bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative assessment of provider satisfaction and experiences with a COVID-19 community mobile health clinic outreach model in underserved Baltimore neighborhoods
Authors: Cadet Kechna , Baker David R , Brown Annice
Published: February 2023

Objective:

Although previous studies have assessed provider perceptions about telehealth, no prior studies have qualitatively assessed the experiences and satisfaction of health-care providers with a community mobile health clinic model within underserved urban settings.

Methods:

This study draws on the views expressed by community health workers ( n = 4), registered nurses ( n = 2), Grace Medical Center outreach specialists ( n = 2), and physician assistants staffing LifeBridge Health’s virtual hospital ( n = 3) to understand their satisfaction and experiences with a COVID-19 community mobile health clinic in underserved Baltimore neighborhoods. Thematic analysis of the interviews was used to extract themes and subthemes of our health-care providers’ experiences with the community mobile health clinic model.

Results:

These individuals shared their experiences addressing social determinants of health, the perceived impact of community mobile health clinic, satisfaction with and limitations of the pilot project, as well as future implications for the community mobile health clinic model. Finally, ideas for how the model can fit into the existing healthcare delivery framework are suggested.

Conclusion:

The context surrounding the COVID-19 pandemic has provided a unique opportunity to critically address healthcare frameworks and models. The LifeBridge community mobile health clinic served as an initiative to truly bridge together community outreach and health access. Among the many themes, health-care providers on the team applauded the model for its potential to bring preventative health care to the patient with the goal of improving patient health outcomes.
Resolution of urethral obstruction using temporary urethral stents in two female cats
Authors: Aubrecht Alex M , Lulich Jody P
Published: February 2023

Case summary

The management of urethral obstructions is well documented in male cats but is less established for females. These cases describe two female cats that presented with non-dissolvable urocystoliths. Urocystoliths were removed by laser lithotripsy and basket retrieval. Following urolith removal, urethral obstruction occurred in both cats. Both cats were successfully managed using temporary urethral stents in lieu of indwelling urethral catheters permitting outpatient, spontaneous recovery of the urethra.

Relevance and novel information

Use of temporary urethral stents has not been described in cats. These novel stents are constructed from materials available in most veterinary facilities, placed without advanced imaging and reside entirely within the urethra and vestibule. Temporary stents are used to bypass urethral disease, facilitating outpatient recovery, and are easily removed when no longer needed. For these reasons, temporary stents are a cost-efficient alternative to permanent stents or indwelling urinary catheters attached to closed urine-collection systems.
Ignorance as a Method: Rethinking Academic Burden in an Accelerated Society
Authors: Lin (林小英) Xiaoying
Published: February 2023

Purpose

This study applies “ignorance” as a theoretical lens to understand students’ academic burden in China as well as the value of free time in social acceleration.

Design/Approach/Methods

The article argues that students’ learning gradually became alienated in different times and spaces. It uses Rosa's social acceleration theory to analyze the logical paradox of the burden reduction policy in China and Benner's plasticity and self-activity principles to highlight the pedagogical value of leisure and free activities.

Findings

The findings suggest the need to maintain the “necessary ignorance” in leisure activities and intervene less in student learning. In this respect, “ignorance” can be viewed as a cognitive method to protect leisure time and rebuild a spontaneous order in learning, which can close the gap caused by the impossible synchronization of specific parties in the education system. Ignorance opens the door to learned spaces, providing more opportunities to reduce academic burden in an accelerated society and stimulate the imagination of education.

Originality/Value

This study reveals the plasticity and self-activity that students develop in free leisure time and space, and reworks the key concept of “inevitable ignorance” expounded by Friedrich Hayek into “necessary ignorance” with pedagogical and ethical meanings. The reconceptualization of academic burden opens up new ways of thinking about educational policy and educational practice.
Increasing Identification and Follow-Up of Older Adult Depression in Primary Care
Authors: Uomoto Keirstin E.
Published: February 2023

Introduction:

Depression is a common mental health disorder faced by older adults that can go undetected and untreated. It was determined that the project site was not screening for depression among their older patient population. Aims: The purpose of this quality improvement project was to determine if the implementation of the Geriatric Depression Scale-15 (GDS-15) would impact the identification of risk factors for depression and follow-up among adults 65 and older.

Methods:

Implementation started in June 2021 in a primary care office in Southern California. Data was collected for this project over a total of 8 weeks. This project was a quality improvement project designed to implement routine depression screening among older adult patients using the GDS-15. Depressive symptoms were identified, and follow-up and treatment for depression in primary care was initiated if indicated by GDS-15 scores. Data were obtained from the project site’s electronic medical record on a total sample size of 443 patients (n = 252 in the comparison group and n = 191 in the implementation group).

Results:

A chi-square test indicated a clinical and statistically significant improvement in the identification rate of depression, X2 (1, N = 443) = 49.76, P < .0001; and follow-up rate X2 (1, N = 70) = 23.94, P < .0001. Clinical significance was found with an increase in the identification of depression and follow-up of older adults in primary care. Demographic variables were also compared for the QI intervention group patients according to those who scored <5 (n = 134) and patients who scored 5 or greater on the GDS-15 (n = 57) again using chi-square tests. The results showed significant differences between gender ( P = .016) and primary diagnosis ( P = .006).

Conclusions:

Findings of this project suggest all older adults should receive a depression screening routinely in primary care to increase the recognition of depression as well as follow-up and treatment.
Book review: Jayaseelan Raj. 2022. Plantation Crisis: Ruptures of Dalit life in the Indian Tea Belt
Authors: Nazer Thanzeel
Published: February 2023

Jayaseelan Raj. 2022. Plantation Crisis: Ruptures of Dalit life in the Indian Tea Belt. London: UCL Press. 256 pp. Figures, maps, tables, appendix, references, index. £40 (hardback—ISBN: 9781800082298)
The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians
Authors: Murray Iain R. , McAdams Timothy R. , Hammond Kyle E. , Haddad Fares S. , Rodeo Scott A. , Abrams Geoffrey D. ,   on behalf of a Group of American Professional Football Physicians, Bankston Larry , Bedi Asheesh , Boublik Martin , Bowen Mark , Bradley James P. , Cooper Dan E. , Craythorne Charles , Curl Leigh-Ann , ElAttrache Neal , Gazzaniga David S. , Kaplan Kevin , Khalfayan Elias Edward , Larson Christopher , Pepe Matthew , Price Mark D. , Schroeppel J. Paul , Voos James , Waslewski Gary , West Robin
Published: February 2023

Background:

There is a lack of published information outlining the use of biologics in National Football League (NFL) athletes and limited data to guide biologic treatment strategies.

Purpose:

To develop a consensus on the use of biologics among NFL team physicians.

Study Design:

Consensus statement.

Methods:

A working group of 6 experts convened a consensus process involving NFL team physicians using validated Delphi methodology. Physicians from 32 NFL teams as well as NFL London were invited to take part. This iterative process was used to define statements on the use of biologics in NFL athletes. A recent scoping review exploring biologics in professional athletes was used to inform the first of 3 rounds of surveys, with statements considered under 7 headings: biologics in general, challenges of treating NFL athletes, terminology/nomenclature, autologous blood products, cell-based therapies, guidance for NFL team physicians, and biologic research in the NFL. In addition to rating agreement, experts were encouraged to propose further items or modifications. Predefined criteria were used to refine item lists after each survey. For a consensus within the final round, defined a priori, items were included in the final information set if a minimum of 75% of respondents agreed and fewer than 10% disagreed.

Results:

Physicians from 26 NFL teams and NFL London responded to the initial invitation to participate in the Delphi process; 88.9% of participating team physicians completed the round 1 survey, with response rates of 87.5% in round 2 and 95.2% in round 3. After 3 rounds, 47 statements reached a consensus. A consensus was achieved that platelet-rich plasma has a positive impact on patellar tendinopathy and on symptoms in early osteoarthritis but not for other indications. NFL team physicians agreed that while cell therapies have the potential to improve symptoms, the misrepresentation of uncharacterized preparations as “stem cells” has contributed to the widespread use of unproven therapies.

Conclusion:

This study established an expert consensus on 47 statements relating to the use of biologics in NFL athletes. In addition to providing clinical guidance for the use of biologics in NFL athletes, this study identified key areas for future focus including the development of athlete education materials.
Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis
Authors: Jónsdóttir Unnur Sædís , Brorsson Annelie , Nilsson Helander Katarina , Tranberg Roy , Larsson Maria E.H.
Published: February 2023

Background:

Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant’s experience before and throughout the rehabilitation process, which can be explored using a qualitative content analysis.

Purpose:

To explore and describe what influences the participant to return to physical activity after an Achilles tendon rupture.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Twenty participants (14 men; mean age, 46 years) were interviewed as part of this study. All participants had ruptured their Achilles tendon 4 to 6 years before the interviews. From the interviews, codes were extracted that evolved into 19 subcategories, 6 categories, and 1 theme.

Results:

The overarching theme that emerged was “Help me and then I can fix this.” The 6 categories were (1) one’s own drive to succeed, (2) having a supportive social network, (3) trusting the support from the health and social systems, (4) receiving and adapting information from others drives persistence in returning to activity, (5) impact of the injury on psychological factors; and (6) influence of physiological aspects.

Conclusion:

To be able to recover properly from an Achilles tendon rupture and return to activity, the study participants described the importance of obtaining the support needed to be able to gain optimal rehabilitation. In the participants’ opinion, for a greater chance of successful treatment and rehabilitation, it was vital to be provided with good support.
Acute stroke management in Turkey: Current situation and future projection
Authors: Topcuoglu Mehmet Akif , Ozdemir Atilla Ozcan
Published: February 2023

In Turkey, the incidence of acute stroke is increasing, obviously with the contribution of the aging population. With the publication of “Directive on Health Services to be Provided to Patients with Acute Stroke” on July 18, 2019 and its entry into force in March 2021, an important period of catching up and updating has begun in the management of acute stroke patients in our country. During this period, 57 comprehensive stroke centers and 51 primary stroke centers were certified. These units have covered approximately 85% of the country’s population. In addition, around 50 interventional neurologists were trained and became the directors of many of these centers. In the following 2 years, the “inme.org.tr campaign” was launched. This campaign, aimed at increasing the public’s knowledge and awareness about stroke, continued unabated during the pandemic period. Now is the time to continue the efforts to ensure homogeneous quality metrics and to develop and continuously improve the established system.
The cost of ischaemic stroke in Croatia
Authors: Benković Vanesa , Parker Mark , Novaković Tanja , Meštrović Andrija , Budinčević Hrvoje
Published: February 2023

Objective:

The aim of this analysis was to estimate 1 year and long-term cost and quality of life of ischaemic stroke patients in Croatia. In addition, we aimed to identify and estimate key categories of costs and outcomes driving the burden of stroke in Croatian healthcare system.

Methods:

Data were derived from analysis of the RES-Q Registry for Croatia in 2018 and supplemented with clinical expert opinion and relevant medical, clinical and economic literature to estimate the course of the disease and treatment patterns in Croatian healthcare system. The health economic model was comprised of a one-year discrete event simulation (DES) mapping real life patient experience and a 10-year Markov model built on existing literature. Cost and health resources use were obtained using Croatian tariffs. Health utilities were mapped to EQ5D from the Barthel Index utilising previously published studies.

Results:

The key aspects determining costs and quality of life were rehabilitation, discharge to residential care (currently 13% of patients in Croatia) and recurrent stroke. Total 1 year cost per patient was 18,221 EUR having 0.372 QALYs.

Conclusion:

Direct costing structure of ischaemic stroke in Croatia is above the value of upper-middle income countries. Our study showed that post stroke rehabilitation seems to be a strong modifier of future post-stroke costs and further research into various models of post-stroke care and rehabilitation could be the answer into more successful rehabilitation that could increase QALY and reduce the economic burden of stroke. Further investment in rehabilitation research and provision might bring promising opportunities to improve long term patient outcomes.
The power of lament: Reckoning with loss in an urban forest
Authors: Phillips Catherine , Atchison Jennifer , Straughan Elizabeth
Published: February 2023

This paper explores the lamenting for a street tree to better understand reactions to ecological loss. It responds to calls for social studies research into how ecological loss is felt and expressed, particularly when that loss and its emotional impact is unrecognised. Drawing on a unique dataset of emails to trees in Melbourne, we consider the most emailed tree, a tree felled despite collective action. Lamenting for this tree is explored as an individual and collective process that includes but extends beyond grief. A lament, we argue, involves shaping and expressing an account of loss that holds others to account. Understood as an embodied and emplaced process, we develop the case for the concept of lament through detailing the feeling, narrating, sharing and placing of loss. We argue that examining lament in this way reveals new insights into lived experiences and expressions related to facing the damage and destruction of nonhuman life and landscapes.
Exploring the influence of individual daily activity patterns on activity-space segregation
Authors: Zheng Zhong , Chen Fei , Lu Junwen , Zhou Suhong
Published: February 2023

Activity-space segregation is a new topic in urban segregation studies. The existing literature did not fully explain its mechanisms. In this study, we tested the hypothesis whether activity-space segregation is influenced by individual daily activity patterns. The dynamic ambient population that individuals interact with was identified with mobile phone big data and the individuals’ experienced segregation at the activity space was measured with travel survey small data. This study compared the differences in individuals’ daily activity patterns by different social-economic groups and examined the influence of the spatiotemporal pattern on the activity-space segregation. It has found that: (1) The degree of segregation in non-mandatory activity spaces during the day is less than that in mandatory activity spaces, and the degree of segregation in residence is the highest. (2) Disadvantaged populations have less leisure time and smaller activities space, and they are subject to greater time and space constraints. Spatiotemporal patterns affect the degree of an individual’s segregation. Those who have less leisure time and shorter travel distances experience higher activity-space segregation. This study has both theoretical and practical significance. The social interaction in non-mandatory activities is very important for decreasing activity-space segregation. It facilitates scientific decision-making for the government.
Effectiveness of an Intravenous Insulin–Based Treatment Protocol for the Management of Hypertriglyceridemia-Associated Acute Pancreatitis
Authors: Perez Valeria , Faust Andrew C. , Taburyanskaya Margarita , Patil Raju A. , Ortegon Anthony
Published: February 2023

Background:

There is burgeoning interest in intravenous insulin for hypertriglyceridemia-induced acute pancreatitis (HTG-AP) as a less invasive alternative to plasmapheresis; however, there are few published descriptions of disease-specific insulin protocols.

Objective:

To compare the efficacy and safety of an insulin infusion–based protocol with nonstandardized medical therapy for HTG-AP.

Methods:

This is a retrospective analysis before and after creation of an HTG-AP-specific insulin infusion treatment protocol. Inclusion criteria were age ≥18 years, an initial triglyceride level >1000 mg/dL, and a diagnosis of AP. The primary outcome of the study was time to a triglyceride level ≤1000 mg/dL.

Results:

Sixty-seven patients were included in this study (26 pre-protocol and 41 in the HTG-AP insulin protocol group). Baseline characteristics between the groups were similar, with median initial triglyceride levels >3500 mg/dL. There was a trend toward patients treated with the HTG-AP-specific infusion reaching a triglyceride level ≤1000 mg/dL faster (43.3 [24.9-72.1] vs 26.9 [17.7-51.1] hours; P = 0.07). Those treated to ≤500 mg/dL achieved this faster with the disease-specific infusion (49.2 [29.4-67.8] vs 70.9 [36.3-107.2] hours, P = 0.04). Hypoglycemia was numerically lower in the HTG-AP-specific insulin infusion group despite higher insulin infusion rates (7.3% vs 19.2%). No patient in the HTG-AP-specific protocol group required plasmapheresis.

Conclusions:

The use of an HTG-AP-specific insulin infusion protocol, compared with antecedent nonstandardized care, resulted in prompter achievement of a triglyceride level ≤500 mg/dL and a strong trend toward faster achievement of ≤1000 mg/dL without an increased risk of hypoglycemia. While intravenous insulin may be considered the initial medical therapy for HTG-AP, further studies are needed to determine the optimal dosing.
Ultrasonographic Appearance of the Lower Extremity Arteries After Femoropopliteal Bypass Surgery
Authors: Kalinin Roman , Suchkov Igor , Klimentova Emma , Mzhavanadze Nina , Shanaev Ivan
Published: February 2023

Objective:

The aim of this study was to assess the ultrasonographic appearance of the lower extremity arteries, after a femoropopliteal bypass surgery.

Materials and Methods:

Ninety patients, with atherosclerotic peripheral artery disease, underwent either autologous vein (30 subjects) or synthetic femoropopliteal bypass grafting, using an end-to-side (30 subjects) or end-to-end anastomotic technique. The outcomes were compared to 30 volunteers, who were recruited to serve as healthy controls. A lower extremity duplex ultrasonogram (DUS) was performed 1 year after treatment. The healthy volunteers underwent DUS at the point of being included in the study.

Results:

In healthy volunteers, the angle between the profunda femoris artery (deep femoral artery, PFA) and common femoral artery (CFA) did not exceed 30° of angulation. The diameter of the CFA, in the bifurcation area, was 9.8 ± 1.5 mm. The bypass patency rates, CFA diameter, PFA angle, and neointimal hyperplasia rates differed between the groups as presented.

Conclusion:

The results that were obtained may indicate the importance of bypass graft surveillance, using DUS, with precise analysis of the topography and geometry of the lower extremity arteries and vascular conduits, during the perioperative period. In addition, in this cohort, femoropopliteal bypass procedures were associated with an increase in the angle of the PFA from 30° to 80° of angulation. An increase in the diameter of the CFA in the area of the proximal anastomosis from 9.8 to 15.1 mm was also noted. In these patients, the saphenous vein bypasses were associated with minimal changes of the vascular geometry and better patency rates.
Role of NKG2D ligands and receptor in haploidentical related donor hematopoietic cell transplantation
Authors: Petersdorf Effie W. , McKallor Caroline , Malkki Mari , He Meilun , Spellman Stephen R. , Hsu Katharine C. , Strong Roland K. , Gooley Ted , Stevenson Phil
Published: February 2023

The recurrence of malignancy after hematopoietic cell transplantation (HCT) is the primary cause of transplantation failure. The NKG2D axis is a powerful pathway for antitumor responses, but its role in the control of malignancy after HCT is not well-defined. We tested the hypothesis that gene variation of the NKG2D receptor and its ligands MICA and MICB affect relapse and survival in 1629 patients who received a haploidentical HCT for the treatment of a malignant blood disorder. Patients and donors were characterized for MICA residue 129, the exon 5 short tandem repeat (STR), and MICB residues 52, 57, 98, and 189. Donors were additionally defined for the presence of NKG2D residue 72. Mortality was higher in patients with MICB-52Asn relative to those with 52Asp (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.24-2.71; P = .002) and lower in those with MICA-STR mismatch than in those with STR match (HR, 0.66; 95% CI, 0.54-0.79; P = .00002). Relapse was lower with NKG2D-72Thr donors than with 72Ala donors (relapse HR, 0.57; 95% CI, 0.35-0.91; P = .02). The protective effects of patient MICB-52Asp with donor MICA-STR mismatch and NKG2D-72Thr were enhanced when all 3 features were present. The NKG2D ligand/receptor pathway is a transplantation determinant. The immunobiology of relapse is defined by the concerted effects of MICA, MICB, and NKG2D germ line variation. Consideration of NKG2D ligand/receptor pairings may improve survival for future patients.
Unraveling the pathophysiology of lower-limb postthrombotic syndrome in adolescents: a proof-of-concept study
Authors: Avila M. Laura , Bentley Robert F. , Bastas Denise , Brandão Leonardo R. , Schneiderman Jane E. , Ward Leigh , Wong Gina , Stephens Samantha , Liu Kuan , Thomas Scott
Published: February 2023

A better understanding of the pathophysiology of pediatric postthrombotic syndrome (PTS) is needed to develop strategies to treat this condition. We investigated calf pump function, exercise capacity, balance in power output, and changes in limb muscle oxygen saturation (SmO2) and fluid content during exercise in 10 pediatric patients with unilateral lower-limb PTS, and in age- and sex-matched controls (1:1-1:2 ratio). Outcomes were investigated using bioimpedance spectroscopy, torque-sensing pedals, and near-infrared spectroscopy during incremental- and constant-load cycling tests. The median age at participation was 17 years (25th-75th percentile, 15-18 years); 68% of participants were females. The median CAPTSure score in the affected leg of affected participants was 35 points (25th-75th percentile, 24-46 points), indicating moderate/severe PTS; 20% of patients had a history of central venous catheter–related thrombosis. Increasing PTS severity was associated with higher calf pump venous volume and higher ejection volume, leading to compensated calf pump performance. We found no evidence of PTS impact on exercise capacity. Leg contribution to power output was similar in affected and unaffected legs. However, the PTS-affected legs showed lower SmO2 during active cycling and recovery with increasing PTS severity, indicating impaired microvascular function in the muscle. These findings suggest that PTS severity is associated with impaired blood flow, presumably from elevated venous pressure during and after exercise. The fact that microvascular function is impaired in young patients with PTS underscores the relevance of developing strategies to mitigate the effects of this chronic vascular disease to minimize its deleterious effects as children grow older.
The history and organization of the Workshop on Population and Speciation Genomics
Authors: Barth Julia M. I. , Handley Scott A. , Kintzl Daniel , Leonard Guy , Malinsky Milan , Matschiner Michael , Meyer Britta S. , Salzburger Walter , Stefka Jan , Trucchi Emiliano
Published: February 2023

With the advent of high-throughput genome sequencing, bioinformatics training has become essential for research in evolutionary biology and related fields. However, individual research groups are often not in the position to teach students about the most up-to-date methodology in the field. To fill this gap, extended bioinformatics courses have been developed by various institutions and provide intense training over the course of two or more weeks. Here, we describe our experience with the organization of a course in one of the longest-running extended bioinformatics series of workshops, the Evomics Workshop on Population and Speciation Genomics that takes place biennially in the UNESCO world heritage town of Český Krumlov, Czech Republic. We list the key ingredients that make this workshop successful in our view, explain the routine for workshop organization that we have optimized over the years, and describe the most important lessons that we have learned from it. We report the results of a survey conducted among past workshop participants that quantifies measures of effective teaching and provide examples of how the workshop setting has led to the cross-fertilisation of ideas and ultimately scientific progress. We expect that our account may be useful for other groups aiming to set up their own extended bioinformatics courses.
Efficacy of PD-1/PD-L1 inhibitors in gastric or gastro-oesophageal junction cancer based on clinical characteristics: a meta-analysis
Authors: Huo Gengwei , Liu Wenjie , Chen Peng
Published: February 2023

Purpose

Programmed death-1 (PD-1) and its ligand (PD-L1) inhibitors have been reported in several clinical trials for gastric cancer and gastroesophageal junction cancer (GC/GEJC). We presently carried out a meta analysis to evaluate the potency of PD-1/PD-L1 inhibitors in advanced GC/GEJC individuals with different clinical features and to determine patients more probably benefiting from the treatment.

Methods

Randomized clinical trials (RCTs) in databases that compared PD-1/PD-L1 inhibitors to chemotherapy in patients with GC/GEJC published before May 2022 were retrieved. Basic characteristics were extracted from the included studies as well as hazard ratios (HR) and 95 percent confidence intervals (CI) for all individuals and subgroups. The inverse variance weighting method was used to evaluate pooled treatment data.

Findings

Four RCTs involving 2,253 individuals were included. The results suggested that PD-1/PD-L1 inhibitors substantially enhanced overall survival (OS) (HR, 0.91; CI 95%, 0.83–1.00; p = 0.04) but not progression free survival (PFS) (HR, 1.17; CI 95%, 0.83–1.64; p = 0.38) in GC/GEJC individuals compared with chemotherapy. Significantly improved OS was observed in individuals aged < 65 years (HR, 0.84; p = 0.003), and men (HR, 0.88; p = 0.02), but not in individuals aged ≥ 65 years (HR, 0.97; p = 0.62), and women (HR, 0.98; p = 0.82).

Implications

PD-1/PD-L1 inhibitors improve OS but not PFS compared with chemotherapy in GC/GEJC. Age and sex could be used to predict the treatment potency of PD-1/PD-L1 inhibitors in GC/GEJC.
Blood lead levels in children residing in a 115-year old urban settlement in Harare, Zimbabwe: a cross sectional study
Authors: Chagonda Svitsai , Chitungo Itai James Blessing , Musarurwa Cuthbert , Nyamayaro Terence
Published: February 2023

Background

Elemental lead (Pb) toxicity in children, irreversibly affects their growth and development. We assessed the prevalence of high blood Pb levels (BLL) in children living in a potentially high risk residential area and also assessed Pb levels in environmental specimens.

Methods

This cross sectional study measured blood lead levels (BLL) in 86children living in Mbare, a densely populated suburb in Harare, Zimbabwe, characterised by dwellings progressively constructed from 1907 through to the 1940s, before the ban of leaded paint. Study participants of both genders were under 6 years of age. Potential risk factors of Pb poisoning were assessed. Pb levels were also assessed in soil, water and paint chip specimens from the study area.

Results

The mean (standard deviation) BLL was 4.3 ± 0.75 g/dL. Twelve (13.95%) participants had BLL of > 5.0ug/dL. Our results showed no significant association between BLL and household income, participant behaviour/habits/activities, sources of drinking water, and the types of cookware used to prepare meals in their households.

Conclusion

Mean BLL observed in the current study were higher compared to those of children of similar age groups in the United States, suggesting that Pb contamination may be more ubiquitous in the Mbare flats area, potentially predisposing these children to impaired development.
Association between multiple vitamins and bone mineral density: a cross-sectional and population-based study in the NHANES from 2005 to 2006
Authors: Zhang Ruyi , Huang Qin , Su Guanhua , Wei Muhong , Cui Yuan , Zhou Haolong , Song Wenjing , Di Dongsheng , Liu Junan , Wang Qi
Published: February 2023

Background

Bone mineral density (BMD) alterations in response to multivitamin exposure were rarely studied. Our study assessed the association of coexposure to six types of vitamins (i.e., vitamins B12, B9, C, D, A and E) with BMD measurements in adults in the US.

Methods

Data were collected from participants aged ≥ 20 years (n = 2757) in the U.S. National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2006. Multiple linear regression, restricted cubic splines, principal component analysis (PCA) and weighted quantile sum (WQS) regression were performed for statistical analysis.

Results

The circulating levels of vitamins B12 and C were positively associated with BMDs, and an inverted L-shaped exposure relationship was observed between serum vitamin C and BMDs. PCA identified two principal components: one for ‘water-soluble vitamins’, including vitamins B12, B9 and C, and one for ‘fat-soluble vitamins’, including vitamins A, D and E. The former was positively associated with total femur (β = 0.009, 95%CI: 0.004, 0.015) and femoral neck (β = 0.007, 95%CI: 0.002, 0.013) BMDs, and the latter was negatively associated with BMDs with non-statistical significance. The WQS index constructed for the six vitamins was significantly related to total femur (β = 0.010, 95%CI: 0.001, 0.018) and femoral neck (β = 0.008, 95%CI: 0.001, 0.015) BMDs, and vitamins B12 and C weighted the most. The WQS index was inversely related to BMDs with non-statistical significance, and vitamins E and A weighted the most.

Conclusion

Our findings suggested a positive association between water-soluble vitamin coexposure and BMD, and the association was mainly driven by vitamins B12 and C. Negative association between fat-soluble vitamin coexposure and BMD was indicated, mainly driven by vitamins E and A. An inverted L-shaped exposure relationship was found between vitamin C and BMD.
The effects of soymilk plus probiotics supplementation on cardiovascular risk factors in patients with type 2 diabetes mellitus: a randomized clinical trial
Authors: Hasanpour Azimeh , Babajafari Siavash , Mazloomi Seyed Mohammad , Shams Mesbah
Published: February 2023

Objective

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular diseases. This study aimed to assess the effects of soymilk plus probiotics co-administration on cardiovascular risk factors in T2DM patients.

Methods

One hundred patients with T2DM (aged 40–75 years old) were randomly assigned into 4 groups (soymilk + probiotics supplement, soymilk + placebo, conventional milk + placebo, and probiotics supplement) for 6 weeks. Standard protocols were followed for the collection of fasting blood samples, dietary intakes, and anthropometric measurements.

Results

It was shown that soymilk + probiotics consumption significantly decreased diastolic blood pressure (DBP) (p = 0.001), triglycerides (TG) (P < 0.001), total cholesterol (TC) (p < 0.01), and insulin (P < 0.003) levels and significantly increased high-density lipoprotein cholesterol (HDL-C) (P = 0.002) levels. Soymilk + placebo administration significantly decreased DBP (p = 0.01), insulin (p = 0.006), and TG (p = 0.001) levels and significantly increased HDL-C (p = 0.03) levels. A significant decrease in insulin (p = 0.003) and systolic blood pressure (SBP) (p = 0.01) levels and an increase in HDL-C (p = 0.04) levels were observed after supplementation with probiotics. Findings from between-group comparisons showed a significant decrease in SBP levels in the probiotics supplement group compared to conventional milk group (p < 0.05).

Conclusion

Soymilk and probiotics consumption might improve some cardiovascular risk factors in patients with T2DM. However, possible synergic effects while consumption of soymilk plus probiotics supplement didn’t show in this study which warranted further research.
Assessing survival time of outpatients with cervical cancer: at the university of Gondar referral hospital using the Bayesian approach
Authors: Gashu Chalachew , Tasfa Buzuneh , Alemu Chekol , Kassa Yoseph
Published: February 2023

Background

Cervical cancer is the 4th most common cancer in women worldwide. as well as the 4th most common cause of cancer-related death. The main objective of this study was to identify factors that affect the survival time of outpatients with cervical cancer.

Methods

A retrolective study including outpatients with cervical cancer was carried out in a hospital. To achieve the aim, 322 outpatients with cervical cancer were included in the study based on the data taken from the medical records of patients enrolled from May 15, 2018, to May 15, 2022, at the University of Gondar referral hospital, Gondar, Ethiopia. The Kaplan–Meier plots and log-rank test were used for the comparison of survival functions; the Cox-PH model and Bayesian parametric survival models were used to analyze the survival times of outpatients with cervical cancer. Integrated nested Laplace approximation methods have been applied.

Results

Out of a total of 322 patients, 118 (36.6%) died as outpatients. The estimated median survival time for patients was 42 months. Using model selection criteria, the Bayesian log-normal accelerated failure time model was found to be appropriate. According to the results of this model, oral contraceptive use, HIV, stage, grade, co-morbid disease, history of abortion, weight, histology type, FIGO stage, radiation, chemotherapy, LVSI, metastatic number, regional nodes examined, and tumor size all have a significant impact on the survival time of outpatients with cervical cancer. The Bayesian log-normal accelerated failure time model accurately predicted the survival time of cervical cancer outpatients.

Conclusions

The findings of this study suggested that reductions in weight, treatment, the presence of comorbid disease, the presence of HIV, squamous cell histology type, having a history of abortion, oral contraceptive use, a large tumor size, an increase in the International Federation of Gynecologists and Obstetricians stage, an increase in metastasis number, an increase in grade, positive regional nodes, lymphatic vascular space invasion, and late stages of cancer all shortened the survival time of cervical cancer outpatients.
‘Guidance should have been there 15 years ago’ research stakeholders’ perspectives on ancillary care in the global south: a case study of Malawi
Authors: Kapumba Blessings M. , Nyirenda Deborah , Desmond Nicola , Seeley Janet
Published: February 2023

Background

Medical researchers in resource-constrained settings must make difficult moral decisions about the provision of ancillary care to participants where additional healthcare needs fall outside the scope of the research and are not provided for by the local healthcare system. We examined research stakeholder perceptions and experiences of ancillary care in biomedical research projects in Malawi.

Methods

We conducted 45 qualitative in-depth interviews with key research stakeholders: researchers, health officials, research ethics committee members, research participants and grants officers from international research funding organisations. Thematic analysis was used to analyse and interpret the findings.

Findings

All stakeholders perceived the provision of ancillary care to have potential health benefits to study participants in biomedical research. However, they also had concerns, particularly related to the absence of guidance to support it. Some suggested that consideration for ancillary care provision could be possible on a case-by-case basis but that most of the support from research projects should be directed towards strengthening the public health system, emphasising public good above individual or personal benefits. Some researchers and ethics committee members raised concerns about potential tensions in terms of funding, for example balancing study demands with addressing participants’ additional health needs.

Conclusion

Our findings highlight the complexities and gaps in the guidance around the provision of ancillary care in Malawi and other resource-constrained settings more generally. To promote the provision of ancillary care, we recommend that national and international guidelines for research ethics include specific recommendations for resource-constrained settings and specific types of research.
Experiences of using surveillance cameras as a monitoring solution at nursing homes: The eldercare personnel’s perspectives
Authors: Emilsson Maria , Karlsson Christina , Svensson Ann
Published: February 2023

Background

As the number of older people increases, so does the need for care. However, the workforce in eldercare cannot increase at the rate required to match the needs. Welfare technologies, such as surveillance cameras, can replace physical visits and be used at night to monitor older people in order to keep them safe, while not disturbing their sleep. The aim of the paper is to analyze obstacles and opportunities associated with implementation and use of surveillance cameras at nursing homes from the perspectives of the practitioners who use the technology, their working environment and the conditions of the older people with cognitive impairment who live in nursing homes.

Methods

Individual semi-structured interviews were conducted with the eldercare personnel at nursing homes to understand their experiences of implementation and use of surveillance cameras. The transcribed interviews were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) was used as a guidance tool.

Results

The results show that the eldercare personnel experienced lack of adequate information, education and support related to using surveillance cameras. Several benefits are highlighted, such as better working environment and that the residents were not unnecessarily disturbed at night. However, the results also show that it is important to clarify that surveillance cameras cannot replace the human presence.

Conclusions

The conclusions from this study are the importance of prerequisites for implementation, and that using surveillance cameras contributed to improvements in the working environment at night and created possibilities to maintain security and integrity for older people living in nursing homes.
Systemic proinflammatory−profibrotic response in aortic stenosis patients with diabetes and its relationship with myocardial remodeling and clinical outcome
Authors: Lee Hyun-Jung , Park Chan Soon , Lee Sahmin , Park Jun-Bean , Kim Hyung-Kwan , Park Sung-Ji , Kim Yong-Jin , Lee Seung-Pyo
Published: February 2023

Background

Previous studies have mainly focused more on how diabetes affects the valve than the myocardium in aortic stenosis (AS). In the pressure-overloaded heart, myocardial fibrosis is an important driver of the progression from compensated hypertrophy to heart failure. Using comprehensive noninvasive imaging and plasma proteomics, we investigated whether and how diabetes aggravates the remodeling of the myocardium and its relation with prognosis in AS patients.

Methods

Severe AS patients were enrolled in two prospective cohorts for imaging and biomarker analysis. The imaging cohort (n = 253) underwent echocardiography and cardiac magnetic resonance, and the biomarker cohort (n = 100) blood sampling with multiplex proximity extension assay for 92 proteomic biomarkers. The composite outcome of hospitalization for heart failure admissions and death was assessed in the imaging cohort.

Results

Diabetic patients were older (70.4 ± 6.8 versus 66.7 ± 10.1 years) with more advanced ventricular diastolic dysfunction and increased replacement and diffuse interstitial fibrosis (late gadolinium enhancement % 0.3 [0.0–1.6] versus 0.0 [0.0–0.5], p = 0.009; extracellular volume fraction % 27.9 [25.7–30.1] versus 26.7 [24.9–28.5], p = 0.025) in the imaging cohort. Plasma proteomics analysis of the biomarker cohort revealed that 9 proteins (E-selectin, interleukin-1 receptor type 1, interleukin-1 receptor type 2, galectin-4, intercellular adhesion molecule 2, integrin beta-2, galectin-3, growth differentiation factor 15, and cathepsin D) were significantly elevated and that pathways related to inflammatory response and extracellular matrix components were enriched in diabetic AS patients. During follow-up (median 6.3 years), there were 53 unexpected heart failure admissions or death in the imaging cohort. Diabetes was a significant predictor of heart failure and death, independent of clinical covariates and aortic valve replacement (HR 1.88, 95% CI 1.06−3.31, p = 0.030).

Conclusions

Plasma proteomic analyses indicate that diabetes potentiates the systemic proinflammatory−profibrotic milieu in AS patients. These systemic biological changes underlie the increase of myocardial fibrosis, diastolic dysfunction, and worse clinical outcomes in severe AS patients with concomitant diabetes.
The various role of microRNAs in breast cancer angiogenesis, with a special focus on novel miRNA-based delivery strategies
Authors: Yang Min , Zhang Ying , Li Min , Liu Xinglong , Darvishi Mohammad
Published: February 2023

After skin malignancy, breast cancer is the most widely recognized cancer detected in women in the United States. Breast cancer (BCa) can happen in all kinds of people, but it's much more common in women. One in four cases of cancer and one in six deaths due to cancer are related to breast cancer. Angiogenesis is an essential factor in the growth of tumors and metastases in various malignancies. An expanded level of angiogenesis is related to diminished endurance in BCa patients. This function assumes a fundamental part inside the human body, from the beginning phases of life to dangerous malignancy. Various factors, referred to as angiogenic factors, work to make a new capillary. Expanding proof demonstrates that angiogenesis is managed by microRNAs (miRNAs), which are small non-coding RNA with 19–25 nucleotides. MiRNA is a post-transcriptional regulator of gene expression that controls many critical biological processes. Endothelial miRNAs, referred to as angiomiRs, are probably concerned with tumor improvement and angiogenesis via regulation of pro-and anti-angiogenic factors. In this article, we reviewed therapeutic functions of miRNAs in BCa angiogenesis, several novel delivery carriers for miRNA-based therapeutics, as well as CRISPR/Cas9 as a targeted therapy in breast cancer.
Anti-obesity effect of the bacterial product nisin in an NIH Swiss mouse model
Authors: Al-Emarah M. K. , Kazerani H. R. , Taghizad F. , Dehghani H. , Elahi M.
Published: February 2023

Obesity is a life-threatening metabolic disorder that predisposes individuals to other diseases. In this study, the effect of nisin, a bacteriocin produced by some bacteria, on an animal model of obesity based on selected parameters was investigated. Forty Swiss NIH mice were randomly divided into four groups and received either a placebo (saline) or nisin (25, 50, or 100 μg/kg, ip) daily for 8 weeks. The mice in all groups were fed a high-sugar diet throughout the experiment. Bodyweight and food intake were measured weekly, and at the end of the experiment, the levels of FBS, serum triglyceride, cholesterol, high-density lipoprotein, low-density lipoprotein, and hepatic enzymes were tested, and red and white blood cell counts, hemoglobin concentration, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration were determined. Finally, the expression levels of some obesity-related genes, including stearoyl-CoA desaturase-1 (SCD-1), glucose transporter-4 (GLUT4), zinc finger protein 423 (zfp423), 422 (ap2), and tumor necrosis factor-alpha (TNF-α), were assessed using reverse transcriptase-quantitative polymerase chain reaction (RT–qPCR). After the experiment, the body weights, abdominal fat, and body mass index were significantly lower in the nisin-treated groups than in the control group. The highest effect was observed with 50 μg/kg nisin. The expression of SCD-1, GLUT4, 422(ap2), and TNF-α decreased significantly following treatment with nisin. No significant differences were observed in the other studied parameters, and no toxic effects were observed for nisin under these experimental conditions. The results suggested that nisin could have antiobesity effects.