bluuebunny/crossref_metadata_2025 huggingface dataset:
The function of timbre in the perception of affective intentions: Effect of enculturation in different musical traditions
Authors: Heng Lena , McAdams Stephen
Published: March 2024

Timbre has been identified as a potential component in the communication of affect in music. Although its function as a carrier of perceptually useful information about sound source mechanics has been established, less is understood about whether and how it functions as a carrier of information for communicating affect in music. To investigate these issues, listeners trained in Chinese and Western musical traditions were presented with Phrases, Measures, and Notes of recorded excerpts interpreted with a variety of affective intentions by performers on instruments from the two cultures. Results showed greater accuracy and more extreme responses in Chinese musician listeners and lowest accuracy in nonmusicians suggesting that musical training plays a role in listeners’ decoding of affective intention. Responses were more differentiated and more accurate with more musical information. Excerpts were also analyzed to determine acoustic features that are correlated with timbre characteristics. Temporal, spectral, and spectrotemporal attributes were consistently used in judging affective intent in music, suggesting purposeful use of these properties by listeners. Comparison between listeners’ use of acoustic features reveals a greater number of shared features between Western musicians and nonmusicians compared to Chinese musicians for valence, although the three groups shared more features for arousal. How timbre is utilized in musical communication appears to be different across musical traditions, and valence responses seem to be more culture-specific and arousal responses more similar across cultures.
The 5 + 1 Practice Research Model in Health Social Work: The “Eye of the Storm”
Authors: Joubert Lynette , Hampson Ralph , Hocking Alison , Braddy Lisa , Ludbrook Catherine , Creaven Fiona , Connolly Sarah , Aibinu Ibukun , Wanke Kim ,   Denotes lead authors
Published: March 2024

Purpose: The 5 +  1 Collaboration is an initiative where five teaching hospitals and a leading Melbourne university collaborate to promote and strengthen research, clinical practice in health social work, teaching, and collaboration. This collaboration fosters greater connection between academics, practitioners, and social work students. The 5 +  1 Collaboration provides a unique platform for the advancement of effective practice, practice-driven research, and student field education placements. Method: In a prospective study (2020 through 2021), employing the 5 + 1 model, at the time of the COVID-19 pandemic, over 100 frontline hospital social workers from five Melbourne hospitals participated in this study to determine, in detail, how the pandemic had affected their work. Results: This provided at a granular level, significant insights relating to the impact of the pandemic on the provision of social work services in the acute hospital setting. Additionally, during the study period, academic social work student placements were made at the five participating hospitals, with the students actively participating as part of the research team and providing feedback about their own experiences. Discussion: The study documented the challenges to hospital social work practice because of the pandemic, how hospital social workers rose to the challenges, and, importantly, adapted their practice and acquired new skills. This information may inform future hospital social work practice. The study also demonstrated that effective on-line student placements were possible, even in the setting of a pandemic.
Manifestation of academic rackets in management research through early career sessions at academic conferences
Authors: Bal P Matthijs , van Rossenberg Yvonne , Orhan Mehmet A
Published: March 2024

This article investigated elite maintenance in the field of management and how early career researchers are taught to behave to become part of the elite. We develop insights into how the elite reproduces itself through socializing subsequent generations of scholars into the norms and hegemonic practices of the elite. Through analysis of sessions for early career researchers at a major academic management conference held online in 2021, we investigated how the elite functions as a racket, instructing the next generations of scholars how to enhance their chances of entering this racket. Relying on role modeling and specific behavioral advice, the elite reproduces itself by laying out the basic rules for the next generations on how to behave as the elite. This includes overemphasizing how early career researchers can join the academic elite while neglecting the discussion of how we could improve the academic system itself. We discuss the implications of racket-like manifestation of academic disciplines, including the control of a rather small group of elite scholars over an entire field of scientific investigation through which alternative voices are suppressed.
Navigating monolingual language ideologies: Educators’ “Yes, BUT” objections to linguistically sustaining pedagogies in the classroom
Authors: Anderson Kate T. , Chang-Bacon Chris , Guzmán Antelo Maria
Published: March 2024

Aims:

We examine how educators articulate tensions between linguistic pluralism and linguistic normativity in written Linguistic Autobiographies through their metacommentary about student language and their role as educators. We specifically focus on “Yes, BUT” objections articulated by 17 participants that frame monolingualism and adherence to idealized forms of English as necessary, despite rhetorical nods to embracing linguistic diversity.

Research questions:

(1) How do participating educators construct “Yes, BUT” objections to linguistic pluralism in their written Linguistic Autobiographies? (2) What language ideologies inform these objections? (3) What ideological positions for educators are implicated?

Design/methodology/approach:

Collaborative emergent qualitative coding and inductive discourse analysis.

Data and analysis:

We analyzed Linguistic Autobiographies written by 50 educators taking an online master’s class in Sociolinguistics for Bilingual Educators and examined features of “Yes, BUT” objections and their ideological justification using collaborative, emergent coding and inductive discourse analysis.

Findings/conclusions:

We document how educators’ “Yes, BUT” objections illuminate discursive moves that justify the seeming embrace, yet ultimate rejection of, linguistic diversity.

Originality:

This study disentangles monolingual language ideologies to address objections inherent to educators’ “Yes, BUT” constructions that arise as common barriers in teacher education. We reframe these objections as emergent degrees of linguistic pluralism, which serve as evidence of the contextual difficulties educators often encounter in schools. We thus acknowledge rather than dismiss the tensions educators face in fostering linguistic pluralism.

Significance/implications:

This study illuminates how language ideologies shape (and possibly offer insights for undoing) complacency in what is often discussed as a long-standing tension between the seemingly mutually exclusive positions of linguistic pluralism and linguistic normativity. We argue that analyzing and addressing these “Yes, BUT” objections in educators’ narratives is key to the disruption of monolingual language ideologies in educational settings and beyond.
Point of View on Outcome Prediction Models in Post-Stroke Motor Recovery
Authors: van der Groen Onno , Ghosh Manonita , Norman Richard , Kuceyeski Amy , Tozlu Ceren , Kimberley Teresa J. , Lin David J. , Buxbaum Laurel J. , Kwakkel Gert , Cramer Steven C. , Edwards Dylan J.
Published: March 2024

Stroke is a leading cause of disability worldwide which can cause significant and persistent upper limb (UL) impairment. It is difficult to predict UL motor recovery after stroke and to forecast the expected outcomes of rehabilitation interventions during the acute and subacute phases when using clinical data alone. Accurate prediction of response to treatment could allow for more timely and targeted interventions, thereby improving recovery, resource allocation, and reducing the economic impact of post-stroke disability. Initial motor impairment is currently the strongest predictor of post-stroke motor recovery. Despite significant progress, current prediction models could be refined with additional predictors, and an emphasis on the time dependency of patient-specific predictions of UL recovery profiles. In the current paper a panel of experts provide their opinion on additional predictors and aspects of the literature that can help advance stroke outcome prediction models. Potential strategies include close attention to post-stroke data collection timeframes and adoption of individual-computerized modeling methods connected to a patient’s health record. These models should account for the non-linear and the variable recovery pattern of spontaneous neurological recovery. Additionally, input data should be extended to include cognitive, genomic, sensory, neural injury, and function measures as additional predictors of recovery. The accuracy of prediction models may be further improved by including standardized measures of outcome. Finally, we consider the potential impact of refined prediction models on healthcare costs.
Enriched Environments in Stroke Units: Defining Characteristics and Limitations
Authors: Anåker Anna , Kevdzija Maja , Elf Marie
Published: March 2024

Background:

Individuals with stroke rehabilitated in an enriched environment (EE) compared to a non-EE are more likely to participate in cognitive and social activities, promoting their rehabilitation and well-being. There is a need for a more comprehensive understanding of methods to implement EEs within complex health systems, particularly in stroke units.

Objective:

The aim of this systematic review was to compile the concept of an EE in stroke units.

Methods:

The literature was sourced from CINAHL, Embase, and Medline databases. A detailed screening and sifting process was used to identify relevant literature. Multiple reviewers independently appraised the identified literature using a Mixed-methods Appraisal Tool. After screening 336 studies, 11 were included.

Results:

This review reveals an EE is challenging to define and almost exclusively about activities based on access to individual and communal equipment. Generally, there are no common descriptions or conceptual agreements.

Conclusions:

To the best of our knowledge, this is the first study to systematically review the concept of an EE in stroke units and shows that more studies on EEs are needed. The weak definitions and unclear theoretical backgrounds of an EE in the included studies could challenge operationalization. Future research should be based on more precise definitions of an EE and broader interventions that include changes to built and natural environments.
The TLK-ASF1 histone chaperone pathway plays a critical role in IL-1β–mediated AML progression
Authors: Lin Hsin-Yun , Mohammadhosseini Mona , McClatchy John , Villamor-Payà Marina , Jeng Sophia , Bottomly Daniel , Tsai Chia-Feng , Posso Camilo , Jacobson Jeremy , Adey Andrew , Gosline Sara , Liu Tao , McWeeney Shannon , Stracker Travis H. , Agarwal Anupriya
Published: March 2024

Identifying and targeting microenvironment-driven pathways that are active across acute myeloid leukemia (AML) genetic subtypes should allow the development of more broadly effective therapies. The proinflammatory cytokine interleukin-1β (IL-1β) is abundant in the AML microenvironment and promotes leukemic growth. Through RNA-sequencing analysis, we identify that IL-1β–upregulated ASF1B (antisilencing function-1B), a histone chaperone, in AML progenitors compared with healthy progenitors. ASF1B, along with its paralogous protein ASF1A, recruits H3-H4 histones onto the replication fork during S-phase, a process regulated by Tousled-like kinase 1 and 2 (TLKs). Although ASF1s and TLKs are known to be overexpressed in multiple solid tumors and associated with poor prognosis, their functional roles in hematopoiesis and inflammation-driven leukemia remain unexplored. In this study, we identify that ASF1s and TLKs are overexpressed in multiple genetic subtypes of AML. We demonstrate that depletion of ASF1s significantly reduces leukemic cell growth in both in vitro and in vivo models using human cells. Using a murine model, we show that overexpression of ASF1B accelerates leukemia progression. Moreover, Asf1b or Tlk2 deletion delayed leukemia progression, whereas these proteins are dispensable for normal hematopoiesis. Through proteomics and phosphoproteomics analyses, we uncover that the TLK-ASF1 pathway promotes leukemogenesis by affecting the cell cycle and DNA damage pathways. Collectively, our findings identify the TLK1-ASF1 pathway as a novel mediator of inflammatory signaling and a promising therapeutic target for AML treatment across diverse genetic subtypes. Selective inhibition of this pathway offers potential opportunities to intervene effectively, address intratumoral heterogeneity, and ultimately improve clinical outcomes in AML.
Frontline management of mantle cell lymphoma
Authors: Ryan Christine E. , Armand Philippe , LaCasce Ann S.
Published: March 2024

Despite many recent therapeutic advances, mantle cell lymphoma (MCL) remains a largely incurable disease. Treatments for patients with relapsed/refractory (R/R) disease are limited in number and in response durability. Therefore, improving the efficacy of frontline (1L) treatment, and specifically maximizing the duration of first remission, remains of critical importance to obtain favorable long-term outcomes. As 1L treatments become more effective, improving tolerability is also becoming an increasingly realistic goal. Targeted agents, which are now mainstays of treatment in R/R MCL, are establishing new, paradigm-changing roles in frontline treatment. Here, we review data supporting current standard-of-care approaches and explore 6 main areas of possible focus for advancement of 1L management: optimizing the chemoimmunotherapy (CIT) backbone, adding targeted agents to CIT, redefining the role of autologous stem cell transplantation, improving maintenance therapy, using targeted agent combinations with omission of CIT, and using measurable residual disease–guided therapy. We highlight several ongoing phase 3 trials that may soon impact frontline MCL management, and outline some areas of necessary investigation as the field continues to strive toward a cure for this disease.
Thrombosis risk in single- and double-heterozygous carriers of factor V Leiden and prothrombin G20210A in FinnGen and the UK Biobank
Authors: Ryu Justine , Rämö Joel T. , Jurgens Sean J. , Niiranen Teemu , Sanna-Cherchi Simone , Bauer Kenneth A. , Haj Amelia , Choi Seung Hoan , Palotie Aarno , Daly Mark , Ellinor Patrick T. , Bendapudi Pavan K.
Published: March 2024

The factor V Leiden (FVL; rs6025) and prothrombin G20210A (PTGM; rs1799963) polymorphisms are 2 of the most well-studied genetic risk factors for venous thromboembolism (VTE). However, double heterozygosity (DH) for FVL and PTGM remains poorly understood, with previous studies showing marked disagreement regarding thrombosis risk conferred by the DH genotype. Using multidimensional data from the UK Biobank (UKB) and FinnGen biorepositories, we evaluated the clinical impact of DH carrier status across 937 939 individuals. We found that 662 participants (0.07%) were DH carriers. After adjustment for age, sex, and ancestry, DH individuals experienced a markedly elevated risk of VTE compared with wild-type individuals (odds ratio [OR] = 5.24; 95% confidence interval [CI], 4.01-6.84; P = 4.8 × 10−34), which approximated the risk conferred by FVL homozygosity. A secondary analysis restricted to UKB participants (N = 445 144) found that effect size estimates for the DH genotype remained largely unchanged (OR = 4.53; 95% CI, 3.42-5.90; P < 1 × 10−16) after adjustment for commonly cited VTE risk factors, such as body mass index, blood type, and markers of inflammation. In contrast, the DH genotype was not associated with a significantly higher risk of any arterial thrombosis phenotype, including stroke, myocardial infarction, and peripheral artery disease. In summary, we leveraged population-scale genomic data sets to conduct, to our knowledge, the largest study to date on the DH genotype and were able to establish far more precise effect size estimates than previously possible. Our findings indicate that the DH genotype may occur as frequently as FVL homozygosity and may confer a similarly increased risk of VTE.
Differential network connectivity analysis for microbiome data adjusted for clinical covariates using jackknife pseudo-values
Authors: Ahn Seungjun , Datta Somnath
Published: March 2024

Background

A recent breakthrough in differential network (DN) analysis of microbiome data has been realized with the advent of next-generation sequencing technologies. The DN analysis disentangles the microbial co-abundance among taxa by comparing the network properties between two or more graphs under different biological conditions. However, the existing methods to the DN analysis for microbiome data do not adjust for other clinical differences between subjects.

Results

We propose a Statistical Approach via Pseudo-value Information and Estimation for Differential Network Analysis (SOHPIE-DNA) that incorporates additional covariates such as continuous age and categorical BMI. SOHPIE-DNA is a regression technique adopting jackknife pseudo-values that can be implemented readily for the analysis. We demonstrate through simulations that SOHPIE-DNA consistently reaches higher recall and F1-score, while maintaining similar precision and accuracy to existing methods (NetCoMi and MDiNE). Lastly, we apply SOHPIE-DNA on two real datasets from the American Gut Project and the Diet Exchange Study to showcase the utility. The analysis of the Diet Exchange Study is to showcase that SOHPIE-DNA can also be used to incorporate the temporal change of connectivity of taxa with the inclusion of additional covariates. As a result, our method has found taxa that are related to the prevention of intestinal inflammation and severity of fatigue in advanced metastatic cancer patients.

Conclusion

SOHPIE-DNA is the first attempt of introducing the regression framework for the DN analysis in microbiome data. This enables the prediction of characteristics of a connectivity of a network with the presence of additional covariate information in the regression. The package with a vignette of our methodology is available through the CRAN repository (https://CRAN.R-project.org/package=SOHPIE), named SOHPIE (pronounced asSofie). The source code and user manual can be found athttps://github.com/sjahnn/SOHPIE-DNA.
Functional analysis and comparative genomics of Rahnella perminowiae S11P1 and Variovorax sp. S12S4, two plant growth-promoting rhizobacteria isolated from Crocus sativus L. (saffron) rhizosphere
Authors: ZOUAGUI Rahma , ZOUAGUI Houda , AURAG Jamal , IBRAHIMI Azeddine , SBABOU Laila
Published: March 2024

Background

Rahnella perminowiae S11P1 and Variovorax sp. S12S4 are two plant growth-promoting rhizobacteria that were previously isolated from the rhizosphere of Crocus sativus L. (saffron), and have demonstrated interesting PGP activities and promising results when used as inoculants in field trials. To further elucidate the molecular mechanisms underlying their beneficial effects on plant growth, comprehensive genome mining of S11P1 and S12S4 and comparative genomic analysis with closely related strains were conducted.

Results

Functional annotation of the two strains predicted a large number of genes involved in auxin and siderophore production, nitrogen fixation, sulfur metabolism, organic acid biosynthesis, pyrroloquinoline quinone production, 1-aminocyclopropane-1-carboxylate (ACC) deaminase activity, volatile organic compounds production, and polyamine biosynthesis. In addition, numerous genes implicated in plant-bacteria interactions, such as those involved in chemotaxis and quorum sensing, were predicted. Moreover, the two strains carried genes involved in bacterial fitness under abiotic stress conditions. Comparative genomic analysis revealed an open pan-genomic structure for the two strains. COG annotation showed that higher fractions of core and accessory genes were involved in the metabolism and transport of carbohydrates and amino acids, suggesting the metabolic versatility of the two strains as effective rhizosphere colonizers. Furthermore, this study reports the first comparison of Multilocus sequence analysis (MLSA) and core-based phylogenies of the Rahnella and Variovorax genera.

Conclusions

The present study unveils the molecular mechanisms underlying plant growth promotion and biocontrol activity of S11P1 and S12S4, and provides a basis for their further biotechnological application in agriculture.
Landscape genomics reveals regions associated with adaptive phenotypic and genetic variation in Ethiopian indigenous chickens
Authors: Kebede Fasil Getachew , Derks Martijn F.L. , Dessie Tadelle , Hanotte Olivier , Barros Carolina Pita , Crooijmans Richard P.M.A. , Komen Hans , Bastiaansen John W.M.
Published: March 2024

Climate change is a threat to sustainable livestock production and livelihoods in the tropics. It has adverse impacts on feed and water availability, disease prevalence, production, environmental temperature, and biodiversity. Unravelling the drivers of local adaptation and understanding the underlying genetic variation in random mating indigenous livestock populations informs the design of genetic improvement programmes that aim to increase productivity and resilience. In the present study, we combined environmental, genomic, and phenotypic information of Ethiopian indigenous chickens to investigate their environmental adaptability. Through a hybrid sampling strategy, we captured wide biological and ecological variabilities across the country. Our environmental dataset comprised mean values of 34 climatic, vegetation and soil variables collected over a thirty-year period for 260 geolocations. Our biological dataset included whole genome sequences and quantitative measurements (on eight traits) from 513 individuals, representing 26 chicken populations spread along 4 elevational gradients (6–7 populations per gradient). We performed signatures of selection analyses ($$ {F}_{ST}$$ and XP-EHH) to detect footprints of natural selection, and redundancy analyses (RDA) to determine genotype-environment and genotype-phenotype-associations. RDA identified 1909 outlier SNPs linked with six environmental predictors, which have the highest contributions as ecological drivers of adaptive phenotypic variation. The same method detected 2430 outlier SNPs that are associated with five traits. A large overlap has been observed between signatures of selection identified by$$ { F}_{ST }$$and XP-EHH showing that both methods target similar selective sweep regions. Average genetic differences measured by $$ {F}_{ST}$$ are low between gradients, but XP-EHH signals are the strongest between agroecologies. Genes in the calcium signalling pathway, those associated with the hypoxia-inducible factor (HIF) transcription factors, and sports performance (GALNTL6) are under selection in high-altitude populations. Our study underscores the relevance of landscape genomics as a powerful interdisciplinary approach to dissect adaptive phenotypic and genetic variation in random mating indigenous livestock populations.
Availability and threshold of the vasoactive-inotropic score for predicting early extubation in adults after rheumatic heart valve surgery: a single-center retrospective cohort study
Authors: Zhao Yang , Zhao Hanlei , Huang Jiao , Mei Bo , Xiang Jun , Wang Yizheng , Lin Jingyan , Huang San
Published: March 2024

Background

Early extubation (EEx) is defined as the removal of the endotracheal tube within 8 h postoperatively. The present study involved determining the availability and threshold of the vasoactive-inotropic score (VIS) for predicting EEx in adults after elective rheumatic heart valve surgery.

Methods

The present study was designed as a single-center retrospective cohort study which was conducted with adults who underwent elective rheumatic heart valve surgery with CPB. The highest VIS in the immediate postoperative period was used in the present study. The primary outcome, the availability of VIS for EEx prediction and the optimal threshold value were determined using ROC curve analysis. The gray zone analysis of the VIS was performed by setting the false negative or positive rate R = 0.05, and the perioperative risk factors for prolonged EEx were identified by multivariate logistic analysis. The postoperative complications and outcomes were compared between different VIS groups.

Results

Among the 409 patients initially screened, 379 patients were ultimately included in the study. The incidence of EEx was determined to be 112/379 (29.6%). The VIS had a good predictive value for EEx (AUC = 0.864, 95% CI: [0.828, 0.900], P < 0.001). The optimal VIS threshold for EEx prediction was 16.5, with a sensitivity of 71.54% (65.85–76.61%) and a specificity of 88.39% (81.15–93.09%). The upper and lower limits of the gray zone for the VIS were determined as (12, 17.2). The multivariate logistic analysis identified age (OR, 1.060; 95% CI: 1.017–1.106; P = 0.006), EF% (OR, 0.798; 95% CI: 0.742–0.859; P < 0.001), GFR (OR, 0.933; 95% CI: 0.906–0.961; P < 0.001), multiple valves surgery (OR, 4.587; 95% CI: 1.398–15.056; P = 0.012), and VIS > 16.5 (OR, 12.331; 95% CI: 5.015–30.318; P < 0.001) as the independent risk factors for the prolongation of EEx. The VIS ≤ 16.5 group presented a greater success rate for EEx, a shorter invasive ventilation support duration, and a lower incidence of complications than did the VIS > 16.5 group, while the incidence of reintubation was similar between the two groups.

Conclusion

In adults, after elective rheumatic heart valve surgery, the highest VIS in the immediate postoperative period was a good predictive value for EEx, with a threshold of 16.5.
Time to recovery and its predictors following traumatic injuries among injured victims in Dessie Comprehensive Specialized Hospital, North East of Ethiopia, 2022: a retrospective follow-up study
Authors: Tilahun Lehulu , Zeleke Mulusew , Desu Birhanu , Dagnew Kirubel , Nega Aytenew , Birrie Endalk , Estifanos Nathan , Tegegne Akele , Feleke Asresu
Published: March 2024

Background

Injuries are an extremely important public health problem worldwide. Despite being largely preventable and despite government efforts, injuries continue to be a major public health issue. Thus, the study tends to evaluate the time to recovery and its predictors for traumatic injuries.

Methods

A hospital-based retrospective follow-up study was used. A total of 329 medical charts were actually reviewed. Traumatic injury victims from January 1, 2018–December 31, 2022 were included, and a simple random sampling technique was utilized. The data was gathered by reviewing medical charts. Data was coded and entered into Epi-Data Manager version 4.6.0.4 statistical software and further analyzed using STATA version 17. Descriptive statistics were performed to see the frequency distribution of variables. A Kaplan-Meier survival estimate and log rank test were performed to plot the overall survival curve and compare the difference in recovery among predictor categories, respectively. A model fitness test was done by using the Cox-Snell residual test and Harrell’s C concordance statistic. Finally, a Cox proportional hazard model was fitted to determine the effect of predictors on recovery time from traumatic injuries.

Results

The median time to recovery of traumatic injuries was 5 days (IQR: 3–10 days), with an overall incidence density of 8.77 per 100 person-days of observation. In the multivariable cox proportional regression model, variables such as being male (AHR: 0.384, 95%CI: 0.190–0.776, P-value: 0.008), the Glasgow coma scale of 13–15 (AHR: 2.563, 95%CI: 1.070–6.139, P-value: 0.035), intentional injury (AHR: 1.934, 95%CI: 1.03–3.632, P-value: 0.040), mild traumatic brain injury (AHR: 2.708, 95%CI: 1.095–6.698, P-value: 0.031), and moderate traumatic brain injury (AHR: 2.253, 95%CI: (1.033–4.911, P-value: 0.041) were statistically significant variables.

Conclusions

The median recovery time for traumatically injured respondents was 5 days. Independent predictors such as the Glasgow coma scale, time taken for surgical management, intent of injury, and traumatic brain injury were statistically significant with time to recovery from trauma.
European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism
Authors: Patrice Carter , Ahmet Fuat , Sylvia Haas , Elizabeth Smyth , Carlos Brotons , Frank Cools , Rupert Bauersachs , Richard Hobbs F. D.
Published: March 2024

Background

Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios.

Methods

A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2.

Results

In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer.

Conclusion

Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.
The stuck haemodialysis catheter—a case report of a rare but dreaded complication following kidney transplantation
Authors: Burnett Cameron , Chandler S. , Jegatheesan D. , Pearch B. , Viecelli A. , Mudge D. W.
Published: March 2024

Background

Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming ‘stuck’ via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period.

Case Presentation

A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications.

Conclusions

This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.
Pull-through technique through antegrade radial artery puncture without sheath insertion in balloon-assisted radiocephalic arteriovenous fistulas maturation
Authors: Yin Jun , Zhang Fengping , Fu Ping
Published: March 2024

Purpose

The aim of this study was to investigate the effectiveness and safety of the pull-through technique through antegrade radial artery puncture without sheath insertion in balloon-assisted radiocephalic AVF maturation.

Methods

We retrospective studied a total of 62 patients with immature radiocephalic AVF, who received balloon-assisted maturation in our hospital. 15 patients received pull-through technique through radial artery without sheath insertion and 47 patients received treatment through a regular venous approach.

Results

The success rate of pull-through technique group and control group was 86.7% (13 out of 15), 89.1% (41 out of 46) respectively. There was no significant difference between two groups (P > 0.05). In our study, there were 2 patients in the pull-through technique group and 3 patients in the control group, which had hematoma in the vein puncture site (P = 0.59). There were also no differences in the primary patency rate between two groups at 6 months and 12 months (76.9% vs 70.7%, 38.4% vs 41.5%, respectively, P > 0.05).

Conclusion

The pull-through technique through antegrade radial artery without sheath insertion in promoting radiocephalic AVF maturation is effective and safe.
Brain frailty associated with stroke events in anterior circulation large artery occlusion
Authors: Tian Jing , Zhang Kun , Cui Junzhao , Qin Jin , Wang Binbin , Zhou Lixia , Li Tong , Bu Kailin , Li Zhongzhong , Liu Lin , Wang Qisong , Yuan Si , Ma Lina , Wang Ye , Wang Rui , Meng Chaoyue , Zhou Biyi , Guo Li , Liu Xiaoyun
Published: March 2024

Objective

To investigate the factors associated with brain frailty and the effect of brain frailty in patients with anterior circulation large artery occlusion (AC-LAO).

Methods

1100 patients with AC-LVO consecutively admitted to the Second Hospital of Hebei Medical University, North China between June 2016 and April 2018 were retrospectively analyzed. The variables associated with brain frailty and stroke outcome were analyzed by ANOVA analysis, the Mann-Whitney U test and multiple linear regression. Based on previous research. Brain frailty score comprises 1 point each for white matter hyperintensity (WMH), old infarction lesions, and cerebral atrophy among 983 participants with baseline brain magnetic resonance imaging or computed tomography.

Results

Among AC-LAO participants, baseline brain frailty score ≥ 1 was common (750/983, 76.3%). Duration of hypertension > 5 years (mean difference [MD] 0.236, 95% CI 0.077, 0.395, p = 0.004), multiple vessel occlusion (MD 0.339, 95% CI 0.068, 0.611, p = 0.014) and basal ganglia infarction (MD -0.308, 95% CI -0.456, -0.160, p < 0.001) were independently associated with brain frailty score. Brain frailty score was independently associated with stroke events, and higher brain frailty scores were associated with higher rates of stroke events (p < 0.001). However, brain frailty has no independent effect on short-term outcome of ACI in AC-LAO patients.

Conclusions

In AC-LAO patients, older age, duration of hypertension > 5 years, and multiple vessel occlusion influenced the brain frailty score. Brain frailty score was independently associated with the occurrence of stroke events in AC-LAO patients.
Experts’ perspectives on the impact of visual impairment and comorbid mental disorders on functioning in essential life domains
Authors: Onnink Marjolein LA , Teunissen Lisanne BA , Verstraten Peter FJ , van Nispen Ruth MA , van der Aa Hilde PA
Published: March 2024

Background

Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people’s daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future.

Methods

A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder.

Results

Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people’s physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences.

Conclusion

VI and comorbid MD have a major impact on people’s daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients’ perspectives.
Characteristics associated with SF-36 in alpha-1 antitrypsin deficiency-associated COPD: a cross-sectional analysis
Authors: Choate Radmila , Holm Kristen E. , Sandhaus Robert A. , Mannino David M. , Strange Charlie
Published: March 2024

Background

Generic measures of health-related quality of life (HRQoL), such as the 36-Item Short Form Survey (SF-36), are widely used in assessing chronic conditions. These tools have an advantage over disease-specific instruments, as they allow comparisons across different health conditions and with the general population. In alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD), HRQoL research remains scarce. This cross-sectional study evaluates the factors associated with HRQoL in a cohort of patients with AATD-associated COPD.

Methods

Our study included participants of AlphaNet (2008-2019), a health management organization for people with AATD in the US who are prescribed augmentation therapy. Norm-based SF-36 scores for the mental and physical component summary scores (MCS and PCS, mean of 50 ± 10 in the general US population) and 8 individual scales were evaluated. Individuals with lung disease and data available on ≥1 measurement on any SF-36 scale and clinically relevant characteristics such as modified Medical Research Council (mMRC) scale, exacerbation frequency, productive cough, and use of oxygen were included in these analyses. Generalized linear regression models were fit to examine the association of baseline characteristics with MCS and PCS scores. Age, sex, regular use of oxygen, exacerbation frequency, mMRC, and productive cough were included in these models.

Results

Participants (n=4398, mean age 57.6 [SD=10.6] years, 45.4% female) had a mean MCS score of 51.2 ± 10.8 and PCS of 36.3 ± 9.8. The average mMRC score was 2.4 ± 1.3, and 56.4% had 2 or more exacerbations per year. Overall, the physical component of SF-36 was more severely impacted compared to the mental component. In multivariable regression analyses, PCS scores were significantly associated with exacerbation frequency, mMRC, regular use of oxygen, and productive cough; MCS was associated with age, sex, exacerbation frequency, mMRC, and productive cough.

Conclusions

These findings demonstrate that patient-perceived physical health is significantly impaired in this cohort of people with AATD-associated COPD compared to mental health. Longitudinal studies are needed to evaluate the change in physical and mental health status over time in this population.
Change in number of pain sites - which factors are important? A 12-year prospective cohort study
Authors: Vilsbøl Susanne , Christiansen David Høyrup , Budtz Cecilie Rud , Andersen Johan Hviid , Mose Søren
Published: March 2024

Background

Pain in multiple body sites is common and often persistent. The purpose of this prospective study was to examine the change in the number of pain sites (NPS) over time and to evaluate to which extent clinical, demographic, lifestyle and health-related factors predict a change in NPS.

Methods

This was a population-based longitudinal cohort study of adults (n = 2,357). Data on pain, demographic, lifestyle, and health-related variables were collected by questionnaires in 2008 and 2020 and register data from 2006 to 2017. Data was analysed with linear regression.

Results

We found a mean decrease in NPS over the 12-year follow-up period (-0.36 (95% CI; -0.44; -0.27) and 56% of this sample reported no change or only one pain site increase/decrease over 12 years. While participants reporting pain for less than 3 months at baseline had almost no change in NPS (-0.04 (95% CI; -0.18; 0.10)), participants with pain for longer than 3 months decreased by -0.51 (95% CI; -0.62; -0.41). Age at baseline (20–49 years), pain intensity, and obesity (BMI ≥ 30) were associated with an increase in NPS over the follow-up period.

Conclusions

NPS is relatively stable over time. We found a small mean decrease in NPS over 12 years varying between participants with pain for longer than 3 months and pain for less than 3 months respectively. The results also indicate that pain intensity, age, and obesity could be relevant factors to consider when predicting change in NPS.
Development and validation of a cadaveric porcine pseudotumor model for oral cancer biopsy and resection training
Authors: Melchior Claire , Isfort Peter , Braunschweig Till , Witjes Max , Van den Bosch Vincent , Rashad Ashkan , Egger Jan , de la Fuente Matías , Röhrig Rainer , Hölzle Frank , Puladi Behrus
Published: March 2024

Objective

The gold standard of oral cancer (OC) treatment is diagnostic confirmation by biopsy followed by surgical treatment. However, studies have shown that dentists have difficulty performing biopsies, dental students lack knowledge about OC, and surgeons do not always maintain a safe margin during tumor resection. To address this, biopsies and resections could be trained under realistic conditions outside the patient. The aim of this study was to develop and to validate a porcine pseudotumor model of the tongue.

Methods

An interdisciplinary team reflecting various specialties involved in the oncological treatment of head and neck oncology developed a porcine pseudotumor model of the tongue in which biopsies and resections can be practiced. The refined model was validated in a final trial of 10 participants who each resected four pseudotumors on a tongue, resulting in a total of 40 resected pseudotumors. The participants (7 residents and 3 specialists) had an experience in OC treatment ranging from 0.5 to 27 years. Resection margins (minimum and maximum) were assessed macroscopically and compared beside self-assessed margins and resection time between residents and specialists. Furthermore, the model was evaluated using Likert-type questions on haptic and radiological fidelity, its usefulness as a training model, as well as its imageability using CT and ultrasound.

Results

The model haptically resembles OC (3.0 ± 0.5; 4-point Likert scale), can be visualized with medical imaging and macroscopically evaluated immediately after resection providing feedback. Although, participants (3.2 ± 0.4) tended to agree that they had resected the pseudotumor with an ideal safety margin (10 mm), the mean minimum resection margin was insufficient at 4.2 ± 1.2 mm (mean ± SD), comparable to reported margins in literature. Simultaneously, a maximum resection margin of 18.4 ± 6.1 mm was measured, indicating partial over-resection. Although specialists were faster at resection (p < 0.001), this had no effect on margins (p = 0.114). Overall, the model was well received by the participants, and they could see it being implemented in training (3.7 ± 0.5).

Conclusion

The model, which is cost-effective, cryopreservable, and provides a risk-free training environment, is ideal for training in OC biopsy and resection and could be incorporated into dental, medical, or oncologic surgery curricula. Future studies should evaluate the long-term training effects using this model and its potential impact on improving patient outcomes.
Medical students’ perceptions of integrating social media into a narrative medicine programme for 5th-year clerkship in Taiwan: a descriptive qualitative study
Authors: Mauludina Yosika Septi , Hoang Bao Lan , Wang Tsai-Yu , Jenq Chang-Chyi , Huang Chi-Hsien , Huang Chien-Da
Published: March 2024

Background

The growing demands in integrating digital pedagogies in learning (e.g., social media) contribute to disrupting many fields, including the medical humanities education. However, the strengths and barriers behind social media and medical humanities context are blurred and contradictive. We examined the perceptions of integrating social media – Facebook – into a narrative medicine (NM) programme for 5th -year clerkship in Taiwan.

Methods

We used purposive sampling to recruit participants. Sixteen medical students (Female/Male: 7/9) participated in four group interviews. Semi-structured focus group interviews were conducted to explore students’ perceptions and experiences of the social media integrated into the NM programme. We analysed the data using a descriptive thematic analysis with a team-based approach. Data were managed and coded using ATLAS.ti version 9.0.

Results

We identified six main themes: (1) Positive experiences of social media integration; (2) Negative experiences of social media integration; (3) Barriers on writing and sharing NM stories in social media; (4) Barriers on reading NM stories in social media; (5) Barriers on reacting contents in social media; (6) Suggestions for future improvement.

Conclusions

The study revealed the strengths and barriers from medical students’ perceptions, when integrating social media into a NM programme. It is important to match students’ experiences, barriers, and perceptions towards learning. Understanding participants’ suggestions for future improvement are also crucial. With this knowledge, we might better develop the social media integration systems that achieve our desired outcomes based on the medical humanities education curricula.