bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource management framework using simulation modeling and multi-objective optimization: a case study of a front-end department of a public hospital in Thailand
Authors: Tanantong Tanatorn , Pannakkong Warut , Chemkomnerd Nittaya
Published: January 2022

Background

The overcrowded patients, which cause the long waiting time in public hospitals, become significant problems that affect patient satisfaction toward the hospital. Particularly, the bottleneck usually happens at front-end departments (e.g., the triage and medical record department) as every patient is firstly required to visit these departments. The problem is mainly caused by ineffective resource management. In order to support decision making in the resource management at front-end departments, this paper proposes a framework using simulation and multi-objective optimization techniques considering both operating cost and patient satisfaction.

Methods

To develop the framework, first, the timestamp of patient arrival time at each station was collected at the triage and medical record department of Thammasat University Hospital in Thailand. A patient satisfaction assessment method was used to convert the time spend into a satisfaction score. Then, the simulation model was built from the current situation of the hospital and was applied scenario analyses for the model improvement. The models were verified and validated. The weighted max–min for fuzzy multi-objective optimization was done by minimizing the operating cost and maximizing the patient satisfaction score. The operating costs and patient satisfaction scores from various scenarios were statistically compared. Finally, a decision-making guideline was proposed to support suitable resource management at the front-end departments of the hospital.

Result

The three scenarios of the simulation model were built (i.e., a real situation, a one-stop service, and partially shared resources) and ensured to be verified and valid. The optimized results were compared and grouped into three situations which are (1) remain the same satisfaction score but decrease the cost (cost decreased by 2.8%) (2) remain the same satisfaction score but increase the cost (cost increased up to 80%) and (3) decrease the satisfaction score and decrease the cost (satisfaction decreased up to 82% and cost decreased up to 59%). According to the guideline, the situations 1 and 3 were recommended to use in the improvement and the situation 2 was rejected.

Conclusion

This research demonstrates the resource management framework for the front-end department of the hospital. The experimental results imply that the framework can be used to support the decision making in resource management and used to reduce the risk of applying a non-improvement model in a real situation.
Transformational Change in maternity services in England: a longitudinal qualitative study of a national transformation programme ‘Early Adopter’
Authors: Taylor Beck , Hewison Alistair , Cross-Sudworth Fiona , Morrell Kevin
Published: January 2022

Background

Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding ‘what works’ in large system transformation.

Methods

A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper.

Results

Alignment of transformation work with Best et al’s rules for ‘what works’ in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new ‘system’ limiting system leaders’ power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change.

Conclusions

Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.
Multidisciplinary residential home intervention to improve outcomes for frail residents
Authors: Steel Anna , Hopwood Helen , Goodwin Elizabeth , Sampson Elizabeth L.
Published: January 2022

Background

Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education.

Methods

A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management.

Results

Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions.

Conclusion

This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.
Optimizing care coordination to address social determinants of health needs for dual-use veterans
Authors: Sjoberg Heidi , Liu Wenhui , Rohs Carly , Ayele Roman A , McCreight Marina , Mayberry Ashlea , Battaglia Catherine
Published: January 2022

Background

Veterans increasingly utilize both the Veteran’s Health Administration (VA) and non-VA hospitals (dual-users). Dual-users are at increased risk of fragmented care and adverse outcomes and often do not receive necessary follow-up care addressing social determinants of health (SDOH). We developed a Veteran-informed social worker-led Advanced Care Coordination (ACC) program to decrease fragmented care and provide longitudinal care coordination addressing SDOH for dual-users accessing non-VA emergency departments (EDs) in two communities.

Methods

ACC had four core components: 1. Notification from non-VA ED providers of Veterans’ ED visit; 2. ACC social worker completed a comprehensive assessment with the Veteran to identify SDOH needs; 3. Clinical intervention addressing SDOH up to 90 days post-ED discharge; and 4. Warm hand-off to Veteran’s VA primary care team. Data was documented in our program database. We performed propensity matching between a control group and ACC participants between 4/10/2018 – 4/1/2020 (N- = 161). A joint survival model using Markov Chain Monte Carlo technique was employed for 30-day outcomes. We performed Difference-In-Difference analyses on number of ED visits, admissions, and primary care physician (PCP) visits 120-day pre/post discharge.

Results

When compared to a matched control group ACC had significantly lower risk of 30-day ED visits (Hazard Ratio (HR) = 0.61, 95% Confidence Interval (CI) = (0.42, 0.92)) and a higher probability of PCP visits at 13–30 days post-ED visit (HR = 1.5, 95% CI = (1.01, 2.22)). Veterans enrolled in ACC were connected to VA PCP visits (50%), VA benefits (19%), home health care (10%), mental health and substance use treatment (7%), transportation (7%), financial assistance (5%), and homeless resources (2%).

Conclusion

We developed and implemented a program addressing dual-users’ SDOH needs post non-VA ED discharge.

Social workers connected dual-users to needed follow-up care and resources which reduced fragmentation and adverse outcomes.
Interaction of obesity polygenic score with lifestyle risk factors in an electronic health record biobank
Authors: Dashti Hassan S. , Miranda Nicole , Cade Brian E. , Huang Tianyi , Redline Susan , Karlson Elizabeth W. , Saxena Richa
Published: January 2022

Background

Genetic and lifestyle factors have considerable effects on obesity and related diseases, yet their effects in a clinical cohort are unknown. This study in a patient biobank examined associations of a BMI polygenic risk score (PRS), and its interactions with lifestyle risk factors, with clinically measured BMI and clinical phenotypes.

Methods

The Mass General Brigham (MGB) Biobank is a hospital-based cohort with electronic health record, genetic, and lifestyle data. A PRS for obesity was generated using 97 genetic variants for BMI. An obesity lifestyle risk index using survey responses to obesogenic lifestyle risk factors (alcohol, education, exercise, sleep, smoking, and shift work) was used to dichotomize the cohort into high and low obesogenic index based on the population median. Height and weight were measured at a clinical visit. Multivariable linear cross-sectional associations of the PRS with BMI and interactions with the obesity lifestyle risk index were conducted. In phenome-wide association analyses (PheWAS), similar logistic models were conducted for 675 disease outcomes derived from billing codes.

Results

Thirty-three thousand five hundred eleven patients were analyzed (53.1% female; age 60.0 years; BMI 28.3 kg/m2), of which 17,040 completed the lifestyle survey (57.5% female; age: 60.2; BMI: 28.1 (6.2) kg/m2). Each standard deviation increment in the PRS was associated with 0.83 kg/m2 unit increase in BMI (95% confidence interval (CI) =0.76, 0.90). There was an interaction between the obesity PRS and obesity lifestyle risk index on BMI. The difference in BMI between those with a high and low obesogenic index was 3.18 kg/m2 in patients in the highest decile of PRS, whereas that difference was only 1.55 kg/m2 in patients in the lowest decile of PRS. In PheWAS, the obesity PRS was associated with 40 diseases spanning endocrine/metabolic, circulatory, and 8 other disease groups. No interactions were evident between the PRS and the index on disease outcomes.

Conclusions

In this hospital-based clinical biobank, obesity risk conferred by common genetic variants was associated with elevated BMI and this risk was attenuated by a healthier patient lifestyle. Continued consideration of the role of lifestyle in the context of genetic predisposition in healthcare settings is necessary to quantify the extent to which modifiable lifestyle risk factors may moderate genetic predisposition and inform clinical action to achieve personalized medicine.
Price, quality, and market dynamics of malaria rapid diagnostic tests: analysis of Global Fund 2009–2018 data
Authors: Wittenauer Rachel , Nowak Spike , Luter Nick
Published: January 2022

Background

Rapid diagnostic tests (RDTs) for malaria are a vital part of global malaria control. Over the past decade, RDT prices have declined, and quality has improved. However, the relationship between price and product quality and their larger implications on the market have yet to be characterized. This analysis used purchase data from the Global Fund together with product quality data from the World Health Organization (WHO) and Foundation for Innovative New Diagnostics (FIND) Malaria RDT Product Testing Programme to understand three unanswered questions: (1) Has the market share by quality of RDTs in the Global Fund’s procurement orders changed over time? (2) What is the relationship between unit price and RDT quality? (3) Has the market for RDTs financed by the Global Fund become more concentrated over time?

Methods

Data from 10,075 procurement transactions in the Global Fund’s database, which includes year, product, volume, and price, was merged with product quality data from all eight rounds of the WHO-FIND programme, which evaluated 227 unique RDT products. To describe trends in market share by quality level of RDT, descriptive statistics were used to analyse trends in market share from 2009 to 2018. A generalized linear regression model was then applied to characterize the relationship between price and panel detection score (PDS), adjusting for order volume, year purchased, product type, and manufacturer. Third, a Herfindahl–Hirschman Index (HHI) score was calculated to characterize the degree of market concentration.

Results

Lower-quality RDTs have lost market share between 2009 and 2018, as have the highest-quality RDTs. No statistically significant relationship between price per test and PDS was found when adjusting for order volume, product type, and year of purchase. The HHI was 3,570, indicating a highly concentrated market.

Conclusions

Advancements in RDT affordability, quality, and access over the past decade risk stagnation if health of the RDT market as a whole is neglected. These results suggest that from 2009 to 2018, this market was highly concentrated and that quality was not a distinguishing feature between RDTs. This information adds to previous reports noting concerns about the long-term sustainability of this market. Further research is needed to understand the causes and implications of these trends.
Co-creating a local environmental epidemiology study: the case of citizen science for investigating air pollution and related health risks in Barcelona, Spain
Authors: Gignac Florence , Righi Valeria , Toran Raül , Errandonea Lucía Paz , Ortiz Rodney , Nieuwenhuijsen Mark , Creus Javier , Basagaña Xavier , Balestrini Mara
Published: January 2022

Background

While the health risks of air pollution attract considerable attention, both scholarly and within the general population, citizens are rarely involved in environmental health research, beyond participating as data subjects. Co-created citizen science is an approach that fosters collaboration between scientists and lay people to engage the latter in all phases of research. Currently, this approach is rare in environmental epidemiology and when co-creation processes do take place, they are often not documented. This paper describes the first stages of an ongoing co-created citizen science epidemiological project in Barcelona (Spain), that included identifying topics that citizens wish to investigate as regards air pollution and health, formulating their concerns into research questions and co-designing the study protocol. This paper also reflects key trade-offs between scientific rigor and public engagement and provides suggestions to consider when applying citizen science to environmental health studies.

Methods

Experts created an online survey and analyzed responses with descriptive statistics and qualitative coding. A pop-up intervention was held to discuss with citizens their concerns about air pollution and health. Later on, a community meeting was organized to narrow down the research topics and list potential research questions. In an online survey, citizens were asked to vote for the research question they would like to investigate with the experts. A workshop was held to choose a study design in which citizens would like to partake to answer their preferred research question.

Results

According to 488 respondents from the first survey, cognitive and mental health were the main priorities of investigation. Based on the second survey, with 27% of the votes from 556 citizens, the most popular research question was, “How does air pollution together with noise and green/blue spaces affect mental health?”. The study design selected was an observational study in which citizens provide daily repeated measures of different cognitive and mental health outcomes and relate them to the air pollution concentrations.

Conclusions

Based on the co-creation activities and the results obtained, we conclude that applying citizen science in an environmental health project is valuable for researchers despite some challenges such as engaging citizens and maximizing representativity.
Depression, anxiety and health-related quality of life in paediatric intracranial germ cell tumor survivors
Authors: Lv Wenyi , Li Bo , Feng Jin , Chen Li , Qiu Xiaoguang , Liu Shuai
Published: January 2022

Background

Little is known about depression and anxiety among paediatric intracranial germ cell tumour (iGCT) survivors. We aimed to evaluate the risk factors associated with depression, anxiety and health-related quality of life (HRQoL) in paediatric iGCT survivors.

Methods

We recruited 200 iGCT patients (and their parents) from Beijing Tiantan Hospital and assessed their HRQoL using the Paediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales. The Children’s Depression Inventory, Screen for Child Anxiety Related Emotional Disorders, and Symptom Checklist 90 were used to evaluate depression and anxiety. The results were analysed based on disease recurrence, tumour location and treatment strategies.

Results

Survivors with recurrent tumours had worse HRQoL scores than those with non-recurrent tumours. Patients with tumours involving both the suprasellar and basal ganglia regions had the worst HRQoL scores. A large proportion of survivors had depression or anxiety. Both depression and anxiety scores were highly correlated with the HRQoL emotional functioning scores. The parent proxy-reports (PPR) and child self-reports were highly correlated in all domains.

Conclusions

This study demonstrated the clinical factors affecting paediatric iGCT survivors’ depression, anxiety, and HRQoL. Therefore, psychological interventions should be implemented. It also suggests that the PedsQL PPR would be helpful for routine screening.
Transcriptome analysis of eutopic endometrium in adenomyosis after GnRH agonist treatment
Authors: Tian Jiao , Kang Nannan , Wang Junxia , Sun Haixiang , Yan Guijun , Huang Chenyang , Mei Jie
Published: January 2022

Background

Adenomyosis is a chronic gynecological disease characterized by invasion of the uterine endometrium into the muscle layer. In assisted reproductive technology (ART), gonadotropin-releasing hormone agonist (GnRHa) is often used to improve pregnancy rates in patients with adenomyosis, but the underlying mechanisms are poorly understood.

Methods

Eutopic endometrial specimens were collected from patients with adenomyosis before and after GnRHa treatment in the midsecretory phase. RNA sequencing (RNA-Seq) of these specimens was performed for transcriptome analysis. The differentially expressed genes (DEGs) of interest were confirmed by real-time PCR and immunohistochemistry.

Results

A total of 132 DEGs were identified in the endometrium of patients with adenomyosis after GnRHa treatment compared with the control group. Bioinformatics analysis predicted that immune system-associated signal transduction changed significantly after GnRHa treatment. Chemokine (C-C motif) ligand 21 (CCL21) was found to be highly expressed in the eutopic endometrium after GnRHa treatment, which may be involved in the improvement of endometrial receptivity in adenomyosis.

Conclusion

This study suggests that molecular regulation related to immune system-associated signal transduction is an important mechanism of GnRHa treatment in adenomyosis. Immunoreactive CCL21 is thought to regulate inflammatory events and participate in endometrial receptivity in adenomyosis.
Agitation-dependent biomechanical forces modulate GPVI receptor expression and platelet adhesion capacity during storage
Authors: Hosseini Ehteramolsadat , Solouki Amin , Haghshenas Masood , Ghasemzadeh Mehran , Schoenwaelder Simone M.
Published: January 2022

Background

Continuous agitation during storage slows down the platelet storage lesions. However, in special circumstances, manual-mixing can be alternatively used to store products for short time periods without compromising platelet quality. Based on this finding, and given the role of shear stress in modulating receptor expression, we were interested in comparing the levels of platelet adhesion receptor, GPVI and platelet adhesion capacity under each storage condition.

Methods

Platelet concentrates (PCs) were divided into three groups: continuously-agitated PCs (CAG-PCs) with or without PP2 (Src kinase inhibitor) and manually-mixed PCs (MM-PCs). Platelet count/MPV, swirling, GPVI and P-selectin expression, GPVI shedding, platelet adhesion/spreading to collagen were examined during 5 days of storage.

Results

While MM- and CAG-PCs showed similar levels of P-selectin expression, GPVI expression was significantly elevated in MM-PCs with lower GPVI shedding/expression ratios, enhanced platelet adhesion/spreading and swirling in manually-mixed PCs. Of note, CAG-PCs treated with PP2 also demonstrated lower P-selectin expression and GPVI shedding, higher GPVI expression and attenuated swirling and spreading capability.

Conclusion

Given the comparable platelet activation state in MM and CAG-PCs as indicated by P-selectin expression, enhanced platelet adhesion/spreading in MM-PCs, along with relatively higher GPVI expression here, supports previous studies demonstrating a role for biomechanical forces in modulating GPVI-dependent function. Thus, lower GPVI expression in CAG-PCs may be due to shear forces induced by agitation, which keeps this receptor down-regulated while also attenuating platelet adhesion/spreading capacities during storage. Low platelet function in PP2-CAG-PCs also highlights the importance of Src-kinases threshold activity in maintaining platelets quality.
Immunogenicity of personalized dendritic-cell therapy in HIV-1 infected individuals under suppressive antiretroviral treatment: interim analysis from a phase II clinical trial
Authors: de Almeida Baptista Marcella Vassão , da Silva Laís Teodoro , Samer Sadia , Oshiro Telma Miyuki , Shytaj Iart Luca , Giron Leila B. , Pena Nathalia Mantovani , Cruz Nicolly , Gosuen Gisele Cristina , Ferreira Paulo Roberto Abrão , Cunha-Neto Edécio , Galinskas Juliana , Dias Danilo , Sucupira Maria Cecilia Araripe , de Almeida-Neto Cesar , Salomão Reinaldo , da Silva Duarte Alberto José , Janini Luís Mário , Hunter James R. , Savarino Andrea , Juliano Maria Aparecida , Diaz Ricardo Sobhie
Published: January 2022

Background

We developed a personalized Monocyte-Derived Dendritic-cell Therapy (MDDCT) for HIV-infected individuals on suppressive antiretroviral treatment and evaluated HIV-specific T-cell responses.

Methods

PBMCs were obtained from 10 HIV+individuals enrolled in trial NCT02961829. Monocytes were differentiated into DCs using IFN-α and GM-CSF. After sequencing each patient’s HIV-1 Gag and determining HLA profiles, autologous Gag peptides were selected based on the predicted individual immunogenicity and used to pulse MDDCs. Three doses of the MDDCT were administered every 15 days. To assess immunogenicity, patients’ cells were stimulated in vitro with autologous peptides, and intracellular IL-2, TNF, and interferon-gamma (IFN-γ) production were measured in CD4+and CD8+T-cells.

Results

The protocol of ex-vivo treatment with IFN-α and GM-CSF was able to induce maturation of MDDCs, as well as to preserve their viability for reinfusion. MDDCT administration was associated with increased expression of IL-2 in CD4+and CD8+T-cells at 15 and/or 30 days after the first MDDCT administration. Moreover, intracellular TNF and IFN-γ expression was significantly increased in CD4+T-cells. The number of candidates that increased in vitro the cytokine levels in CD4+and CD8+T cells upon stimulation with Gag peptides from baseline to day 15 and from baseline to day 30 and day 120 after MDDCT was significant as compared to Gag unstimulated response. This was accompanied by an increasing trend in the frequency of polyfunctional T-cells over time, which was visible when considering both cells expressing two and three out of the three cytokines examined.

Conclusions

MDDC had a mature profile, and this MDDCT promoted in-vitro T-cell immune responses in HIV-infected patients undergoing long-term suppressive antiretroviral treatment.

Trial registrationNCT02961829: (Multi Interventional Study Exploring HIV-1 Residual Replication: a Step Towards HIV-1 Eradication and Sterilizing Cure,https://www.clinicaltrials.gov/ct2/show/NCT02961829, posted November 11th, 2016)
Implementing effective community-based surveillance in research studies of maternal, newborn and infant outcomes in low resource settings
Authors: Shannon Caitlin , Hurt Chris , Soremekun Seyi , Edmond Karen , Newton Sam , Amenga-Etego Seeba , Tawiah-Agyemang Charlotte , Hill Zelee , Manu Alexander , Weobong Ben , Kirkwood Betty , Hurt Lisa
Published: January 2022

Background

Globally adopted health and development milestones have not only encouraged improvements in the health and wellbeing of women and infants worldwide, but also a better understanding of the epidemiology of key outcomes and the development of effective interventions in these vulnerable groups. Monitoring of maternal and child health outcomes for milestone tracking requires the collection of good quality data over the long term, which can be particularly challenging in poorly-resourced settings. Despite the wealth of general advice on conducting field trials, there is a lack of specific guidance on designing and implementing studies on mothers and infants. Additional considerations are required when establishing surveillance systems to capture real-time information at scale on pregnancies, pregnancy outcomes, and maternal and infant health outcomes.

Main body

Based on two decades of collaborative research experience between the Kintampo Health Research Centre in Ghana and the London School of Hygiene and Tropical Medicine, we propose a checklist of key items to consider when designing and implementing systems for pregnancy surveillance and the identification and classification of maternal and infant outcomes in research studies. These are summarised under four key headings: understanding your population; planning data collection cycles; enhancing routine surveillance with additional data collection methods; and designing data collection and management systems that are adaptable in real-time.

Conclusion

High-quality population-based research studies in low resource communities are essential to ensure continued improvement in health metrics and a reduction in inequalities in maternal and infant outcomes. We hope that the lessons learnt described in this paper will help researchers when planning and implementing their studies.
Integration of Aspergillus niger transcriptomic profile with metabolic model identifies potential targets to optimise citric acid production from lignocellulosic hydrolysate
Authors: Upton Daniel J. , Kaushal Mehak , Whitehead Caragh , Faas Laura , Gomez Leonardo D. , McQueen-Mason Simon J. , Srivastava Shireesh , Wood A. Jamie
Published: January 2022

Background

Citric acid is typically produced industrially byAspergillus niger-mediated fermentation of a sucrose-based feedstock, such as molasses. The fungusAspergillus nigerhas the potential to utilise lignocellulosic biomass, such as bagasse, for industrial-scale citric acid production, but realising this potential requires strain optimisation. Systems biology can accelerate strain engineering by systematic target identification, facilitated by methods for the integration of omics data into a high-quality metabolic model. In this work, we perform transcriptomic analysis to determine the temporal expression changes during fermentation of bagasse hydrolysate and develop an evolutionary algorithm to integrate the transcriptomic data with the available metabolic model to identify potential targets for strain engineering.

Results

The novel integrated procedure matures our understanding of suboptimal citric acid production and reveals potential targets for strain engineering, including targets consistent with the literature such as the up-regulation of citrate export and pyruvate carboxylase as well as novel targets such as the down-regulation of inorganic diphosphatase.

Conclusions

In this study, we demonstrate the production of citric acid from lignocellulosic hydrolysate and show how transcriptomic data across multiple timepoints can be coupled with evolutionary and metabolic modelling to identify potential targets for further engineering to maximise productivity from a chosen feedstock. The in silico strategies employed in this study can be applied to other biotechnological goals, assisting efforts to harness the potential of microorganisms for bio-based production of valuable chemicals.
MIND diet and the risk of dementia: a population-based study
Authors: de Crom Tosca O. E. , Mooldijk Sanne S. , Ikram M. Kamran , Ikram M. Arfan , Voortman Trudy
Published: January 2022

Background

Adherence to the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet has been linked to a decreased risk of dementia, but reverse causality and residual confounding by lifestyle may partly account for this link. We aimed to address these issues by studying the associations over cumulative time periods, which may provide insight into possible reverse causality, and by using both historical and more contemporary dietary data as this could give insight into confounding since historical data may be less affected by lifestyle factors.

Methods

In the population-based Rotterdam Study, dietary intake was assessed using validated food frequency questionnaires in 5375 participants between 1989 and 1993 (baseline I) and in a largely non-overlapping sample in 2861 participants between 2009 and 2013 (baseline II). We calculated the MIND diet score and studied its association with the risk of all-cause dementia, using Cox models. Incident all-cause dementia was recorded until 2018.

Results

During a mean follow-up of 15.6 years from baseline I, 1188 participants developed dementia. A higher MIND diet score at baseline I was associated with a lower risk of dementia over the first 7 years of follow-up (hazard ratio (HR) [95% confidence interval (CI)] per standard deviation (SD) increase, 0.85 [0.74, 0.98]), but associations disappeared over longer follow-up intervals. The mean follow-up from baseline II was 5.9 years during which 248 participants developed dementia. A higher MIND diet score at baseline II was associated with a lower risk of dementia over every follow-up interval, but associations slightly attenuated over time (HR [95% CI] for 7 years follow-up per SD increase, 0.76 [0.66, 0.87]). The MIND diet score at baseline II was more strongly associated with the risk of dementia than the MIND diet score at baseline I.

Conclusion

Better adherence to the MIND diet is associated with a decreased risk of dementia within the first years of follow-up, but this may in part be explained by reverse causality and residual confounding by lifestyle. Further research is needed to unravel to which extent the MIND diet may affect the risk of dementia.
Tumor-induced osteomalacia: a case report
Authors: Aligail Khalid , Dave Joel A. , Ross Ian Louis
Published: January 2022

Background

Tumor-induced osteomalacia is a rare, acquired paraneoplastic syndrome, including hypophosphatemia, high serum alkaline phosphatase, reduced active vitamin D, suboptimal bone mineral density, bone pain, fragility fractures, and muscle weakness.

Case presentation

We report a case of 74–year–old male of mixed ancestry with hypophosphatemia resistant to treatment despite optimal compliance, associated with profound reduction of bone mineral density and multiple nontraumatic fractures, including bilateral rib fractures, lower-thoracic (T11, T12) vertebrae, and two fractures involving the surgical and anatomical neck of the right humerus. We discuss an approach to identifying the underlying cause of hypophosphatemia associated with fragility fractures, and options for management of this rare condition.

Conclusion

Although rare, tumor-induced osteomalacia can be diagnosed if a logical stepwise approach is implemented. Surgery could be curative if the tumor is properly located and is resectable.
Barriers and determinants of postpartum family planning uptake among postpartum women in Western Ethiopia: a facility-based cross-sectional study
Authors: Tilahun Temesgen , Bekuma Tariku Tesfaye , Getachew Motuma , Oljira Rut , Seme Assefa
Published: January 2022

Background

Despite Ethiopia’s efforts to avail postpartum family planning (PPFP) services, the unmet need for family planning among postpartum women remains high. Therefore, this study is aimed to assess barriers and determinants of postpartum family-planning uptake among women visiting Maternal, Neonatal, and Child Health (MNCH) services in public health facilities of western Ethiopia.

Methods

A facility-based cross-sectional study design with a quantitative method was conducted on 989 postpartum women in Western Ethiopia from September 1 to October 30, 2020. Data were collected through face-to-face interviews using pretested structured questionnaires, entered using EPI-INFO version 7.0, and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05.

Result

In this study, 56.1% of participants had used PPFP in the last year. The most commonly used method was injectable (51.7%). Family planning use before the index pregnancy (AOR = 2.09;95%CI:1.29,3,41),counselling on PPFP during antenatal care and delivery (AOR = 4.89;95%CI:2.31,10.37),health facility delivery (AOR = 7.61;95%CI:4.36,13.28), skilled birth attendance (AOR = 4.99;95%CI:2.88,8.64),COVID-19 restrictions (AOR = 0.59;95%CI:0.39,0.90) were factors associated with PPFP utilization. Being breastfeeding and amenorrhea were major reasons for not using postpartum family planning.

Conclusion

Post-partum family planning utilization among study participants was low. Given the associated factors, it is recommended that health facilities should make postpartum family planning one of their top priorities and focus on these factors to improve its utilization.
Home practice in mindfulness-based interventions for psychosis groups: a systematic review and qualitative study
Authors: Jacobsen Pamela , Choksi Twinkle , Sawyer Katherine , Maximen Cassia , Harding Emma , Richardson Matthew
Published: January 2022

Background

Regular home practice is considered a core component of mindfulness groups and may be associated with better treatment outcomes. This study aimed to (1) review the existing evidence on how much home practice people do in mindfulness-based interventions for psychosis groups, and (2) explore participants’ experiences of the barriers and facilitators to completing home practice in a mindfulness for psychosis group using a qualitative study.

Methods

In study 1, we conducted a systematic review of mindfulness-based interventions for psychosis studies and extracted data on home practice rates. In study 2, we conducted semi-structured interviews with people who had completed a mindfulness for psychosis group (N = 5) as part of their routine community care, specifically focusing on experiences of home practice.

Results

Out of 43 studies included in the systematic review, only 5 reported any data on amount of home practice, and none examined the relationship between completion of home practice and treatment outcomes. In the qualitative study, participants described home practice as being difficult but important. Arising themes were similar to findings from previous (non-psychosis) studies suggesting that generic challenges are common, rather than being specific to psychosis.

Conclusions

We recommend that future mindfulness-based interventions for psychosis studies record data on home practice rates, in order to investigate any association between home practice and treatment outcome. Our qualitative findings suggest home practice can be a valued part of mindfulness for psychosis group, and a normalising approach could be taken when and if participants encounter common challenges.
Hospital revisits after paediatric tonsillectomy: A cohort study
Authors: Tran Aimy H. L. , Chin Ken L. , Horne Rosemary S. C. , Liew Danny , Rimmer Joanne , Nixon Gillian M.
Published: January 2022

Background

Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort.

Methods

We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery.

Results

Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3–7) and readmission (IQR 3–8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery.

Conclusions

Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge.

Graphical Abstract
Effect of pyrene-induced changes in root activity on growth of Chinese cabbage (Brassica campestris L.), and the health risks caused by pyrene in Chinese cabbage at different growth stages
Authors: Yang Xiaosong , Hu Zhengyi , Liu Yuexian , Xie Xiaofan , Huang Lijuan , Zhang Ruili , Dong Biya
Published: January 2022

Background

Polycyclic aromatic hydrocarbons (PAHs) pose a potential risk to ecological safety and human health. They have a range of effects on plant growth and there have been few reports on the health risks associated with ingestion of vegetable crops at different growth stages.

Methodology

In this study, a pot experiment in which Chinese cabbage (Brassica campestris L.) were grown in a greenhouse for 75 days was used to investigate the dose–effect relationship of pyrene with plant growth and also the exposure risk for adults of ingestion of Chinese cabbage at different growth stages.

Results

The results showed that low doses of pyrene (5–45 mg kg−1) promoted plant growth (20–220% and 55–97% higher than control treatment for the root biomass and shoot biomass, respectively), but significant inhibition was observed at a high dose (405 mg kg−1) (41–66% and 43–91% lower than control treatment for the root biomass and shoot biomass, respectively). High doses of pyrene reduced soil bacterial abundance and diversity during the growth of Chinese cabbage, and increased malondialdehyde (MDA) levels in the plant. The effects of pyrene on plant biomass were mainly attributed to changes in root activity induced by pyrene, as the relationship between soil pyrene concentration and biomass was similar to that between soil pyrene concentration and root activity. Furthermore, structural equation modeling analysis showed that pyrene altered growth of the vegetable by directly affecting root activity. The incremental lifetime cancer risk for adults is highest for ingestion of Chinese cabbage at the seedling stage, followed in decreasing order by the rosette stages and heading stages.

Conclusions

The health risk of consumers who have the possibility to ingest the Chinese cabbage planted in pyrene-contaminated soil would be decreased with the increasing growth periods. However, further studies are required to confirm the dose–effect relationship between pyrene concentration and Chinese cabbage growth on a field scale.

Graphical Abstract
Spatio-temporal distribution of shallow very-low-frequency earthquakes between December 2020 and January 2021 in Kumano-nada, Nankai subduction zone, detected by a permanent seafloor seismic network
Authors: Yamamoto Yojiro , Ariyoshi Keisuke , Yada Shuichiro , Nakano Masaru , Hori Takane
Published: January 2022

We estimate the hypocenter locations and the centroid moment tensor solutions of the shallow very-low-frequency earthquake (sVLFE) activity that occurred in the Kumano-nada region of the Nankai Trough megathrust zone in central Japan from December 2020 to January 2021. Using seafloor observation data, we examined the detailed spatio-temporal distribution of the sVLFE activity. During this episode, the activity area was within the vicinity in which the sVLFE activity has been observed in the past and can be divided into two major parts. The sVLFE activity started from the eastern side and remained there for the first 5 days and then migrated to the western side via secondary expansion. The eastern active area is located just below the outer ridge and coincides with the location where the paleo-Zenith Ridge subducted. The western activity area is centered between the outer wedge and the outer ridge with the primary active area being at the outer wedge. Comparing the activity in the eastern and western areas, the eastern side is more active, but the individual moment releases on this side are smaller than those on the western side. This may indicate a difference in the fluid pressure along the plate boundary between the eastern and western areas. After the second expansion of the active area, we observed several migration patterns within the expanded area with a faster velocity than those of the initial and second expansions. The direction of these migrations is opposite to that of the first and second expansions. This indicates that the fluid pressure and/or stress level in the sVLFE generation region changed with time within this episode. Furthermore, many waveforms with sVLFE characteristics were observed at only one or a few observation points near the trough axis in the middle to latter half of January 2021. This indicates the occurrence of small-scale sVLFEs in the vicinity of the trough axis at the end of this sVLFE episode.

Graphical Abstract
Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study
Authors: Thürig Grégoire , Panadero-Morales Raùl , Giovannelli Luca , Kocher Franziska , Peris José Luis , Tannast Moritz , Petek Daniel
Published: January 2022

Purpose

This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique.

Methods

Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability.

Results

Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial"to "almost perfect"reproducibility and an "almost perfect"reliability.

Conclusion

This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints.

Level of evidence

Level IV diagnostic study