bluuebunny/crossref_metadata_2025 huggingface dataset:
Gray matter atrophy in relapsing-remitting multiple sclerosis is associated with white matter lesions in connecting fibers
Authors: Bussas Matthias , Grahl Sophia , Pongratz Viola , Berthele Achim , Gasperi Christiane , Andlauer Till , Gaser Christian , Kirschke Jan S , Wiestler Benedikt , Zimmer Claus , Hemmer Bernhard , Mühlau Mark
Published: September 2021

Background:

Lesions of brain white matter (WM) and atrophy of brain gray matter (GM) are well-established surrogate parameters in multiple sclerosis (MS), but it is unclear how closely these parameters relate to each other.

Objective:

To assess across the whole cerebrum whether GM atrophy can be explained by lesions in connecting WM tracts.

Methods:

GM images of 600 patients with relapsing-remitting MS (women = 68%; median age = 33.0 years, median expanded disability status scale score = 1.5) were converted to atrophy maps by data from a healthy control cohort. An atlas of WM tracts from the Human Connectome Project and individual lesion maps were merged to identify potentially disconnected GM regions, leading to individual disconnectome maps. Across the whole cerebrum, GM atrophy and potentially disconnected GM were tested for association both cross-sectionally and longitudinally.

Results:

We found highly significant correlations between disconnection and atrophy across most of the cerebrum. Longitudinal analysis demonstrated a close temporal relation of WM lesion formation and GM atrophy in connecting fibers.

Conclusion:

GM atrophy is associated with WM lesions in connecting fibers. Caution is warranted when interpreting group differences in GM atrophy exclusively as differences in early neurodegeneration independent of WM lesion formation.
Predicting Anxiety from the Complex Interaction Between Masculinity and Spiritual Beliefs
Authors: Boxer Andrew , Gill Peter Richard
Published: September 2021

Research suggests that adherence to traditional and hegemonic masculinities can be detrimental to men’s mental health. In particular, anxiety can result from the incongruence between idealised and lived experiences. Emerging research suggests that holding spiritual beliefs may protect against such anxiety. This Australian study investigated whether two aspects of spiritualism (Spiritual Openness and Spiritual Support) could moderate the relationship between four stereotypical masculine behaviours (Success Dedication, Restrictive Emotionality, Inhibited Affection and Exaggerated Self-Reliance and Control) and anxiety. A cross-sectional, correlational design, with a heterogeneous, Western community sample included 331 male participants aged 18–67 ( M = 24.57, SD = 10.37). In partial support of the hypotheses, two significant moderation models were found. Both Spiritual Support and Spiritual Openness moderated the relationship between Exaggerated Self-Reliance and Control and anxiety. There were no significant moderations for Success Dedication, Restrictive Emotionality, and Inhibited Affection. Masculinity and spiritualism did not have significant direct effects on anxiety. These findings suggest that when working with men and their mental health, it may be important to consider the congruence between their behaviors and belief systems, as spirituality was only protective against anxiety where these beliefs were congruent with masculine self-reliance and control. It appears that the potential benefit of spirituality in reducing masculine anxiety is dependent on the man being more open to external supports, and having a lower need for control.
Enhancement of heat transfer in a synthetic jet actuated by piston cylinder
Authors: Jacob Arun , Shafi KA , Reby Roy KE
Published: September 2021

Modern electronics demand more powerful cooling systems due to an increase in heat dissipation. The traditional cooling techniques reached their limit and the synthetic jet impingement arises as a promising method for cooling of modern electronic systems. This paper presents the experimental studies on the heat transfer characteristics of a synthetic jet. The synthetic jet is driven by a piston actuator. The effects of dimensionless parameters like the distance between the orifice and heater plate (Z/D), the ratio of stroke length to diameter of orifice ( L/D), Stokes number, and Reynolds number are discussed. The effect of orifice geometry, number of orifices are also presented. The results indicate that the Z/D and Stokes number have a significant influence on the heat transfer rate. As the Stokes number increases the heat transfer increases due to an increase in axial momentum and turbulence in the flow direction. For circular orifice and at high Z/D, the L/D ratio should be higher for better heat transfer. Rectangular orifice performs better than square and circular geometries. When compared to single jet multiple jets have a higher heat transfer rate. Maximum and minimum values of normalized pressure ( Pnr) are achieved for high Stokes number and smaller areas of the orifice.
Adaptive region tracking control for underwater vehicles with large initial deviation and general uncertainty
Authors: Gong Wei , Wang Yujia , Lv Tu
Published: September 2021

A region tracking control system is developed for underwater vehicles with large initial deviation and general uncertainty. The developed system is a nonlinear cascaded system, consisting of two subsystems in series. The fixed-gain controller of the first subsystem is designed to compensate for the region tracking error caused by the large initial deviation. In the second subsystem, the radial basis function neural network is adopted to approximate the general uncertainty along with the external disturbance and modelling uncertainty. According to the Lyapunov theory, the control law of the two subsystems and adaptive law of the second subsystem are derived to ensure the region tracking errors asymptotically converge to zero. The validity of the control system is verified by a series of comparisons on simulation results.
Specialised dental services and referral pathways
Authors: Iles Rebecca , Cheales Elizabeth
Published: September 2021

The term ‘oral health’ not only defines a state of being free from oral and facial pain, diseases and disorders, but alsoencapsulates the impact that such disease may have on an individual’s quality of life, considering both the functional (biting, chewing, smiling, speaking) and psychosocial aspects of wellbeing. Despite the well-established relationship between oral health and overall health and wellbeing, the separation of medicine and dentistry, both educationally and organisationally, results in unmet health needs and poorer patient outcomes. This article aims to give an overview of available dental services, referral pathways and how general practitioner and dentists can work together to provide holistic, patient-centred care.
Mucoprotective drugs can prevent and treat nonsteroidal anti-inflammatory drug-induced small bowel enteropathy: a systematic review and meta-analysis of randomized controlled trials
Authors: Teutsch Brigitta , Boros Eszter , Váncsa Szilárd , Váradi Alex , Frim Levente , Kiss Szabolcs , Dembrovszky Fanni , Helyes Zsuzsanna , Patrícia Sarlós , Péter Hegyi , Erőss Bálint
Published: September 2021

Background:

Small bowel enteropathy (SBE) is a complication of nonsteroidal anti-inflammatory drug (NSAID) therapy occurring in 71% of NSAID users. We aimed to analyse the efficacy and safety of medications to prevent and treat NSAID-induced SBE in randomized controlled trials (RCTs).

Methods:

This review was registered on PROSPERO (CRD42021223371). We systematically searched four databases until 20 October for comparing mucoprotective (MP), antibiotic and probiotic treatments to placebo, proton-pump inhibitors (PPIs) or histamine-2 (H2) receptor antagonists in NSAID-associated small intestinal injuries. The main outcomes were mucosal integrity, mucosal breaks after treatment, mucosal injury improvement and complete healing of mucosal breaks. Meta-analytical calculations for weighted mean differences (WMDs) and odds ratios (ORs) were performed with the random-effects model and interpreted with 95% confidence intervals (CIs).

Results:

A total of 18 RCTs were included in the quantitative synthesis. MP medications administered preventively reduced the number of mucosal erosions (WMD = −1.24, CI: −2.15 to −0.34) and lead to a significantly lower chance of developing mucosal breaks after treatment (OR = 0.38, CI: 0.16–0.93). MP therapy was associated with a higher rate of complete healing of mucosal breaks (OR = 5.39, CI: 2.79–10.42). In the qualitative synthesis, there were tendencies for a lower increase in the mean number of mucosal breaks and reddened lesions with prophylactic and a higher decrease in mucosal breaks with therapeutic MP drug administration.

Conclusion:

MP treatment administered with NSAIDs can prevent and reduce small intestinal mucosal lesions.
ALBI score and outcomes in patients with hepatocellular carcinoma: post hoc analysis of the randomized controlled trial KEYNOTE-240
Authors: Vogel Arndt , Merle Philippe , Verslype Chris , Finn Richard S. , Zhu Andrew X. , Cheng Ann-Lii , Chan Stephen Lam , Yau Thomas , Ryoo Baek-Yeol , Knox Jennifer , Daniele Bruno , Qin Shukui , Wei Ziwen , Miteva Yanna , Malhotra Usha , Siegel Abby B. , Kudo Masatoshi
Published: September 2021

Aims:

This post hoc analysis evaluated albumin/bilirubin (ALBI) score, an objective measure of liver function, in patients receiving pembrolizumab plus best supportive care (BSC) compared with placebo plus BSC in the KEYNOTE-240 study.

Methods:

Patients with confirmed hepatocellular carcinoma (HCC) and progression after/intolerance to sorafenib, Child–Pugh class A liver function, and Eastern Cooperative Oncology Group performance status of 0–1 were randomly assigned 2:1 to pembrolizumab 200 mg or placebo intravenously every 3 weeks plus BSC for ⩽35 cycles or until confirmed progression/unacceptable toxicity. Outcomes were assessed by ALBI grade.

Results:

Of 413 patients, at baseline 116 had an ALBI grade 1 score (pembrolizumab, n = 74; placebo, n = 42) and 279 had an ALBI grade 2 score ( n = 193; n = 86). Change from baseline in ALBI score to the end of treatment was similar in both arms [difference in least squares mean, −0.039; 95% confidence interval (CI): −0.169 to 0.091]. Time to ALBI grade increase was similar in both arms [median for pembrolizumab versus placebo: 7.8 versus 6.9 months; hazard ratio (HR) = 0.863 (95% CI: 0.625–1.192)]. Regardless of baseline ALBI grade, a trend toward improved overall survival was observed with pembrolizumab [grade 1: HR = 0.725 (95% CI: 0.454–1.158); grade 2: HR = 0.827 (95% CI: 0.612–1.119)].

Conclusion:

Pembrolizumab did not adversely impact liver function compared with placebo in patients with HCC, as measured by changes in ALBI scores. A trend toward improved overall survival was observed with pembrolizumab in both ALBI grade groups. ClinicalTrials.gov identifier: NCT02702401.
Population-adjusted indirect treatment comparison of maintenance PARP inhibitor with or without bevacizumab versus bevacizumab alone in women with newly diagnosed advanced ovarian cancer
Authors: Hettle Robert , McCrea Charles , Lee Chee Khoon , Davidson Richard
Published: September 2021

Background:

In patients with newly diagnosed ovarian cancer, bevacizumab and poly(ADP-ribose) polymerase (PARP) inhibitors, alone or in combination, have shown benefit as maintenance treatment following platinum-based chemotherapy. However, no trials have compared a PARP inhibitor plus bevacizumab versus a PARP inhibitor, or a PARP inhibitor versus bevacizumab. We performed an unanchored population-adjusted indirect treatment comparison to estimate the relative efficacy and safety of maintenance treatments for newly diagnosed advanced ovarian cancer.

Methods:

Analyses were performed using aggregate data from the PRIMA trial and patient-level data from a subset of patients from the PAOLA-1 trial that met surgery and staging eligibility criteria of PRIMA. Propensity weights were used to match baseline characteristics of the PAOLA-1 subset to those of the PRIMA population. Analysis was performed in overall (biomarker-unselected) and homologous recombination repair deficiency (HRD)-positive populations.

Results:

A total of 595/806 (266/387 HRD-positive) PAOLA-1 patients were included. After matching, the effective sample size for PAOLA-1 was 532 (242 HRD-positive). Maintenance olaparib plus bevacizumab reduced the risk of disease progression or death by 43% [hazard ratio (HR) 0.57; 95% confidence interval (CI): 0.47–0.69] versus niraparib and by 40% (HR 0.60; 95% CI: 0.49–0.74) versus bevacizumab in the biomarker-unselected population and by 43% (HR 0.57; 95% CI: 0.41–0.79) and 60% (HR 0.40; 95% CI: 0.29–0.55), respectively, in the HRD-positive population. Progression-free survival (PFS) benefits of maintenance niraparib and bevacizumab arms were comparable in the biomarker-unselected population (HR 1.07; 95% CI: 0.87–1.32); however, niraparib showed a 30% reduced risk compared with bevacizumab (HR 0.70; 95% CI: 0.51–0.97) in the HRD-positive population.

Conclusions:

In biomarker-unselected and HRD-positive patients, combination treatment with olaparib plus bevacizumab as maintenance treatment improves PFS for women with newly diagnosed advanced ovarian cancer compared with either bevacizumab or niraparib alone. Results are hypothesis generating and could guide randomised trial design.
Not all KIT 557/558 codons mutations have the same prognostic influence on recurrence-free survival: breaking the exon 11 mutations in gastrointestinal stromal tumors (GISTs)
Authors: Incorvaia Lorena , Badalamenti Giuseppe , Fanale Daniele , Vincenzi Bruno , Luca Ida De , Algeri Laura , Barraco Nadia , Brando Chiara , Bonasera Annalisa , Bono Marco , Castiglia Marta , Cancelliere Daniela , Cani Massimiliano , Corsini Lidia Rita , Fiorino Alessia , Galvano Antonio , Pedone Erika , Perez Alessandro , Pivetti Alessia , Graceffa Giuseppa , Pantuso Gianni , Cabibi Daniela , Russo Antonio , Bazan Viviana
Published: September 2021

Background:

Although the gastrointestinal stromal tumor (GIST) genotype is not currently included in risk-stratification systems, a growing body of evidence shows that the pathogenic variant (PV) type and codon location hold a strong prognostic influence on recurrence-free survival (RFS). This information has particular relevance in the adjuvant setting, where an accurate prognostication could help to better identify high-risk tumors and guide clinical decision-making.

Materials and Methods:

Between January 2005 and December 2020, 96 patients with completely resected GISTs harboring a KIT proto-oncogene receptor tyrosine kinase ( KIT) exon 11 PV were included in the study. We analyzed the type and codon location of the PV according to clinicopathological characteristics and clinical outcome; the metastatic sites in relapsed patients were also investigated.

Results:

Tumors harboring a KIT exon 11 deletion or deletion/insertion involving the 557 and/or 558 codons, showed a more aggressive clinical behavior compared with tumors carrying deletion/deletion/insertion in other codons, or tumors with duplication/insertion/single-nucleotide variant (SNV) (7-year RFS: 50% versus 73.1% versus 88.2%, respectively; p < 0.001). Notably, among 18 relapsed patients with 557 and/or 558 deletion or deletion/insertion, 14 patients (77.8%) harbored deletions simultaneously involving 557 and 558 codons, while only 4 patients (22.2%) harbored deletions involving only 1 of the 557/558 codons. Thus, when 557 or 558 deletions occurred separately, the tumor showed a prognostic behavior similar to the GIST carrying deletions outside the 557/558 position. Remarkably, patients with GISTs stratified as intermediate risk, but carrying the 557/558 deletion, showed a similar outcome to the high-risk patients with tumors harboring deletions in codons other than 557/558, or duplication/insertion/SNV.

Conclusion:

Our data support the inclusion of the PV type and codon location in routine risk prediction models, and suggest that intermediate-risk patients whose GISTs harbor 557/558 deletions may also need to be treated with adjuvant imatinib like the high-risk patients.
Soluble biological markers in osteoarthritis
Authors: Rousseau Jean-Charles , Chapurlat Roland , Garnero Patrick
Published: September 2021

In recent years, markers research has focused on the structural components of cartilage matrix. Specifically, a second generation of degradation markers has been developed against type II collagen neoepitopes generated by specific enzymes. A particular effort has been made to measure the degradation of minor collagens III and X of the cartilage matrix. However, because clinical data, including longitudinal controlled studies, are very scarce, it remains unclear whether they will be useful as an alternative to or in combination with current more established collagen biological markers to assess patients with osteoarthritis (OA). In addition, new approaches using high-throughput technologies allowed to detect new types of markers and improve the knowledge about the metabolic changes linked to OA. The relative advances coming from phenotype research are a first attempt to classify the heterogeneity of OA, and several markers could improve the phenotype characterization. These phenotypes could improve the selection of patients in clinical trials limiting the size of the studies by selecting patients with OA characteristics corresponding to the metabolic pathway targeted by the molecules evaluated. In addition, the inclusion of rapid progressors only in clinical trials would facilitate the demonstration of efficacy of the investigative drug to reduce joint degradation. The combination of selective biochemical markers appears as a promising and cost-effective approach to fulfill this unmet clinical need. Among the various potential roles of biomarkers in OA, their ability to monitor drug efficacy is probably one of the most important, in association with clinical and imaging parameters. Biochemical markers have the unique property to detect changes in joint tissue metabolism within a few weeks.
Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism
Authors: Yu Jane , Lenord Jason , Lau Michelle , Brunel Laurencie , Gray Rachael , Donahoe Shannon L , Boland Lara
Published: September 2021

Case summary

A 7-year-old male neutered domestic longhair cat was presented with chronic progressive gynaecomastia, polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behavioural changes were not reported and virilisation was not present on physical examination. Pertinent haematology, biochemistry and urinalysis findings at the time of referral included mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation of adrenal hormones with a low-dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hyperaldosteronism and hypercortisolism. Adrenalectomy was performed and histopathology was consistent with an adrenocortical tumour. Clinical signs and hormone elevations resolved postoperatively.

Relevance and novel information

To our knowledge, this is the second report of gynaecomastia secondary to an adrenal tumour in a male neutered cat and the first associated with hyperprogesteronism.
Negotiating incomplete contracts
Authors: Erikson Truls , Knockaert Mirjam
Published: September 2021

When planning is possible, as in predictive environments, comprehensive contracting is not only desirable, but also useful. However, under conditions of fundamental uncertainty, as is the case in non-predictive environments, incomplete contracting approaches likely prevail. In this study, we explore how trust in such environments affects the way in which venturing professionals negotiate, and how the outcome subsequently manifests itself in the negotiated agreement. In particular, building upon a sample of Norwegian firms, we find that stewardship relationships are more prone to incomplete contracting approaches than agency relationships, paving the way for a relational approach to contracting when uncertainty is high. Implications for theory and practice are discussed.
Diffusion-weighted MR imaging in chronic non-bacterial osteitis: Proof-of-concept of the apparent diffusion coefficient as an outcome measure
Authors: Møller Jakob M , Andreasen Caroline M , Buus Thomas W , Pedersen Susanne J , Østergaard Mikkel , Thomsen Henrik S , Jurik Anne G
Published: September 2021

Background

The apparent diffusion coefficient (ADC), as determined by whole-body diffusion-weighted MRI, may be useful as an outcome measure for monitoring response to treatment in chronic non-bacterial osteitis.

Purpose

To test and demonstrate the feasibility of ADC-measurement methods for use as outcome measure in chronic non-bacterial osteitis.

Materials and Methods

Using data from a randomized pilot study, feasibility of change-score ADC between baseline and second MRI (ΔADC12) and third MRI (ΔADC13) as outcome measure was assessed in three settings: “whole-lesion,” “single-slice per lesion,” and “index-lesion per patient”. Bone marrow edema lesions were depicted on short tau inversion recovery sequence at baseline and copied to ADC maps at the three time-points. Correlations between the three settings were measured as were analysis of variances. Discriminant validity was assessed as inter- and intra-observer reproducibility and smallest detectable change.

Results

12 subjects were enrolled, and MRI was performed at baseline and weeks 12 and 36. Pearson correlation was high ( r > 0.86; p ≤ 0.01) for ΔADC between single-slice—whole-lesion and whole-lesion—index-lesion and tended to be significant for single-slice—index-lesion settings ( p = 0.06). For ΔADC12 and ΔADC13, Bland–Altman plots showed small differences (0.02, 0.03) and narrow 95% limits-of-agreement (−0.13–0.09, −0.07–0.05 μm2/s) between whole-lesion and single-slice ROI settings. Inter-observer reproducibility measured by intra-class correlation coefficient was poor-to-fair (range: 0.09–0.31), whereas intra-observer reproducibility was good-to-excellent (range: 0.67–0.90). Smallest detectable changes were between 0.21–0.28 μm2/s.

Conclusion

ADC change-score as outcome measure was feasible, and the single-slice per lesion ROI setting performed almost equally to whole-lesion setting resulting in reduced assessment time.
Looking for consistency in an uncertain world: test-retest reliability of neurophysiological and behavioral readouts in autism
Authors: Beker Shlomit , Foxe John J. , Venticinque John , Bates Juliana , Ridgeway Elizabeth M. , Schaaf Roseann C. , Molholm Sophie
Published: September 2021

Background

Autism spectrum disorders (ASD) are associated with altered sensory processing and perception. Scalp recordings of electrical brain activity time-locked to sensory events (event-related potentials; ERPs) provide precise information on the time-course of related altered neural activity, and can be used to model the cortical loci of the underlying neural networks. Establishing the test-retest reliability of these sensory brain responses in ASD is critical to their use as biomarkers of neural dysfunction in this population.

Methods

EEG and behavioral data were acquired from 33 children diagnosed with ASD aged 6–9.4 years old, while they performed a child-friendly task at two different time-points, separated by an average of 5.2 months. In two blocked conditions, participants responded to the occurrence of an auditory target that was either preceded or not by repeating visual stimuli. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability of measures of sensory (auditory and visual) ERPs and performance, for the two experimental conditions. To assess the degree of reliability of the variability of responses within individuals, this analysis was performed on the variance of the measurements, in addition to their means. This yielded a total of 24 measures for which ICCs were calculated.

Results

The data yielded significant good ICC values for 10 of the 24 measurements. These spanned across behavioral and ERPs data, experimental conditions, and mean as well as variance measures. Measures of the visual evoked responses accounted for a disproportionately large number of the significant ICCs; follow-up analyses suggested that the contribution of a greater number of trials to the visual compared to the auditory ERP partially accounted for this.

Conclusions

This analysis reveals that sensory ERPs and related behavior can be highly reliable across multiple measurement time-points in ASD. The data further suggest that the inter-trial and inter-participant variability reported in the ASD literature likely represents replicable individual participant neural processing differences. The stability of these neuronal readouts supports their use as biomarkers in clinical and translational studies on ASD. Given the minimum interval between test/retest sessions across our cohort, we also conclude that for the tested age-range of ~ 6 to 9.4 years, these reliability measures are valid for at least a 3-month interval. Limitations related to EEG task demands and study length in the context of a clinical trial are considered.
Drawing the line between sustainable and unsustainable fish: product differentiation that supports sustainable development through trade measures
Authors: Baumgartner Urs , Bürgi Bonanomi Elisabeth
Published: September 2021

Background

Unsustainable production practices and increased demand for fish have aggravated negative social, ecological, and environmental impacts in fisheries and aquaculture. Measures to correct bad practices have mainly been introduced by private actors. However, there is increased demand for state intervention, particularly regarding trade regulations for fish and other agricultural products. Building on discussions about product differentiation through trade measures that favour sustainable products, this study looked at how sustainable and unsustainable fish has been distinguished in Switzerland. In interviewing experts in the fish trade and sales business in Switzerland, the research aimed at understanding the actors and forces that shape the concept of sustainable fish in the country.

Results

Three ways of product differentiation for sustainable fish by private actors were identified in Switzerland: ecolabels, “Swiss produce”, and recommendations in the form of a “consumer guide for fish”. Currently, price is the main constraint on consumption of sustainable products in the country. Defining “sustainable fish” is challenging and subject to interpretation. All existing measures to differentiate sustainable from unsustainable fish products in Switzerland have shortcomings, particularly in terms of discrimination and inclusiveness. Fish ecolabels play a key role in product differentiation, but experts believe that they fail to accommodate all aspects of sustainability.

Conclusion

Our findings imply that the Swiss state should play a more important role if it aims to fulfil the promise of article 104a of the Swiss Constitution, which seeks to foster sustainable production and cross-border trade relations that contribute towards this goal. Preferred trade treatment for sustainable fish products is a potential option to increase the production and consumption of sustainable fish. When designing measures for product differentiation, a careful choice is paramount to address sustainability in a holistic, inclusive, and transparent way and in order not to violate existing trade obligations. Due to similarities between the Swiss and other fish markets, we assume that governments in general and members of the European Union in particular must play an active role in shaping the definition and trade of sustainable fish products if they seek to comply with their sustainability commitments.
Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study
Authors: Wintemute Kimberly , Noor Meh , Bhatt Aashka , Bloch Gary , Arackal Suja , Kalia Sumeet , Aliarzadeh Babak , La Tona Sabrina , Lo Joyce , Pinto Andrew D. , Greiver Michelle
Published: September 2021

Background

Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened.

Methods

This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization.

Results

128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization.

Conclusions

We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.
Cytomegalovirus reactivation in immunocompetent mechanical ventilation patients: a prospective observational study
Authors: Zhang Zhihui , Liu Xuesong , Sang Ling , Chen Sibei , Wu Zhan , Zhang Jierong , Sun Yining , Huang Yongbo , Xu Yonghao , He Weiqun , Li Yimin , Liu Xiaoqing
Published: September 2021

Background

Cytomegalovirus (CMV) reactivation is associated with adverse prognoses of critically ill patients. However, the epidemiology and predictors of CMV reactivation in immunocompetent patients receiving mechanical ventilation (MV) are not clear. The aim of this study was to investigate the epidemiology and predictors of CMV reactivation in immunocompetent patients requiring MV.

Methods

A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with MV at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week for 28 days (Days 1, 7, 14, 21, and 28). CMV serology, laboratory findings, and clinical data were obtained during hospitalization.

Results

Among 71 patients, 13 (18.3%) showed CMV reactivation within 28 days in the ICU. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body mass index (BMI), sepsis, N-terminal pro-b-type natriuretic peptide (NT-proBNP), blood urea nitrogen (BUN), and hemoglobin (Hb) levels (P < 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were independently associated with CMV reactivation patients (P < 0.05). Moreover, the area under the receiver operating characteristic (AUROC) of BMI, Hb, and BMI combined with Hb was 0.69, 0.70, and 0.76, respectively. The duration of MV, hospitalization expense, length of ICU stay, and 90 day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P < 0.05).

Conclusions

Among immunocompetent patients with MV, the incidence of CMV reactivation was 18.3%. CMV reactivation was associated with several adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.
Concerns about transmission, changed services and place of birth in the early COVID-19 pandemic: a national survey among Danish pregnant women. The COVIDPregDK study
Authors: Schrøder Katja , Stokholm Lonny , Rubin Katrine Hass , Jørgensen Jan Stener , Nohr Ellen Aagaard , Petersen Lone Kjeld , Bliddal Mette
Published: September 2021

Background

The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted (‘freebirth’) due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth.

Methods

We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020.

Results

The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners’ attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41).

Conclusion

Danish pregnant womens’ concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.
Prevalence of anxiety and its associated factors among infertile patients after ‘two-child’ policy in Chongqing, China: a cross-sectional study
Authors: Gui Wenwu , Yang Xi , Jiang Huimin , Wu Hongwen , Zeng Mao , Wen Yidi , Qiu Tian , Zhang Yong , Ma Zhi , Tong Chao , Luo Li , Zhao Yong , Wang Lianlian
Published: September 2021

Background

With the prevalence of infertility increasing every year around the world, it has seriously impacted the individual quality of family and social life. Anxiety is one of the most prevalent anxiety disorders among infertile patients. After the two-child policy, whether it affected the prevalence of anxiety is controversial. This study aimed to determine the prevalence of anxiety and its potential risk factors among Chinese infertile women after the enforcement of ‘two-child policy’.

Methods

This cross-sectional study included 693 infertile patients in a reproductive medical center in Chongqing, China, between February 2016 and December 2018. Data was collected by Self-filling questionnaires including basic demographic information and the Generalized Anxiety Disorder-7 (GAD-7). SPSS statistical software (IBM SPSS version 25) was used to analyse the obtained data. Descriptive analysis was used to describe basic information and anxiety scores, the chi-square test and binary logistic regression were used to analyse the relationship between anxiety and other variables.

Results

The prevalence of anxiety among total infertile patients was 21.8%, and its 23.5% among first-child infertile patients (FI), and 18.4% among second-child infertile patients (SI) respectively (P > 0.05). Binary logistic regression showed that patients with lower education levels were more likely to have anxiety (P < 0.01). Patients with middle salary incomes were more likely to have anxiety (OR = 1.860, 95% CI: 1.068–3.238). Oral contraception taking history (OR = 1.778, 95% CI: 1.186–2.667), and history of allergy (OR = 2.098, 95% CI: 1.219–3.612) were associated with anxiety.

Conclusions

Under the full liberalization of the “two-child policy”, the total prevalence of anxiety among Chinese infertile female is comparatively high. Low education levels, middle incomes, oral contraception taking and allergy history can be the related risk factors of anxiety. We promote that all infertile patients should be evaluated for the prevalence of anxiety, especially those with potential risks, and receive consultant or targeted treatment when needed.
Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review
Authors: Malheiro Rui , Peleteiro Bárbara , Correia Sofia
Published: September 2021

Background

Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery.

Main body

A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality.

A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections.

Conclusions

Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.
“I’m not alone, my story matters”: Incarcerated women’s perspectives on the impact and acceptability of group psychotherapy involving imaginal exposure to sexual assault memories
Authors: Zielinski Melissa J. , Karlsson Marie E. , Bridges Ana J.
Published: September 2021

Background

Although it is clear that incarcerated women need access to effective therapies for trauma sequelae, some have argued that one of the most effective treatments – exposure therapy – should not be provided in carceral settings due to the presumed lack of safety and stability making such an intervention inappropriate. Group therapy, the typical mode of intervention in prisons, has also been presumed to be unacceptable for exposure-based processing due to assumptions that hearing others’ trauma narratives would be traumatizing and unhelpful to listeners. However, there is a lack of data to support either of the aforementioned assumptions. This study examined the acceptability of an exposure-based group therapy for women survivors of sexual violence who were currently incarcerated (N = 61) by asking women themselves about their experiences completing an exposure-based group therapy protocol (SHARE; SurvivorsHealing fromAbuse:Recovery throughExposure) while incarcerated. We assessed women’s reasons for enrolling in the group, satisfaction with various therapy components (e.g., exposure, skill-building) and the treatment overall, and experiences of both sharing and listening to trauma narratives using a feedback survey that included a mix of multiple-choice and open-ended questions. Treatment dropout was examined as an additional index of acceptability.

Results

Treatment completion was very high (88.8%). Nearly all women who completed the group reported that they would recommend it to other incarcerated women (96.7%, with the remaining 3.3% reporting “it depends”). Qualitative results revealed overwhelmingly positive feedback about the effect of the group and indicated that sharing and listening to trauma narratives in a group setting serve discrete but dually important functions. Specifically, women almost universally experienced listening to others’ trauma narratives (i.e., exposures) in the SHARE group context as helpful—making them feel less alone and normalizing their experiences. Sharing one’s own story primarily provided an emotional release and/or transformation (i.e., an intrapersonal rather than interpersonal function).

Conclusions

Our findings challenge common concerns about the appropriateness of 1) prison as a context for trauma-focused treatments, including exposure and 2) sharing trauma narratives in a group setting. Unless empirical evidence demonstrating harm is uncovered, best practices for PTSD and other trauma-related sequelae—those recommended in reputable treatment guidelines and interventions like SHARE that incorporate components shown to be effective (e.g., cognitive challenging, exposure)—should be offered to incarcerated women as part of standard of care.
Fourteen years of manifestations and factors of health insurance fraud, 2006–2020: a scoping review
Authors: Villegas-Ortega José , Bellido-Boza Luciana , Mauricio David
Published: September 2021

Background

Healthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and factors. The objective is to identify the definition, manifestations and factors that influence health insurance fraud (HIF).

Methods

A scoping review on health insurance fraud published between 2006 and 2020 was conducted in ACM, EconPapers, PubMed, ScienceDirect, Scopus, Springer and WoS.

Results

Sixty-seven studies were included, from which we identified 6 definitions, 22 manifestations (13 by the medical provider, 7 by the beneficiary and, 2 by the insurance company) and 47 factors (6 macroenvironmental, 15 mesoenvironmental, 20 microenvironmental, and 6 combined) associated with health insurance fraud. We recognized the elements of fraud and its dependence on the legal framework and health coverage. From this analysis, we propose the following definition: “Health insurance fraud is an act of deception or intentional misrepresentation to obtain illegal benefits concerning the coverage provided by a health insurance company”. Among the most relevant manifestations perpetuated by the provider are phantom billing, falsification of documents, and overutilization of services; the subscribers are identity fraud, misrepresentation of coverage and alteration of documents; and those perpetrated by the insurance company are false declarations of benefits and falsification of reimbursements. Of the 47 factors, 25 showed an experimental influence, including three in the macroenvironment: culture, regulations, and geography; five in the mesoenvironment: characteristics of provider, management policy, reputation, professional role and auditing; 12 in the microenvironment: sex, race, condition of insurance, language, treatments, chronic disease, future risk of disease, medications, morale, inequity, coinsurance, and the decisions of the claims-adjusters; and five combined factors: the relationships between beneficiary-provider, provider-insurance company, beneficiary-insurance company, managers and guānxi.

Conclusions

The multifactorial nature of HIF and the characteristics of its manifestations depend on its definition; Identifying the influence of the factors will support subsequent attempts to combat HIF.
Kinetics of DPPH• scavenging by bacterioruberin from Haloferax alexandrinus GUSF-1 (KF796625)
Authors: Alvares Jyothi Judith , Furtado Irene Jeronimo
Published: September 2021

This is the first account of the kinetics of free radical scavenging by bacterioruberin obtained from cells of Haloferax alexandrinus GUSF-1(KF796625), grown at optimum conditions of 25% NaCl, pH 7, 42 °C, 150 rpm in NaCl Tryptone yeast extract medium and light. Bacterioruberin separated from methanolic extract displayed characteristics absorption peaks at 368, 386, 463, 492 and 525 nm and gave an m/z value of 740.4 (C50H76O4) in Liquid Chromatography-Mass Spectroscopy validating its purity. Bacterioruberin (13 µM) decolorized and decayed 0.2 mM 1,1-diphenyl-2-picrylhydrazyl radicals (DPPH•) monitored at 517 nm and reached a steady state within 30 min. An EC50 of 6.50 µM ± 0.27 (4.81 µg/mL ± 0.2) was deduced for the 0.2 mM DPPH•-bacterioruberin reaction using the GraphPad Prism 9 statistical software and employing the right-angled triangle technique. The study also revealed a comprehensive information of the total kinetic activity of bacterioruberin with DPPH•: the antioxidant activity index was 16.38 ± 0.67; time needed to reach the steady state with the added EC50—30 min; the antiradical power 30.77 ± 1.27 and the antiradical efficiency of 54.7 × 10–3 ± 2.24, thus reflecting the strong antioxidant nature of bacterioruberin. Scavenging of DPPH• by bacterioruberin was a pseudo-first-order reaction with a rate constant k2 of 2.76 × 10–5 ± 0.001 µM−1 s−1 calculated at t = 0 or initial time and t = 30 min. The knowledge of the kinetics of bacterioruberin to scavenge DPPH• adds to its effective application as an antioxidant in medicinal use, pharmaceutical products and others. Additionally, the use of simple conventional method of DPPH• free radical scavenging, monitored using  an easily available laboratory spectrophotometer, will certainly help in the effective use of any antioxidant compound.