bluuebunny/crossref_metadata_2025 huggingface dataset:
Insider Ownership and Real Earnings Management in Indian Companies
Authors: Potharla Srikanth , Shette Rachappa
Published: December 2022

The present study aims to examine, and to test the monitoring effect of institutional investment on, the relationship between insider ownership and real earnings management in Indian companies. The study examines the non-linear association between insider ownership and real earnings management using a sample of listed non-financial companies in the Indian market from 2011 to 2018. The study used pooled data OLS regression and Quantile regression. The findings reveal significant non-linear U-shaped relationship between insider ownership and real earnings management and that the large-size institutional investment makes such non-linear relationship insignificant. Contribution of the present study to the literature is two-fold. First, it proves the differential impact of the size of insider ownership on real earnings management. It indicates that firms having large-size insider ownership have greater scope for real earnings management, underscoring the need for the more scrutiny of reported earnings by the outsider shareholders. Second, it proves significant positive effect of the size of institutional investment in constraining the entrenchment by the insider owners. It signals that firms with large-size institutional investment have better quality of financial reporting and also contribute to efficient price discovery in the capital markets.
Evaluation of Risk as Conducive Environment for Earning Manipulation and Moderation Effect of Corporate Governance: Empirical Study of Listed Indian Firms
Authors: Busru Showkat Ahmad , Shanmugasundaram G  , Singh Saumya
Published: December 2022

Separation of decision-making and risk-bearing functions in dispersed ownership structures offer scope for opportunistic behaviour of managers. Hence necessitate proactive governing mechanism for ratification and monitoring of decisions from the initiation and implementation of the decisions for protection of shareholders as well as stake holders interest. The motive of this paper is to evaluate whether risky behaviour provide conducive environment for earning manipulation and analyze the moderating effect of corporate governance (CG) and ownership attributes in reducing earnings management practices in high risk conditions. A structural Partial least square (PLS) equations model was developed to analyze the relationship and CG constructs moderating role was evaluated. Based on a sample of 270 listed Indian firms in NSE during the period of 9 years from 2007–2008 to 2015–2016 using smart-PLS, it was detected that market risk, financing and investing risk manifold opportunities of managers to maximise their own benefits by manipulating the information in their discretion (discretionary accruals measured through modified Jones Model). CG mechanism constructs like audit, risk and compensation committees, board activities, board characteristics, transparency have been found significant in moderating the relationship between risk and earning management while board composition and ownership structure have failed to restrain the opportunistic behaviour of managers in favourable risky environment contradicting acceptance of efficient monitoring hypothesis and resource based view in India corporate setting.
An Empirical Study of Motivational and Driving Factors on Women Entrepreneurship Venturing in India
Authors: Khan Kahkashan
Published: December 2022

Globally, the rate of women entrepreneurship has been growing at more than 10% each year. In fact, women have started to open their own business. Women entrepreneurs create job for themselves as well as for others too. Women in India are gaining importance in the era of economic, liberalisation, privatisation and globalisation. The institutional policy and framework for developing entrepreneurial skills and providing training and education to the women have opened the door for economic development, as well as in empowering the women. One can see a plethora of successful women entrepreneurs successfully venturing in India both in social as well as economic fields. There are number of schemes started by government of India to uplift women. Such schemes are such as National Skill Development Policy, Mudra Yojna Schemes, National Skill Development Mission, Mahila Udyam Nidhi Scheme, Stree Shakti Package, Annapurna Scheme and many more.

Women entrepreneurship can be regarded as one of the most important tools to empower women in India. Still the women face gender base problem in starting and growing their venture. This article generally explores the motivational and driving factors that help women entrepreneurs to venture in India. Random sampling techniques have been used on 80 women entrepreneurs while conducting the research. The researcher has used Pearson correlations and Regression Analysis for testing the hypothesis. The overall result of this article depicts that there is a significant effect of pull motivation factors and marginal effect of push motivational factors on women entrepreneurs who are venturing their business in India.
Arthroscopic Bankart Repair With Remplissage as an Alternative to Latarjet for Anterior Glenohumeral Instability With More Than 15% Glenoid Bone Loss
Authors: Horinek Jeffrey L. , Menendez Mariano E. , Narbona Pablo , Lädermann Alexandre , Barth Johannes , Denard Patrick J.
Published: December 2022

Background:

Surgical management of anterior shoulder instability continues to evolve. The clinical effectiveness of arthroscopic Bankart repair with remplissage (REMP) in patients with increasing glenoid bone loss (GBL) has not been thoroughly compared with Latarjet.

Purpose/Hypothesis:

The purpose of this study was to compare 2-year outcomes of REMP versus open Latarjet in patients with >15% GBL. We hypothesized that there would be no difference.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A multicenter, retrospective study was performed on a consecutive series of patients who underwent primary REMP or Latarjet by 4 shoulder specialists between August 2013 and December 2019 for >15% GBL. Procedure performance was based on shared decision making between the surgeon and patient. Baseline and 2-year postoperative range of motion (ROM) and the following patient-reported outcomes (PROs) were collected: Western Ontario Shoulder Instability Index, Single Assessment Numeric Evaluation, and visual analog scale for pain. Return to sport, satisfaction, complications, recurrence, and revisions were reviewed.

Results:

A total of 47 patients were available for study, including 22 who underwent REMP and 25 who underwent Latarjet. Baseline demographic characteristics, ROM, and PROs were similar between the groups. Mean preoperative GBL (REMP 25.8% ± 7.8% vs Latarjet 25.1% ± 9.0%; P = .800) and off-track lesions (REMP 59.1% vs Latarjet 44.0%; P = .302) were similar. Postoperative change in external rotation favored Latarjet (10° ± 22° vs –4° ± 13°; P = .017). Postoperative PROs, return to the sports (86.4% vs 87.5%; P = .99), and satisfaction (95.5% vs 95.8%; P = .99) were similar between groups. There were no recurrent dislocations in either group. One infected hematoma was encountered in the Latarjet cohort.

Conclusion:

At short-term follow-up, the hypothesis was upheld. REMP and Latarjet provided similar outcomes for patients with >15% GBL, although REMP patients experienced slightly decreased external rotation. Although larger series and longer-term follow-ups are required, remplissage may be considered in patients with >15% glenoid bone loss.
Exploring Experiences of Workplace Violence and Attempts to Address Violence Among Mental Health Nurses in the Kingdom of Saudi Arabia
Authors: Alyousef Seham Mansour , Alhamidi Sami Abdulrahman
Published: December 2022

Introduction

Workplace violence has emerged as a global phenomenon requiring immediate attention. The nursing profession is primarily affected, and the unique vulnerability of nurses to workplace violence is particularly evident in the field of mental health nursing.

Aims

This study explores the experiences of mental health nurses with work-related violence and attempts to combat this violence in the context of inpatient mental health facilities in Saudi Arabia.

Methods

This research comprises a qualitative exploratory study consisting of semistructured interviews with 16 participants using open-ended questions. The participants are psychiatric/mental health nurses with experience in the field, so this methodological approach facilitates a detailed investigation of their encounters with workplace violence.

Results

This study reveals that nurses experience violence in accordance with two main themes and subthemes: experiences of workplace violence, the influence of violence on work settings, and efforts required to combat violence. Data show that these participants consider of prime importance access to training to increase safety through knowledge, improved communication, and protective skills, along with adequate staffing and a safe built environment.

Conclusion

The research findings confirm the urgency of addressing the needs of mental health nurses in inpatient psychiatric hospitals. Policymakers in the healthcare field must be aware of the inpatient psychiatric care climate and the need for support from those who staff these areas of practice. Training in specialized knowledge and skills is required to ensure a safe work environment as well as appropriate staffing levels, and a safe built environment. These conditions may be required to recruit and retain mental health nurses capable of providing best-practice care.
Subaltern? Illustrated: A Study of Ambedkar Cartoons
Authors: Saha Barnali
Published: December 2022

Just like any other narrative form, cartoons too, by virtue of their storytelling ability, have problematized Dalit life history and delineated the trauma, tragedy and unflinching representational terms. Charting sociopolitical topics, cartoons are an example of popular culture influencing public opinion. With caricature, prose, topical content and a dash of humour, cartoons form a special category of news and a critical form of political journalism. When Elizabeth Edwards discusses the raw history and potential of photographs, she emphasizes their visual sovereignty, which is not only vital for the production of photography but also for the interpretation of images, and through them, the insertion of the human voice. Similarly, cartoons succeed in combining their visual sovereignty with their ethnographic potential because of their interpretive ingenuousness. As such, cartoons articulate lines of instability indiscernible under the garb of mythical solidarity of a myriad of political ideologies. Cartoonists construct publics and counter publics by problematizing the impact of sociopolitics on human beings through the construction of interpretative communities bound by visual perceptions. In other words, cartoons, particularly political cartoons, represent highly complex modern attempts to formulate visual identities under specific historical and political conditions that resonate with the readership. The present research article seeks to problematize Dalit representation in cartoons by non-Dalit illustrators against the work of a Dalit cartoonist to critically study the politics of representation, the discourse of powers and the dialectics of caste. The article seeks to study if and how Dalit agency is, respectively, illustrated or elided, how symbols and caricatures demonstrate the truth of Dalit life and the aesthetics of the Dalit experience. For the purpose of the study, the article especially focusses on the figure of Ambedkar, the iconic Dalit voice and the benevolent patriarch of Dalit ideology, and studies his representation in a series of political cartoons published between 1932 and 1956.
Civil Society Involvement and Resultant Health Care Utilization: A Study of Sickle Cell Disease Patients Across Communities in Kerala
Authors: Augustine Anupama , Nair Manju S.
Published: December 2022

Civil society initiatives have helped in attempts to bring equity and efficiency in health systems by providing direct health services to vulnerable sections in society and indulging in health promotion and information exchange. Kerala, despite the presence of civil society in the health sector shows a pattern of ‘health divide’, with tribal communities experiencing a higher health burden than non-tribal communities. This becomes problematic in the case of some peculiar diseases, particularly genetic diseases such as Sickle Cell Disease (SCD). The article explores the involvement of civil society in health systems with a special focus on SCD and enquires into links between socio-economic position and health care utilization patterns. The study identifies the existence of inter-community differences in health care utilization across social classes, depicting the fact that even after the involvement of civil society organizations, socio-economic stratifiers still remain an important impediment in uplifting the health status of SCD patients.
hUCMSCs carrying exenatide prevent T1DM by improving intestinal microflora composition and islet tissue damage repair
Authors: Wang Wei , Wang Yahao , Chi Jingwei , Tan Xiaojun , Hu Jianxia , Ma Xiaolong , Sun Xiaofang , Che Kui , Lv Wenshan , Wang Yangang
Published: December 2022

Background

Exenatide is a stable analogue of glucagon-like peptide 1 that can reduce postprandial hyperglycemia and has been utilized as adjunctive therapy for type 1 diabetes mellitus (T1DM). The human umbilical cord is a rich source of MSCs, and human umbilical cord mesenchymal stem cells (hUCMSCs) also show potential to enhance insulin secretion. Here, we aimed to explore the effects of hUCMSCs carrying exenatide in T1DM and further identify the possible mechanisms involved.

Methods

hUCMSCs were isolated from human umbilical cord tissues, identified, and transduced with recombinant lentivirus carrying exenatide to obtain exenatide-carrying hUCMSCs (hUCMSCs@Ex-4).

Results

The results showed that hUCMSCs@Ex-4 restored the blood glucose levels and body weight of NOD mice, and repressed immune cell infiltration and islet tissue changes. Additionally, in T1DM mice, treatment with hUCMSCs@Ex-4 reduced the blood glucose levels and promoted repair of islet tissue damage. Moreover, hUCMSCs@Ex-4 attenuated renal tissue lesions in T1DM mice. Applying bioinformatic analysis, the effects of hUCMSCs@Ex-4 were suggested to correlate with decreased abundance of pro-inflammatory intestinal bacteria and increased abundance of anti-inflammatory intestinal bacteria.

Conclusion

Overall, the study indicated that hUCMSCs carrying exenatide might improve beneficial intestinal microflora abundance and promote islet tissue damage repair, thereby alleviating T1DM.
Gut microbiota analyses of Saudi populations for type 2 diabetes-related phenotypes reveals significant association
Authors: Al-Muhanna Fahad A. , Dowdell Alexa K. , Al Eleq Abdulmohsen H. , Albaker Waleed I. , Brooks Andrew W. , Al-Sultan Ali I. , Al-Rubaish Abdullah M. , Alkharsah Khaled R. , Sulaiman Raed M. , Al-Quorain Abdulaziz A. , Cyrus Cyril , Alali Rudaynah A. , Vatte Chittibabu , Robinson Fred L. , Zhou Xin , Snyder Michael P. , Almuhanna Afnan F. , Keating Brendan J. , Piening Brian D. , Al-Ali Amein K.
Published: December 2022

Background

Large-scale gut microbiome sequencing has revealed key links between microbiome dysfunction and metabolic diseases such as type 2 diabetes (T2D). To date, these efforts have largely focused on Western populations, with few studies assessing T2D microbiota associations in Middle Eastern communities where T2D prevalence is now over 20%. We analyzed the composition of stool 16S rRNA from 461 T2D and 119 non-T2D participants from the Eastern Province of Saudi Arabia. We quantified the abundance of microbial communities to examine any significant differences between subpopulations of samples based on diabetes status and glucose level.

Results

In this study we performed the largest microbiome study ever conducted in Saudi Arabia, as well as the first-ever characterization of gut microbiota T2D versus non-T2D in this population. We observed overall positive enrichment within diabetics compared to healthy individuals and amongst diabetic participants; those with high glucose levels exhibited slightly more positive enrichment compared to those at lower risk of fasting hyperglycemia. In particular, the genus Firmicutes was upregulated in diabetic individuals compared to non-diabetic individuals, and T2D was associated with an elevated Firmicutes/Bacteroidetes ratio, consistent with previous findings.

Conclusion

Based on diabetes status and glucose levels of Saudi participants, relatively stable differences in stool composition were perceived by differential abundance and alpha diversity measures. However, community level differences are evident in the Saudi population between T2D and non-T2D individuals, and diversity patterns appear to vary from well-characterized microbiota from Western cohorts. Comparing overlapping and varying patterns in gut microbiota with other studies is critical to assessing novel treatment options in light of a rapidly growing T2D health epidemic in the region. As a rapidly emerging chronic condition in Saudi Arabia and the Middle East, T2D burdens have grown more quickly and affect larger proportions of the population than any other global region, making a regional reference T2D-microbiome dataset critical to understanding the nuances of disease development on a global scale.
Pinpointing genomic loci for drought-induced proline and hydrogen peroxide accumulation in bread wheat under field conditions
Authors: Kamruzzaman Mohammad , Beyene Mekides Abebe , Siddiqui Md Nurealam , Ballvora Agim , Léon Jens , Naz Ali Ahmad
Published: December 2022

Background

Proline (Pro) and hydrogen peroxide (H2O2) play a critical role in plants during drought adaptation. Genetic mapping for drought-induced Pro and H2O2production under field conditions is very limited in crop plants since their phenotyping with large populations is labor-intensive. A genome-wide association study (GWAS) of a diversity panel comprised of 184 bread wheat cultivars grown in natural field (control) and rain-out shelter (drought) environments was performed to identify candidate loci and genes regulating Pro and H2O2accumulation induced by drought.

Results

The GWAS identified top significant marker-trait associations (MTAs) on 1A and 2A chromosomes, respectively for Pro and H2O2in response to drought. Similarly, MTAs for stress tolerance index (STI) of Pro and H2O2were identified on 5B and 1B chromosomes, respectively. Total 143 significant MTAs were identified including 36 and 71 were linked to drought and 2 and 34 were linked to STI for Pro and H2O2,respectively. Next, linkage disequilibrium analysis revealed minor alleles of significant single-markers and haplotypes were associated with higher Pro and H2O2accumulation under drought. Several putative candidate genes for Pro and H2O2content encode proteins with kinase, transporter or protein-binding activities.

Conclusions

The identified genetic factors associated with Pro and H2O2biosynthesis underlying drought adaptation lay a fundamental basis for functional studies and future marker-assisted breeding programs.
Predictive value of TRPV2 expression from peripheral blood mononuclear cells on the early recurrence of atrial fibrillation after radiofrequency catheter ablation
Authors: Ling Xuebin , Wang Jun , Qin Xue , Lin Chufen , Jie Wei , Chen Yane , Fu Dajia , Yang Yang , Meng Qingwen , Lin Jing , Liu Hui , Li Tianfa , Guo Junli
Published: December 2022

Background

Recent study has shown that the transient receptor potential vanilloid 2 (TRPV2) channel was exclusively upregulated in patients with atrial fibrillation (AF), and that this overexpression might be detrimental for occurrence and maintenance of AF. We aimed to characterize the expression levels of TRPV2 mRNA in peripheral blood mononuclear cells (PBMCs) with/without early recurrence of atrial fibrillation (ERAF) after radiofrequency catheter ablation (RFCA), and to find a reliable predictor for ERAF.

Methods

65 patients of AF, who underwent RFCA successfully, then divided into two groups according to ERAF during following 3 months. PBMCs were isolated from whole blood by Ficoll gradient centrifugation before and after RFCA. Gene set enrichment analysis was performed to evaluate TRPV channels expression levels and Kyoto Encyclopedia of Genes and Genomes (KEGG) mapping was used for pathway enrichment analysis.

Results

There was no significant difference in the TRPV2 mRNA expression level between the two groups before RFCA, while without ERAF group of TRPV2 expression was markedly reduced compared to ERAF group after RFCA. Moreover, the number of TRPV2 expression was confirmed as an independent predictor for the first time through receiver operating characteristic and Kaplan–Meier survival curve analysis. It should be pointed out that the above results were only used to predict ERAF, and have no predictive significance for late recurrence of atrial fibrillation according to the current data. Additionally, ERAF was inversely correlated with P wave dispersion. KEGG mapping further clustered 41 pathways, revealing that ‘‘cyclic guanosine monophosphate-protein kinase G signaling pathway’’ was significantly enriched.

Conclusions

We firstly assume that downregulated expression of peripheral TRPV2 appear in patients without ERAF after RFCA. TRPV2 may thus represent a novel predictor of early phase after successful radiofrequency ablation.
The effects of an emergency department length-of-stay management system on severely ill patients’ treatment outcomes
Authors: Kim Young Eun , Lee Hyang Yuol
Published: December 2022

Purpose

This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients.

Methods

Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system.

Results

A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p < .001). Six hundred forty-two patients (76.6%) in Group 1 were discharged to their home (normal discharge) and 979 patients (81.7%) were discharged to their home in Group 2, but the discharge-as-death rate was 14.1% in Group 1 and 7.5% in Group 2 (χ2 = 29.80, p < .001).

Conclusion

With the application and attainment of the ED LOS management system for severely ill patients, we have concluded the new system produced a lower LOS in the ED, 30 days in-hospital mortality, length of the hospitalization, mortality rate, and a higher rate of normal discharge.
Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
Authors: Tros Willemijn , van der Steen Jenny T. , Liefers Janine , Akkermans Reinier , Schers Henk , Numans Mattijs E. , van Peet Petra G. , Groenewoud A. Stef
Published: December 2022

Background

Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer, organ failure, or multimorbidity.

Methods

In this mixed-methods study in the Netherlands, we analysed health records selected from a database with primary care routine data and with a recorded ACP conversation in the last two years before death of patients who died with cancer, organ failure, or multimorbidity. We compared actual timing of ACP initiation as recorded in health records of 51 patients with the perceived optimal timing as determined by 83 independent GPs who studied these records. Further, to identify and compare triggers for GPs to initiate ACP, we analysed the health record documentation around the moments of the recorded actual timing of ACP initiation and the perceived optimal timing of ACP initiation. We combined quantitative descriptive statistics with qualitative content analysis.

Results

The recorded actual timing of ACP initiation was significantly closer to death than the perceived optimal timing in patients with cancer (median 88 vs. 111 days before death (p = 0.049)), organ failure (227 vs. 306 days before death (p = 0.02)) and multimorbidity (113 vs. 338 days before death (p = 0.006)). Triggers for recorded actual versus perceived optimal timing were similar across the three groups, the most frequent being ‘expressions of patients’ reflections or wishes’ (14% and 14% respectively) and ‘appropriate setting’ (10% and 13% respectively).

Conclusion

ACP in general practice was initiated and recorded later in the illness trajectory than considered optimal, especially in patients with organ failure or multimorbidity. As triggers were similar for recorded actual and perceived optimal timing, we recommend that GPs initiate ACP shortly after a trigger is noticed the first time, rather than wait for additional or more evident triggers when the illness is in an advanced stage.
Association between loneliness and its components and cognitive function among older Chinese adults living in nursing homes: A mediation of depressive symptoms, anxiety symptoms, and sleep disturbances
Authors: Wang Qingyan , Zan Chang , Jiang Fen , Shimpuku Yoko , Chen Sanmei
Published: December 2022

Objective

This study aimed to investigate the associations between loneliness and its components and cognitive function among older Chinese adults living in nursing homes and to test whether depressive symptoms, anxiety symptoms, and sleep disturbances mediate these associations.

Methods

The sample comprised 228 Chinese individuals aged ≥ 65 years living in nursing homes who were free of dementia and psychiatric or serious somatic diseases. Loneliness was evaluated using the UCLA Loneliness Scale. Global cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment. Multivariable linear regression analyses were performed to examine the associations between loneliness and its components and global cognitive function. A mediation analysis was used to test the potential mediating effects of depressive symptoms, anxiety symptoms, and sleep disturbances.

Results

The mean (SD) age of the participants was 80.8 (6.3) years, and 58.3% were women. Compared with the lowest quartile of loneliness degree, the multivariable-adjusted beta coefficient (95% confidence interval [95% CI]) for the highest quartile was -1.32 (-2.61 to -0.02) (P for trend = 0.03). Loneliness components, personal feelings of isolation and the lack of relational connectedness but not the lack of collective connectedness, were also inversely associated with cognitive function. Significant indirect effects on cognitive function were observed for loneliness and its two components (personal feelings of isolation and the lack of relational connectedness) in mediating pathways via depressive symptoms, anxiety symptoms, and sleep disturbances (all p < 0.05).

Conclusions

A higher degree of loneliness and its two components, personal feelings of isolation and the lack of relational connectedness, are associated with worse cognitive function among Chinese residents in nursing homes. Depressive symptoms, anxiety symptoms, and sleep disturbances may at least partially mediate these associations.
Long-term outcome and factors associated with restenosis after combination therapy of balloon angioplasty and stenting for symptomatic intracranial stenosis
Authors: Ueda Toshihiro , Takaishi Satoshi , Yoshie Tomohide , Usuki Noriko , Tatsuno Kentaro , Ohtsubo Haruki , Araga Takashi , Kaga Yasuyuki , Takada Tatsuro
Published: December 2022

Background

The optimal treatment for intracranial artery stenosis (ICAS) has not been established. We retrospectively examined the initial and long-term outcomes associated with restenosis of a combination therapy of balloon angioplasty and stenting for symptomatic atherosclerotic ICAS.

Methods

Consecutive patients who underwent balloon angioplasty and/or stenting for ≥ 70% ICAS between 2006 and 2020 were analyzed. Patients within 48 h of stroke onset were excluded. The following procedures were established as standards at our institution: (1) primary balloon angioplasty alone was initially performed; (2) stenting for insufficient dilatation, recoiling, or dissection was conducted; and (3) stenting was considered for restenosis. Intracranial ischemic and hemorrhagic complications within 30 days after treatment were used to evaluate periprocedural safety. Recurrent ischemic events, restenosis and restenosis related factors were used to be evaluate the long-term outcome.

Results

A total of 160 patients were recruited. Initial treatment consisted of balloon angioplasty (n = 101) and stenting (n = 59). Intracranial complications within 30 days after treatment were ischemic in five (3.1%) and hemorrhagic in four patients (2.5%). The incidence of these complication was 3.1% in the stenting group and 2.5% in the balloon angioplasty group. The mean follow-up period was 53.9 months. Restenosis was found in 42 patients (26%). Recurrent ischemic events during follow-up were noted in 14 patients (8.8%), of which six patients had TIA and eight patients had ischemic stroke. Restenosis-associated factors included diabetes, coronary artery disease, percent stenosis after treatment, and balloon angioplasty in logistic univariate analysis. Multivariate Cox regression analysis showed that diabetes (HR: 2.084, CI: 1.039–4.180, p = 0.0386), length of lesion (HR; 1.358, CI: 1.174–1.571, p < 0.0001), and balloon angioplasty (HR: 4.194, CI: 1.083–16.239, p = 0.0379) were independent predictors for restenosis.

Conclusion

Combination therapy of balloon angioplasty and stenting for symptomatic ICAS had a low perioperative stroke rate and may improve long-term outcome. Balloon angioplasty, diabetes, and length of lesion were significantly associated with restenosis.
Understanding context in the implementation of emergency obstetric and neonatal care in health facilities in Osun State, Nigeria- a mixed-methods study
Authors: Komolafe Abiola Olubusola , Oyelade Oyeyemi Olajumoke , Adedini Sunday Adepoju , Irinoye Omolola Oladunni
Published: December 2022

Background

Successful implementation of Emergency Obstetric and Neonatal Care (EmONC) is likely to improve pregnancy outcomes and is essential for quality maternity care. Context in implementation is described as factors that enabled or disabled implementation of interventions. While the context of implementation is important for the effectiveness of evidence-based interventions, the context of EmONC implementation has not been widely studied in Nigeria.

Methods

The research design was cross-sectional descriptive. A mixed-methods approach was used to assess and explore the context of implementing EmONC in referral centres in Osun state. A purposive sampling technique was used to select the three tertiary health facilities in Osun State and six secondary health facilities from the six administrative zones in the State. A total of 186 healthcare providers in these referral centres participated in the quantitative part of the study, and eighteen in-depth interviews were conducted for its qualitative aspect. An adapted questionnaire from Context Assessment Index and an interview guide were used to collect data. Quantitative data were analysed using descriptive and inferential statistics at 0.05 significance level, while qualitative data were analysed using the thematic approach.

Results

The percentage mean score of context strength in EmONC implementation was 63% ± 10.46 in secondary and 68% ± 10.47 in tertiary health facilities. There was a significant difference in the leadership (F (1, 184) = 8.35, p < 0.01), evaluation (F (1, 184) = 5.35, p = 0.02) and overall context (F (1, 184) = 6.46, p = 0.01) of EmONC implementation in secondary and tertiary health facilities. Emerging themes in EmONC context were: Resources for EmONC implementation; Demand for EmONC; Efficiency of funding; Institutional leadership; and Performance evaluation.

Conclusions

The context of EmONC implementation in the referral health facilities was generally weak. The secondary health facilities’ weaknesses were worse compared to the tertiary health facilities. The five key contextual factors could inform strategies for improving EmONC implementation in health facilities to ensure improved access to care that will reduce deaths from obstetric complications in Nigeria.
Safety and short-term outcomes of gastrectomy after preoperative chemotherapy plus immunotherapy versus preoperative chemotherapy: a retrospective cohort study
Authors: Wang Yinkui , Lei Xiaokang , Shan Fei , Li Shuangxi , Jia Yongning , Miao Rulin , Xue Kan , Li Zhemin , Ji Jiafu , Li Ziyu
Published: December 2022

Background

The safety and short-term outcomes of gastrectomy after preoperative chemotherapy plus immunotherapy (PCIT) versus preoperative chemotherapy (PCT) in patients with advanced gastric cancer (AGC) remain unclear. This study was conducted to compare the safety and short-term efficacy of PCIT with those of PCT in patients with AGC.

Methods

We retrospectively reviewed the data of patients with AGC who received PCIT or PCT at Peking University Cancer Hospital and Institute Gastrointestinal Cancer Center I between January 2019 and June 2021. The clinical characteristics were recorded, and short-term oncological outcomes were compared. Independent t tests, Mann‒Whitney U tests, chi-square tests, and Fisher’s exact tests were used to calculate differences. The correlation analyses were performed using Pearson correlation. All p values were two-sided, and a p value < 0.05 was considered statistically significant. All the above statistical analyses were conducted by the SPSS version 24.0 software package (IBM Corp., Armonk, NY, USA).

Results

A total of 162 AGC patients were included in this study, including 25 patients who received PCIT and 137 patients who received PCT. There were no significant differences in preoperative treatment-related adverse events (TRAEs) between the PCIT group and the PCT group (p = 0.088). Compared with the PCT group, the PCIT group had comparable postoperative functional recovery, with no significant differences in terms of time to first aerofluxus (p = 0.349), time to first defecation (p = 0.800), time to liquid diet (p = 0.233), or length of stay (p = 0.278). No significant differences were observed in terms of postoperative complications (p = 0.952), postoperative pain intensity at 24, 48, or 72 h (p = 0.375, p = 0.601, and p = 0.821, respectively), or postoperative supplementary analgesic use between the two groups (p = 0.881). In addition, the postoperative complication rate was 33.3% following laparoscopic approaches and 31.2% following open approaches in the PCIT group, with no significant difference (p = 1.000).

Conclusion

In patients with AGC, gastrectomy with D2 or D2 + lymphadenectomy after PCIT had comparable short-term oncological outcomes to PCT.
Response to brolucizumab treatment for refractory serous pigment epithelial detachment secondary to polypoidal choroidal vasculopathy
Authors: Nam Seung Wan , Byun Zeeyoon , Ham Don-Il , Kong Mingui
Published: December 2022

Purpose

To report the efficacy and safety of brolucizumab in the treatment of refractory serous pigment epithelial detachment (PED) secondary to polypoidal choroidal vasculopathy (PCV).

Methods

Twenty-six eyes of 26 patients were included. Intravitreal brolucizumab 6.0 mg was administered, followed by pro re nata (PRN) retreatment at monthly follow-ups. All patients underwent spectralis domain optical coherence tomography (SD-OCT), fluorescein angiography, and indocyanine green angiography before the first brolucizumab injection. SD-OCT was repeated at follow-up visits. The height and width of the serous PEDs, measured using SD-OCT, were analyzed.

Results

The number of previous anti-VEGF injections was 12.3 ± 15.0. During brolucizumab treatment, anatomical improvement was achieved and maintained in the height and width of the PEDs (p < 0.05). However, the visual outcome did not improve significantly (p > 0.05). A good response was achieved in 69.2% of eyes at 1 month and at the last visit. Relapse and complete resolution were observed in 27.8 and 23.1% of patients, respectively. The number of brolucizumab injections was 2.00 ± 0.85. Intraocular inflammation, vascular obstruction, and retinal pigment epithelial tears were not observed.

Conclusion

Intravitreal brolucizumab may be an effective and safe treatment option for refractory serous PEDs in patients with PCV.
Experiences of service transitions in Australian early intervention psychosis services: a qualitative study with young people and their supporters
Authors: Milton Alyssa , Powell Tacita , Conn Katrina , Einboden Rochelle , Buus Niels , Glozier Nicholas
Published: December 2022

Background

Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed.

Methods

Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion.

Results

The analysis identified four major service-related transitions in a YP’s journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services.

Conclusion

Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.
The identification and verification of hub genes associated with pulmonary arterial hypertension using weighted gene co-expression network analysis
Authors: Wu Weibin , Chen Ai , Lin Siming , Wang Qiuran , Lian Guili , Luo Li , Xie Liangdi
Published: December 2022

Background

Pulmonary arterial hypertension (PAH) is characterized by a progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, with complex etiology, difficult treatment and poor prognosis. The objective of this study was to investigate the potential biomarkers for PAH based on bioinformatics analysis.

Methods

The GSE117261 datasets were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified by screening PAH patients and controls. Then the DEGs were analyzed using a Weighted Gene Co-expression Network Analysis (WGCNA) and the key modules were determined, and to further explore their potential biological functions via Gene Ontology analysis (GO), Kyoto Encyclopedia of Genes and Genomes Pathway analysis (KEGG), and Gene Set Enrichment Analysis (GSEA). Moreover, Protein–protein interaction (PPI) networks were constructed to identify hub gene candidates in the key modules. Finally, real-time quantitative polymerase chain reaction was supplied to detect the expressions of hub genes in human pulmonary arterial smooth cells treated with cobalt chloride (COCl2) which was used to mimic hypoxia.

Results

There were 2299 DEGs identified. WGCNA indicated that yellow module was the key one correlated with PAH. GO and KEGG analysis demonstrated that genes in the yellow module were mainly enriched in ‘Pathways in cancer’. GSEA revealed that ‘HALLMARK_MYC_TARGETS_V1’ was remarkably enriched in PAH. Based on the PPI network, vascular endothelial growth factor A, proto-oncogene receptor tyrosine kinase (KIT), PNN interacting serine and arginine rich protein (PNISR) and heterogeneous nuclear ribonucleoprotein H1 (HNRNPH1) were identified as the hub genes. Additionally, the PCR indicated that the elevated expressions of PNISR and HNRNPH1 were in line with the bioinformatics analysis. ROC analysis determined that PNISR and HNRNPH1 may be potential biomarkers to provide better diagnosis of PAH.

Conclusion

PNISR and HNRNPH1 were potential biomarkers to diagnosis PAH. In summary, the identified DEGs, modules, pathways, and hub genes provide clues and shed light on the potential molecular mechanisms of PAH.
Attrition and social vulnerability during 2-year-long structured care in type 2 diabetes, the ERMIES randomized controlled trial
Authors: Flaus-Furmaniuk Anna , Fianu Adrian , Lenclume Victorine , Chirpaz Emmanuel , Balcou-Debussche Maryvette , Debussche Xavier , Marimoutou Catherine
Published: December 2022

Background

Diabetes self-management education is exposed to attrition from services and structured ambulatory care. However, knowledge about factors related to attrition in educational programs remains limited. The context of social vulnerability due to low income may interfere. The aim of this study was to identify the sociodemographic, clinical, psychometric, and lifestyle factors associated with attrition from the ERMIES multicentre randomized parallel controlled trial (RCT) that was interrupted due to the combination of both slow inclusion and high attrition.

Methods

The ERMIES trial was performed from 2011 to 2016 on Reunion Island, which is characterized by a multicultural population and high social vulnerability. The original objective of the RCT was to test the efficacy of a2-year structured group self-management education in improving blood glucose in adult patients with nonrecent, insufficiently controlled type 2 diabetes. One hundred participants were randomized to intensive educational intervention maintained over two years (n = 51) versus only initial education (n = 49). Randomization was stratified on two factors: centres (five strata) and antidiabetic treatment (two strata: insulin-treated or not). Sociodemographic, clinical, health-care access and pathway, psychometric and lifestyle characteristics data were collected at baseline and used to assess determinants of attrition in a particular social context and vulnerability. Attrition and retention rates were measured at each visit during the study. Multiple correspondence analysis and Cox regression were performed to identify variables associated with attrition.

Results

The global attrition rate was 26% during the study, with no significant difference between the two arms of randomization (9 dropouts out of 51 patients in the intervention group and 17 out of 49 in the control group). Male gender, multiperson household, low household incomes (< 800 euros), probable depression and history of hospitalization or medical leave at inclusion were associated with a higher risk of attrition from the study in multivariate regression.

Conclusions

Social context, vulnerability, and health care history were related to attrition in this 2-year longitudinal comparative study of structured care. Considering these potential determinants and biases is of importance in scaling up interventions aimed at the optimization of long-term care in type 2 diabetes mellitus.

Trial registration

ID_RCB number: 2011-A00046-35, Clinicaltrials.gov number: NCT01425866 (Registration date: 30/08/2011).

Source of funding: Ministry of Health, France.
Assessment of the oral health literacy and oral health behaviors among nurses in China: a cross-sectional study
Authors: An Ran , Chen Wen-feng , Li Siyu , Wu Zitong , Liu Meizi , Sohaib Muhammad
Published: December 2022

Purpose

Oral health is important for general health; nurses are expected to possess good oral health awareness and work together for public oral health promotion. The purpose of this study is to investigate oral health literacy (OHL)and oral health behaviors of nurses, and explore the association between oral health literacy with demographic variables and oral health behaviors.

Methods

A cross-sectional study in a tertiary hospital was conducted using a short-form Health Literacy in Dentistry-14 (HeLD-14) and a 16-items oral health behaviors questionnaire. Information about the subjects’ demographic details including age, gender, place of residence, marital status, marital status, education level, monthly household income, working experience, etc. were collected. Independent sample t- test, One- way ANOVA, and multivariable regression were used to identify the association of oral health literacy with demographic variables and oral health behaviors.

Results

A total number of 317 nursing nurses participated in the survey, with a mean OHL score of 36.72, SD10.531, 21.8% were categorized as good, 34.1% medium and 44.2% poor oral health literacy; monthly household income, self-rated oral health, brushing time, use of fluoride toothpaste, and regular oral examination were signficantly associated with OHL scores.

Conclusion

The overall oral health literacy of the nurse population is at a moderate to low level. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nurses, especially nurses with low monthly household income and poor self-assessed oral health status. Nursing administrators and nursing educators should pay more attention to the oral health status of the nurse population.