bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and Ethnic Disparities in the Use and Outcomes of Transcatheter Mitral Valve Replacement: Analysis From the National Inpatient Sample Database
Authors: Ismayl Mahmoud , Abbasi Muhannad Aboud , Al‐Abcha Abdullah , El‐Am Edward , Walters Ryan W. , Goldsweig Andrew M. , Alkhouli Mohamad , Guerrero Mayra , Anavekar Nandan S.
Published: March 2023

Background

Racial and ethnic disparities in outcomes exist following many cardiac procedures. Transcatheter mitral valve replacement (TMVR) has grown as an alternative to mitral valve surgery for patients at high surgical risk. The outcomes of TMVR by race and ethnicity are unknown. We aimed to evaluate racial and ethnic disparities in the outcomes of TMVR.

Methods and Results

We analyzed the National Inpatient Sample database from 2016 to 2020 to identify hospitalizations for TMVR. Racial and ethnic disparities in TMVR outcomes were determined using logistic regression models. Between 2016 and 2020, 5005 hospitalizations for TMVR were identified, composed of 3840 (76.7%) White race, 505 (10.1%) Black race, 315 (6.3%) Hispanic ethnicity, and 345 (6.9%) from other races (Asian, Pacific Islander, American Indian or Alaska Native, Other). Compared with other racial and ethnic groups, Black patients were significantly younger and more likely to be women (both
P
<0.01). There were no significant differences between White, Black, and Hispanic patients in in‐hospital mortality (5.2% versus 5.0% versus <3.5%;
P
=0.89) and procedural complications, including heart block (
P
=0.91), permanent pacemaker (
P
=0.49), prosthetic valve dysfunction (
P
=0.45), stroke (
P
=0.37), acute kidney injury (
P
=0.32), major bleeding (
P
=0.23), and blood transfusion (
P
=0.92), even after adjustment for baseline characteristics. Adjusted vascular complications were higher in Black compared with White patients (
P
=0.03). Trend analysis revealed a significant increase in TMVR in all racial and ethnic groups from 2016 to 2020 (
P
trend
<0.05).

Conclusions

Between 2016 and 2020, Black and Hispanic patients undergoing TMVR had similar in‐hospital outcomes compared with White patients, except for higher vascular complications in Black patients. Further comparative studies of TMVR in clinically similar White patients and other racial and ethnic groups are warranted to confirm our findings.
Monitoring of Hemodynamics With Right Heart Catheterization in Children With Pulmonary Arterial Hypertension
Authors: Grynblat Julien , Malekzadeh‐Milani Sophie‐Guiti , Meot Mathilde , Perros Frédéric , Szezepanski Isabelle , Morisset Stéphane , Ovaert Caroline , Bonnet Caroline , Maragnes Pascale , Ranchoup Julien , Humbert Marc , Montani I. David , Levy Marilyne , Bonnet Damien
Published: March 2023

Background

Right heart catheterization (RHC) is a high‐risk procedure in children with pulmonary arterial hypertension without clear guidelines for the indications and targets of invasive reassessment. Our objectives are to define the aims of repeated RHC and evaluate the correlation between noninvasive criteria and hemodynamic parameters.

Methods and Results

Clinical and hemodynamic characteristics from 71 incident treatment‐naïve children (median age 6.2 years) with pulmonary arterial hypertension who had a baseline and reevaluation RHC were analyzed. Correlations between noninvasive predictors and hemodynamic parameters were tested. Adverse outcomes were defined as death, lung transplantation, or Potts shunt. At baseline, pulmonary vascular resistance index (hazard ratio [HR] 1.07 per 1 WU·m
2
increase [95% CI, 1.02–1.12],
P
=0.002), stroke volume index (HR 0.95 per 1 L·min
−1
·m
−2
increase [95% CI, 0.91–0.99],
P
=0.012), pulmonary artery compliance index (HR 0.16 per 1 mL·mm Hg
−1·
m
−2
increase [95% CI, 0.051–0.52],
P
=0.002), and right atrial pressure (HR, 1.31 per 1 mm Hg increase [95% CI, 1.01–1.71],
P
=0.043) were associated with adverse outcomes. Pulmonary vascular resistance index, pulmonary artery compliance index, and right atrial pressure were still associated with a worse outcome at second RHC. Noninvasive criteria accurately predicted hemodynamic evolution; however, 70% of the patients who had improved based on noninvasive criteria still presented at least 1 “at risk” hemodynamics at second RHC.

Conclusions

Pulmonary vascular resistance index, pulmonary artery compliance index, and right atrial pressure are solid predictors of adverse outcomes in pediatric pulmonary arterial hypertension and potential therapeutic targets. Noninvasive criteria accurately predict the evolution of hemodynamic parameters, but insufficiently. Repeated RHC are helpful to identify children with persistent higher risk after treatment introduction.
Introduction. Space Diplomacy: The Final Frontier of Theory and Practice
Authors: Cross Mai’a K. Davis , Pekkanen Saadia M.
Published: March 2023

A quantum leap is under way in space as a domain of human activity. The global space economy has rapidly reached almost USD450 billion in size and is projected to grow to over USD1 trillion by the 2040s. There are hundreds of actors involved, from space agencies to private companies to start-ups. Over 70 countries have space programmes and 14 have launch capabilities. These developments have involved intense transnational and international co-operation and competition, across both the public and private sectors. With such rapid changes underway, this article takes stock of how these developments impact international relations. Overall, this is the first special issue in the field of international relations to use theories of diplomacy to bring to light the various ways in which experts, scientists, astronauts, space enthusiasts and professional diplomats, among others, have shaped the formal and informal interactions among states in this key area of foreign policy.
Hieracium umbellonigritum (Asteraceae), a new hybridogenous species from the Sudetes in Poland
Authors: SZELĄG ZBIGNIEW
Published: March 2023

N/A
A taxonomic revision of Taraxacum sect. Dissecta, a continental steppe group common in Siberia and adjacent regions of Central Asia
Authors: KIRSCHNER JAN , ŠTĚPÁNEK JAN
Published: March 2023

Steppe and similar habitats in southern Siberia, Mongolia and adjacent regions harbour a considerable diversity of Taraxacum sect. Dissecta (Asteraceae, Crepidinae); its taxonomic revision is presented. A thorough study of live and herbarium plants revealed 30 species that belong, or are very close, to T. sect. Dissecta; seven species were known previously and 23 are described as new, mostly from the Altai Republic, Novosibirsk, Irkutsk, Lake Baikal and Bratsk. Their distribution includes the Asiatic part of Russia, Kazakhstan, Kyrgyzstan, Mongolia and Xinjiang, China. The name T. dissectum (Ledeb.) Ledeb. is relegated to the synonymy of T. pubescens (Fr.) Fr. A detailed analysis of the original material of the name T. collinum revealed that it consists of mostly juvenile plants belonging to several species of T. sect. Dissecta, and that it requires further study on newly collected material. The frequently reported occurrence of T. sect. Dissecta (as T. dissectum) in the European mountain ranges was reassessed. The reports from the Pyrenees belong to T. pyrenaicum and related species of T. sect. Obliqua. Two mutually similar species, often referred to as T. dissectum, recognized as T. aquilonare Hand.-Mazz. and T. zermattense Dahlst., were studied in order to reconsider the hypothesis that they represent T. sect. Dissecta in the Alps. On the basis of morphological and phytogeographical data, we present this hypothesis as quite plausible but requiring experimental, phylogeographic evidence; a full treatment of both species is also given. The name T. compactum is typified and the species is excluded from T. sect. Dissecta; it belongs to T. sect. Qaisera.
Characterization of chloroprene rubber-modified asphalt binders
Authors: Moazami Goodarzi Mahdi , Nazari Hossein , Naderi Koorosh , Moghadas Nejad Fereidoon , Babaii Ashourabadi Eshagh
Published: March 2023

Despite being one of the potential candidates for a suitable elastomeric additive to modify asphalt binders, there is a lack of research on using chloroprene rubber (CR). This study evaluates the suitability of using CR to enhance asphalt binder properties, particularly rutting and fatigue performances. Two different grades of asphalt binder (60/70 and 85/100 penetration grade) were modified by 3.5% and 7% CR to meet this end. The conventional physical, high-temperature storage stability, rotational viscosity (RV), dynamic shear rheometer (DSR), multiple stress creep recovery (MSCR), and linear amplitude sweep (LAS) tests were used to examine various features of the CR-modified asphalt binder. Results indicate that CR decreases penetration, ductility, and temperature susceptibility and increases softening point and viscosity of the asphalt binder. Additionally, the CR-modified binder can present acceptable pumpability and workability within the construction temperature range. However, the CR-modified binder has phase separation potential, particularly at high modification contents. Based on the results of MSCR and LAS tests, CR can effectively increase the rutting resistance, elastic recovery, and fatigue life of the asphalt binder. Nevertheless, the CR-modified asphalt binder’s rutting and fatigue behaviors depend mainly on the grade of the base asphalt binder.
Homeostatic Regulation of Energetic Arousal During Acute Social Isolation: Evidence From the Lab and the Field
Authors: Stijovic Ana , Forbes Paul A. G. , Tomova Livia , Skoluda Nadine , Feneberg Anja C. , Piperno Giulio , Pronizius Ekaterina , Nater Urs M. , Lamm Claus , Silani Giorgia
Published: March 2023

Recent evidence suggests that social contact is a basic need governed by a social homeostatic system. Little is known, however, about how conditions of altered social homeostasis affect human psychology and physiology. Here, we investigated the effects of 8 hr of social isolation on psychological and physiological variables and compared this with 8 hr of food deprivation in a lab experiment ( N = 30 adult women). Social isolation led to lowered self-reported energetic arousal and heightened fatigue, comparable with food deprivation. To test whether these findings would extend to a real-life setting, we conducted a preregistered field study during a COVID-19 lockdown ( N = 87 adults; 47 women). The drop in energetic arousal after social isolation observed in the lab replicated in the field study for participants who lived alone or reported high sociability, suggesting that lowered energy could be part of a homeostatic response to the lack of social contact.
Heterogeneity of crisis communication practices in hotels: Anti-COVID-19 measures on Adriatic beach hotels’ websites
Authors: Šuligoj Metod
Published: March 2023

Based on situational crisis communication theory, this study designs a research framework to identify differences in crisis communication practises on beach hotel websites in different Adriatic countries and between three consecutive summer seasons due to the COVID-19 pandemic. A qualitative inductive content analysis of official pandemic-related guidelines/recommendations from national and international competent organizations was carried out. Subsequently, an overlooked repeated measures design with deductive quantitative content analysis of crisis communications on hotel websites during the three summer seasons was conducted. Employing the McNemar test, the Cochran's Q-test and Friedman test with post-hoc comparisons, it was discovered that (1) beside the bolstering strategy, the new ‘ignore strategy’ of crisis communication was also identified, which has many implications, (2) communication of anti-COVID-19 measures is statistically significant and relatively strongly associated with the country in which hotels are located, and (3) the number of different announcements on anti-COVID-19 measures is significantly different only between two seasons.
Cutting the STEM of future skills: beyond the STEM vs art dichotomy in England
Authors: Ashton Heidi
Published: March 2023

For the last decade education policy in England has been underpinned by a dichotomisation of education into STEM versus Arts. The rationale is that STEM graduates gain more lucrative employment via the desirability of the ‘STEM skills’ which it is stated are increasingly in demand and imperative for economic prosperity. Through a literature review and analysis of policy documents and reports this paper examines evidence regarding the assumptions that are inherent in this claim. In doing so it reveals that the rationale for this approach is deeply flawed, particularly in relation to future skills needs. This raises questions not only for the current direction of policy but fundamentally the notion of STEM as a useful and meaningful acronym in this context. The evidence instead calls for an integrated, dynamic and strategic approach to education policy that fundamentally moves beyond the false dichotomy of STEM versus Arts.
Adjuvant therapy of biliary tract cancers
Authors: Kefas Joanna , Bridgewater John , Vogel Arndt , Stein Alexander , Primrose John
Published: March 2023

Biliary tract cancers (BTCs) are rare and heterogeneous malignant tumours including cholangiocarcinoma and gallbladder cancer. They are very aggressive, often refractory to chemotherapy and associated with an overall poor prognosis. Surgical resection remains the only potentially curative treatment option but less than 35% present with resectable disease. Adjuvant treatments have been widely used but until recently, supportive data were limited to non-randomised, non-controlled retrospective studies. Recent evidence from the BILCAP trial has established adjuvant capecitabine as the standard of care. But there are still unanswered questions as to the role of adjuvant therapy. Further prospective data and translational research with reproducible evidence of clinical benefit are needed. In this review of adjuvant therapy in resectable BTCs, we will summarise the latest evidence setting current treatment standards and highlight future prospects.
The promotion action of AURKA on post-ischemic angiogenesis in diabetes-related limb ischemia
Authors: Bai Tao , Li Mingxing , Liu Yuanfeng , Qiao Zhentao , Zhang Xusheng , Wang Yafeng , Wang Zhiwei
Published: March 2023

Background

Diabetes-related limb ischemia is a challenge for lower extremity amputation. Aurora Kinase A (AURKA) is an essential serine/threonine kinase for mitosis, while its role in limb ischemia remains unclear.

Method

Human microvascular endothelial cells (HMEC-1) were cultured in high glucose (HG, 25 mmol/L d-glucose) and no additional growth factors (ND) medium to mimic diabetes and low growth factors deprivation as in vitro model. Diabetic C57BL/6 mice were induced by streptozotocin (STZ) administration. After seven days, ischemia was surgically performed by left unilateral femoral artery ligation on diabetic mice. The vector of adenovirus was utilized to overexpress AURKA in vitro and in vivo.

Results

In our study, HG and ND-mediated downregulation of AURKA impaired the cell cycle progression, proliferation, migration, and tube formation ability of HMEC-1, which were rescued by overexpressed AURKA. Increased expression of vascular endothelial growth factor A (VEGFA) induced by overexpressed AURKA were likely regulatory molecules that coordinate these events. Mice with AURKA overexpression exhibited improved angiogenesis in response to VEGF in Matrigel plug assay, with increased capillary density and hemoglobin content. In diabetic limb ischemia mice, AURKA overexpression rescued blood perfusion and motor deficits, accompanied by the recovery of gastrocnemius muscles observed by H&E staining and positive Desmin staining. Moreover, AURKA overexpression rescued diabetes-related impairment of angiogenesis, arteriogenesis, and functional recovery in the ischemic limb. Signal pathway results revealed that VEGFR2/PI3K/AKT pathway might be involved in AURKA triggered angiogenesis procedure. In addition, AURKA overexpression impeded oxidative stress and subsequent following lipid peroxidation both in vitro and in vivo, indicating another protective mechanism of AURKA function in diabetic limb ischemia. The changes in lipid peroxidation biomarkers (lipid ROS, GPX4, SLC7A11, ALOX5, and ASLC4) in in vitro and in vivo were suggestive of the possible involvement of ferroptosis and interaction between AUKRA and ferroptosis in diabetic limb ischemia, which need further investigation.

Conclusions

These results implicated a potent role of AURKA in diabetes-related impairment of ischemia-mediated angiogenesis and implied a potential therapeutic target for ischemic diseases of diabetes.
p20BAP31 induces cell apoptosis via both AIF caspase-independent and the ROS/JNK mitochondrial pathway in colorectal cancer
Authors: Jiang Xiaohan , Li Guoxun , Zhu Benzhi , Zang Jingnan , Lan Tian , Jiang Rui , Wang Bing
Published: March 2023

Background

During cell apoptosis, the C-terminus of BAP31 is cleaved by caspase-8 and generates p20BAP31, which has been shown to induce an apoptotic pathway between the endoplasmic reticulum (ER) and mitochondria. However, the underlying mechanisms of p20BAP31 in cell apoptosis remains unclear.

Methods

We compared the effects of p20BAP31 on cell apoptosis in six cell lines and selected the most sensitive cells. Functional experiments were conducted, including Cell Counting Kit 8 (CCK-8), reactive oxygen species (ROS), and mitochondrial membrane potential (MMP) assay. Then, cell cycle and apoptosis were investigated by flow cytometry and verified by immunoblotting. Next, NOX inhibitors (ML171 and apocynin), ROS scavenger (NAC), JNK inhibitor (SP600125), and caspase inhibitor (Z-VAD-FMK) were used to further investigate the underlying mechanisms of p20BAP31 on cell apoptosis. Finally, apoptosis-inducing factor (AIF) translocation from the mitochondria to the nuclei was verified by immunoblotting and immunofluorescence assay.

Results

We found that overexpression of p20BAP31 indeed induced apoptosis and had a much greater sensitivity in HCT116 cells. Furthermore, the overexpression of p20BAP31 inhibited cell proliferation by causing S phase arrest. Further study revealed that p20BAP31 reduced MMP, with a significant increase in ROS levels, accompanied by the activation of the MAPK signaling pathway. Importantly, the mechanistic investigation indicated that p20BAP31 induces mitochondrial-dependent apoptosis by activating the ROS/JNK signaling pathway and induces caspase-independent apoptosis by promoting the nuclear translocation of AIF.

Conclusions

p20BAP31 induced cell apoptosis via both the ROS/JNK mitochondrial pathway and AIF caspase-independent pathway. Compared with antitumor drugs that are susceptible to drug resistance, p20BAP31 has unique advantages for tumor therapy.
Novel bispecific aptamer targeting PD-1 and nucleolin for cancer immunotherapy
Authors: Fu Junjun , Yao Fengjiao , An Yacong , Li Xundou , Wang Wenya , Yang Xian-Da
Published: March 2023

Background

Immune checkpoint blockade (ICB) is a promising strategy for cancer treatment and has achieved remarkable clinical results. Further improvement of ICB efficacy may advance cancer immunotherapy and has evident medical importance. Here in this study, a PD-1 aptamer was functionalized with a tumor-homing nucleolin aptamer (AS1411) to build a novel bispecific agent (BiApt) for boosting the efficacy of ICB therapy.

Results

The two aptamers were coupled together via sticky ends to form BiApt, which had an average size of 11.70 nm. Flow cytometry revealed that BiApt could bind with both the activated T cells and the nucleolin-expressing tumor cells. In addition, BiApt could recruit more T cells to the vicinity of nucleolin-positive tumor cells. Functionally, BiApt enhanced the PBMC-mediated anticancer cytotoxicity in vitro compared with free PD-1 aptamer. Moreover, in an animal model of CT26 colon cancer, BiApt significantly boosted the antitumor efficacy vs. free PD-1 aptamer.

Conclusion

The results suggest that bispecific agent combining ICB and tumor-homing functions has potential to improve the efficacy of ICB immunotherapy.
GVC: efficient random access compression for gene sequence variations
Authors: Adhisantoso Yeremia Gunawan , Voges Jan , Rohlfing Christian , Tunev Viktor , Ohm Jens-Rainer , Ostermann Jörn
Published: March 2023

Background

In recent years, advances in high-throughput sequencing technologies have enabled the use of genomic information in many fields, such as precision medicine, oncology, and food quality control. The amount of genomic data being generated is growing rapidly and is expected to soon surpass the amount of video data. The majority of sequencing experiments, such as genome-wide association studies, have the goal of identifying variations in the gene sequence to better understand phenotypic variations. We present a novel approach for compressing gene sequence variations with random access capability: the Genomic Variant Codec (GVC). We use techniques such as binarization, joint row- and column-wise sorting of blocks of variations, as well as the image compression standard JBIG for efficient entropy coding.

Results

Our results show that GVC provides the best trade-off between compression and random access compared to the state of the art: it reduces the genotype information size from 758 GiB down to 890 MiB on the publicly available 1000 Genomes Project (phase 3) data, which is 21% less than the state of the art in random-access capable methods.

Conclusions

By providing the best results in terms of combined random access and compression, GVC facilitates the efficient storage of large collections of gene sequence variations. In particular, the random access capability of GVC enables seamless remote data access and application integration. The software is open source and available at https://github.com/sXperfect/gvc/.
Integrated transcriptomics contrasts fatty acid metabolism with hypoxia response in β-cell subpopulations associated with glycemic control
Authors: Miranda Mario A , Macias-Velasco Juan F , Schmidt Heather , Lawson Heather A
Published: March 2023

Background

Understanding how heterogeneous β-cell function impacts diabetes is imperative for therapy development. Standard single-cell RNA sequencing analysis illuminates some factors driving heterogeneity, but new strategies are required to enhance information capture.

Results

We integrate pancreatic islet single-cell and bulk RNA sequencing data to identify β-cell subpopulations based on gene expression and characterize genetic networks associated with β-cell function in obese SM/J mice. We identify β-cell subpopulations associated with basal insulin secretion, hypoxia response, cell polarity, and stress response. Network analysis associates fatty acid metabolism and basal insulin secretion with hyperglycemic-obesity, while expression of Pdyn and hypoxia response is associated with normoglycemic-obesity.

Conclusions

By integrating single-cell and bulk islet transcriptomes, our study explores β-cell heterogeneity and identifies novel subpopulations and genetic pathways associated with β-cell function in obesity.
Cardiac magnetic resonance feature tracking myocardial strain analysis in suspected acute myocarditis: diagnostic value and association with severity of myocardial injury
Authors: Gao Qian , Yi Wenfang , Gao Chao , Qi Tianfu , Li Lili , Xie Kaipeng , Zhao Wei , Chen Wei
Published: March 2023

Background

Albeit that cardiac magnetic resonance feature tracking (CMR-FT) has enabled quantitative assessment of global myocardial strain in the diagnosis of suspected acute myocarditis, the cardiac segmental dysfunction remains understudied. The aim of the present study was using CMR-FT to assess the global and segmental dysfunction of the myocardium for diagnosis of suspected acute myocarditis.

Methods

Forty-seven patients with suspected acute myocarditis (divided into impaired and preserved left ventricular ejection fraction [LVEF] groups) and 39 healthy controls (HCs) were studied. A total of 752 segments were divided into three subgroups, including segments with non-involvement (SNi), segments with edema (SE), and segments with both edema and late gadolinium enhancement (SE+LGE). 272 healthy segments served as the control group (SHCs).

Results

Compared with HCs, patients with preserved LVEF showed impaired global circumferential strain (GCS) and global longitudinal strain (GLS). Segmental strain analysis showed that the peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) values significantly reduced in SE+LGE compared with SHCs, SNi, SE. PCS significantly reduced in SNi (-15.3 ± 5.8% vs. -20.3 ± 6.4%, p < 0.001) and SE (-15.2 ± 5.6% vs. -20.3 ± 6.4%, p < 0.001), compared with SHCs. The area under the curve (AUC) values of GLS (0.723) and GCS (0.710) were higher than that of global peak radial strain (0.657) in the diagnosis of acute myocarditis, but the difference was not statistically significant. Adding the Lake Louise Criteria to the model resulted in a further increase in diagnostic performance.

Conclusions

Global and segmental myocardial strain were impaired in patients with suspected acute myocarditis, even in the edema or relatively non-involved regions. CMR-FT may serve as an incremental tool for assessment of cardiac dysfunction and provide important additional imaging-evidence for distinguishing the different severity of myocardial injury in myocarditis.
The optimal pre-post allocation for randomized clinical trials
Authors: Ma Shiyang , Wang Tianying
Published: March 2023

Background

In pre-post designs, analysis of covariance (ANCOVA) is a standard technique to detect the treatment effect with a continuous variable measured at baseline and follow-up. For measurements subject to a high degree of variability, it may be advisable to repeat the pre-treatment and/or follow-up assessments. In general, repeating the follow-up measurements is more advantageous than repeating the pre-treatment measurements, while the latter can still be valuable and improve efficiency in clinical trials.

Methods

In this article, we report investigations of using multiple pre-treatment and post-treatment measurements in randomized clinical trials. We consider the sample size formula for ANCOVA under general correlation structures with the pre-treatment mean included as the covariate and the mean follow-up value included as the response. We propose an optimal experimental design of multiple pre-post allocations under a specified constraint, that is, given the total number of pre-post treatment visits. The optimal number of the pre-treatment measurements is derived. For non-linear models, closed-form formulas for sample size/power calculations are generally unavailable, but we conduct Monte Carlo simulation studies instead.

Results

Theoretical formulas and simulation studies show the benefits of repeating the pre-treatment measurements in pre-post randomized studies. The optimal pre-post allocation derived from the ANCOVA extends well to binary measurements in simulation studies, using logistic regression and generalized estimating equations (GEE).

Conclusions

Repeating baselines and follow-up assessments is a valuable and efficient technique in pre-post design. The proposed optimal pre-post allocation designs can minimize the sample size, i.e., achieve maximum power.
Estimated Covid-19 burden in Spain: ARCH underreported non-stationary time series
Authors: Moriña David , Fernández-Fontelo Amanda , Cabaña Alejandra , Arratia Argimiro , Puig Pedro
Published: March 2023

Background

The problem of dealing with misreported data is very common in a wide range of contexts for different reasons. The current situation caused by the Covid-19 worldwide pandemic is a clear example, where the data provided by official sources were not always reliable due to data collection issues and to the high proportion of asymptomatic cases. In this work, a flexible framework is proposed, with the objective of quantifying the severity of misreporting in a time series and reconstructing the most likely evolution of the process.

Methods

The performance of Bayesian Synthetic Likelihood to estimate the parameters of a model based on AutoRegressive Conditional Heteroskedastic time series capable of dealing with misreported information and to reconstruct the most likely evolution of the phenomenon is assessed through a comprehensive simulation study and illustrated by reconstructing the weekly Covid-19 incidence in each Spanish Autonomous Community.

Results

Only around 51% of the Covid-19 cases in the period 2020/02/23–2022/02/27 were reported in Spain, showing relevant differences in the severity of underreporting across the regions.

Conclusions

The proposed methodology provides public health decision-makers with a valuable tool in order to improve the assessment of a disease evolution under different scenarios.
Lost in transition? Community residential facility staff and stakeholder perspectives on previously incarcerated older adults’ transitions into long-term care
Authors: Poulin Laura I. L. , Colibaba Amber , Skinner Mark W. , Balfour Gillian , Byrne David , Dieleman Crystal
Published: March 2023

Background

Establishing an effective continuum of care is a pivotal part of providing support for older populations. In contemporary practice; however, a subset of older adults experience delayed entry and/or are denied access to appropriate care. While previously incarcerated older adults often face barriers to accessing health care services to support community reintegration, there has been limited research on their transitions into long-term care. Exploring these transitions, we aim to highlight the challenges of securing long-term care services for previously incarcerated older adults and shed light on the contextual landscape that reinforces the inequitable care of marginalized older populations across the care continuum.

Methods

We performed a case study of a Community Residential Facility (CRF) for previously incarcerated older adults which leverages best practices in transitional care interventions. Semi-structured interviews were conducted with CRF staff and community stakeholders to determine the challenges and barriers of this population when reintegrating back into the community. A secondary thematic analysis was conducted to specifically examine the challenges of accessing long-term care. A code manual representing the project themes (e.g., access to care, long-term care, inequitable experiences) was tested and revised, following an iterative collaborative qualitative analysis (ICQA) process.

Results

The findings indicate that previously incarcerated older adults experience delayed access and/or are denied entry into long-term care due to stigma and a culture of risk that overshadow the admissions process. These circumstances combined with few available long-term care options and the prominence of complex populations already in long-term care contribute to the inequitable access barriers of previously incarcerated older adults seeking entry into long-term care.

Conclusions

We emphasize the many strengths of utilizing transitional care interventions to support previously incarcerated older adults as they transition into long-term care including: 1) education & training, 2) advocacy, and 3) a shared responsibility of care. On the other hand, we underscore that more work is needed to redress the layered bureaucracy of long-term care admissions processes, the lack of long-term care options and the barriers imposed by restrictive long-term care eligibility criteria that sustain the inequitable care of marginalized older populations.
Determining the factors influencing the selection of post-acute care models by patients and their families: a qualitative content analysis
Authors: Hsu Ya-Hui , Lee Tsong-Hai , Chung Kuo-Piao , Tung Yu-Chi
Published: March 2023

Background

This study conducted in-depth interviews to explore the factors that influence the choice of a post-acute care (PAC) model (inpatient rehabilitation hospital, skilled nursing facility, home health, and outpatient rehabilitation) among stroke patients and their families.

Methods

We conducted semi-structured, in-depth interviews of 21 stroke patients and their families at four hospitals in Taiwan. Content analysis was used in this qualitative study.

Results

Results revealed five main factors that influence respondents’ choice of PAC: (1) medical professionals’ suggestions, (2) health care accessibility, (3) continuity and coordination of care, (4) willingness and prior experience of patients and their relatives and friends, and (5) economic factors.

Conclusions

This study identifies five main factors that affect the choice of PAC models among stroke patients and their families. We suggest that policymakers establish comprehensive health care resources based on the needs of patients and families. Health care providers shall provide professional recommendations and adequate information to support decision-making, which aligns with the preferences and values of patients and their families. From this research, we hope to improve the accessibility of PAC services in order to enhance the quality of care for stroke patients.
Efficacy and safety of decompressive craniectomy in acute ischemic stroke patients treated with intravenous thrombolysis
Authors: Sadeghi-Hokmabadi Elyar , Mirzaei Farhad , Yazdchi Mohammad , Jalili Javad , Sadeghpour Yalda , Nemati-Anari Behzad , Farhoudi Mehdi , HamianRoumiani Pouneh
Published: March 2023

Introduction

The optimal timing for decompressive hemicraniectomy (DHC) after intravenous thrombolysis (IVT) remains unclear. This study in patients with acute ischemic stroke treated with IVT aimed to assess the safety of DHC and patient outcome.

Methods

Data was extracted from the Tabriz stroke registry from June 2011 up to September 2020. In all, 881 patients were treated with IVT. Among these, 23 patients underwent DH. Six patients were excluded due to symptomatic intracranial hemorrhage (parenchymal hematoma type 2 based on SITS-MOST definition) after IVT, but other types of bleeding after venous thrombolysis, including HI1, HI2, and PH1 were not excluded; so the remaining 17 patients were enrolled in the study. Functional Outcome was defined as the proportion of patients who achieved mRS score of 2–3 (moderate disability), 4–5 (severe disability), or 6 (mortality) at 90 days after stroke. mRSwas assess by trained neurologist at the hospital clinic with direct interview Safety outcome was assessed by comparison of two scans just prior to and after craniectomy. Any new hemorrhage or worsening of previous hemorrhage was reported. Parenchymal hematoma type 2, based on ECASS II definition, was considered as major surgical complication. This study was approved by the local ethics committee of the Tabriz University of Medical Sciences (Ethics Code: IR.TBZMED.REC.1398.420).

Results

At the three-month mRS follow up, six patients (35%) had moderate and five (29%) had severe disability. The outcome of death was observed in six patients (35%).Nine of 15 patients (60%) underwent surgery in the first 48 hours after onset of symptoms. No patient over 60 years of age survived to the three-month follow up; 67% of those who were under60 years and underwent DH in the first 48 hours had favorable outcome. Hemorrhagic complication was seen in 64% of patients but none was major.

Conclusion

Results of this study showed that the rate of major bleeding and outcome of acute ischemic stroke patients who underwent DHC after IVT is comparable with the reported data in the literature and intentionally waiting for the fibrinolytic effects of IVT to disappear may not outweigh the benefits of DHC. Although the findings of the study should be interpreted with caution and larger studies are needed to confirm the results.
Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis
Authors: Johansson Margareta , Alvan Jonatan , Pettersson Agneta , Hildingsson Ingegerd
Published: March 2023

Background

Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women’s and clinicians’ attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS.

Methods

The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual.

Results

The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000–2022), involving 242 women and 141 clinicians. From the women’s perspectives, two themes arose: women regarded CS as the safest mode of birth; and women’s rights to receive support and acceptance for a CS request. From the clinicians’ perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women’s rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options.

Conclusion

Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman’s birth preferences, they also felt the need to resist a woman’s request for CS and encourage her to give birth vaginally due to the associated increases in health risks.
Association between primary Spanish language and quality of intrapartum care among Latina women: a secondary analysis of the Listening to Mothers in California survey
Authors: Valdez Jessica J. , Jackson Andrea V. , Marshall Cassondra
Published: March 2023

Background

Language barriers play significant roles in quality of healthcare. Limited studies have examined the relationships between Spanish language and quality of intrapartum care. The objective was to determine the association between primary Spanish language and quality of intrapartum care so as to further inform best practices for non-English speaking patients in the labor and delivery setting.

Methods

We used the 2016 Listening to Mothers in California survey data, which included a statewide representative sample of women who gave birth in hospitals. Our analytical sample included 1202 Latina women. Multivariable logistic regression was used to examine the association between primary language (monolingual English vs. monolingual Spanish vs. bilingual Spanish/English) and perceived discrimination due to language, perceived pressure for medical interventions, and mistreatment during labor, adjusting for maternal sociodemographics and other maternal and neonatal factors.

Results

Over one-third of the study population spoke English (35.6%), less than one-third spoke Spanish (29.1%), and greater than one-third spoke bilingual Spanish/English (35.3%). Overall, 5.4% of Latina women perceived discrimination due to language spoken, 23.1% perceived pressure for any medical intervention, and 10.1% experienced either form of mistreatment. Compared to English-speakers, Spanish-speakers were significantly more likely to report discrimination due to language (aOR 4.36; 95% CI 1.15–16.59), but were significantly less likely to experience pressure for certain medical interventions (labor induction or cesarean delivery) during labor (aOR 0.34; 95% CI 0.15–0.79 for induction; aOR 0.44; 95% CI 0.18–0.97 for cesarean delivery). Bilingual Spanish/English-speakers also significantly reported discrimination due to language to a lesser extent than monolingual Spanish-speakers (aOR 3.37; 95% CI 1.12–10.13). Any form of Spanish language (monolingual or bilingual) was not significantly associated with mistreatment.

Conclusions

Spanish language may contribute to experiences of discrimination during intrapartum care among Latina women. Future research is needed to explore perceptions of pressure, discrimination and mistreatment, among patients with limited English proficiency.
Factors related to women’s use of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register
Authors: Ambalu Rachel , Rashid Sadiq , Atwa Saul , Otira Mariam , Ndolo Lucia , Ojakaa David
Published: March 2023

Background

In concert with international commitments, the Government of Kenya identified Universal Health Coverage (UHC), mainly through the National Health Insurance Fund (NHIF), as one of its four priority agenda to enable its populations access health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the Innovative Partnership for Universal and Sustainable Healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The main objective of this study is to examine use of health insurance cover among Women of Reproductive Age (WRA) in Navakholo sub-county, Kakamega County.

Methods

We analysed data captured during household registration conducted in February 2021 which embraced a question on use of health insurance cover including NHIF. The dataset consisted 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained Community Health Volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. Data were analysed through frequency distributions and logistic regression (descriptive and causal methods) using STATA software.

Results

Insurance coverage, all providers included, in Navakholo sub-county stood at 11% among women aged 15–49 years. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the region where Navakholo is situated. Social determinant variables – age, perceived condition of the household, and wealth ranking – are highly significant in the relationship with use of health insurance cover while measures of reproductive health and health vulnerability are not.

Conclusion

In Navakholo sub-county of Western Kenya, all—health-insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to use of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training – upstream and downstream – on community household registration and data processing should be conducted to arrive at better quality data.
The association between psychosocial factors and mental health symptoms in cervical spine pain with or without radiculopathy on health outcomes: a systematic review
Authors: Mansfield Michael , Thacker Mick , Taylor Joseph L. , Bannister Kirsty , Spahr Nicolas , Jong Stephanie T. , Smith Toby
Published: March 2023

Background

Neck pain, with or without radiculopathy, can have significant negative effects on physical and mental wellbeing. Mental health symptoms are known to worsen prognosis across a range of musculoskeletal conditions. Understanding the association between mental health symptoms and health outcomes in this population has not been established. Our aim was to systematically review the association between psychosocial factors and/or mental health symptoms on health outcomes in adults with neck pain, with or without radiculopathy.

Methods

A systematic review of published and unpublished literature databases was completed. Studies reporting mental health symptoms and health outcomes in adults with neck pain with or without radiculopathy were included. Due to significant clinical heterogeneity, a narrative synthesis was completed. Each outcome was assessed using GRADE.

Results

Twenty-three studies were included (N = 21,968 participants). Sixteen studies assessed neck pain only (N = 17,604 participants); seven studies assessed neck pain with radiculopathy (N = 4,364 participants). Depressive symptoms were associated with poorer health outcomes in people with neck pain and neck pain with radiculopathy. These findings were from seven low-quality studies, and an additional six studies reported no association. Low-quality evidence reported that distress and anxiety symptoms were associated with poorer health outcomes in people with neck pain and radiculopathy and very low-quality evidence showed this in people with neck pain only. Stress and higher job strain were negatively associated with poorer health outcomes measured by the presence of pain in two studies of very low quality.

Conclusions

Across a small number of highly heterogenous, low quality studies mental health symptoms are negatively associated with health outcomes in people with neck pain with radiculopathy and neck pain without radiculopathy. Clinicians should continue to utilise robust clinical reasoning when assessing the complex factors impacting a person’s presentation with neck pain with or without radiculopathy.

PROSPERO registration number

CRD42020169497.
Disclosing medical errors: how do we prepare our students?
Authors: Swinfen Dirkie , Labuschagne Mathys , Joubert Gina
Published: March 2023

Purpose

Despite patient safety initiatives, medical errors remain common and devastating. Disclosing errors is not only ethical, but also promotes restoration of the doctor-patient relationship. However, studies show active avoidance of error disclosure and the need for explicit training. In the South African setting, sparse information exists in terms of undergraduate medical training in error disclosure. To address this knowledge gap, the training of error disclosure in an undergraduate medical programme was examined, against the background of the available literature. The objective was to formulate a strategy to improve error disclosure teaching and practice, with the goal of improving patient care.

Methods

Firstly, the literature was reviewed regarding the training of medical error disclosure. Secondly, the undergraduate medical training in error disclosure was probed, by looking at the pertinent findings from a broader study on undergraduate communication skills training. The design of the study was descriptive and cross-sectional. Anonymous questionnaires were distributed to all fourth- and fifth-year undergraduate medical students. Data were predominantly analysed quantitatively. Open-ended questions were analysed qualitatively using grounded theory coding.

Results

Out of 132 fifth-year medical students, 106 participated (response rate 80.3%), while 65 out of 120 fourth-year students participated (response rate 54.2%). Of these participants, 48 fourth-year students (73.9%) and 64 fifth-year students (60.4%) reported infrequent teaching in the disclosure of medical errors. Almost half of the fourth-year students (49.2%) considered themselves novices in error disclosure, while 53.3% of fifth-year students rated their ability as average. According to 37/63 (58.7%) fourth-year students and 51/100 (51.0%) fifth-year students, senior doctors seldom or never modelled patient-centred care in the clinical training setting. These results resonated with the findings of other studies that showed lack of patient-centredness, as well as insufficient training in error disclosure, with resultant low confidence in this skill.

Conclusion

The study findings confirmed a dire need for more frequent experiential training in the disclosure of medical errors, in undergraduate medical education. Medical educators should view errors as learning opportunities to improve patient care and model error disclosure in the clinical learning environment.