bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient perceptions of microaggressions and discrimination toward patients during emergency department care
Authors: Punches Brittany E. , Osuji Evans , Bischof Jason J. , Li‐Sauerwine Simiao , Young Henry , Lyons Michael S. , Southerland Lauren T.
Published: June 2023

Background

Disparities in emergency department (ED) care based on race and ethnicity have been demonstrated. Patient perceptions of emergency care can have broad impacts, including poor health outcomes. Our objective was to measure and explore patient experiences of microaggressions and discrimination during ED care.

Methods

This mixed‐methods study of adult patients from two urban academic EDs integrates quantitative discrimination measures and semistructured interviews of discrimination experiences during ED care. Participants completed demographic questionnaires and the Discrimination in Medical Settings (DMS) scale and were invited for a follow‐up interview. Transcripts of recorded interviews were analyzed leveraging conventional content analysis with line‐by‐line coding for thematic descriptions.

Results

The cohort included 52 participants, with 30 completing the interview. Nearly half the participants were Black (n = 24, 46.1%) and half were male (n = 26, 50%). “No” or “rare” experiences of discrimination during the ED visit were reported by 22/48 (46%), some/moderate discrimination by 19/48 (39%), and significant discrimination in 7/48 (15%). Five main themes were found: (1) clinician behaviors—communication and empathy, (2) emotional response to health care team actions, (3) perceived reasons for discrimination, (4) environmental pressures in the ED, and (5) patients are hesitant to complain. We found an emergent concept where persons with moderate/high DMS scores, in discussing instances of discrimination, frequently reflected on previous health care experiences rather than on their current ED visit.

Conclusions

Patients attributed microaggressions to many factors beyond race and gender, including age, socioeconomic status, and environmental pressures in the ED. Of those who endorsed moderate to significant discrimination via survey response during their recent ED visit, most described historical experiences of discrimination during their interview. Previous experiences of discrimination may have lasting effects on patient perceptions of current health care. System and clinician investment in patient rapport and satisfaction is important to prevent negative expectations for future encounters and counteract those already in place.
A randomised controlled trial testing acceptance of practitioner‐referral versus self‐referral to stop smoking services within the Lung Screen Uptake Trial
Authors: Kotti Theodora , Katsampouris Evangelos , Ruparel Mamta , McEwen Andy , Dickson Jennifer L. , Duffy Stephen W. , Waller Jo , Janes Samuel M. , Quaife Samantha L.
Published: June 2023

Background and aims

Optimising smoking cessation (SC) referral strategies within lung cancer screening (LCS) could significantly reduce lung cancer mortality. This study aimed to measure acceptance of referral to SC support by either practitioner‐referral or self‐referral among participants attending a hospital‐based lung health check appointment for LCS as part of the Lung Screen Uptake Trial.

Design

Single‐blinded two‐arm randomised controlled trial.

Setting

England.

Participants

Six hundred forty‐two individuals ages 60 to 75 years, who self‐reported currently smoking or had a carbon monoxide reading over 10 ppm during the lung health check appointment.

Intervention and comparator

Participants were randomised (1:1) to receive either a contact information card for self‐referral to a local stop smoking service (SSS) (self‐referral, n = 360) or a SSS referral made on their behalf by the nurse or trial practitioner (practitioner‐referral, n = 329).

Measurements

The primary outcome was acceptance of the practitioner‐referral (defined as participants giving permission for their details to be shared with the local SSS) compared with acceptance of the self‐referral (defined as participants taking the physical SSS contact information card to refer themselves to the local SSS).

Findings

Half (49.8%) accepted the practitioner‐made referral to a local SSS, whereas most (88.5%) accepted the self‐referral. The odds of accepting the practitioner‐referral were statistically significantly lower (adjusted odds ratio = 0.10; 95% confidence interval = 0.06–0.17) than the self‐ referral. In analyses stratified by group, greater quit confidence, quit attempts and Black ethnicity were associated with increased acceptance within the practitioner‐referral group. There were no statistically significant interactions between acceptance by referral group and any of the participants’ demographic or smoking characteristics.

Conclusions

Among participants in hospital‐based lung cancer screening in England who self‐reported smoking or met a carbon monoxide cut‐off, both practitioner‐referral and self‐referral smoking cessation strategies were highly accepted. Although self‐referral was more frequently accepted, prior evidence suggests practitioner‐referrals increase quit attempts, suggesting practitioner‐referrals should be the first‐line strategy within lung cancer screening, with self‐referral offered as an alternative.
A frameshift‐deletion mutation in Reelin causes cerebellar hypoplasia in White Swiss Shepherd dogs
Authors: Littlejohn Mathew D. , Sneddon Nick , Dittmer Keren , Keehan Mike , Stephen Melissa , Drögemüller Michaela , Garrick Dorian
Published: June 2023

Cerebellar hypoplasia is a heterogeneous neurological condition in which the cerebellum is smaller than usual or not completely developed. The condition can have genetic origins, with Mendelian‐effect mutations described in several mammalian species. Here, we describe a genetic investigation of cerebellar hypoplasia in White Swiss Shepherd dogs, where two affected puppies were identified from a litter with a recent common ancestor on both sides of their pedigree. Whole genome sequencing was conducted for 10 dogs in this family, and filtering of these data based on a recessive transmission hypothesis highlighted five protein‐altering candidate variants – including a frameshift‐deletion of the Reelin (RELN) gene (p.Val947*). Given the status of RELN as a gene responsible for cerebellar hypoplasia in humans, sheep and mice, these data strongly suggest the loss‐of‐function variant as underlying these effects. This variant has not been found in other dog breeds nor in a cohort of European White Swiss Shepherds, suggesting a recent mutation event. This finding will support the genotyping of a more diverse sample of dogs, and should aid future management of the harmful allele through optimised mating schemes.
‘It is a life changing experience’: The experiences of living kidney donors who live in rural Australia
Authors: Skaczkowski Gemma , Barrett Alison , Olver Ian , Dollman James , Gunn Kate M.
Published: June 2023

Introduction

A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations.

Objective

To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs.

Design/Setting/Participants

Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis.

Findings

Eight themes were identified: (1) donor's emotional well‐being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well‐being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall.

Conclusion

Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.
Spontaneous pneumothorax rates following video‐assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease
Authors: Kennedy Nicholas , Petrakis Nicholas , Chan Justin , Jurisevic Craig
Published: June 2023

Background

Recurrent primary spontaneous pneumothorax (PSP) is routinely treated by video‐assisted thoracoscopic (VATS) talc pleurodesis (with or without localized resection of macroscopic bullous disease). There is a paucity of published data regarding durability of the procedure and the rate of recurrent pneumothorax after such surgery, and this has significant implications from a prognostic and employment limitation perspective.

Methods

Patients who underwent a VATS talc pleurodesis (with or without localized resection of macroscopic bullous disease) for the treatment of their second or subsequent PSP or a PSP were followed for recurrent ipsilateral pneumothorax and new contralateral PSP. Follow up was by way of telephone interview and medical record verification out to 48 months.

Results

New contralateral pneumothorax occurred in 7 patients (11.1%) in the talc pleurodesis plus wedge resection group and 2 (1.8%) in the talc pleurodesis only group. There was one case of recurrent ipsilateral pneumothorax in a patient who had no inflammatory response to talc insufflation.

Conclusion

Video‐assisted thoracoscopic (VATS) talc pleurodesis (and lung resection for macroscopic bullous disease) is a durable treatment for recurrent PSP. Patients with macroscopic disease have a significant risk of subsequent contralateral PSP.
When nudgees become nudgers: Exploring the use of self‐nudging to promote fruit intake
Authors: van Rookhuijzen Merije , de Vet Emely , Gort Gerrit , Adriaanse Marieke A.
Published: June 2023

The current study explored (1) the immediate and prolonged effects of self‐nudges promoting fruit intake in the home environment, (2) whether the effect of self‐nudges on fruit intake persists after self‐nudges are no longer used (i.e. a temporal spillover effect) and (3) whether self‐nudges can install healthy eating habits that, in turn, explain the temporal spillover effect. Participants (N = 331) were randomly assigned to either a control or self‐nudge condition in which they had to choose a self‐nudge promoting fruit consumption for 8 weeks. Thereafter, participants were asked to remove the self‐nudge for 1 week to assess a possible temporal spillover effect. Results showed a positive effect of the self‐nudges on fruit consumption right after implementation that continued during the 8 weeks in which the self‐nudge was implemented, which was accompanied by an increase in fruit intake habit strength. However, a mixed picture emerged regarding the temporal spillover effect and no support was found for a mediation effect of habit strength. Although this study is only a first exploration of self‐nudging to increase healthy food consumption, results indicate that self‐nudging may be a promising extension of traditional nudging that can influence behaviour beyond out‐of‐home settings.
What is cooperative breeding in mammals and birds? Removing definitional barriers for comparative research
Authors: Ben Mocha Yitzchak , Scemama de Gialluly Sophie , Griesser Michael , Markman Shai
Published: June 2023

Cooperative breeding (i.e. when alloparents care for the offspring of other group members) has been studied for nearly a century. Yet, inconsistent definitions of this breeding system still hamper comparative research. Here, we identify two major inconsistencies, discuss their consequences and propose a way forward. First, some researchers restrict the term ‘cooperative breeding’ to species with non‐breeding alloparents. We show that such restrictive definitions lack distinct quantitative criteria to define non‐breeding alloparents. This ambiguity, we argue, reflects the reproductive‐sharing continuum among cooperatively breeding species. We therefore suggest that cooperative breeding should not be restricted to the few species with extreme reproductive skew and should be defined independent of the reproductive status of alloparents. Second, definitions rarely specify the type, extent and prevalence of alloparental care required to classify species as cooperative breeders. We thus analysed published data to propose qualitative and quantitative criteria for alloparental care. We conclude by proposing the following operational definition: cooperative breeding is a reproductive system where >5% of broods/litters in at least one population receive species‐typical parental care and conspecifics provide proactive alloparental care that fulfils >5% of at least one type of the offspring's needs. This operational definition is designed to increase comparability across species and disciplines while allowing to study the intriguing phenomenon of cooperative breeding as a behaviour with multiple dimensions.
Identification of copy number variants with genome sequencing: Clinical experiences from the NYCKidSeq program
Authors: Bonini Katherine E. , Thomas‐Wilson Amanda , Marathe Priya N. , Sebastin Monisha , Odgis Jacqueline A. , Di Biase Miranda , Kelly Nicole R. , Ramos Michelle A. , Insel Beverly J. , Scarimbolo Laura , Rehman Atteeq U. , Guha Saurav , Okur Volkan , Abhyankar Avinash , Phadke Shruti , Nava Caroline , Gallagher Katie M. , Elkhoury Lama , Edelmann Lisa , Zinberg Randi E. , Abul‐Husn Noura S. , Diaz George A. , Greally John M. , Suckiel Sabrina A. , Horowitz Carol R. , Kenny Eimear E. , Wasserstein Melissa , Gelb Bruce D. , Jobanputra Vaidehi
Published: June 2023

Copy number variations (CNVs) play a significant role in human disease. While chromosomal microarray has traditionally been the first‐tier test for CNV detection, use of genome sequencing (GS) is increasing. We report the frequency of CNVs detected with GS in a diverse pediatric cohort from the NYCKidSeq program and highlight specific examples of its clinical impact. A total of 1052 children (0–21 years) with neurodevelopmental, cardiac, and/or immunodeficiency phenotypes received GS. Phenotype‐driven analysis was used, resulting in 183 (17.4%) participants with a diagnostic result. CNVs accounted for 20.2% of participants with a diagnostic result (37/183) and ranged from 0.5 kb to 16 Mb. Of participants with a diagnostic result (n = 183) and phenotypes in more than one category, 5/17 (29.4%) were solved by a CNV finding, suggesting a high prevalence of diagnostic CNVs in participants with complex phenotypes. Thirteen participants with a diagnostic CNV (35.1%) had previously uninformative genetic testing, of which nine included a chromosomal microarray. This study demonstrates the benefits of GS for reliable detection of CNVs in a pediatric cohort with variable phenotypes.
HIF‐1α promotes astrocytic production of macrophage migration inhibitory factor following spinal cord injury
Authors: Hao Huifei , Hou Yuxuan , Li Aicheng , Niu Li , Li Shaolan , He Bingqiang , Zhang Xingyuan , Song Honghua , Cai Rixin , Zhou Yue , Yao Chun , Wang Yongjun , Wang Yingjie
Published: June 2023

Background

Macrophage migration inhibitory factor (MIF) is an important mediator of neuropathology in various central nervous system (CNS) diseases. However, little is known about its inducers for production from the nerve cells, as well as the underlying regulatory mechanism. Injury‐induced HIF‐1α has been shown to exacerbate neuroinflammation by activating multiple downstream target molecules. It is postulated that HIF‐1α is involved in the regulation of MIF following spinal cord injury (SCI).

Methods

SCI model of Sprague–Dawley rats was established by cord contusion at T8–T10. The dynamic changes of HIF‐1α and MIF protein levels at lesion site of rat spinal cord were determined by Western blot. The specific cell types of HIF‐1α and MIF expression were examined by immunostaining. Primary astrocytes were isolated from the spinal cord, cultured and stimulated with various agonist or inhibitor of HIF‐1α for analysis of HIF‐1α‐mediated expression of MIF. Luciferase report assay was used to determine the relationship between HIF‐1α and MIF. The Basso, Beattie, and Bresnahan (BBB) locomotor scale was used to assess the locomotor function following SCI.

Results

The protein levels of HIF‐1α and MIF at lesion site were significantly elevated by SCI. Immunofluorescence demonstrated that both HIF‐1α and MIF were abundantly expressed in the astrocytes of the spinal cord. By using various agonists or inhibitors of HIF‐1α, it was shown that HIF‐1α sufficiently induced astrocytic production of MIF. Mechanistically, HIF‐1α promoted MIF expression through interaction with MIF promoter. Inhibition of HIF‐1α activity using specific inhibitor markedly reduced the protein levels of MIF at lesion site following SCI, which in turn favored for the functional recovery.

Conclusion

SCI‐induced activation of HIF‐1α is able to promote MIF production from astrocytes. Our results have provided new clues for SCI‐induced production of DAMPs, which may be helpful for clinical treatment of neuroinflammation.
Fibroblast growth factor 21 ameliorates behavior deficits in Parkinson's disease mouse model via modulating gut microbiota and metabolic homeostasis
Authors: Yang Changwei , Wang Wuqiong , Deng Pengxi , Wang Xinyi , Zhu Lin , Zhao Liangcai , Li Chen , Gao Hongchang
Published: June 2023

Aims

The effects of FGF21 on Parkinson's disease (PD) and its relationship with gut microbiota have not been elucidated. This study aimed to investigate whether FGF21 would attenuate behavioral impairment through microbiota–gut–brain metabolic axis in 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP) induced PD mice model.

Methods

Male C57BL/6 mice were rendomized into 3 groups: vehicle (CON); MPTP 30 mg/kg/day i.p. injection (MPTP); FGF21 1.5 mg/kg/d i.p. injection plus MPTP 30 mg/kg/day i.p. injection (FGF21 + MPTP). The behavioral features, metabolimics profiling, and 16 s rRNA sequencing were performed after FGF21 treatment for 7 days.

Results

MPTP‐induced PD mice showed motor and cognitive deficits accompanied by gut microbiota dysbiosis and brain‐region‐specific metabolic abnormalities. FGF21 treatment dramatically attenuated motor and cognitive dysfunction in PD mice. FGF21 produced a region‐specific alteration in the metabolic profile in the brain in ways indicative of greater ability in neurotransmitter metabolism and choline production. In addition, FGF21 also re‐structured the gut microbiota profile and increased the relative abundance of Clostridiales, Ruminococcaceae, and Lachnospiraceae, thereby rescuing the PD‐induced metabolic disorders in the colon.

Conclusion

These findings indicate that FGF21 could affect behavior and brain metabolic homeostasis in ways that promote a favorable colonic microbiota composition and through effects on the microbiota–gut–brain metabolic axis.
Effect of cryothermic and radiofrequency Cox‐Maze IV ablation on atrial size and function assessed by 2D and 3D echocardiography, a randomized trial. To freeze or to burn
Authors: Boano Gabriella , Vánky Farkas , Åström Aneq Meriam
Published: June 2023

Background

Atrial linear scars in Cox‐Maze IV procedures are achieved using Cryothermy (Cryo) or radiofrequency (RF) techniques. The subsequent postoperative left atrial (LA) reverse remodelling is unclear. We used 2‐ and 3‐dimensional echocardiography (2‐3DE) to compare the impact of Cryo and RF procedures on LA size and function 1 year after Cox‐maze IV ablation concomitant with Mitral valve (MV) surgery.

Methods

Seventy‐two patients with MV disease and AF were randomized to Cryo (n = 35) or RF (n = 37) ablation. Another 33 patients were enroled without ablation (NoMaze). All patients underwent an echocardiogram the day before and 1 year after surgery. The LA function was assessed on 2D strain by speckle tracking and 3DE.

Results

Forty‐two ablated patients recovered sinus rhythm (SR) 1 year after surgery. They had comparable left and right systolic ventricular function, LA volume index (LAVI), and 2D reservoir strain before surgery. At follow‐up, the 3DE extracted reservoir and booster function were higher after RF (37 ± 10% vs. 26 ± 6%; p < 0.001) than Cryo ablation (18 ± 9 vs. 7 ± 4%; p < 0.001), while passive conduit function was comparable between groups (24 ± 11 vs. 20 ± 8%; p = 0.17). The extent of LAVI reduction depended on the duration of AF preoperatively.

Conclusions

SR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. Compared to RF, the extension of ablation area produced by Cryo implies a structural LA remodelling affecting LA systolic function.
Cerebrovascular and cardiovascular responses to the Valsalva manoeuvre during hyperthermia
Authors: Perry Blake G. , Korad Stephanie , Mündel Toby
Published: June 2023

Background

During hyperthermia, the perturbations in mean arterial blood pressure (MAP) produced by the Valsalva manoeuvre (VM) are more severe. However, whether these more severe VM‐induced changes in MAP are translated to the cerebral circulation during hyperthermia is unclear.

Methods

Healthy participants (n = 12, 1 female, mean ± SD: age 24 ± 3 years) completed a 30 mmHg (mouth pressure) VM for 15 s whilst supine during normothermia and mild hyperthermia. Hyperthermia was induced passively using a liquid conditioning garment with core temperature measured via ingested temperature sensor. Middle cerebral artery blood velocity (MCAv) and MAP were recorded continuously during and post‐VM. Tieck's autoregulatory index was calculated from the VM responses, with pulsatility index, an index of pulse velocity (pulse time) and mean MCAv (MCAvmean) also calculated.

Results

Passive heating significantly raised core temperature from baseline (37.9 ± 0.2 vs. 37.1 ± 0.1°C at rest, p < 0.01). MAP during phases I through III of the VM was lower during hyperthermia (interaction effect p < 0.01). Although an interaction effect was observed for MCAvmean (p = 0.02), post‐hoc differences indicated only phase IIa was lower during hyperthermia (55 ± 12 vs. 49.3 ± 8 cm s−1 for normothermia and hyperthermia, respectively, p = 0.03). Pulsatility index was increased 1‐min post‐VM in both conditions (0.71 ± 0.11 vs. 0.76 ± 0.11 for pre‐ and post‐VM during normothermia, respectively, p = 0.02, and 0.86 ± 0.11 vs. 0.99 ± 0.09 for hyperthermia p < 0.01), although for pulse time only main effects of time (p < 0.01), and condition (p < 0.01) were apparent.

Conclusion

These data indicate that the cerebrovascular response to the VM is largely unchanged by mild hyperthermia.
Long‐term efficacy of antireflux mucosectomy in patients with refractory gastroesophageal reflux disease
Authors: Sumi Kazuya , Inoue Haruhiro , Ando Ryohei , Fujiyoshi Mary Raina Angeli , Fujiyoshi Yusuke , Tanabe Mayo , Shimamura Yuto , Onimaru Manabu
Published: June 2023

Objectives

Minimally invasive treatments have been applied for gastroesophageal reflux disease (GERD), but the long‐term results are controversial. Antireflux mucosectomy (ARMS) is a simple endoscopic procedure that does not require the insertion of a foreign body. We provide the first report on the long‐term results of ARMS.

Methods

This was a single‐center, single‐arm trial, prospective study of 88 patients with proton pump inhibitor (PPI)‐refractory GERD who underwent ARMS between June 2012 and June 2017. Primary outcomes were the rates of long‐term effectiveness and PPI discontinuation. Secondary outcomes were to compare patients' preoperative background characteristics, questionnaire, and multichannel intraluminal impedance and pH monitoring data to examine the predictive factors of ARMS. The clinical course was reviewed, including the need for additional treatment after ARMS.

Results

Antireflux mucosectomy produced a long‐term effect in 68.3% of the patients, and PPI could be discontinued in 42% of patients. There were significant differences in age, intensity of preoperative symptoms, and acid‐related indicators. Forty‐five percent (27/60) had reflux hypersensitivity and ARMS provided long‐term effectiveness in 81% of these patients. There was no significant difference in subjective symptom assessment between those with short‐term and long‐term efficacy. Additional treatment was administered in 23% (14/60) and scheduled at 1–2 years’ follow‐up.

Conclusions

Antireflux mucosectomy showed long‐term efficacy, and many of the cases with short‐term effects were able to maintain them. In addition, ARMS is also effective in patients with reflux hypersensitivity, and provides a treatment option that bridges the gap between surgical and medical treatment.
Crosstalk between genetic variability of adiponectin and leptin, glucose‐insulin system and subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes. The Verona Newly Diagnosed Type 2 Diabetes Study 14
Authors: Zusi Chiara , Csermely Alessandro , Rinaldi Elisabetta , Bertoldo Kezia , Bonetti Sara , Boselli Maria Linda , Travia Daniela , Bonora Enzo , Bonadonna Riccardo C. , Trombetta Maddalena
Published: June 2023

Aim

To evaluate the relationship of genetic variability of adiponectin (ADIPOQ), leptin (LEP) and leptin receptor (LEPR) genes with glucose‐insulin system and markers of subclinical atherosclerosis (ATS) in patients with newly diagnosed type 2 diabetes.

Materials and methods

In 794 subjects we performed: 1) euglycemic hyperinsulinemic clamp to assess insulin sensitivity; 2) mathematical modelling of a 5h‐OGTT to estimate β‐cell function; 3) resting ECG; 4) carotid artery and lower limb artery eco‐doppler sonography to identify ATS; 5) genotyping of tag‐SNPs within ADIPOQ, LEP and LEPR gene.

Results

Regression analyses showed: 1) adiponectin levels were negatively associated with BMI, waist‐to‐hip ratio and triglycerides and positively with HDL and insulin sensitivity (p‐all<0.03); 2) leptin levels were positively associated with BMI, HDL‐cholesterol and plasma triglycerides and negatively with insulin sensitivity (p‐all<0.001). Two SNPs (rs1501299 and rs2241767) within ADIPOQ gene were associated with circulating levels of adiponectin. The ADIPOQ‐GAACA haplotype was associated with plasma adiponectin (p=0.034; β=‐0.24), ECG abnormalities (p=0.012; OR=2.76), carotid ATS (p=0.025; OR=2.00) and peripheral limb artery ATS (p=0.032; OR=1.90). The LEP‐CTA haplotype showed an association with ischemic ECG abnormalities (p=0.017; OR=2.24). Finally, LEPR‐GAACGG was associated with circulating leptin (p=0.005; β=‐0.31) and worst β‐cell function (p=0.023; β=‐15.10). Omnibus haplotype analysis showed that ADIPOQ haplotypes were associated with levels of adiponectin and common carotid artery ATS, LEP with peripheral limb artery ATS, whereas LEPR haplotypes influenced circulating levels of leptin.

Conclusions

Results of this study reinforce knowledge on adipokines’ role in regulating glucose metabolism; in particular highlighted the potential atherogenic role of leptin and the anti atherogenic role of adiponectin.
Serum uric acid lowering and effects of sodium‐glucose cotransporter‐2 inhibitors on gout: A meta‐analysis and meta‐regression of randomized controlled trials
Authors: Banerjee Mainak , Pal Rimesh , Maisnam Indira , Chowdhury Subhankar , Mukhopadhyay Satinath
Published: June 2023

Aims

To pool the effects of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors on gout and to investigate the association of these effects with baseline serum uric acid (SUA), SUA lowering, and underlying conditions, such as type 2 diabetes mellitus (T2DM)/heart failure (HF).

Methods

PubMed, Embase, Web of Science, Cochrane Library and clinical trial registry websites were searched for randomized controlled trials (RCTs) or post hoc analyses (≥1‐year duration; PROSPERO:CRD42023418525). The primary outcome was a composite of gouty arthritis/gout flares and commencement of anti‐gout drugs (SUA‐lowering drugs/colchicine). Hazard ratios (HRs) with 95% confidence interval (CI) were pooled using a generic inverse‐variance method with a random‐effects model. Mixed‐effects model univariate meta‐regression analysis was performed.

Results

Five RCTs involving 29 776 patients (T2DM, n = 23 780) and 1052 gout‐related events were identified. Compared to placebo, SGLT2 inhibitor use was significantly associated with reduced risk of composite gout outcomes (HR 0.55, 95% CI 0.45‐0.67; I2 = 61%, P < 0.001). Treatment benefits did not differ between trials being conducted exclusively in baseline HF versus those conducted in patients with T2DM (P‐interaction = 0.37), but were greater with dapagliflozin 10 mg and canagliflozin 100/300 mg (P < 0.01 for subgroup differences). Sensitivity analysis excluding trials that evaluated the effects of empagliflozin 10/25 mg (HR 0.68, 95% CI 0.57‐0.81; I2 = 0%) accentuated the benefits of SGLT2 inhibitors with no between‐trial heterogeneity (HR 0.46, 95% CI 0.39‐0.55; I2 = 0%). Univariate meta‐regression found no impact of baseline SUA, SUA lowering on follow‐up, diuretic use, or other variables on their anti‐gout effects.

Conclusion

We found that SGLT2 inhibitors significantly reduced the risk of gout in individuals with T2DM/HF. Lack of an association with SUA‐lowering effects suggests that metabolic and anti‐inflammatory effects of SGLT2 inhibitors may predominantly mediate their anti‐gout benefits.
Severe hypoglycaemia in adults presenting to a hospital emergency department: Clinical characteristics, comorbidities, and mortality outcomes
Authors: Song Soon H. , Frier Brian M.
Published: June 2023

Aims

To determine the clinical characteristics, risk factors and mortality outcomes associated with severe hypoglycaemia (SH) treated at a hospital emergency department.

Materials and Methods

Adult patients presenting with SH to the Northern General Hospital, Sheffield, UK over a 44‐month period were assessed for clinical characteristics, coexisting comorbidities and mortality outcomes, including cause of death, and analysed by age of diabetes onset, below and above age 40 years. Factors that predicted mortality were determined.

Results

A total of 619 episodes of SH occurred in 506 individuals. Most had type 1 (T1D; n = 172 [34.0%]) or type 2 diabetes (T2D; n = 216 [42.7%]), but several attendees did not have diabetes (non‐DM; n = 110 [21.7%]). Irrespective of age of diabetes onset, patients with T2D had more socioeconomic deprivation and comorbidities (P < 0.005). SH was uncommon in those with young‐onset T2D, who constituted 7.2% of all episodes in diabetes. Hospital admission was high (60%‐75%). The T2D cohort had the longest inpatient stay (median 5 days, vs. 2 and 3 days for the T1D and non‐DM cohorts, respectively). Survival after the index SH episode was lower and mortality was higher in the non‐DM (39.1%) and T2D (38.0%) cohorts than the T1D cohort (13.3%; all P < 0.05), with a median time to death of 13, 113 and 465 days, respectively. Most deaths (78%‐86%) were from non‐cardiovascular causes. Charlson index predicted mortality and poor survival in T1D and T2D (both P < 0.05).

Conclusions

Severe hypoglycaemia requiring emergency hospital treatment is associated with non‐cardiovascular deaths and exerts a disproportionately greater impact on mortality in people with T2D and those without diabetes. Multimorbidity is an important risk factor for SH and increases mortality risk.
Democratic Citizenship Education in Digitized Societies: A Habermasian Approach
Authors: Culp Julian
Published: June 2023

In this article Julian Culp offers a new conceptualization of democratic citizenship education in light of the transformations of contemporary Western societies to which the use of digital technologies has contributed. His conceptualization adopts a deliberative understanding of democracy that provides a systemic perspective on society‐wide communicative arrangements and employs a nonideal, critical methodology that concentrates on overcoming democratic deficits. Based on this systemic, deliberative conception of democracy, Culp provides an analysis of the public sphere's normative deficits and argues that current political communication may be systemically distorted. Drawing on this analysis, he suggests that practices of democratic citizenship education in digitized societies must not concentrate narrowly on the effective and responsible use of digital technologies. Instead, these practices should also focus on the economic and cultural conditions that are co‐responsible for the structural problems of political communication as well as address the democratic deficits that are reflected in inadequate communicative arrangements.
Inclusive Universalism as a Normative Principle of Education
Authors: Stojanov Krassimir
Published: June 2023

In recent years we have seen a newfound engagement with Jürgen Habermas's work in philosophy of education, focusing on his conception of argumentative dialogue, or discourse, as the origin of both truth‐related epistemic judgments and justifications of moral norms that claim rightness rather than truth. In this article, Krassimir Stojanov first reconstructs the way in which Habermas determines the relation between truth and rightness, and he then shows that moral rightness functions as a “truth‐analogue” since moral norms, like true facts, transcend the actual and local practices of their justification. In the case of moral rightness, this transcendence occurs as an infinite process of inclusion of the perspectives and interests of all potentially concerned persons — also (and foremost) the perspectives and interests of those who are strange to each other in their respective values, worldviews, and interests. With this account of “truth‐analogue” moral rightness, Habermas conceptualizes a kind of processual and “difference‐sensible” universalism, which is very different from the substantialist universalism of some traditional conceptions of education, or Bildung. In the final section, Stojanov shows why including children in their otherness as children in the discursive process of production of moral knowledge, and thus treating them with a kind of epistemic respect, is a constitutive condition for that process. The demand for the discursive inclusion of children follows from the discourse ethics approach, but it requires an enlargement and some corrections of that approach.
Whole metagenome sequencing reveals host plant influences microbial community associated with larvae ofAnastrepha obliqua
Authors: Cárdenas‐Hernández Valentina , Velasco‐Cuervo Sandra , Toro‐Perea Nelson
Published: June 2023

The interactions between phytophagous insects and microorganisms allow the former to take advantage of plant tissue as a food resource, despite being nutritionally deficient and abundant in toxic metabolites. The West Indian fruit fly,Anastrepha obliqua(Macquart) (Diptera: Tephritidae), is a polyphagous species that feeds, as a larva, on the fruits of plants of various families. In Colombia, some of its hosts are red mombin (Spondias purpureaL.), mango (Mangifera indicaL.) (both Anacardiaceae), and star fruit (Averrhoa carambolaL.) (Oxalidaceae). We used whole metagenome sequencing (WMS) to characterize and compare the microbiota and microbiomes ofA. obliqualarvae when they fed on these three fruits. The microbiota constituted of bacteria, fungi, and, to a lesser extent, archaea, and the number of microorganisms in each of these groups varied among host plants. On mango, the main group was Firmicutes; on star fruit and red mombin, Proteobacteria. In addition, on red mombin, fungal groups were more represented than on the other two fruits. For four dominant microbial species,Acetobacter persiciIino et al.,Gluconobacter sphaericus(Ameyama) Malimas et al.,Tatumella ptyseosHollis et al., andWeissella confusa(Holzapfel & Kandler) Collins et al., the genomes were reconstructed. The annotation of these genomes allowed us to determine thatA. persici,G. sphaericus, andT. ptyseoscontain a large number of genes involved in amino acid metabolism pathways, whereasW. confusacontains many genes involved in carbohydrate metabolism pathways. These genes are important for the use of food resources, considering the poor nutritional composition of plant material. Our results form a starting point for understanding the contribution of microorganisms to the ability ofA. obliquato utilize its host plants, the evolutionary implications, and possible applications for the control of this pest insect.
Strategizing: The state of the art in the Milan School
Authors: Telfener Umberta , Ticozzelli Elia
Published: June 2023

It is important to understand the need to have directions and goals in order to organize a therapeutic path. After having considered the common aspects of strategic therapies, the authors—both representing the Milan School of Boscolo and Cecchin—explain the unavoidable use of a strategic attitude and its evolution, from the adherence to the Palo Alto model, to Tomm's (1987) proposal, to considering strategizing the fourth guideline of the Milan Approach. We then discuss the utilization of strategizing in the present times. Does it make sense to speak of directive or nondirective psychotherapists now a days? The answer is that if we take a second‐order positioning—which is the attitude that distinguishes therapy from a common chat among friends—we are inevitably and contemporarily both directive and nondirective. An example from the botanical field is offered.
Helicobacter hepaticus promotes liver fibrosis through oxidative stress induced by hydrogenase in BALB/c mice
Authors: Cao Shuyang , Zhang Yuanyuan , Bao Ruoyu , Wang Tao , Zhu Liqi , Zhang Quan
Published: June 2023

Background

It has been documented that Helicobacter hepaticus produces a nickel‐containing hydrogen‐oxidizing hydrogenase enzyme, which is necessary for hydrogen‐supported amino acid uptake. Although H. hepaticus infection has been shown to promote liver inflammation and fibrosis in BALB/c mice, the impact of hydrogenase on the progression of liver fibrosis induced by H. hepaticus has not been explored.

Materials and Methods

BALB/c mice were inoculated with hydrogenase mutant (ΔHyaB) or wild type (WT) H. hepaticus 3B1 for 12 and 24 weeks. H. hepaticus colonization, hepatic histopathology, serum biochemistry, expression of inflammatory cytokines, and oxidative stress signaling pathways were detected.

Results

We found that ΔHyaB had no influence on the colonization of H. hepaticus in the liver of mice at 12 and 24 weeks post infection (WPI). However, mice infected by ΔHyaB strains developed significantly alleviated liver inflammation and fibrosis compared with WT infection. Moreover, ΔHyaB infection remarkably increased the expression of hepatic GSH, SOD, and GSH‐Px, and decreased the liver levels of MDA, ALT, and AST compared to WT H. hepaticus infected group from 12 to 24 WPI. Furthermore, mRNA levels of Il‐6, Tnf‐α, iNos, Hmox‐1, and α‐SMA were significantly decreased with an increase of Nfe2l2 in the liver of mice infected by ΔHyaB strains. In addition, ΔHyaB H. hepaticus restored the activation of the Nrf2/HO‐1 signaling pathway, which is inhibited by H. hepaticus infection.

Conclusions

These data demonstrated that H. hepaticus hydrogenase promoted liver inflammation and fibrosis development mediated by oxidative stress in male BALB/c mice.
Recent prevalence and characteristics of patients with hepatitis delta virus in Hokkaido, Japan
Authors: Sasaki Takashi , Suda Goki , Ohara Masatsugu , Hosoda Shunichi , Kawagishi Naoki , Kohya Risako , Yoda Tomoka , Maehara Osamu , Ohnishi Shunsuke , Yoshida Sonoe , Fu Qingjie , Yang Zijian , Tokuchi Yoshimasa , Kitagataya Takashi , Suzuki Kazuharu , Nakai Masato , Sho Takuya , Natsuizaka Mitsuteru , Komukai Sho , Ogawa Koji , Sakamoto Naoya
Published: June 2023

Aim

Although hepatitis delta virus (HDV) coinfection with hepatitis B virus (HBV) is a global health concern, the global prevalence of HDV infections remains unknown due to insufficient data in many countries. In Japan, HDV prevalence has not been updated for over 20 years. We aimed to investigate the recent prevalence of HDV infections in Japan.

Methods

We screened 1264 consecutive patients with HBV infection at Hokkaido University Hospital between 2006 and 2022. Patients' serums were preserved and subsequently tested for HDV antibody (immunoglobulin‐G). Available clinical information was collected and analyzed. We compared the changes in liver fibrosis using the Fibrosis‐4 (FIB‐4) index between propensity‐matched patients with and without the evidence of anti‐HDV antibodies and corrected for baseline FIB‐4 index, nucleoside/nucleotide analog treatment, alcohol intake, sex, HIV coinfection, liver cirrhosis, and age.

Results

After excluding patients without properly stored serums and those lacking appropriate clinical information, 601 patients with HBV were included. Of these, 1.7% of patients had detectable anti‐HDV antibodies. Patients with anti‐HDV antibody serum positivity had a significantly higher prevalence of liver cirrhosis, significantly lower prothrombin time, and a higher prevalence of HIV coinfection than those who demonstrated serum anti‐HDV antibody negativity. A propensity‐matched longitudinal analysis revealed that liver fibrosis (FIB‐4 index) progressed more rapidly in patients with positive results for anti‐HDV antibody tests.

Conclusions

The recent prevalence of HDV infections in Japanese patients with HBV was 1.7% (10/601). These patients experienced rapid liver fibrosis progression, highlighting the importance of routine HDV testing.
Lived experiences of young adults facing a recent diagnosis of cancer: A phenomenological study
Authors: Shahmari Mehraban , Nikbakht Nasrabadi Alireza , Rezaie Elaheh , Dashti Seemin , Nasiri Elhameh , Zare Leily
Published: June 2023

Introduction

Young adulthood is a period of prosperity and freshness characterized by developmental achievement, which can be inhibited by various diseases such as cancer. Typically considered a terminal disease, if diagnosed in young adulthood, cancer may trigger a tremendous psychosomatic shock. The nature of facing a recent cancer diagnosis affects the whole coping process. Addressing young adults' experiences at the confirmation point of cancer diagnosis will facilitate supporting them through the early recognition of probable problems in the future. Therefore, the present study aimed to analyse the lived experiences of young adults facing a recent cancer diagnosis.

Methods

This qualitative study adopted an interpretive phenomenology design. In this study, 12 patients (with an age range of 20–40) were selected using the purposive sampling method. Data collection was done through in‐depth, semistructured interviews. The data were analysed following the method proposed by Diekelmann et al.

Findings

Three main themes and nine subthemes were extracted from the data: (1) spiritual detachment and then acceptance through spirituality in the form of denial and then forced acceptance, sense of guilt and spiritual help‐seeking, and anger towards God and then humbleness, (2) the shock of facing an extraordinary life shaped by disturbed role‐play and unusual lifestyle, (3) anticipatory anxiety concerning the sense of rejection, negative perspective towards future, inability to afford the costs and worries about the future of the family members.

Conclusion

This was the first study providing significant insights into the experiences of young adults facing a recent cancer diagnosis. The diagnosis of cancer can shadow all aspects of young adults' lives. The findings of the present study empower healthcare professionals to provide newly diagnosed young adults with appropriate health services.

Patient Contributions

To identify and recruit the participants, we explained the objectives of the present study to the unit managers either by phone or in person. The participants were approached and interviewed by three authors. Participation was voluntary and the participants received no financial contribution for their time.
Parents of children with cancer require health literacy support to meet their information needs
Authors: Tan Chai Eng , Lau Sie Chong Doris , Abdul Latiff Zarina , Lee Chee Chan , Teh Kok Hoi , Mohd Sidik Sherina
Published: June 2023

Background

Timely and relevant information helps parents to cope when a child is diagnosed with cancer. However, obtaining and understanding information is not a straightforward process for parents.

Objectives

This article aims to explain paediatric cancer parents' information behaviour related to the care of their child.

Methods

Qualitative in‐depth interviews were conducted with fourteen Malaysian paediatric cancer parents and eight healthcare professionals who worked with paediatric cancer patients. Reflexivity and inductive approaches were used to interpret the data to identify meaningful themes and subthemes.

Results

Three themes about how paediatric cancer parents interact with information emerged: Acquiring information, internalising information, and using information. Information may be actively sought or passively acquired. Cognitive and affective aspects influence how information is internalised into meaningful knowledge. Knowledge then leads to further action including further information gathering.

Conclusion

Paediatric cancer parents need health literacy support to meet their information needs. They require guidance in identifying and appraising suitable information resources. Development of suitable supporting materials is needed to facilitate parents' ability to comprehend information related to their child's cancer. Understanding parents' information behaviour could assist healthcare professionals in providing information support in the context of paediatric cancer.
Multi‐scale habitat overlap in two broad‐ranged sympatric Neotropical forest eagles reveals shared environmental space and habitat use
Authors: Sutton Luke J. , Anderson David L. , Franco Miguel , Gomes Felipe Bittioli R. , McClure Christopher J. W. , Miranda Everton B. P. , Vargas F. Hernán , Vargas González José de J. , Puschendorf Robert
Published: June 2023

Quantifying resource partitioning between co‐occurring species can provide insight into processes facilitating coexistence by closely related species, a fundamental question in ecology. We tested whether the habitat requirements of two closely related Neotropical forest eagles, the Crested Eagle Morphnus guianensis and Harpy Eagle Harpia harpyja, differ at fine and coarse resolutions across their shared geographical range. Using landcover and topographical covariates, we quantified potential resource overlap first using higher resolution (30 arc‐s, ~ 1‐km2 data) generalized linear models (GLMs), and secondly using coarser‐grain (2.5 arc‐min, ~ 4.5‐km2 data) environmental ordination to capture the potential effect of scale on habitat overlap. The distribution of both eagles was largely explained by canopy tree species richness and canopy structural complexity, with peak suitability of 60–80% evergreen forest cover. Both eagles were negatively associated with mosaic forest and cultivated areas. From the GLMs, habitat overlap was >93% in geographical space but was reduced to 73% when considering environmental space, a proxy for resource overlap. From ordination (principal component analysis), resource overlap was 67% in environmental space, with randomization tests supporting equivalent environmental space for both eagles. Our results suggest that at the continental scale, Crested and Harpy Eagles share identical environmental space when quantified at fine and broad scales, with little difference in distribution and habitat use. At the continental scale used here, both eagles can coexist, presumably with sufficient habitat heterogeneity for coexistence when they occur in close proximity. Therefore, further research is required at the local level to capture fully where coexistence at the local scale is facilitated more by fine‐scale habitat selection, or difference in diet between two species with indistinguishable habitat use.