bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Exercise on Acute Senescent Lymphocyte Counts: A Systematic Review and Meta-Analysis
Authors: Sardeli Amanda Veiga , Mori Marcelo A. , Lord Janet M.
Published: January 2022

Background: Highly differentiated, senescent lymphocytes are pro-inflammatory and contribute to age-related systemic inflammation, called inflammageing. There are several reports of acute changes in senescent lymphocyte counts post exercise, which potentially have consequences for systemic inflammation. However, there is little consensus since the studies differ with respect to participants, exercise protocols, cellular markers assessed, and the time point of assessment post exercise. Objective: We performed a systematic review and meta-analysis to assess the impact of exercise on senescent lymphocyte counts in blood immediately, 1 h and 2 h post exercise. Methods: The search was performed in PubMed (MEDLINE), Web of Science, Embase, Scopus, and Cochrane, on January 11, 2021. The 13 studies selected tested aerobic exercise effects, mainly in young men. They assessed the counts of lymphocytes (CD4 T cells, CD8 T cells, and NK cells), with the following immune cell marker combinations: KLRG1+, CD57+ (only NK cells), EMRA T cells (CD45RA+CCR7−CD28−CD27−), CD28−CD27−, KLRG1+CD28−, and CD28−. Independent extraction of articles was done by 2 researchers. Results: Standardized mean difference (SMD) and 95% confidence interval between baseline and post exercise showed significant increase (SMD >0.9, p < 0.003) in all types of senescent lymphocytes counts immediately post exercise. At 1 h post exercise, senescent CD4 T cells returned to baseline values (p = 0.74), CD8 T cells were reduced (−0.26 [−0.41; −0.11], p = 0.001), and senescent NK cells were raised (0.62 [0.14; 1.10], p = 0.01) above baseline. By 2 h post exercise, senescent CD4 T cells were reduced (−0.94 [−1.40; −0.48], p < 0.001), CD8 T cells remained below baseline (−0.53 [−1.04; −0.009], p = 0.04), and NK cells had returned to baseline values (−0.29 [−0.64; 0.07], p = 0.11). The main determinants of heterogeneity between studies were cytomegalovirus (CMV) serostatus and the characteristics of exercise protocols. CMV+ individuals had a higher immediate lymphocytosis and 1 h post lymphopenia than CMV− individuals. Exercise performed at higher intensities and shorter durations led to higher magnitude of change in senescent lymphocyte counts at all time-points. Conclusion: The differing effects of exercise on senescent NK cells and CD4 and CD8 T cells suggest differing susceptibility to factors modulating lymphocyte extravasation such as adrenaline and exercise intensity.
Closer to Nature: The Role of MSCs in Recreating the Microenvironment of the Hematopoietic Stem Cell Niche in vitro
Authors: Wuchter Patrick , Diehlmann Anke , Klüter Harald
Published: January 2022

Background: The stem cell niche in human bone marrow provides scaffolds, cellular frameworks and essential soluble cues to support the stemness of hematopoietic stem and progenitor cells (HSPCs). To decipher this complex structure and the corresponding cellular interactions, a number of in vitro model systems have been developed. The cellular microenvironment is of key importance, and mesenchymal stromal cells (MSCs) represent one of the major cellular determinants of the niche. Regulation of the self-renewal and differentiation of HSPCs requires not only direct cellular contact and adhesion molecules, but also various cytokines and chemokines. The C-X-C chemokine receptor type 4/stromal cell-derived factor 1 axis plays a pivotal role in stem cell mobilization and homing. As we have learned in recent years, to realistically simulate the physiological in vivo situation, advanced model systems should be based on niche cells arranged in a three-dimensional (3D) structure. By providing a dynamic rather than static setup, microbioreactor systems offer a number of advantages. In addition, the role of low oxygen tension in the niche microenvironment and its impact on hematopoietic stem cells need to be taken into account and are discussed in this review. Summary: This review focuses on the role of MSCs as a part of the bone marrow niche, the interplay between MSCs and HSPCs and the most important regulatory factors that need to be considered when engineering artificial hematopoietic stem cell niche systems. Conclusion: Advanced 3D model systems using MSCs as niche cells and applying microbioreactor-based technology are capable of simulating the natural properties of the bone marrow niche more closely than ever before.
Rural-Urban Differences in Diagnosed Cervical Artery Dissection in New York State
Authors: Hunter Madeleine Dulany , Kulick Erin R. , Miller Eliza , Willey Joshua , Boehme Amelia K. , Branas Charles , Elkind Mitchell S.V.
Published: January 2022

Background: Cervical artery dissection (CeAD) is a leading cause of stroke in young adults. Incidence estimates may be limited by under- or overdiagnosis. Objective: We aimed to investigate if CeAD diagnosis would be higher in urban centers compared to rural regions of New York State (NYS). Methods: For this ecological study, administrative codes were used to identify CeAD discharges in the NYS Statewide Planning and Research Cooperative System (SPARCS) from 2009 to 2014. Rural Urban Commuting Area (RUCA) codes were taken from the US Department of Agriculture and included the classifications metropolitan, micropolitan, small town, and rural. Negative binomial models were used to calculate effect estimates and 95% confidence limits (eβ; 95% CL) for the association between RUCA classification and the number of dissections per ZIP code. Models were further adjusted by population. Results: Population information was obtained from the US Census Bureau on 1,797 NYS ZIP codes (70.7% of NYS ZIP codes), 826 of which had at least 1 CeAD-related discharge from 2009 to 2014. Nonrural ZIP codes were more likely to report more CeAD cases relative to rural areas even after adjusting for population (metropolitan effect = eβ 5.00; 95% CI: 3.75–6.66; micropolitan effect 3.02; 95% CI: 2.16–4.23; small town effect 2.34; 95% CI: 1.58–3.47). Conclusions: CeAD diagnosis correlates with population density as defined by rural-urban status. Our results could be due to underdiagnosis in rural areas or overdiagnosis with increasing urbanicity.
Whole-Exome Sequencing in 10 Unrelated Patients with Syndromic Hidradenitis Suppurativa: A Preliminary Step for a Genotype-Phenotype Correlation
Authors: Marzano Angelo Valerio , Genovese Giovanni , Moltrasio Chiara , Tricarico Paola Maura , Gratton Rossella , Piaserico Stefano , Garcovich Simone , Boniotto Michele , Brandão Lucas , Moura Ronald , Crovella Sergio
Published: January 2022

Background: The genetics of syndromic hidradenitis suppurativa (HS), an immune-mediated condition associated with systemic comorbidities such as inflammatory bowel diseases and arthritis, has not been completely elucidated. Objective: To describe clinical features and genetic signature of patients with the main syndromic HS forms, i.e., PASH, PAPASH, and PASH/SAPHO overlapping. Methods: Whole-exome sequencing (WES) approach was performed in ten patients with syndromic HS. Results: Three clinical settings have been identified based on presence/absence of gut and joint inflammation. Four PASH patients who had also gut inflammation showed three different variants in NOD2 gene, two variants in OTULIN, and a variant in GJB2, respectively. Three PAPASH and three PASH/SAPHO overlapping patients who had also joint inflammation showed two different variants in NCSTN, one in WDR1 and PSTPIP1, and two variants in NLRC4, one of whom was present in a patient with a mixed phenotype characterized by gut and joint inflammation. Limitations: Limited number of patients that can be counterbalanced by the rarity of syndromic HS. Conclusion: Syndromic HS can be considered as a polygenic autoinflammatory condition; currently WES is a diagnostic tool allowing more accurate genotype-phenotype correlation.
Uncovering of Key Pathways and miRNAs for Intracranial Aneurysm Based on Weighted Gene Co-Expression Network Analysis
Authors: Ma Zhengfei , Zhong Ping , Yue Peidong , Sun Zhongwu
Published: January 2022

Background: Intracranial aneurysm (IA) is a serious cerebrovascular disease. The identification of key regulatory genes can provide research directions for early diagnosis and treatment of IA. Methods: Initially, the miRNA and mRNA data were downloaded from the Gene Expression Omnibus database. Subsequently, the limma package in R was used to screen for differentially expressed genes. In order to investigate the function of the differentially expressed genes, a functional enrichment analysis was performed. Moreover, weighted gene co-expression network analysis (WGCNA) was performed to identify the hub module and hub miRNAs. The correlations between miRNAs and mRNAs were assessed by constructing miRNA-mRNA regulatory networks. In addition, in vitro validation was performed. Finally, diagnostic analysis and electronic expression verification were performed on the GSE122897 dataset. Results: In the present study, 955 differentially expressed mRNAs (DEmRNAs, 480 with increased and 475 with decreased expression) and 46 differentially expressed miRNAs (DEmiRNAs, 36 with increased and 10 with decreased expression) were identified. WGCNA demonstrated that the yellow module was the hub module. Moreover, 16 hub miRNAs were identified. A total of 1,124 negatively regulated miRNA-mRNA relationship pairs were identified. Functional analysis demonstrated that DEmRNAs in the targeted network were enriched in vascular smooth muscle contraction and focal adhesion pathways. In addition, the area under the curve of 16 hub miRNAs was >0.8. It is implied that 16 hub miRNAs may be used as potential diagnostic biomarkers of IA. Conclusion: Hub miRNAs and key signaling pathways were identified by bioinformatics analysis. This evidence lays the foundation for understanding the underlying molecular mechanisms of IA and provided potential therapeutic targets for the treatment of this disease.
Implementation of the Ummi Method in Recognition of the Hijaiyyah Letters on Students of TKIT Nur Hikmah (Kindergarten) Bekasi during the Covid-19 Pandemic
Authors: Firdaus Fattah
Published: January 2022

Pandemic disease Covid-19 change many role of life. This involve many sector and unit in education, including kindergarten has to adapt a strategy during this situation. This study aims to determine how the implementation of the Ummi method in introducing hijaiyyah letters at the 4-5 years age students in TKIT Nur Hikmah on pandemic disease Covid-19. This study used a descriptive qualitative research approach in order to obtain broad and in-depth information about purpose of the study. The data source in this study were the principal of TKIT Nur Hikmah Bekasi, coordinator of Ummi method, competition teacher and parents of TKIT Nur Hikmah. The data collection used observation, interview, and documentation. The results showed that the implementation of the Ummi method in introducing the hijaiyyah letters in children on pandemic disease Covid-19 consisted of planning, implementation, evaluation and supervision. The use of the Ummi method provides a basic understanding of the hijaiyyah letters and the ease of distinguishing letters properly and correctly, both sequentially and randomly. The Ummi method on pandemic disease Covid-19 also has advantages, such as it is easy to understand and use, while the disadvantages are that it cannot be taught by uncertified Ummi method. In the Pandemic, the role of information technology and media becomes very important to connect between teachers and students. Teaching with the Ummi method will have a good impact on the child's future, because if the cultivation of Hijaiyyah learning is carried out early, where the letters are the letters used in the Al-Quran, it will have an impact on the behavior of children to have noble character.
Men´s Health: novas tendências pós-modernas, antigas hegemonias masculinas
Authors: Jesus Milena Santos de , Teixeira Sylvia Maria Campos
Published: January 2022

Trata-se de um estudo a respeito das transformações do gênero masculino numa perspectiva da masculinidade como um produto de uma construção sociocultural. Para tanto, a partir do corpus discursivo da revista Men’s Health, procuraremos detectar a identidade masculina contemporânea, a crise do modelo tradicional de masculinidade e a constituição de uma memória discursiva sobre a identificação do masculino no espaço social pós-moderno. As bases teóricas serão os da Análise do Discurso, de orientação francesa, com as teorias de MAINGUENEAU (1997), FOUCAULT (1998), BADINTER (1993) e dos Estudos Culturais
A comparative study of pulse pressure variation, stroke volume variation and central venous pressure in patients undergoing kidney transplantation
Authors: Kim Kyung Mi , Kim Gaab Soo , Han Minsoo
Published: January 2022

Introduction:

Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) – dynamic preload indexes – are robust predictors of fluid responsiveness. This study aimed to compare the accuracy of PPV and CVP against SVV in predicting fluid responsiveness in terms of cost-effectiveness after a standardised empiric volume challenge in KT patients.

Methods:

36 patients undergoing living-donor KT were analysed. PPV, SVV, CVP and cardiac index (CI) were measured before and after fluid loading with a hydroxyethyl starch solution (7 mL/kg of ideal body weight). Patients were classified as responders (n = 12) or non-responders (n = 24) to fluid loading when CI increases were ≥10% or <10%, respectively. The ability of PPV, SVV and CVP to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) curves.

Results:

SVV and CVP measured before fluid loading were correlated with changes in CI caused by fluid expansion (r = 0.33, P = 0.049 and r = −0.37, P = 0.026) in contrast to PPV (r = 0.14, P = 0.429). The ROC analysis showed that SVV and CVP predicted response to volume loading (area under the ROC curve = 0.781 and 0.727, respectively; P < 0.05).

Conclusion:

Under the conditions of our study, SVV and CVP exhibited similar performance in predicting fluid responsiveness and could inform fluid management during KT as compared with PPV.
The Heat Is On: Observations and Trends of Heat Stress Metrics during Florida Summers
Authors: McAllister Caitlyn , Stephens Aaron , Milrad Shawn M.
Published: January 2022

Extreme heat is annually the deadliest weather hazard in the United States and is strongly amplified by climate change. In Florida, summer heat waves have increased in frequency and duration, exacerbating negative human health impacts on a state with a substantial older population and industries (e.g., agriculture) that require frequent outdoor work. However, the combined impacts of temperature and humidity (heat stress) have not been previously investigated. For eight Florida cities, this study constructs summer climatologies and trend analyses (1950–2020) of two heat stress metrics: heat index (HI) and wet-bulb globe temperature (WBGT). While both incorporate temperature and humidity, WBGT also includes wind and solar radiation and is a more comprehensive measure of heat stress on the human body. With minor exceptions, results show increases in average summer daily maximum, mean, and minimum HI and WBGT throughout Florida. Daily minimum HI and WBGT exhibit statistically significant increases at all eight stations, emphasizing a hazardous rise in nighttime heat stress. Corresponding to other recent studies, HI and WBGT increases are largest in coastal subtropical locations in central and southern Florida (i.e., Daytona Beach, Tampa, Miami, and Key West) but exhibit no conclusive relationship with urbanization changes. Danger (103°–124°F; 39.4°–51.1°C) HI and high (>88°F; 31.1°C) WBGT summer days exhibit significant frequency increases across the state. Especially at coastal locations in the Florida Peninsula and Keys, danger HI and high WBGT days now account for >20% of total summer days, emphasizing a substantial escalation in heat stress, particularly since 2000.

Significance Statement

Extreme heat is the deadliest U.S. weather hazard. Although Florida is known for its warm and humid climate, it is not immune from heat stress (combined temperature and humidity) impacts on human health, particularly given its older population and prevalence of outdoor (e.g., agriculture) work. We analyze summer trends in two heat stress metrics at eight Florida cities since 1950. Results show that heat stress is increasing significantly, particularly at coastal locations in central and southern Florida and at night. The number of dangerous heat stress days per summer is also increasing across Florida, especially since 2000. Our analysis emphasizes that despite some acclimation, Florida is still susceptible to a serious escalation in extreme heat as the climate warms.
The Evolving Role of External Forcing in North Atlantic SST Variability over the Last Millennium
Authors: Klavans Jeremy M. , Clement Amy C. , Cane Mark A. , Murphy Lisa N.
Published: January 2022

Atlantic multidecadal variability (AMV) impacts temperature, precipitation, and extreme events on both sides of the Atlantic Ocean basin. Previous studies with climate models have suggested that when external radiative forcing is held constant, the large-scale ocean and atmosphere circulation are associated with sea surface temperature (SST) anomalies that have similar characteristics to the observed AMV. However, there is an active debate as to whether these internal fluctuations driven by coupled atmosphere–ocean variability remain influential to the AMV on multidecadal time scales in our modern, anthropogenically forced climate. Here we provide evidence from multiple large ensembles of climate models, paleoreconstructions, and instrumental observations of a growing role for external forcing in the AMV. Prior to 1850, external forcing, primarily from volcanoes, explains about one-third of AMV variance. Between 1850 and 1950, there is a transitional period, where external forcing explains one-half of AMV variance, but volcanic forcing only accounts for about 10% of that. After 1950, external forcing explains three-quarters of AMV variance. That is, the role for external forcing in the AMV grows as the variations in external forcing grow, even if the forcing is from different sources. When forcing is relatively stable, as in earlier modeling studies, a higher percentage of AMV variations are internally generated.
Divergence and Dispersion of Global Eddy Propagation from Satellite Altimetry
Authors: Chen Ge , Chen Xiaoyan , Cao Chuanchuan
Published: January 2022

It is well understood that isolated eddies are presumed to propagate westward intrinsically at the speed of the annual baroclinic Rossby wave. This classic description, however, is known to be frequently violated in both propagation speed and its direction in the real ocean. Here, we present a systematic analysis on the divergence of eddy propagation direction (i.e., global pattern of departure from due west) and dispersion of eddy propagation speed (i.e., zonal pattern of departure from Rossby wave phase speed). Our main findings include the following: 1) A global climatological phase map (the first of its kind to our knowledge) indicating localized direction of most likely eddy propagation has been derived from 28 years (1993–2020) of satellite altimetry, leading to a leaf-like full-angle pattern in its overall divergence. 2) A meridional deflection map of eddy motion is created with prominent equatorward/poleward deflecting zones identified, revealing that it is more geographically correlated rather than polarity determined as previously thought (i.e., poleward for cyclonic eddies and equatorward for anticyclonic ones). 3) The eddy–Rossby wave relationship has a duality nature (waves riding by eddies) in five subtropical bands centered around 27°N and 26°S in the two hemispheres, outside which their relationship has a dispersive nature with dominant waves (eddies) propagating faster in the tropical (extratropical) oceans. Current, wind, and topographic effects are major external forcings responsible for the observed divergence and dispersion of eddy propagations. These results are expected to make a significant contribution to eddy trajectory prediction using physically based and/or data-driven models.
Why Does Convection Weaken over Sumatra Island in an Active Phase of the MJO?
Authors: Zhao Ning , Wu Peiming , Yokoi Satoru , Hattori Miki
Published: January 2022

This study investigated the diurnal cycle of convection over Sumatra Island in an active phase of the Madden–Julian oscillation (MJO) during the Pre-Years of the Maritime Continent (YMC) observation campaign in December 2015 based on in situ and satellite observations and a convection-permitting numerical model. Observations suggest that before the active phase of the MJO in early December, convection occurred frequently over the island during the afternoon and at midnight. By contrast, during the active phase of the MJO in mid-December, afternoon convection over the island was delayed and suppressed, and midnight convection was suppressed. Numerical experiments also successfully replicated the main features of the observed modulations. In general, during the active phase of the MJO, the troposphere became drier in the Sumatra region. While the clouds reduced the solar radiation over the land, the sea breeze was also found to be delayed and weakened. As a result, the afternoon convection initiation was delayed and weakened. Further analyses suggested that the sea breeze was weakened mainly due to the orographic stagnation effect rather than the slightly reduced land–sea temperature contrast. On the other hand, the increased stratiform-anvil clouds induced the anomalous evaporative cooling in the midtroposphere and generated island-scale subsidence during the nighttime, which finally led to the suppression of inland convection. Overall, our study reveals the modulation of diurnal convection over Sumatra Island by an active phase of the MJO and also shows the potential role of land–sea interaction in convection initiation and maintenance.
Salbutamol Toxicity in a Newborn Due to Unintentional Oral Ingestion of Inhalation Respules—A Case Report
Authors: Arutla Sravani , Panigrahy Nalinikanta , Venkatlakshmi Alla
Published: January 2022

Cases of salbutamol toxicity by oral ingestion and inhalation are rarely reported in the pediatric age group and have never been reported in neonates. We report a case of salbutamol toxicity by unintentional oral ingestion of inhalation respules in a newborn, which led to tachycardia and QT prolongation requiring medical management. The importance of breastfeeding, identifying similar looking medications, and keeping them separately at home are discussed.
Single-cell analysis reveals selection of TP53-mutated clones after MDM2 inhibition
Authors: Maslah Nabih , Verger Emmanuelle , Giraudier Stéphane , Chea Mathias , Hoffman Ronald , Mascarenhas John , Cassinat Bruno , Kiladjian Jean-Jacques
Published: January 2022

The mechanisms of transformation of chronic myeloproliferative neoplasms (MPN) to leukemia are largely unknown, but TP53 mutations acquisition is considered a key event in this process. p53 is a main tumor suppressor, but mutations in this protein per se do not confer a proliferative advantage to the cells, and a selection process is needed for the expansion of mutant clones. MDM2 inhibitors may rescue normal p53 from degradation and have been evaluated in a variety of cancers with promising results. However, the impact of these drugs on TP53-mutated cells is underexplored. We report herein evidence of a direct effect of MDM2 inhibition on the selection of MPN patients’ cells harboring TP53 mutations. To decipher whether these mutations can arise in a specific molecular context, we used a DNA single-cell approach to determine the clonal architecture of TP53-mutated cells. We observed that TP53 mutations are late events in MPN, mainly occurring in the driver clone, whereas clonal evolution frequently consists of sequential branching instead of linear consecutive acquisition of mutations in the same clone. At the single-cell level, the presence of additional mutations does not influence the selection of TP53 mutant cells by MDM2 inhibitor treatment. Also, we describe an in vitro test allowing to predict the emergence of TP53 mutated clones. Altogether, this is the first demonstration that a drug treatment can directly favor the emergence of TP53-mutated subclones in MPN.
ECCsplorer: a pipeline to detect extrachromosomal circular DNA (eccDNA) from next-generation sequencing data
Authors: Mann Ludwig , Seibt Kathrin M. , Weber Beatrice , Heitkam Tony
Published: January 2022

Background

Extrachromosomal circular DNAs (eccDNAs) are ring-like DNA structures physically separated from the chromosomes with 100 bp to several megabasepairs in size. Apart from carrying tandemly repeated DNA, eccDNAs may also harbor extra copies of genes or recently activated transposable elements. As eccDNAs occur in all eukaryotes investigated so far and likely play roles in stress, cancer, and aging, they have been prime targets in recent research—with their investigation limited by the scarcity of computational tools.

Results

Here, we present the ECCsplorer, a bioinformatics pipeline to detect eccDNAs in any kind of organism or tissue using next-generation sequencing techniques. Following Illumina-sequencing of amplified circular DNA (circSeq), the ECCsplorer enables an easy and automated discovery of eccDNA candidates. The data analysis encompasses two major procedures: first, read mapping to the reference genome allows the detection of informative read distributions including high coverage, discordant mapping, and split reads. Second, reference-free comparison of read clusters from amplified eccDNA against control sample data reveals specifically enriched DNA circles. Both software parts can be run separately or jointly, depending on the individual aim or data availability. To illustrate the wide applicability of our approach, we analyzed semi-artificial and published circSeq data from the model organisms Homo sapiens and Arabidopsis thaliana, and generated circSeq reads from the non-model crop plant Beta vulgaris. We clearly identified eccDNA candidates from all datasets, with and without reference genomes. The ECCsplorer pipeline specifically detected mitochondrial mini-circles and retrotransposon activation, showcasing the ECCsplorer’s sensitivity and specificity.

Conclusion

The ECCsplorer (available online at https://github.com/crimBubble/ECCsplorer) is a bioinformatics pipeline to detect eccDNAs in any kind of organism or tissue using next-generation sequencing data. The derived eccDNA targets are valuable for a wide range of downstream investigations—from analysis of cancer-related eccDNAs over organelle genomics to identification of active transposable elements.
General practitioners’ experiences with, views of, and attitudes towards, general practice-based pharmacists: a cross-sectional survey
Authors: Hasan Ibrahim Ameerah S. , Barry Heather E. , Hughes Carmel M.
Published: January 2022

Background

There is limited United Kingdom (UK) literature on general practice-based pharmacists’ (PBPs’) role evolution and few studies have explored general practitioners’ (GPs’) experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs’ experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI).

Methods

A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically.

Results

The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts.

Conclusion

Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs’, community pharmacists’ and patients’ views of this role in general practice is required to corroborate study findings.
Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study
Authors: Wei Yun , Wang Feiyue , Pan Zhaolu , Wang Meirong , Jin Guanghui , Lu Xiaoqin
Published: January 2022

Background

Physical examination is a core component of consultation. Little is known about the status quo of physical examinations performed by general practitioners in community health service institutions in China. The aim of this study was to investigate general practitioners’ performance of physical examinations in consultations.

Methods

An observational study was conducted in 5 community health service institutions in Beijing between November 2019 and January 2020. Eleven general practitioners were observed for one workday. Information of consecutive consultations was recorded including patient characteristics, reasons for encounter, physical examinations performed by general practitioners, length of consultation time and time spent on specific activities in consultations.

Results

A total of 682 consultations of 11 general practitioners were recorded. Physical examinations were performed in 126 consultations (15.8%). Physical examination was more likely to be performed in patients visiting with symptoms (P < 0.001). Majority of the 126 physical examinations were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%). No physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. Total 2823 min of activities were observed and recorded. General practitioners only spent 3.1% of the recorded time on physical examination, which was less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The average time spent on physical examinations was 0.8±0.4 min per consultation.

Conclusion

Physical examination was insufficiently performed by general practitioners in community health service institutions in Beijing. More time and commitment should be advocated for improving the quality of physical examinations in primary care.
Attitudes & behaviors toward the management of tobacco smoking patients: qualitative study with French primary care physicians
Authors: Coindard Guillaume , Acquadro Michaël , Chaumont Raphaël , Arnould Benoit , Boisnault Philippe , Collignon-Portes Rachel , Duhot Didier , Raineri François , Tugaut Béatrice , Aubin Henri-Jean
Published: January 2022

Background

Smoking cessation is a major public health issue. In France, primary care physicians (PCP) are the first contact points for tobacco management. The objective of this study was to understand how PCPs are involved in the management of smoking cessation: ownership, commitment, barriers.

Methods

A qualitative study was conducted using group and individual semi-structured techniques with PCPs. A thematic analysis of verbatim transcripts was performed to identify concepts and sub-concepts of interest. Saturation was evaluated retrospectively to ensure adequate sample size.

Results

A sample of 35 PCPs were interviewed, 31 in four focus groups and four in individual interviews. PCPs discussed their roles in the management of tobacco smoking cessation, including the different strategies they are using (e.g., Minimal Intervention Strategy, Motivational Interviewing), the multiple barriers encountered (e.g., lack of time, patients’ resistance to medical advice), the support resources and the treatment and intervention they prescribed (e.g. nicotine replacement therapy, supporting therapist).

Conclusions

This study provides a better understanding of the beliefs, attitudes, and behaviors of PCPs in managing smoking cessation. Guiding and encouraging patients toward smoking cessation remains a major objective of PCPs. While PCPs reported that progress has been made in recent years in terms of tools, technology and general awareness, they still face major barriers, some of which could be overcome by appropriate training.
Inflammation-scores as prognostic markers of overall survival in lung cancer: a register-based study of 6,210 Danish lung cancer patients
Authors: Winther-Larsen Anne , Aggerholm-Pedersen Ninna , Sandfeld-Paulsen Birgitte
Published: January 2022

Background

Inflammation-scores based on general inflammation markers are suggested as prognostic markers of overall survival (OS) in lung cancer. However, whether these inflammation-scores improves the prognostication performed by well-established prognostic markers is unsettled. In a large register-based lung cancer patient cohort, nine different inflammation-scores were compared, and their ability to optimize the prognostication of OS was evaluated.

Methods

Lung cancer patients diagnosed from 2009–2018 in The Central Denmark Region were identified in the Danish Lung Cancer Registry. Pre-treatment inflammation markers were extracted from the clinical laboratory information system. Prognostication of OS was evaluated by Cox proportional hazard models. Comparison of the inflammation-scores and their added value to established prognostic markers were assessed by Akaike's information criteria and Harrel's C-index.

Results

In total, 5,320 patients with non-small cell lung cancer (NSCLC) and 890 patients with small cell lung cancer (SCLC) were identified. In NSCLC, the Aarhus composite biomarker score (ACBS), including albumin, C-reactive protein, neutrophil count, lymphocyte count and haemoglobin, and the neutrophil-lymphocyte-ratio (NLR) were superior. Furthermore, they improved the prognostication of OS significantly (p <0.0001) (ACBS: HR: 2.24 (95%CI: 1.97–2.54); NLR: HR: 1.58 (95%CI: 1.47 – 1.69)). In SCLC, three scores were equally superior and improved the prognostication of OS p < 0.0001): neutrophil–lymphocyte-ratio (HR:1.62 (95%CI: 1.38–1.90)), modified Glasgow Prognostic Score (mGPS) (HR:1.70 (95%CI: 1.55–1.86) and the Combined NLR and GPS (CNG) (HR:2.10 (95%CI: 1.77–2.49).

Conclusions

The ACBS was the optimal score in NSCLC, whereas neutrophil–lymphocyte-ratio, mGPS and CNG were equally superior in SCLC. Additionally, these inflammation-scores all optimised the prognostication of OS and added value to well-established prognostic markers.
An exploration of immunohistochemistry-based prognostic markers in patients undergoing curative resections for colon cancer
Authors: Bennedsen Astrid Louise Bjørn , Cai Luyi , Hasselager Rune Petring , Özcan Aysun Avci , Mohamed Khadra Bashir , Eriksen Jens Ole , Eiholm Susanne , Bzorek Michael , Fiehn Anne-Marie Kanstrup , Hviid Thomas Vauvert F. , Gögenur Ismail
Published: January 2022

Background

The immune system recognizes and destroys cancer cells. However, cancer cells develop mechanisms to avoid detection by expressing cell surface proteins. Specific tumour cell surface proteins (e.g. HLA-G, PD-L1, CDX2) either alone or in combination with the relative presence of immune cells (CD3 and CD8 positive T-cells) in the tumour tissue may describe the cancer cells’ ability to escape eradication by the immune system. The aim was to investigate the prognostic value of immunohistochemical markers in patients with colon cancer.

Methods

We conducted a retrospective study including patients diagnosed with pT3 and pT4 colon cancers. Immunohistochemical staining with HLA-G, PD-L1, CDX2, CD3, and CD8 was performed on tissue samples with representation of the invasive margin. PD-L1 expression in tumour cells and immune cells was reported conjointly. The expression of CD3 and CD8 was reported as a merged score based on the expression of both markers in the invasive margin and the tumour centre. Subsequently, a combined marker score was established based on all of the markers. Each marker added one point to the score when unfavourable immunohistochemical features was present, and the score was categorized as low, intermediate or high depending on the number of unfavourable stains. Hazard ratios for recurrence, disease-free survival and mortality were calculated.

Results

We included 188 patients undergoing colon cancer resections in 2011–2012. The median follow-up was 41.7 months, during which 41 (21.8%) patients had recurrence and 74 (39.4%) died. In multivariable regression analysis positive HLA-G expression (HR = 3.37, 95%CI [1.64–6.93]) was associated with higher recurrence rates, while a preserved CDX2 expression (HR = 0.23, 95%CI [0.06–0.85]) was associated with a lower risk of recurrence. An intermediate or high combined marker score was associated with increased recurrence rates (HR = 20.53, 95%CI [2.68–157.32] and HR = 7.56, 95%CI [1.06–54.16], respectively). Neither high expression of PD-L1 nor high CD3-CD8 score was significantly associated with recurrence rates. Patients with a high CD3-CD8 score had a significantly longer DFS and OS.

Conclusions

In tumour cells, expression of HLA-G and loss of CDX2 expression were associated with cancer recurrence. In addition, a combination of certain tumour tissue biomarkers was associated with colorectal cancer recurrence.
“You can’t un-ring the bell”: a mixed methods approach to understanding veteran and family perspectives of recovery from military-related posttraumatic stress disorder
Authors: St. Cyr Kate , Liu Jenny J. W. , Cramm Heidi , Nazarov Anthony , Hunt Renee , Forchuk Callista , Deda Erisa , Richardson J. Don
Published: January 2022

Background

Military-related posttraumatic stress disorder (PTSD) is a complex diagnosis with non-linear trajectories of coping and recovery. Current approaches to the evaluation of PTSD and treatment discontinuation often rely on biomedical models that dichotomize recovery based on symptom thresholds. This approach may not sufficiently capture the complex lived experiences of Veterans and their families. To explore conceptualizations of recovery, we sought perspectives from Veterans and their partners in a pilot study to understand: 1) how Veterans nearing completion of treatment for military-related PTSD and their partners view recovery; and 2) the experience of progressing through treatment towards recovery.

Methods

We employed a concurrent mixed methods design. Nine Veterans nearing the end of their treatment at a specialized outpatient mental health clinic completed quantitative self-report tools assessing PTSD and depressive symptom severity, and an individual, semi-structured interview assessing views on their treatment and recovery processes. Veterans’ partners participated in a separate interview to capture views of their partners’ treatment and recovery processes. Descriptive analyses of self-report symptom severity data were interpreted alongside emergent themes arising from inductive content analysis of qualitative interviews.

Results

While over half of Veterans were considered “recovered” based on quantitative assessments of symptoms, individual reflections of “recovery” were not always aligned with these quantitative assessments. A persistent narrative highlighted by participants was that recovery from military-related PTSD was not viewed as a binary outcome (i.e., recovered vs. not recovered); rather, recovery was seen as a dynamic, non-linear process. Key components of the recovery process identified by participants included a positive therapeutic relationship, social support networks, and a toolkit of adaptive strategies to address PTSD symptoms.

Conclusions

For participants in our study, recovery was seen as the ability to navigate ongoing issues of symptom management, re-engagement with meaningful roles and social networks, and a readiness for discontinuing intensive, specialized mental health treatment. The findings of this study highlight important considerations in balancing the practical utility of symptom severity assessments with a better understanding of the treatment discontinuation-related needs of Veterans with military-related PTSD and their families, which align with a contemporary biopsychosocial approach to recovery.
Stress-induced hyperphagia: empirical characterization of stress-overeaters
Authors: Kaiser Birgit , Gemesi Kathrin , Holzmann Sophie Laura , Wintergerst Monika , Lurz Martin , Hauner Hans , Groh Georg , Böhm Markus , Krcmar Helmut , Holzapfel Christina , Gedrich Kurt
Published: January 2022

Background

Stressful situations can have an impact on an individual’s eating behavior. People vulnerable to the influence of stress tend to change the quantity and quality of their food intake. Variables such as sex and body mass index (BMI) seem to be related to this stress-eating behavior, but it is rather unclear what factors account to the parameters associated with stress-eating behavior. The aim of this survey was to identify further characteristics of adults in Germany related to stress-overeating, focusing on stress perception, coping, eating motives and comfort foods as well as personality types.

Methods

This online survey was performed throughout Germany and comprised a 38-item pre-tested questionnaire. Stress-induced overeating was classified based on the Salzburg Stress Eating Scale (SSES). Moreover, validated questionnaires were used to identify additional characteristics of stress eaters. Participants were recruited using a convenience sampling approach, and data were collected between January and April 2021.

Results

The overall sample consisted of 1222 participants (female 80.8%, aged 31.5±12.8). 42.1% of participants were identified as stress-overeaters. Among the remaining group, 78.9% stated to eat less, 21.1% to eat equally when stressed. Female participants had a higher mean SSES score compared to male participants. The BMI was positively correlated to SSES, r(1220)=0.28, p>0.005. ‘Agreeableness’ (BigFive) was found to be a negative predictor of stress-overeating. The most pronounced difference in eating motives (The Eating Motivation Survey, TEMS) was found for ‘Affect Regulation’ and ‘Weight Control’.

Conclusions

The results indicate that stress-overeating affects a large proportion of the surveyed population. BMI, personality and eating motives additionally characterize stress-overeaters and may contribute to develop new approaches to address unhealthy stress-related eating patterns.
Making the grade: licensing examination performance by medical school accreditation status
Authors: van Zanten Marta , Boulet John R. , Shiffer Christine D.
Published: January 2022

Background

Accreditation systems strive to ensure the quality of undergraduate (basic) medical education and encourage ongoing improvements. Despite increasing global emphasis on quality assurance activities, there is limited research linking accreditation of medical education to improved student and graduate outcomes. The purpose of this study is to compare the United States Medical Licensing Examination® (USMLE®) performance of students and graduates who attended international medical schools accredited by an agency recognized by the World Federation of Medical Education (WFME) to individuals who attended schools that did not meet this criterion.

Methods

During the 2018-2020 study period, 39,650 individuals seeking Educational Commission for Foreign Medical Graduates® (ECFMG®) certification took one or more USMLE examinations. We cross-tabulated USMLE performance (first-attempt pass/fail result) and medical school accreditation status.

Results

Individuals seeking ECFMG certification who attended international medical schools accredited by an agency recognized by WFME had higher or comparable USMLE first-attempt pass rates compared to individuals who attended medical schools that did not meet this criterion.

Conclusions

Implementing and maintaining meaningful accreditation systems requires substantial resources. These results provide important positive evidence that external evaluation of educational programs is associated, on average, with better educational outcomes, including in the domains of basic science, clinical knowledge, and clinical skills performance.
How do working conditions affect the turnover intention of medical social workers in China?
Authors: Li Na , Peng Jin , Yang Rui
Published: January 2022

Background

The development of medical social work is an indispensable part of the Healthy China Strategy. However, the medical service field has the fewest social workers in all service fields in China. Creating favorable working conditions can reduce the turnover intention of social workers in the medical service field. So it is necessary to integrate the existing theoretical models to deeply analyze the multiple influencing paths of working conditions on the medical social workers’ turnover intention in the context of China.

Methods

The data we used came from the China Social Work Longitudinal Survey (CSWLS) conducted in 56 cities across the country in 2019. It adopted a multi-stage random sampling method and the sample of medical social workers was selected according to their current service field and the sample size finally entering the model was 382. We tested the relationships with the Structural Equation Model (SEM) by STATA 16.0.

Results

Job-related stress play the most significant role in explaining the formation mechanism of medical social workers’ turnover intention. On the one hand, job-related stress can reduce the job satisfaction of medical social workers, further increasing their turnover intention; on the other hand, job-related stress can increase job burnout of medical social workers, further reducing their job satisfaction and ultimately increasing the turnover intention. Job satisfaction plays a full mediating effect between the job burnout of medical social workers and their turnover intention. The social support and job autonomy provided by social work agencies have limited effects on decreasing the turnover intention of medical social workers.

Conclusions

The two paths of job-related stress affecting turnover intention successfully integrate the Job Demands-Resources Model and the Price-Mueller Turnover Model into the same theoretical framework providing a theoretical basis for reducing the turnover intention and behavior of social workers in the medical service field, improving the management level in the medical service system and promoting the overall healthy and sustainable development of medical social work in China.