bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study
Authors: Oprea Diana , Sauvé Nadine , Pasquier Jean-Charles
Published: December 2021

Background

Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome.

Methods

This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome.

Results

Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different.

Conclusion

Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.
ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline
Authors: Brinlee Alexander W. , Dickenson Scott B. , Hunter-Giordano Airelle , Snyder-Mackler Lynn
Published: December 2021

Context:

Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians’ current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice.

Evidence Acquisition:

Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms ACLR protocols, guidelines, ACLR rehabilitation, ACL graft, ACL open kinetic chain (OKC) exercise and closed kinetic chain (CKC) exercise, ACLR return to sport, ACLR psychological factors, and ACL injury prevention.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey–Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline.

Conclusion:

Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport.

Strength of Recommendation Taxonomy (SORT):

B.
Recurrent, oral cavity tumor-like exophytic lesions mimicking neoplastic disease in a patient with history of human papillomavirus-mediated squamous cell carcinoma
Authors: Hawthorne McKenna , Tham Tristan , Ponder Brent , Georgolios Alexandros
Published: December 2021

Reactive hyperplasia is a phenomenon responsible for exophytic lesions in the oral cavity, and may appear to be suspicious, especially in patients who have a significant history of malignancy. Here, we present a case of reactive hyperplasia mimicking recurrence in a patient who was previously treated for tonsillar carcinoma. Physicians who commonly see patients with oral lesions, particularly oral surgeons and otolaryngologists, should be cognizant of the unusual presentation of these lesions as they may mimic the physical characteristics of recurrence.
Political Messaging Over Time: A Comparison of US Presidential Candidate Facebook Posts and Tweets in 2016 and 2020
Authors: Stromer-Galley Jennifer , Rossini Patrícia , Hemsley Jeff , Bolden Sarah E. , McKernan Brian
Published: December 2021

Political campaigns have a temporal nature, which means that the strategic environment shapes the nature of candidate communication, especially the stages of campaigning—from surfacing to the general election. As social media platforms have matured and political campaigns have normalized their use of those platforms in this decade, this study examines the 2016 and 2020 US presidential campaign communication on Facebook and Twitter using data from the Illuminating project at Syracuse University. Our objective is to explore how the stages of the campaign cycle shape political communication. We also explore social media platforms as additional factors. Moreover, given the distinct and anti-normative communication style of Donald Trump, we examine whether his communication is an outlier relative to his competition in the primaries and the general election, and while a challenger in 2016 and an incumbent in 2020. Our results suggest that campaign messaging changes over the stages of the campaign, with candidates more likely to advocate for themselves during the crowded primaries, and then engage in high volumes of calls to action in the general election. The 2016 posts were substantially more attack-focused than in 2020. There is some evidence to suggest that the global pandemic affected the ways in which campaigns used their social media accounts. Of note, campaigns seem to heavily rely on Facebook for all types of strategic communication, even as the academic community primarily analyzes Twitter. Finally, Trump’s sum-total of his discourse is less negative than Clinton’s in 2016 and more advocacy-focused, overall.
Applying a Christian perspective to educating gifted students through the talent development framework
Authors: Mofield Emily L , Mofield William EA
Published: December 2021

In this article, we examine conceptions of giftedness through a Christian perspective and through a talent development paradigm ( Subotnik et al., 2011 ). We intersect aims of Christian education with a developmental view of giftedness in order to inform pedagogical approaches in educating gifted/high-potential students. In applying the characteristics of Christian pedagogy of uniqueness, purpose, stewardship, and Christian character, teachers of the gifted can create contexts for students to explore authentic learning experiences in ways that develop specific strengths and talents for kingdom purposes.
GPS for Success: A Practitioner-Based Study With High School Students
Authors: Spargo Allison , Mullen Patrick , Gutierrez Daniel , Kramer Jennifer
Published: December 2021

We describe the conceptual framework and practitioner-based study outcomes of a school-based substance use prevention intervention focused on strengthening student commitment to their personal vision. This study found increases related to goal clarity and identification of a mentor following the intervention. We suggest implications for future school-based substance use prevention services and future research to evaluate the program.
Past and Present: Surveying Medieval India Amidst the Present Perceptions of the Past in Popular Medium
Authors: Zafar Samana , Ahmad Khanday Pervaiz
Published: December 2021

In today’s Indian cinema, there is a deluge of films based on historical background. One of the central themes of many of these movies is the description and the representation of the ‘other’. Padmavat is the quintessential example and sums up all the ideas served in movies of this genre which were released before and after it. Padmini, Ratan Sen, Alauddin Khalji as depicted in the movie are the tropes through which the idea about a particular period of Indian history is creatively visualised and presented. It also forms the perception of the past at the popular level and helps in the development of common consciousness and majoritarian common sense. In the light of this kind of cinema, this article tries to survey medieval India based on the reading of the historical sources to understand the nature of various kinds of binary and otherness through the multifarious representations of the other.
Engaging in Anti-Oppressive Public Health Teaching: Challenges and Recommendations
Authors: Aqil Anushka R. , Malik Mannat , Jacques Keilah A. , Lee Krystal , Parker Lauren J. , Kennedy Caitlin E. , Mooney Graham , German Danielle
Published: December 2021

Introduction. Public health students are not systematically trained how positionality and power impact public health practice. A grounding in anti-oppression equips practitioners with tools to recognize the impact of present and historical contexts, foster critical self-reflection, and address systems of oppression. The goal of this study was to gather evidence of how anti-oppression is incorporated in public health teaching. Method. Purposive sampling was used to identify public health faculty who engage in anti-oppressive practice across accredited schools of public health espousing an explicit commitment to social justice. Semistructured in-depth interviews were conducted between January and April 2020 via Zoom; analyses were informed by constructivist grounded theory. Results. Twenty-six faculty from eight schools of public health and one school of medicine participated. Participants highlighted challenges in and techniques on how to engage in anti-oppressive teaching. Three overarching methods for incorporating anti-oppressive principles in pedagogy were identified: facilitating critical consciousness, creating equitable and mindful classrooms, and discussing historical context and systems of oppression, alongside discussing challenges associated with using an anti-oppressive lens in teaching. Conclusions. Anti-oppression is an explicit framework that can be incorporated in training future public health practitioners to work toward dismantling systems of oppression through addressing issues of power and privilege. Findings from this study indicate that faculty are interested in and engage in anti-oppressive teaching but lack consistent training and institutional support. This study offers tools that faculty can employ in the classroom toward practicing anti-oppressive public health pedagogy.
Exploring Disaster Mitigation in India: A Financial Viewpoint
Authors: Sharma Sanjay
Published: December 2021

Disaster management is a multidimensional and multistage process. It broadly includes preparedness, rescue, relief rehabilitation and mitigation. Disaster mitigation is an integral part of disaster management. In fact, it is an act of pre disaster stage. It involves the material and social activities to convert disaster-prone areas into disaster resilient one. Disaster mitigation requires proper vulnerability mapping and funds to carry out disaster specific mitigative activities. It is for this reason that Disaster management Act 2005 provides for creation of Disaster Mitigation Funds at national, state and district levels. Irrespective of the consistent demands from states various finance commissions did not recognizing mitigation as an integral part of disaster risk funding as mitigation was left up to the centrally sponsored schemes. However, this task was performed by 15th Finance Commission by creating and allocating the disaster mitigation funds. The FC-XV replaced the earlier expenditure based allocation of funds and devised a new formula based on physical and socio-economic factors like vulnerability of a state to selected disasters like flood and drought and its ratio of poverty. It is under this background that the present research article makes a modest attempt to explore the financial perspective of disaster mitigation in India. Methodologically speaking this paper applies qualitative and qualitative research tools. It is analytical and descriptive in approach and exploratory in its findings. Major part of the present research is based on the primary sources like reports and acts of government of India and texts of international agreements. In addition, it also includes secondary sources like books and journals.
Early Symptoms of Patients With COVID-19 in Family Medicine Centers in South India: A Retrospective Study
Authors: Rahman Sajitha M. F. , Pricilla Ruby Angeline , Biswas Arnab , Dharmasivam Vinodhini , Abraham Sunil , Sankarapandian Venkatesan
Published: December 2021

Introduction:

A recent Cochrane review on the diagnostic accuracy of initial signs and symptoms of COVID-19 reported on the lack of evidence from studies conducted in community-based health-care settings. Since a broad spectrum of patients present to primary health-care services, testing for patients with noninfluenza-like illness and atypical presentations is debatable. Hence, there is an urgent need for documenting the early presenting symptoms of COVID-19 among patients seeking medical care in primary health-care settings.

Aim:

In this study, we aim to document the early symptoms of patients with COVID-19 and the proportion of asymptomatic infection in family medicine centers in South India.

Design:

This is a retrospective study of the early symptoms of patients who tested positive between June and December 2020. The data and clinical notes of patients were retrieved from the hospital information system.

Setting:

This study was undertaken by the Department of Family Medicine (DFM) in a private not-for-profit academic institution in South India. The DFM provides primary and secondary health-care services to nearly 1,50,000 patients from the local urban communities.

Results:

A total of 330 patients were tested for COVID-19 and the study included 94 patients who tested positive. Around 37% participants were asymptomatic. The commonest symptom was fever (58.6%), followed by tiredness/myalgia (48.3%), loss of taste or smell or appetite (43.1%), and cough or cold (37.9%). Most participants (78.2%) were hospitalized and the rest (21.8%) were home-quarantined. Only 5 (5.7%) of them died due to COVID-19 infection.

Conclusion:

The results of the study reiterates the role of social distancing, self-isolation, proper masking, and greater vaccination coverage as significant public health interventions.
Investigational curative gene therapy approaches to sickle cell disease
Authors: Williams David A. , Esrick Erica
Published: December 2021

Sickle cell disease (SCD) is an inherited blood condition resulting from abnormal hemoglobin production. It is one of the most common genetic diseases in the world. The clinical manifestations are variable and range from recurrent acute and debilitating painful crises to life-threatening pulmonary, cardiovascular, renal, and neurologic complications. The only curative treatment of SCD at this time is bone marrow transplantation (also called hematopoietic stem cell transplantation) using healthy blood stem cells from an unaffected brother or sister or from an unrelated donor if one can be identified who is a match in tissue typing. Unfortunately, only a minority of patients with sickle cell has such a donor available. The use of autologous hematopoietic stem cells and alternative types of genetic modifications is currently under study in clinical research trials for this disease. The approaches include the use of viral vectors to express globin genes that are modified to prevent sickle hemoglobin polymerization or to express interfering RNAs to “flip the switch” in adult red cells from adult β-sickle hemoglobin to fetal hemoglobin using a physiologic switch, and several gene editing approaches with the goal of inducing fetal hemoglobin or correcting/modifying the actual sickle mutation. In this audio review, we will discuss these different approaches and review the current progress of curative therapy for SCD using gene therapy.
Sheet Bulk Forming of Thin-Walled Components with External Gearing through Upsetting Using Controllable Deformation Zone Method
Authors: Zhuang Xincun , Liang Meile , Zhu Shengfa , Zhu Yin , Zhao Zhen
Published: December 2021

Sheet-bulk metal forming (SBMF) is a promising process for manufacturing complex sheet components with functional elements. In this study, the entire forming process for a typical thin-walled component with external gearing is investigated, including sheet forming and bulk forming processes. Deep drawn cups are prepared during sheet forming; subsequently, upsetting is performed on the sidewall to form external gearing. The upsetting method performed is known as upsetting with a controllable deformation zone (U-CDZ). Compared with the conventional upsetting method, a floating counter punch with a counter force is used in the U-CDZ method such that the forming mechanism is changed into the accumulation of the deformation zone instead of deformation throughout the entire sidewall. The effects of the counter force and material flow are investigated to understand the mechanism. The forming quality, i.e., the formfilling and effective strain distribution, improved, whereas a high forming load is avoided. In addition, a punch with a lock bead is used to prevent folding at the inner corner during the experiment.
Computational modelling of chromosomally clustering protein domains in bacteria
Authors: Cotroneo Chiara E. , Gormley Isobel Claire , Shields Denis C. , Salter-Townshend Michael
Published: December 2021

Background

In bacteria, genes with related functions—such as those involved in the metabolism of the same compound or in infection processes—are often physically close on the genome and form groups called clusters. The enrichment of such clusters over various distantly related bacteria can be used to predict the roles of genes of unknown function that cluster with characterised genes. There is no obvious rule to define a cluster, given their variability in size and intergenic distances, and the definition of what comprises a “gene”, since genes can gain and lose domains over time. Protein domains can cluster within a gene, or in adjacent genes of related function, and in both cases these are chromosomally clustered. Here, we model the distances between pairs of protein domain coding regions across a wide range of bacteria and archaea via a probabilistic two component mixture model, without imposing arbitrary thresholds in terms of gene numbers or distances.

Results

We trained our model using matched gene ontology terms to label functionally related pairs and assess the stability of the parameters of the model across 14,178 archaeal and bacterial strains. We found that the parameters of our mixture model are remarkably stable across bacteria and archaea, except for endosymbionts and obligate intracellular pathogens. Obligate pathogens have smaller genomes, and although they vary, on average do not show noticeably different clustering distances; the main difference in the parameter estimates is that a far greater proportion of the genes sharing ontology terms are clustered. This may reflect that these genomes are enriched for complexes encoded by clustered core housekeeping genes, as a proportion of the total genes. Given the overall stability of the parameter estimates, we then used the mean parameter estimates across the entire dataset to investigate which gene ontology terms are most frequently associated with clustered genes.

Conclusions

Given the stability of the mixture model across species, it may be used to predict bacterial gene clusters that are shared across multiple species, in addition to giving insights into the evolutionary pressures on the chromosomal locations of genes in different species.
Choline intake and associations with egg and dairy consumption among pregnant women attending a high-risk antenatal clinic in South Africa: the NuEMI study
Authors: Robb Liska , Joubert Gina , Jordaan Elizabeth Margaretha , Ngounda Jennifer , Walsh Corinna May
Published: December 2021

Background

The importance of adequate choline intake during pregnancy has been well documented, but low intake is common. Total choline intake, main food sources of choline, as well as associations between choline intake and egg and dairy consumption were determined in a sample of pregnant women attending the high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa.

Methods

A cross-sectional study design was used. Trained fieldworkers collected dietary intake data using a validated quantified food frequency questionnaire (QFFQ), after which all food items were matched to foods in the USDA Database for the Choline Content of Common Foods (Release 2) to quantify choline intake. Logistic regression with backward selection (p < 0.05) was used to determine whether egg and dairy consumption were independently associated with a choline intake below the adequate intake (AI) level.

Results

The median daily intake of choline was 275 mg (interquartile range 185 mg – 387 mg) (N = 681). Most participants (84.7%) consumed less than the AI of 450 mg/day for choline. Meat and meat products, cereals, eggs and dairy contributed mostly to choline intake. Food items that contributed most to choline intake included full-cream milk, maize porridge, brown bread, deep-fried potatoes and deep-fried dough (vetkoek). A choline intake below the AI was significantly associated with lower egg and dairy intakes (p < 0.0001 and p = 0.0002 respectively).

Conclusion

Most pregnant women in the current study had choline intakes below the AI. It is recommended that public health messaging targeted at pregnant women promote the consumption of foods that can significantly contribute to choline intake, such as eggs and dairy.
A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the ‘Childhood Obesity: a plan for action’ (2016, 2018, 2019)
Authors: Griffin Naomi , Phillips Sophie M. , Hillier-Brown Frances , Wistow Jonathan , Fairbrother Hannah , Holding Eleanor , Powell Katie , Summerbell Carolyn
Published: December 2021

Background

The UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas.

Methods

Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions.

Results

While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children.

Conclusions

We propose an alternative conceptualisation of the policy ‘problem’, that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.
A community-centric multi-disciplinary education program with the 8-section brocade Tai Chi therapy for patients with osteoarthritis of the knee – a pilot study
Authors: Ho Kevin Ki-Wai , Pong Gerald , Poon Queena Wai-Chin , Kwok Jojo Yan-Yan , Chau Wai-Wang , Ong Michael Tim-Yun
Published: December 2021

Background

Osteoarthritis (OA) of the knee is one of the most common chronic degenerative joint diseases, and a multi-disciplinary approach to educating patients with OA knee are effective in symptoms management. Tai Chi exercise is a novel approach to relieving knee OA symptoms. Combining both educational program and Tai Chi has not yet been explored.

Methods

Multi-disciplinary education program included a total of 4-week 2-h weekly talks delivered by different health professionals with live demonstrations. This was then followed by a 1-h Tai Chi class (Baduanjin). Results from IPAQ (Physical activity level), WOMAC (evaluate knee OA conditions), and SF-36v2 (quality of life) were collected at the first class of education program, 3 and 6 months after the end of Tai Chi class. CSQ-8 (program effectiveness) was administered on the last day of Tai Chi class.

Results

One hundred and twelve patients joined the program. The overall attendance was over 90% with close-to-zero dropout rate. Satisfaction scored high in 85% of patients. WOMAC pain scores (p = 0.04) and SF-36v2 emotional role (p = 0.02) were statistically decreasing (improving) at 6 months after the program. SF-36v2 physical role and mental health tended to improve with time.

Conclusions

Combining both multidisciplinary education program program and Tai Chi exercise for knee OA patients was proven feasible. This program received high satisfaction, high attendance and very low dropout rates without any adverse event. Patients’ pain and emotion were significantly improved. A large-scale randomized trial introducing a control group is recommended.

Trial registration

Registry: ClinicalTrials.gov

Registration number: NCT04204213

Date of registration: 18/12/2019 (Retrospectively registered)
Factors influencing student’s specialty choices in Lomé faculty of medicine (Togo)
Authors: Teclessou Julienne Noude , Dabouda Aminou , Akakpo Sefako , Kassang Panawe , Saka Bayaki , Kombate Koussake , Pitche Palokinam
Published: December 2021

Background

The choice of specialty in medicine is an important decision for the individual, but also for health system. This choice combined personals reasons, professional desires and needs of the health system. The number of specialists in the country depends of this choice. Very few studies have focused on factors influencing the choice of specialties among medical students in Africa. Also, in the absence of specialist needs planning in Togo. This study, aims to determine the factors influencing the choice of specialty among students at the Faculty of Health Sciences of the University of Lomé (FSS-UL).

Methods

This was a descriptive cross-sectional study that took place from June 1 to June 30, 2019 with medical students of the doctoral cycle and doctors in specialization studies in the various Diploma of Special Study (DSS) available at the FSS-UL.

Data collection was done at the surveyed’s training sites. Pre-established and pre-tested fact sheets were giving and explained to the students by data collection team. Data collection team return at the surveyed’s training sites 72 h after to collect pre-established fact sheets. Following variables study including: factors (individual; related to the medical curriculum); the advantages and attractiveness of the specialty that can influence students’ choice. Data analysis was carried out using Epi Info 6.0 software. The significance threshold was 5%.

Results

At the time of the survey, the FSS-UL had 147 doctoral students and 211 specialty students. A total of 251 participants responded to the questionnaires. These included 140 doctoral students and 111 specialty students. The choice of specialties requiring night work such as gynecology, surgery was significantly associated with the male sex (p = 0.001). There was significant association between having financial support (p = 0.001), remuneration related to the specialty (p = 0.0001) and the decision to beginning specialty studies immediately completing general medical studies. Interest in lectures (p = 0.003), teacher support as a mentor in the specialty (p = 0.01) and easy accessibility to teachers (p = 0.008) were medical curriculum factors significantly associated with specialty choice. Facility to work in public and private sector was mentioned by 55.3% of respondents who chose gynecology (p = 0.03).

Interest in lectures (p = 0.003), was significantly associated with choice of fundamental sciences; and work in international fields was significantly associated with the choice of pediatric and public health (p = 0.0001).

Conclusion

Factors influencing the choice of certain specialty were balance between family and professional life; financial support to studies, the remuneration opportunities related to the specialty, access to university career. Intervention on these factors will allow a balance between the numbers of doctors trained in the different specialties.
Medication discrepancies among hospitalized patients with hypertension: assessment of prevalence and risk factors
Authors: Abu Farha Rana , Yousef Alaa , Gharaibeh Lobna , Alkhalaileh Waed , Mukattash Tareq , Alefishat Eman
Published: December 2021

Background

Medication errors remained among the top 10 leading causes of death worldwide. Furthermore, a high percentage of medication errors are classified as medication discrepancies. This study aimed to identify and quantify the different types of unintentional medication discrepancies among hospitalized hypertensive patients; it also explored the predictors of unintentional medication discrepancies among this cohort of patients.

Methods

This was a prospective observational study undertaken in a large teaching hospital. A convenience sample of adult patients, taking ≥4 regular medications, with a prior history of treated hypertension admitted to a medical or surgical ward were recruited. The best possible medication histories were obtained by hospital pharmacists using at least two information sources. These histories were compared to the admission medication orders to identify any possible unintentional discrepancies. These discrepancies were classified based on their severity. Finally, the different predictors affecting unintentional discrepancies occurrence were recognized.

Results

A high rate of unintentional medication discrepancies has been found, with approximately 46.7% of the patients had at least one unintentional discrepancy. Regression analysis showed that for every one year of increased age, the number of unintentional discrepancies per patient increased by 0.172 (P = 0.007), and for every additional medication taken prior to hospital admission, the number of discrepancies increased by 0.258 (P= 0.003). While for every additional medication at hospital admission, the number of discrepancies decreased by 0.288 (P < 0.001). Cardiovascular medications, such as diuretics and beta-blockers, were associated with the highest rates of unintentional discrepancies in our study. Medication omission was the most common type of the identified discrepancies, with approximately 46.1% of the identified discrepancies were related to omission. Regarding the clinical significance of the identified discrepancies, around two-third of them were of moderate to high significance (n= 124, 64.2%), which had the potential to cause moderate or severe worsening of the patient´s medical condition.

Conclusions

Unintentional medication discrepancies are highly prevalent among hypertensive patients. Medication omission was the most commonly encountered discrepancy type. Health institutions should implement appropriate and effective tools and strategies to reduce these medication discrepancies and enhance patient safety at different care transitions. Further studies are needed to assess whether such discrepancies might affect blood pressure control in hypertensive patients.
‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia
Authors: Petrie Katherine , Deady Mark , Lupton Deborah , Crawford Joanna , Boydell Katherine M. , Harvey Samuel B.
Published: December 2021

Background

Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training.

Method

Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach.

Results

Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being.

Conclusion

The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training.
TRB3 mediates vascular remodeling by activating the MAPK signaling pathway in hypoxic pulmonary hypertension
Authors: Cao Xiaopei , Fang Xiaoyu , Guo Mingzhou , Li Xiaochen , He Yuanzhou , Xie Min , Xu Yongjian , Liu Xiansheng
Published: December 2021

Background

Hypoxic pulmonary hypertension (PH) is a refractory pulmonary vascular remodeling disease, and the efficiency of current PH treatment strategies is unsatisfactory. Tribbles homolog 3 (TRB3), a member of the pseudokinase family, is upregulated in diverse types of cellular stresses and functions as either a pro-proliferative or pro-apoptotic factor depending on the specific microenvironment. The regulatory mechanisms of TRB3 in hypoxic PH are poorly understood.

Methods

We performed studies using TRB3-specific silencing and overexpressing lentiviral vectors to investigate the potential roles of TRB3 on hypoxic pulmonary artery smooth muscle cells (PASMCs). Adeno-associated virus type 1(AVV1) vectors encoding short-hairpin RNAs against rat TRB3 were used to assess the role of TRB3 on hypoxic PH. TRB3 protein expression in PH patients was explored in clinical samples by western blot analysis.

Results

The results of whole-rat genome oligo microarrays showed that the expression of TRB3 and endoplasmic reticulum stress (ERS)-related genes was upregulated in hypoxic PASMCs. TRB3 protein expression was significantly upregulated by hypoxia and thapsigargin. In addition, 4-PBA and 4μ8C, both inhibitors of ERS, decreased the expression of TRB3. TRB3 knockdown promoted apoptosis and damaged the proliferative and migratory abilities of hypoxic PASMCs as well as inhibited activation of the MAPK signaling pathway. TRB3 overexpression stimulated the proliferation and migration of PASMCs but decreased the apoptosis of PASMCs, which was partly reversed by specific inhibitors of ERK, JNK and p38 MAPK. The Co-IP results revealed that TRB3 directly interacts with ERK, JNK, and p38 MAPK. Knockdown of TRB3 in rat lung tissue reduced the right ventricular systolic pressure and decreased pulmonary medial wall thickness in hypoxic PH model rats. Further, the expression of TRB3 in lung tissues was higher in patients with PH compared with those who have normal pulmonary artery pressure.

Conclusions

TRB3 was upregulated in hypoxic PASMCs and was affected by ERS. TRB3 plays a key role in the pathogenesis of hypoxia-induced PH by binding and activating the ERK, JNK, and p38 MAPK pathways. Thus, TRB3 might be a promising target for the treatment of hypoxic PH.
Association between clinical and IVF laboratory parameters and miscarriage after single euploid embryo transfers
Authors: del Carmen Nogales María , Cruz María , de Frutos Silvia , Martínez Eva María , Gaytán María , Ariza Marta , Bronet Fernando , Garcia-Velasco Juan A.
Published: December 2021

Background

The goal of this study was to investigate which factors, excluding embryo aneuploidies, are associated with miscarriage in patients who have undergone a single euploid blastocyst transfer.

Methods

Retrospective, observational and multicenter study with 2832 patients undergoing preimplantational genetic testing for aneuploidies (PGT-A) due to repeated implantation failure, recurrent pregnancy loss, advanced maternal age or severe male factor were transferred one single euploid embryo.

Results

One of the main findings was a significant relationship between body mass index (BMI) and miscarriage rates (13.4% in underweight women, 12.1% in normal weight, 14.5% in overweight, and 19.2% in obese women, odds ratio [OD] 1.04; 95% confidence interval [CI], 1.01–1.07 p = 0.006). Endometrial thickness (OD 0.65; 95%, 0.52–0.77 p = 0.04) and type of endometrial preparation (natural cycle or hormone replacement cycle) (OD 0.77; 95%, 0.52–0.77, p = 0.04) were also associated with miscarriage rates.

Conclusions

BMI was strongly associated to miscarriage rates. We also observed a weaker association with endometrial thickness and with the type of endometrial preparation (natural cycle or hormone replacement cycle). None of the other studied variables (biopsy day, maternal and male age, duration of infertility, cycle length, previous miscarriages, previous live births, previous In Vitro Fertilization (IVF) cycles, endometrial pattern and/or diagnosis) were associated with miscarriage rates.
Transcriptional responses of Daphnis nerii larval midgut to oral infection by Daphnis nerii cypovirus-23
Authors: Kuang Wendong , Yan Chenghua , Zhan Zhigao , Guan Limei , Wang Jinchang , Chen Junhui , Li Jianghuai , Ma Guangqiang , Zhou Xi , Jin Liang
Published: December 2021

Background

Daphnis nerii cypovirus-23 (DnCPV-23) is a new type of cypovirus and has a lethal effect on the oleander hawk moth, Daphnis nerii which feeds on leave of Oleander and Catharanthus et al. After DnCPV-23 infection, the change of Daphnis nerii responses has not been reported.

Methods

To better understand the pathogenic mechanism of DnCPV-23 infection, 3rd-instar Daphnis nerii larvae were orally infected with DnCPV-23 occlusion bodies and the transcriptional responses of the Daphnis nerii midgut were analyzed 72 h post-infection using RNA-seq.

Results

The results showed that 1979 differentially expressed Daphnis nerii transcripts in the infected midgut had been identified. KEGG analysis showed that protein digestion and absorption, Toll and Imd signaling pathway were down-regulated. Based on the result, we speculated that food digestion and absorption in insect midgut might be impaired after virus infection. In addition, the down-regulation of the immune response may make D. nerii more susceptible to bacterial infections. Glycerophospholipid metabolism and xenobiotics metabolism were up-regulated. These two types of pathways may affect the viral replication and xenobiotic detoxification of insect, respectively.

Conclusion

These results may facilitate a better understanding of the changes in Daphnis nerii metabolism during cypovirus infection and serve as a basis for future research on the molecular mechanism of DnCPV-23 invasion.
The effect of intraoperative dexmedetomidine on cognitive dysfunction after surgery: a updated meta-analysis
Authors: Li Jianli , Yin Qifan , Xun Xuejiao , He Jinhua , Yu Dongdong , Wang Zhibin , Rong Junfang
Published: December 2021

Background

Postoperative cognitive dysfunction (POCD) is one of the most common. Neuroprotective effects of dexmedetomidine (DEX) are reported in previous studies but evidence regarding the POCD is still unclear. In order to gain latest evidence, the present study analyzes the outcomes of randomized controlled trials (RCTs) which utilized DEX with general anaesthesia perioperatively.

Method

Four online databases (PubMed, Embase, the Cochrane Library, and CNKI) were used to find relevant RCTs to conduct systematic analysis. All studies comparing the incidence of POCD or MMSE score between the DEX group and the placebo or comparator group in patients undergoing general anaesthetic surgery were eligible for inclusion. Based on the inclusion and exclusion criteria, the studies were selected. This meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous data and standardized mean difference (SMD) and 95% CIs for continuous data as effective measures.

Results

In total of 21 studies were included in this meta-analysis. The results showed that the incidence of POCD in DEX group was significantly lower than the control group on the first (OR = 0.36, 95% CI 0.24–0.54),third (OR = 0.45,95% CI 0.33–0.61) and seventh (OR = 0.40,95% CI 0.26–0.60) postoperative days; the MMSE scores in DEX group were higher than the control group on the first (SMD = 1.24, 95% CI 1.08–1.41), third(SMD = 1.09, 95%CI 0.94–1.24) and seventh (SMD = 3.28, 95% CI 1.51–5.04) postoperative days.

Conclusions

Intraoperative DEX use can ameliorate the POCD of patients who received surgical operations under general anesthesia, and effectively reduce the incidence of POCD and improve MMSE score.
Investigating N-3 Fatty Acids to prevent Neonatal Tobacco-related outcomeS (INFANTS): study protocol for a double-blind, randomized, placebo-controlled parallel clinical trial of n-3 polyunsaturated fatty acids in pregnant smokers
Authors: Murff Harvey J. , Greevy Robert A. , Sanghani Reesha S. , Hartmann Katherine E. , Hartert Tina V. , Graves Cornelia R. , Lee Scott S. , Tindle Hilary A.
Published: December 2021

Background

Tobacco use during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes, increasing the risk of preterm birth, intrauterine growth restriction and sudden infant death syndrome. Fewer than half of pregnant smokers can quit on their own. Identifying safe and effective therapies to prevent tobacco-related adverse pregnancy outcomes and/or increase smoking cessation in pregnant women would have a substantial public health impact. Cigarette smoking is associated with a relative deficiency in circulating n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) levels. A recent analysis found that smokers taking n-3 LCPUFAs during pregnancy had a reduction in preterm labor risk when compared to non-smokers. Studies have shown that supplemental n-3 LCPUFAs may also reduce nicotine cravings and daily cigarette use. Thus, smokers may benefit from supplemental n-3 LCPUFAs by lowering the risk of preterm labor and/or increased smoking cessation. To address important remaining knowledge gaps, we propose the Investigating N-3 Fatty Acids to prevent Neonatal Tobacco related outcomeS (INFANTS).

Methods

The INFANTS study is a multicenter, randomized, double-blind, placebo-controlled study that will randomize 400 pregnant smokers to either supplemental n-3 LCPUFAs or placebo. Participants will be enrolled between 12 and 24 weeks’ gestation and followed until 6 weeks after delivery. We will recruit from clinical centers throughout Middle Tennessee. We will assess smoking behavior after 12 weeks of supplementation using self-report and validated biomarkers of tobacco exposure. We will measure response to supplementation using biological markers of n-3 LCPUFA status. Our primary endpoint will be preterm labor as reflected by gestational age at delivery. Our secondary endpoint will be change from baseline in cigarettes per day at 12 weeks.

Discussion

This study tests the hypothesis that smoking-induced n-3 LCPUFA deficiencies contribute to tobacco-related adverse pregnancy outcomes and that supplementation of n-3 LCPUFAs in pregnant smokers may prevent these complications. If our study demonstrates that supplemental n-3 LCPUFAs are effective at reducing the risk of tobacco-related adverse neonatal outcomes and/or reducing tobacco use during pregnancy, our results could have an immediate and major impact on pregnancy care and neonatal outcomes.

Trial registration

ClinicalTrials.gov NCT04417595. Registered on April 21, 2020