Radial motion relative to the ulna was evaluated using Intel real sense cameras and a custom developed program. The forearms were dissected, and a radial osteotomy was performed. Using a custom-made plate, radial stability was assessed with an UV of + 4, 0, and −4 mm by measuring the maximum and minimum radial position relative to the ulna during a simulated Shuck test. The volar radioulnar ligaments and triangular fibrocartilage complex (TFCC) were then sectioned, and testing was repeated at each UV state.

Results:

Sectioning significantly increased radial translation at neutral ( P = .008), +4 mm UV ( P = .008), and −4 mm UV ( P = .018). There were no significant differences in translation between the 3 UV groups with the DRUJ intact ( P = .124). The ulnar negative (−4 mm) state had significantly lower translation compared to the positive (+4 mm) ( P < .001) and the neutral (0 mm) ( P = .026) UV states. There were no significant differences between the positive and neutral UV groups with the DRUJ sectioned.

Conclusions:

Fixating the radius in −4 mm of ulnar negativity significantly decreased radial translation after sectioning the volar radioulnar ligament and TFCC. Ulnar variance had no effect on stability with an intact DRUJ.

Study Type:

Biomechanical Study
Research Participation in Substance Use Disorder Trials: Design and Methods of a Multi-Site Nested Qualitative Study
Authors: Richardson Lindsey , Jaffe Kaitlyn , Socias M. Eugenia , Le Foll Bernard , Lim Ron , Jutras-Aswad Didier
Published: October 2022

Background

Given the health and social harms of problematic substance use, randomized controlled trials (RCTs) are critical in developing and testing pharmacotherapies for substance use disorders. However, substance use RCTs can be challenging to conduct, considering the social and structural barriers to participating in research among people with substance use disorders (PSUD), including stigma, poverty, and criminalization—factors that can shape trial recruitment, enrollment, protocol adherence and study retention. Despite these barriers, adequate representation and participation of PSUD in RCT research is essential to assessing and developing treatments, and thus a deeper understanding of RCT participation dynamics among PSUD is needed to support clinical trial research.

Methods

We conducted a nested qualitative study within a Canadian, multisite, phase IV, open-label, pragmatic RCT that tested two approved opioid agonist treatments, methadone and buprenorphine/naloxone, among patients with prescription opioid use disorder. A subset of individuals ( n = 60) participating in this RCT were interviewed across four different regions in Canada at the beginning and end of their trial involvement, as well as study clinicians ( n = 16) and staff ( n = 16) operating the trial.

Conclusion

As a nested study within a real-world addiction medicine trial, this research offers an innovative approach to investigating the experiences, strategies, and challenges associated with RCTs among PSUD. While we acknowledge challenges related to the operations of multisite research and engaging marginalized populations in experimental research, this study has the potential to generate critical insights around the RCT experiences of PSUDs and trial staff to inform the conduct of future RCTs.
Intergenerational Professional Development and Learning of Teachers: A Mixed Methods Study
Authors: Portela Pruaño Antonio , Bernárdez Gómez Abraham , Marrero Galván Juan José , Nieto Cano José Miguel
Published: October 2022

Schools, as in the case of other organizations, face complex challenges due to generational phenomena. In addition to an increasingly aging teaching workforce, schools are becoming more age-diverse, with coexisting multiple generations. Two consequences of this situation are the declining availability of relevant and critical knowledge for schools as teachers retire and the difficulties associated with maintaining professional relationships among teachers of different generations. These challenges have highlighted the significance of understanding the relevance of generations of teachers and identifying ways to build on generational diversity. Specifically, intergenerational collaboration and learning are needed to meet these challenges. Accordingly, this study aims to (1) examine generational diversity among teachers, (2) inquire into their interactions and the learning processes accompanying collaborative experiences in professional development, and (3) explore how these experiences and processes can enhance professional learning and practice. To this end, an exploratory mixed methods research project is conducted, comprising a multiphase design with two exploratory sequential studies (QUAL→quan). The participants are a sample of beginner, veteran, and retired teachers from Spain’s publicly funded schools. In the qualitative strands of the study, data collection techniques comprise focus groups and semi-structured in-depth interviews followed by thematic analysis. In the quantitative strands, questionnaires (a multidimensional scale and a survey experiment) are the major data sources, which are subjected to descriptive and inferential statistical (factor and conjoint) analyses. The focus is primarily on the qualitative strands.
Recalling the Hunger Winter: Evoking famine memory beyond the national
Authors: de Zwarte Ingrid , Janssen Lindsay
Published: October 2022

This article seeks to demonstrate how hunger legacies function as connecting vectors in later times. By investigating the comparative uses of memory in Dutch newspapers in the period 1945–1995, it reveals how recollections of the Dutch ‘Hunger Winter’ of 1944–1945 were evoked to make sense of current episodes of hunger, as well as to stimulate political and societal engagement among readers with famines across the world. In so doing, the article shows how memories of the Dutch famine were placed in larger transnational discourses of suffering, experienced by other oppressed and war-stricken communities, ultimately making the Hunger Winter a benchmark for understanding famine, deprivation and humanitarianism. Crucially, this article stresses the need to move beyond national paradigms in the study of famine memory, thereby allowing for a better understanding of the transnational workings of memory.
Surgical excision and skin grafting combined with intralesional injection of triamcinolone for the treatment of keloids after syndactyly release
Authors: Jiang Yongkang , Zhou Shengbo , Tian Jingshun , Du Xingchao , Sun Wenhai , Wang Bin
Published: October 2022

The purpose of this study was to investigate the efficacy of surgery combined with triamcinolone acetonide injection in managing the difficult problem of keloid formation after syndactyly release. Twenty-two patients with keloid formation after syndactyly release were retrospectively reviewed. They were divided into a simple surgery group and a surgery plus injection group. Complications, web quality, scar score and satisfaction were assessed and compared. In the surgery plus injection group, three patients (3/13) experienced recurrence and ten webs were good, whereas in the simple surgery group, seven patients (7/9) experienced recurrence and five webs were poor. The mean Vancouver Scar Scale score was significantly lower (4.3 versus 7.8) and the mean Faces Questionnaire satisfaction score was higher (4.2 versus 2.6) in the surgery plus injection group. Combining surgical excision with early and repeated intralesional injection can achieve better results with low recurrence rate and side effects.

Level of evidence: IV
Telehealth Fatigue: Is It Real? What Should Be Done?
Authors: Huang Jingtong , Yeung Andrea M. , Eiland Leslie A. , Huang Erich S. , Raymond Jennifer K. , Klonoff David C.
Published: October 2022

This commentary article discusses the recent trends and changes in popularity of telehealth usage as well as the most recent efforts to redefine telehealth value and usability. Six strategies to improve the patient experience and increase telehealth acceptance by overcoming simultaneous barriers are presented, which include (1) creating a new healthcare paradigm using telehealth, (2) scheduling the telehealth visit, (3) preparing for the telehealth visit, (4) conducting the telehealth visit, (5) using data and biomarkers, and (6) providing digital equity. With the application of these strategies, we believe that the recent decline in the popularity of telehealth can be reversed.
Cordyceps militaris Extract and the Main Component, Cordycepin, Modulate the Functions of Prostate Cancer Cells Partially Through the Adenosine A1 Receptor
Authors: Kusama Kazuya , Suzuki Takumi , Motohashi Ryosuke , Nobusawa Takumi , Ota Koichiro , Azumi Mana , Yoshie Mikihiro , Miyaoka Hiroaki , Tamura Kazuhiro
Published: October 2022

Our previous study demonstrated that an extract of Cordyceps militaris (CM) derived from Samia Cynthia ricini inhibits testosterone-induced prostate hypertrophy in an animal model. However, the bioactive components in the CM extract that modulate the function of prostate cells have not been identified and characterized. To do this, the present study explored the effective component(s) from CM that influences the viability of androgen-responsive LNCaP prostate cancer cells and androgen-independent PC3 prostate cancer cells. Several fractions of CM, separated by gel filtration chromatography, decreased the viability and proliferation of both types of prostate cancer cells in either the presence or absence of testosterone propionate (TP). The fractions reduced TP-induced expression of the androgen-regulated genes FKBP5, TMPRSS2, and KLK3. NMR identified cordycepin, adenosine, and uridine as the active components in the CM fractions. The proliferation of LNCaP cells was inhibited by cordycepin, but not by either adenosine or uridine. Cordycepin, adenosine, and uridine reduced TP-mediated increases in FKBP5 and TMPRSS2 expression, and TP-mediated phosphorylation of the androgen receptor. Specific adenosine A1, A2, and A3 receptor antagonists did not block the inhibitory effects of cordycepin on cell proliferation, whereas the A1 receptor antagonist CPDPX (8-cyclopentyl-1,3-dipropylxanthine) reversed cordycepin-mediated inhibition of FKBP5 and TMPRSS2 expression. Thus, cordycepin exhibited both adenosine receptor–independent and adenosine A1 receptor–dependent effects. These findings suggest that cordycepin inhibits the proliferation of prostate cells independently of adenosine receptors, and that its modulatory effect on androgen-regulated gene expression is mediated through the adenosine A1 receptor.
A Field-expedient Arm Care Screening Tool Can Identify Musculoskeletal Risk Factors in Baseball Players
Authors: Matsel Kyle A. , Hoch Matt C. , Butler Robert J. , Westgate Philip M. , Malone Terry R. , Uhl Tim L.
Published: October 2022

Background:

Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time prevent high school baseball coaches from performing movement screens on their players.

Hypothesis:

The arm care screen (ACS) will be highly sensitive to detecting musculoskeletal risk factors.

Study Design:

Cross-sectional.

Level of Evidence:

Level 3.

Methods:

A total of 150 baseball players were independently scored on the ACS electronically by reviewing a video recording of each player’s screening performance. Discriminability of the ACS was determined with a 2 × 2 contingency table dichotomizing musculoskeletal risk factors as present or absent based on a predetermined cutoff value and those who passed or failed the corresponding ACS subtest.

Results:

High sensitivity was observed on the reciprocal shoulder mobility (0.89; 95% CI 0.81-0.94), 90/90 total body rotation (0.86; 95% CI 0.79-0.92), and lower body diagonal reach (0.85; 95% CI 0.78-0.91) tests of the ACS suggesting sufficient ability to identify musculoskeletal impairments and risk factors.

Conclusion:

The ACS is a simplistic screening tool that the coach can administer to discriminate between youth, high school, and college-level baseball players who possess musculoskeletal risk factors. The ACS subtests demonstrated high sensitivity for correctly identifying musculoskeletal risk factors common in baseball players and can be useful as a screening tool for baseball coaches developing arm care exercise programs.

Clinical Relevance:

A field-expedient screen could provide coaches the ability to identify musculoskeletal risk factors that need to be addressed to minimize injury risk factors in a time-efficient manner.
New School Principals’ Training Experiences and Transition to Leadership Roles in Urban Education: A Mixed-Methods Approach
Authors: Giraldo-García Regina J. , Orozco Luis E.
Published: October 2022

This study used a mixed-methods explanatory design and Mezirow’s transformative learning theory to explore the experiences of new school principals in a professional development leadership program and its influence on their self-efficacy as leaders in a Midwestern urban K-12 school district. Surveys, semi-structured interviews, reflection notes, and analytical memos were used as data sources. Key findings included (a) transformation in perceived self-efficacy resulting from program participation and (b) engagement in critical reflection on their role as school leaders. The findings suggested that new principals need support following the leadership training and more research on their experiences after assuming leadership roles.
Understanding Health Self-Management Challenges and Needs for Older Adults with and without Mobility and Sensory Disabilities
Authors: Nie Qiong , Rogers Wendy A.
Published: October 2022

Health self-management could be challenging for older adults with disabilities and technology has great potential to support them for managing health activities. Assessing users’ needs is a significant technique to develop useful technologies. However, studies overwhelmingly collected and analyzed qualitative data in smaller samples or quantitative data in populations with single type of disability. This study aimed to analyze a national level dataset to assess the frequency of and challenges with managing health activities in older population with and without disabilities and identify potential support solutions to provide guidance for technology interventions. In this study, 4,541 older adults from the National Health and Aging Trends Study were grouped into five sub-groups (non-disability, mobility, vision, hearing, multiple disability). The findings indicated lower participation in wellness activities (e.g., exercise) than disease management activities (e.g., taking medicines, going to medical appointment). Around one tenth of older adults reported difficulty with tracking medicines and 23.4%-64.3% of respondents reported being accompanied during medical appointments. Managing health activities was more challenging for older adults with mobility and multiple disabilities. They were more likely to have difficulties and receive assistance with managing these activities, including accessing online health information. In conclusion, needs of older adults to manage health varied across activities and for people with different types of disabilities. We provide direction for person-centered and tailored interventions to respond to these needs.
Using Journey Mapping to Visualize Patient Experiences for Quality Improvement Initiatives
Authors: Maddox Kyle , Masalonis Anthony , Motiwala Aneesa , Adams Kathleen , Eugene Nakina , Speir Ross
Published: October 2022

Journey mapping is a powerful user experience tool depicting customers’ interactions with an enterprise. This paper shows how the U.S. Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention (OMHSP), and the Veterans Health Administration (VHA) Office of Health Informatics (OHI) Human Factors Engineering Group, utilized journey mapping to discover patients’ psychotherapy experiences. The team conducted semi-structured interviews with Veterans, Caregivers, and Psychotherapy providers; and focus groups with OMHSP stakeholders, presenting successive iterations of four journey maps. The study used interview data to produce maps detailing representative depression patients’ mental health care experiences including: a patient suffering from coronavirus (COVID-19); a patient experiencing homelessness; a highly functional patient navigating implicit racial bias; and a patient resistant to therapy and his caregiver. The study identified areas of success and opportunities for improvement. Key findings included the importance of primary care in referrals; the desire to include family members in treatment; travel concerns in patients’ decisions about their care; the importance of viewing mental health care as part of a holistic view incorporating Veterans’ infrastructure (housing, employment, technology access, etc.); and varying levels of comfort toward technology and telehealth. The data also show opportunities to utilize health information technology to improve psychotherapy data collection and effect targeted quality improvement.
Communicating Level of Certainty Associated with Human Factors Findings and Recommendations in Healthcare
Authors: Fuller Helen J.A. , Adams Kathleen
Published: October 2022

While there is a need for human factors engineering (HFE) in health systems design, the pace of operations in most healthcare systems often requires deviation from optimal HFE practices. We must provide sufficiently useful and usable findings to the design team and stakeholders to support project decisions while also tempering their expectations and properly calibrating their level of certainty around the findings and recommendations. As members of an HFE team in a series of projects related to the implementation of a new electronic health record (EHR) in a large healthcare system, we describe some early efforts with project teams and initial missteps that limited the effectiveness of HFE work. We also describe communication strategies we are piloting that appear to achieve better results in terms of project team engagement, stakeholder buy-in, and validity and utility of findings.
Accelerating the Continuous Improvement of Connected Medical Devices Using Product Analytics
Authors: Horton Randy , Moll Bob , Yew Ke Li
Published: October 2022

Data acquisition on how users are using your product can often be slow to obtain and not lend itself to large-scale deployments or fast release updates. Product analytics is an integrated set of data about your users’ behaviors that allows you to analyze these behaviors, both at the level of the individual user and in aggregate, to gain insights about larger patterns and trends in real time. The use of product analytics in MedTech is still nascent but holds tremendous promise to help turbocharge an evolution towards the frequent release of medical devices. In the context of Software as a Medical Device (SaMD), digital therapeutics (DTx), and other types of connected medical devices, product analytics adds value in three different areas: device design and development, device operations and end-user support, and helping users better use their device and improve their health outcomes.
The Best of Both Worlds: Using Qualitative and Quantitative Feedback to Improve the Design of Connected Medical Devices
Authors: Horton Randy , Moll Bob , Yew Ke Li
Published: October 2022

The medical device industry has a long legacy of product development processes that are heavily influenced by the design of the device hardware. As devices have become connected, often to smartphones via connections such as Bluetooth, software is playing an increasing role in the overall system and in particular the user interface. As a result, iterative agile design practices that are prevalent in software are starting to influence the connected device development process. These modern agile practices put the user at the center of the design problem. But what is the best way in this new world to get feedback from users such that the overall product can be improved? In this paper, we share two techniques, one qualitative and one quantitative, that can answer this question. We’ll also explore the synergy of using both techniques together.
Role of Trust in AI-Driven Healthcare Systems: Discussion from the Perspective of Patient Safety
Authors: Bilal Unver Mehmet , Asan Onur
Published: October 2022

In the field of healthcare, enhancing patient safety depends on several factors (e.g., regulation, technology, care quality, physical environment, human factors) that are interconnected. Artificial Intelligence (AI), along with an increasing realm of use, functions as a component of the overall healthcare system from a multi-agent systems viewpoint. Far from a stand-alone agent, AI cannot be held liable for the flawed decisions in healthcare. Also, AI does not have the capacity to be trusted according to the most prevalent definitions of trust because it does not possess emotive states or cannot be held responsible for their actions. A positive experience of AI reliance come to be indicative of ‘trustworthiness’ rather than ‘trust’, implying further consequences related to the patient safety. From a multi-agent systems viewpoint, ‘trust’ requires all the environmental, psychological and technical conditions being responsive to patient safety. It is fertilized for the overall system in which ‘responsibility’, ‘accountability’, ‘privacy’, ‘transparency; and ‘fairness’ need to be secured for all the parties involved in AI-driven healthcare, given the ethical and legal concerns and their threat to the trust.
A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System
Authors: Sridhar Srinivasan , Carnegie Nicole , Mouat-Hunter Amy , McCrory Bernadette
Published: October 2022

Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value < 0.01), discharge disposition (P-value < 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.
Virtual Family-Centered Rounds During the COVID-19 Pandemic – Technology Usability Analysis
Authors: Attef Maryam , Dulude Catherine , Trudel Chantal , Buba Melanie
Published: October 2022

Family-centered rounds (FCR) are multidisciplinary rounds, involving patients and caregivers with the aim of shared decision making in medical care planning. In response to the COVID-19 pandemic, a tertiary care pediatric hospital re-engineered the in-person FCR process used by inpatient Pediatric Medicine teams implemented virtual family-centered rounds (vFCR). As part of a mixed methods study evaluating vFCR, naturalistic observation was used to evaluate the usability of vFCR technology. Functional and user requirements were assessed and confirmed through observation of interactions with technology intended to support vFCR. The duration of individual patient rounds and transition time between patients was also captured. Technology interactions were assessed in terms of what worked (successful interactions) and what did not work (usability issues and errors). Neilsen and Norman’s (1994) usability heuristics were used to support the evaluation and explanation of findings. While naturalistic observation yielded clear results in terms of effectiveness and efficiency, user satisfaction was not formally examined. The identified usability requirements and key characteristics for ease of use and adoption of vFCR identified in this study can be used by other hospitals looking to implement or improve inpatient virtual care technology usability.
Factors Influencing the Willingness to Download COVID-19 Contact Tracing Apps: The Moderating Effect of Persuasive Design and Smartphone Usage Experience
Authors: Oyibo Kiemute , Pelegrini Morita Plinio
Published: October 2022

The COVID-19 pandemic culminated in the global roll-out of contact tracing apps, also known as exposure notification apps (ENAs), to contain the spread of the virus. ENAs notify users about a possible infection and advises them to take certain health measures such as self-isolation and COVID-19 test. While some work has been done on the factors that influence ENA adoption, little attention has been paid to the moderating effect of persuasive design and smartphone usage experience. This paper sets out to bridge this gap using the Government of Canada’s official app “COVID Alert” and Canadian non-adopter population (n = 133) as a case study. Of the seven factors we investigated, perceived trust (β = 0.29, p < 0.01) and perceived enjoyment (β = 0.21, p < 0.05) turned out to be the only significant predictors of non-adopters’ willingness to download the app in the overall model. Both persuasive design and smartphone usage experience moderated some of the relationships in the model. For example, while perceived enjoyment is significant in the persuasive design submodel (β = 0.34, p < 0.01) and low-experience submodel (β = 0.36, p < 0.001), it is not in the control design and high-experience submodels. Moreover, perceived enjoyment (β = 0.36, p < 0.001) and privacy concern (β = -0.46, p < 0.05) turned out to be the strongest predictors in the low-experience and high-experience submodels, respectively. These results indicate that, to improve the download of ENAs, sponsors should implement and highlight app features that foster trust in marketing campaigns and app-store descriptions. Particularly, they should highlight their privacy-protection feature and hedonic attribute among the high-experience and low-experience groups, respectively.