bluuebunny/crossref_metadata_2025 huggingface dataset:
The Consensus Project: Participation in cervical cancer screening by the first cohorts of girls offered HPV vaccination at age 15–16 years in Italy
Authors: Visioli Carmen B , Giorgi Rossi Paolo , Armaroli Paola , Iossa Anna , Rizzolo Raffaella , Bonelli Luigina A , Venturino Ezio , Carozzi Francesca M , Bisanzi Simonetta , De Marco Laura , Giordano Livia , Camussi Elisa , Del Mistro Annarosa , Zappa Marco
Published: March 2023

Objective

To evaluate the association between human papillomavirus vaccination status and participation in cervical cancer screening (at age 25) by the first cohorts of girls who were offered vaccination at the age of 15 to 16 years in Italy.

Methods

Women born in 1993, 1994 and 1995 were invited to participate in cervical cancer screening between 2018 and 2020. We report participation in screening by vaccination status in three large areas, Florence province, Piedmont region and Savona province, where the Consensus Project was carried out. The relative risk of participation among vaccinated (≥2 doses) and unvaccinated women was estimated. Odds ratios (OR) of participation by vaccination status were estimated by logistic regression, adjusted by birthplace and birth cohort.

Results

Overall, 34,993 women were invited for screening: 13,006 (37.2%) participated and 10,062 of these agreed to participate in the Consensus intervention study. Among the invited women and screening participants, vaccinated women were 51.0% and 60.6%, respectively. Comparing vaccinated and unvaccinated women, the adjusted OR of screening participation was 1.80 (95% confidence interval (CI): 1.72–1.89), 2.17 (95% CI: 1.94–2.42), 1.59 (95% CI: 1.50–1.68) and 1.15 (95% CI: 0.86–1.54) for overall, Florence, Piedmont and Savona, respectively. About 33% of the invited women were unvaccinated and did not participate in screening: 25.8%, 59.5% and 64.2% of women born in Italy, in high migration pressure countries and in advanced development countries, respectively.

Conclusions

Screening participation was higher among vaccinated than unvaccinated women. Active policies are needed to reduce inequalities, targeting the unscreened and unvaccinated population, particularly non-native women, to accelerate cervical cancer elimination in Italy.
Ameliorative Effects of Ponicidin Against the Isoproterenol-induced Acute Myocardial Infarction in Rats
Authors: Zhang Xuemei , Seshadri Vidya Devanathadesikan , Jiang Qihua
Published: March 2023

Background

Cardiovascular disease (CVD) is a group of heart disorders, which is a major cause of non-communicable disease-related mortalities worldwide. Myocardial infarction (MI) is an acute disorder due to the poor supply of oxygen and blood to the myocardium. MI is the foremost form of CVD, which is the primary cause of mortality worldwide.

Objectives

Here, we intended to discover the ameliorative properties of the ponicidin against the isoproterenol (ISO)-stimulated MI in rats.

Materials and Methods

About 85 mg/kg of ISO was administered to the rats to trigger the MI and then treated with 25 and 50 mg/kg of ponicidin. The body weight and heart weight of all rats were determined. The total protein, c-reactive protein (CRP), and uric acid levels were examined. The activities of cardiac function markers such as creatine kinase (CK), ALT, AST, and gamma-glutamyl transferase (GGT) were examined. The antioxidants such as glutathione (GSH), GST, and GPx were examined by the previous methods. The status of Na+/K+, Mg2+, and Ca2+ ATPase activities was assessed using kits. The status of Na+, K+, and Ca2+ ions and inflammatory makers such as TNF-α and IL-6 were investigated using respective kits. The histopathological analysis was performed on the heart tissues to detect the histological changes.

Results

The results revealed that ponicidin increased body weight and decreased heart weight in MI rats. The status of CRP and uric acid was decreased and total protein was augmented in the ponicidin-treated MI rats. The AST, ALT, CK, and GGT activities were appreciably decreased in serum and elevated in the cardiac tissues of the ponicidin-administered MI rats. Furthermore, the ponicidin improved the antioxidant levels, decreased the TNF-α and IL-6, and regulated the Na+, K+, and Ca2+ ion transports in the MI rats. The activities of Na+/K+, Mg2+, and Ca2+ ATPase enzymes were remarkably increased in the heart tissues by the ponicidin-treated MI rats. Ponicidin treatment also ameliorated the ISO-stimulated histological alterations in the heart tissue of the MI rats.

Conclusion

Ponicidin treatment appreciably improved the antioxidants, Na+/K+, Mg2+, and Ca2+ ATPase enzyme activities, decreased the inflammatory markers, and regulated the cardiac marker enzyme activities in the MI rats. Hence, it can be a talented therapeutic candidate in the future to treat MI.
Lethality and deterrence in affairs of honor: The case of the Antebellum U.S. South
Authors: Ahn Tom , Shea Paul , Sandford Jeremy
Published: March 2023

Duels remained an important and surprisingly common means of settling disputes in the American South until after the Civil War. We examine two historical puzzles. First, why did dueling persist as a preferred tool to resolve conflicts in the South? Second, why did duelers use relatively inaccurate weapons when deadlier weapons were available? We construct a game theoretic model and conduct simulation exercises to find the following results. One, when the public views dueling as an appropriate means of mitigating the effects of libel, then it encourages socially desirable behavior such as reduced libel and more moderate behavior. Two, a sufficiently high mortality rate may deter libel without resulting in many dueling deaths. Third, if mortality rates are too high, dueling is no longer an effective institution. We compile a novel data set of newspaper accounts of duels from digitized archives to present empirical evidence that buttresses our insights from the model.
Comparison of Droperidol and Midazolam Versus Haloperidol and Lorazepam for Acute Agitation Management in the Emergency Department
Authors: Allen Patrick J. , Johanson Kendra E. , Reveles Kelly R. , Neff Luke A. , Lock Ashley E.
Published: March 2023

Background:

Acute agitation accounts for up to 2.6% of visits to the emergency department (ED). To date, a standard of care for the management of acute agitation has not been established. Few studies have evaluated antipsychotic and benzodiazepine combinations.

Objective:

The purpose of this study was to evaluate effectiveness and safety of combination therapy for acute agitation with intramuscular (IM) droperidol and midazolam (D+M) compared with IM haloperidol and lorazepam (H+L) in patients in the ED.

Methods:

This was a single-center, retrospective medical record review of patients presenting to a large, academic ED with acute agitation from July 2020 through October 2021. The primary outcome was percentage of patients requiring additional agitation medication within 60 minutes of combination administration. Secondary outcomes included average time to repeat dose administration and average number of repeat doses required before ED discharge.

Results:

A total of 306 patients were included for analysis: 102 in the D+M group and 204 in the H+L group. Repeat dose within 60 minutes occurred in 7 (6.9%) and 28 (13.8%) patients in the D+M and H+L groups, respectively ( P = 0.065). A total of 28.4% of D+M patients and 30.9% of H+L patients required any repeat dose during their ED visit. Time to repeat dose was 12 and 24 minutes in the D+M and H+L, respectively ( P = 0.22). The adverse event rate was 2.9% in each group.

Conclusion and Relevance:

IM D+M resulted in a lower rate of repeat doses of acute agitation medication compared with IM H+L, though this was not statistically significant. Both therapies were safe, and the adverse event rate was low.
Association Between Transforming Growth Factor-β1 Polymorphisms and Ischemic Stroke Susceptibility: A Meta-Analysis
Authors: Peng Xiao-Qin , Cheng Fan , Zhou Lan
Published: March 2023

Epidemiological studies have suggested a potential relationship between the transforming growth factor-β1 (TGF-β1) gene and ischemic stroke (IS) risk; however, the current results are inconsistent. Therefore, we performed this meta-analysis to assess the precise association between TGF-β1 polymorphisms and IS risk. Online databases were searched for themes related to TGF-β1 polymorphisms and ARE risk. Quantitative calculations of odds ratios (ORs) and confidence intervals (CIs) were performed using 5 genetic models of each variant locus. Heterogeneity tests, cumulative analyses, sensitivity analyses, and publication bias were conducted to examine statistical power. Moreover, changes in the secondary structure and minimum free energy (MFE) were explored using in silico analysis. Nineteen case-control studies were included in our meta-analysis on rs1800468 G>A, rs1800469 C>T, and rs1800470 T>C polymorphisms and IS risk. Overall, only a marginal association was found between the rs1800469 C>T polymorphism and IS risk (T vs C: OR = 1.12, 95%CI = 1.00-1.46, P = .05, I2 = 77.0%). Otherwise, no significant association was observed between the rs1800468 G>A and rs1800470 T>C polymorphisms and IS risk in general and stratified analyses. Moreover, no significant changes in secondary structure and MFE were found in any of the 3 polymorphic loci. Current evidence cautiously suggests that TGF-β1 polymorphisms are not associated with IS susceptibility.
Occurrence of FVIII Inhibitors in Hemophilia A Patients Following an Institutional Switch to a Third Generation B-Domain-Deleted FVIII
Authors: Hooimeijer Louise H , Stein-Wit Marjet A , Voskuilen Marja AJ , Lukens Michaël V , Meijer Karina , Mäkelburg Anja BU , Tamminga Rienk YJ
Published: March 2023

In 2018, Refacto AFR, a B-domain-deleted third-generation FVIII concentrate, became our preferential product. After the introduction, the development of inhibitors was prospectively monitored; retrospectively, we sought for risk factors in the patients who developed a de-novo inhibitor. Over a period of 15 months, 4/19 adult patients with non-severe haemophilia who were treated on demand for surgery, developed high titer antibodies to FVIII after administration of Refacto AFR; 5/52 mostly severe patients on prophylaxis, developed an inhibitor (3 ≥ 0.1 BU; 1 > 0.6 BU, 1 high titre) after they switched to Refacto AFR; all were children <14 years of age and with >100 exposure days, none related to surgery or intensive treatment; all received KovaltryR before. In conclusion: inhibitors were encountered in on demand patients and previously treated prophylaxis patients; this observation might be a coincidental finding, but also risk factors like genotype and surgery and/or that Refacto AFR is more immunogenic should be considered. For the patients on prophylaxis we hypothesize that loss of tolerance by preceding KovaltryR might have contributed to inhibitor development.
Somatic Super-Enhancer Epigenetic Signature for Overall Survival Prediction in Patients with Breast Invasive Carcinoma
Authors: Yang Xu , Zheng Wenzhong , Li Mengqiang , Zhang Shiqiang
Published: March 2023

To analyze genome-wide super-enhancers (SEs) methylation signature of breast invasive carcinoma (BRCA) and its clinical value. Differential methylation sites (DMS) between BRCA and adjacent tissues from The Cancer Genome Atlas (TCGA) database were identified by using ChAMP package in R software. Super-enhancers were identified sing ROSE software. Overlap analysis was used to assess the potential DMS in SEs region. Feature selection was performed by Cox regression and least absolute shrinkage and selection operator (LASSO) algorithm based on TCGA training cohort. Prognosis model validation was performed in TCGA training cohort, TCGA validation cohort, and gene expression omnibus (GEO) test cohort. The gene ontology and KEGG analysis revealed that SEs target genes were significantly enriched in cell-migration-associated processes and pathways. A total of 83 654 DMS were identified between BRCA and adjacent tissues. Around 2397 DMS in SEs region were identified by overlap study and used to feature selection. By using Cox regression and LASSO algorithm, 42 features were selected to develop a clinical prediction model (CPM). Both training (TCGA) and validation cohorts (TCGA and GEO) show that the CPM has ideal discrimination and calibration. The CPM based on DMS at SE regions has ideal discrimination and calibration, which combined with tumor node metastasis (TNM) stage could improve prognostication, and thus contribute to individualized medicine.
An Unforeseen Outcome of COVID-19: The Triggering of Adult-Onset Still’s Disease
Authors: Alzuhaily Hasan , Mohamad Seba , Alsalloum Lama , Al-Sayed Safaa
Published: March 2023

Background:

Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disorder with unknown etiology by which an infectious trigger is usually responsible for the onset of the disease. It is diagnosed by exclusion when certain clinical, biochemical, and radiological criteria are met after excluding all other potential causes. Besides, SARS‑CoV‑2 infection is increasingly being reported to have autoimmune complications. In the literature, 3 AOSD cases have been reported to be triggered by SARS‑CoV‑2 infection and here we report the fourth.

Case presentation:

A 24-year-old female doctor suffered from fever, sore throat, and mild cough a few days after a shift in the COVID-19 ward. A week later, she developed polyarthritis, salmon-colored rash, and high-grade fever, and the laboratory findings were indicating an inflammatory syndrome. COVID-19 IgM antibodies were positive indicating recent infection. After running a battery of tests, infectious, neoplastic, and rheumatic causes of these symptoms that persisted for about 50 days were excluded which led to a diagnosis of AOSD after fulfilling its criteria with subsequent treatment with methylprednisolone. Drastic improvement was achieved with no recurrence until the date of reporting.

Conclusion:

This case presents a new consequence of COVID-19 and adds to the emerging cumulative experiences with this disease. We encourage health care professionals to report such cases to further understand the nature of this infection and its possible outcomes.
Positive Newborn Screening for Severe Combined Immunodeficiency: What Should the Pediatrician Do?
Authors: Mongkonsritragoon Wimwipa , Huang Jenny , Fredrickson Mary , Seth Divya , Poowuttikul Pavadee
Published: March 2023

Severe combined immunodeficiency (SCID) is a group of diseases characterized by low T-cell count and impaired T-cell function, resulting in severe cellular and humoral immune defects. If not diagnosed and treated promptly, infants affected by this condition can develop severe infections which will result in death. Delayed treatment can markedly reduce the survival outcome of infants with SCID. T-cell receptor excision circle (TREC) levels are measured on newborn screening to promptly identify infants with SCID. It is important for primary care providers and pediatricians to understand the approach to managing infants with positive TREC-based newborn screening as they may be the first contact for infants with SCID. Primary care providers should be familiar with providing anticipatory guidance to the family in regard to protective isolation, measures to minimize the risk of infection, and the coordination of care with the SCID coordinating center team of specialists. In this article, we use case-based scenarios to review the principles of TREC-based newborn screening, the genetics and subtypes of SCID, and management for an infant with a positive TREC-based newborn screen.
Spatial spillover and determinants of tourism efficiency: A low carbon emission perspective
Authors: Liu Hongwei , Gao Chenchen , Tsai Henry
Published: March 2023

This paper measures tourism carbon efficiency (TCE) in China by incorporating energy consumption and carbon dioxide (CO2) emissions into an efficiency assessment framework, and to further investigate the determinants of TCE by considering the spatial spillover effects. To do this, a bootstrap slacks-based measure (SBM) model was applied to assess the TCE in 30 provincial-level administrative regions of China from 2008 to 2019. Next, the Moran’s index and spatial Durbin model (SDM) were adopted to explore the spatial distribution and determinants of TCE. The results indicate that regional differences affect the level of China’s TCE, as do spatial spillover effects. In addition, technology innovation, urbanization rate, and government support positively affect TCE. In contrast, economic growth negatively affects TCE. Educational attainment, green infrastructure, and government support have a negative spatial spillover effect on TCE. Transportation infrastructure has a negative total effect on TCE.
Know(ing) Infrastructure: The Wayback Machine as object and instrument of digital research
Authors: Ogden Jessica , Summers Edward , Walker Shawn
Published: March 2023

From documenting human rights abuses to studying online advertising, web archives are increasingly positioned as critical resources for a broad range of scholarly Internet research agendas. In this article, we reflect on the motivations and methodological challenges of investigating the world’s largest web archive, the Internet Archive’s Wayback Machine (IAWM). Using a mixed methods approach, we report on a pilot project centred around documenting the inner workings of ‘Save Page Now’ (SPN) – an Internet Archive tool that allows users to initiate the creation and storage of ‘snapshots’ of web resources. By improving our understanding of SPN and its role in shaping the IAWM, this work examines how the public tool is being used to ‘save the Web’ and highlights the challenges of operationalising a study of the dynamic sociotechnical processes supporting this knowledge infrastructure. Inspired by existing Science and Technology Studies (STS) approaches, the paper charts our development of methodological interventions to support an interdisciplinary investigation of SPN, including: ethnographic methods, ‘experimental blackbox tactics’, data tracing, modelling and documentary research. We discuss the opportunities and limitations of our methodology when interfacing with issues associated with temporality, scale and visibility, as well as critically engage with our own positionality in the research process (in terms of expertise and access). We conclude with reflections on the implications of digital STS approaches for ‘knowing infrastructure’, where the use of these infrastructures is unavoidably intertwined with our ability to study the situated and material arrangements of their creation.
Multi-State Implementation of Go NAPSACC to Support Healthy Practices in the Early Care and Education Setting
Authors: West Margaret , Dooyema Carrie , Smith Falon T. , Willis Erik A. , Clarke Emily , Shira Starr Aviva , Hall Kelly , Hales Derek P. , Ward Dianne S.
Published: March 2023

Childhood obesity in the United States is a serious problem that puts children at risk for poor health. Effective state-wide interventions are needed to address childhood obesity risk factors. Embedding evidence-based initiatives into state-level Early Care and Education (ECE) systems has the potential to improve health environments and promote healthy habits for the 12.5 million children attending ECE programs. Go NAPSACC, an online program that was adapted from an earlier paper version of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC or NAP SACC), provides an evidence-based approach that aligns with national guidance from Caring for Our Children and the Centers for Disease Control and Prevention. This study describes approaches undertaken across 22 states from May 2017 to May 2022 to implement and integrate Go NAPSACC into state-level systems. This study describes challenges encountered, strategies employed, and lessoned learned while implementing Go NAPSACC state-wide. To date, 22 states have successfully trained 1,324 Go NAPSACC consultants, enrolled 7,152 ECE programs, and aimed to impact 344,750 children in care. By implementing evidence-based programs, such as Go NAPSACC, ECE programs state-wide can make changes and monitor progress on meeting healthy best practice standards, increasing opportunities for all children to have a healthy start.
Specialty Box Program: Implementing Tailored Food Boxes to Serve the Community During the COVID-19 Pandemic
Authors: Butler Candace , Rollinson Aniessa , Glover Chasidie , Carmenia Ashley
Published: March 2023

Although food pantries play a key role in addressing food insecurity across the United States, the usual methods of getting food to people in need were severely challenged during the COVID-19 crisis. Chronic disease, lack of transportation, and food insecurity are social determinants that amplify health disparities at higher rates among racial and ethnic minorities throughout the greater Charlotte, North Carolina, area. Loaves & Fishes, a local network of food pantries, partnered with RAO Community Health to develop and support the sustainability of the Specialty Box Program which provides whole grains and foods low in sodium, sugar, and fat to people with chronic disease. As a pilot initiative developed during the COVID-19 pandemic, the Specialty Box Program used a mobile food pharmacy and home-delivery services to increase access to healthier foods. The request for specialty boxes more than doubled the program’s initial goal, showing a continued need for healthier food options beyond the pilot phase. Through Loaves & Fishes’ infrastructure, we leveraged our current partnerships, funding resources, and response plans. The result was a sustainable program that can be replicated in other areas where nutrition security is inadequate.
Program Infrastructure the Key to Success: A Pilot Crosswalk Installation to Promote Walkability, Pedestrian Safety, and Physical Activity in the U.S. Virgin Islands
Authors: Ross Desiree Terese , Cash Haley L. , Orr John , Fenton Mark
Published: March 2023

Background & Aims

While physical inactivity can contribute to chronic diseases, regular activity like walking can help prevent them. In 2010, one in three adults in the U.S. Virgin Islands (USVI) was physically inactive, higher than most U.S. states and territories. There are few walkable destinations and sidewalks along streets in the USVI. Since community- and street-scale design features can influence walking, we convened a 3-day walkability institute in the USVI to (1) learn about physical activity and best practices for design and (2) develop public health infrastructure that supports implementation. Island teams were formed to develop and implement a territory-wide action plan, focused on passing a Complete Streets policy, and demonstration projects on the islands of St. Croix, St. John, and St. Thomas to advance and pass this policy. An example of the demonstration projects and their significance is the completed one in St. Croix, which is the focus of this article.

Methods

Island teams applied critical components of functioning program infrastructure as described in the Component Model of Infrastructure (CMI) such as engaged data, multilevel leadership, responsive plans and planning, and networked partnerships. We evaluated whether a crosswalk installation in St. Croix could alter driver and pedestrian behavior and create a safer environment for pedestrians. Observers recorded pedestrian crossing time, driver speed, and other behaviors before and after crosswalk installation.

Results

Pedestrians took significantly fewer average seconds to cross the street in the postdemonstration period (9.83) compared with predemonstration (13.4) ( p = .03). Average car speed declined between the predemonstration (24.3) and long-term demonstration periods (p < .01) and from the postdemonstration (24.7) to the long-term demonstration period (18.2) ( p < .01). A greater percentage of pedestrians used the crosswalk to cross the street between the postdemonstration (12.5%) and long-term demonstration periods (53.7%) (p < .01).

Implications

The demonstration project in St. Croix shows that improvements to built environment infrastructure can increase safety for pedestrians, thus improving walkability in the USVI. We discuss the importance of CMI elements observed in the success of the St. Croix demonstration and its effectiveness in promoting a Complete Streets policy and the lack of these elements on St. John hindering progress there. Public health practitioners can apply the CMI to future physical activity promotion projects in the USVI and other settings as having functioning program infrastructure helps overcome challenges including natural disasters and a global pandemic and can achieve progress toward sustained policy and systems change.
Street Smart: Developing Relationships to Support Walkable Communities for All
Authors: McIff Brett , Ralls Brenda , Van Wagenen Hugh , Waters Megan , Fletcher Linnea , Fronberg Rebecca
Published: March 2023

Background. Physical activity promotion is an essential intervention for the prevention of chronic disease by reducing the risk of cardiovascular disease, Type 2 diabetes, and certain types of cancers, as well as improving brain health. Previous approaches that emphasized physical fitness did not meet the needs of the larger population due to not incorporating integration of movement into daily life. Changes that result in the addition of even small amounts of physical activity, such as through active transportation, can make a big difference in quality of life and longevity. Innovative Approach. To increase opportunities for active transportation, Utah agencies are working across sectors to incorporate physical activity into routine, day-to-day activities that may help to address this challenging public health problem. Human-powered travel is a key component of community design supporting health and healthy behaviors. The Utah Department of Health and Human Services (DHHS) built relationships with partners in order to promote active transportation. Lessons Learned & Recommendations. This article will demonstrate ways in which public health, transportation, and planning agencies can better engage to provide opportunities for all people to be physically active. DHHS addresses the importance of sharing public health data among state agencies, inclusion of under-represented populations in community feedback, and engaging in shared projects that will support the involvement of public health in transportation planning.
Creating a Narrative for Change: Health Promotion Students’ Perspectives on the Power of Photovoice Research
Authors: De Leon Breanna , Mahama Fatawu , Raymond Ashley , Palmer Cheryl A , Breny Jean M.
Published: March 2023

The use of Critical Race Theory, Photovoice, and Community-Based Participatory Research has helped uncover the root causes of issues such as systemic racism in the fields of public health and health promotion. Often, we see studies using traditional research methods to investigate potential causal factors of disparities in minoritized communities report only quantitative data. While these data are imperative for understanding the severity of disparities, quantitative-only approaches cannot address nor can they improve the critical root causes of these disparities. As a team of BIPOC graduate students in public health, we conducted a community-based participatory research project using Photovoice methodology to explore inequities in Black and Brown communities exacerbated during the COVID-19 pandemic. The participatory nature of this research revealed cumulative challenges across the social determinants of health in New Haven and Bridgeport, Connecticut. It allowed us to engage in local-level advocacy to promote health equity as our findings illuminated the need for community-led and community-engaged action. Health and racial inequities cannot be effectively addressed if public health research and programming do not collaborate with the community to build community capacity, empowerment, and trust. We describe our experiences doing community-based participatory research to investigate inequities and provide reflections on their value for public health students. As responses to health inequities and disparities become more politically polarized in the United States, it is critical for public health and health education students to use research methodologies that elevate communities that have been historically marginalized and neglected. Together, we can catalyze equitable change.
Effectiveness of Off-Loading Devices in Patients With Active Diabetic Foot Ulcer: A Systematic Review
Authors: Velasco-Rodríguez-Rabadán Susana , Tardáguila-García Aroa , Sanz-Corbalán Irene , García-Madrid Marta , López-Moral Mateo , Lázaro-Martínez José Luis
Published: March 2023

A systematic review of the effectiveness of off-loading in the diabetic foot was done. Searches were conducted in October 2022 using the PubMed and Scielo databases. Randomized clinical trials or controlled clinical trials were included. Two authors performed the study selection and data extraction, and any discrepancies between the 2 reviewers were resolved through discussion with a third reviewer. Fourteen papers met the selection criteria with 822 patients included, but the sample sizes in all studies were small. Most of the published studies were done in European countries. Total contact cast was the most effective off-loading. The present review studies the effectiveness of off-loading systems in patients with diabetic foot ulcer, as well as different off-loading methods, with total contact cast proving to be the gold standard, despite its adverse effects.
Assessing the Relationship Between Liver Metastases and the Survival of Patients With Non-Small Cell Lung Cancer After Immune Checkpoint Inhibitors Treatment: A Systematic Review and Meta-Analysis
Authors: Xu Huilin , Ming Pingpo , Zhao Zhenyu , Zhao Nan , Zhou Dingjie , Tang Xixian , Cao Dedong
Published: March 2023

Objective:

It is not well determined whether liver metastasis is a prognostic factor for survival of metastatic non-small cell lung cancer (NSCLC) patients who received immune checkpoint inhibitors (ICIs). We compared the efficacy of ICIs in patients with NSCLC with or without liver metastases, aiming to evaluate the impact of liver metastasis on survival of NSCLC.

Methods:

We systematically searched Pubmed, Embase, and the Cochrane library databases for randomized controlled trials (RCTs) on the efficacy of ICIs in the treatment of NSCLC patients with or without liver metastases. The duration of this search was from January 1, 2000 to June 1, 2022. The reviewers screened the literature, extracted data and conducted quality assessment, and used RevMan 5.4 software and Stata 14 to perform analyses.

Results:

A total of 17 RCTs were included, published from 2019 to 2022. For NSCLC patients with liver metastases, the risk of disease progression decreased by 36% (HR = 0.64; 95% CI: 0.55-0.75; P < .01) when treated with ICIs, and the death risk (HR = 0.82; 95% CI: 0.72-0.94; P < .01) was also reduced after ICIs treatment. For those without liver metastases, they had significantly improved PFS (HR = 0.56; 95% CI: 0.52-0.60; P < .01) and OS (HR = 0.73; 95% CI: 0.67-0.80; P < .01), compared to those of the control group. Subgroup analysis of OS in liver metastases patients suggested that OS benefit was associated with treatment strategy (for anti-PD-L1 plus chemotherapy versus chemotherapy, HR=1.04; 95% CI: 0.81-1.34; P =.75).

Conclusion:

For NSCLC patients with or without liver metastases, ICIs administration could improve both PFS and OS, especially for those without liver metastases. More RCTs are essential to verify these findings.
Using “Age and Total-PSA” as the Main Indicators: The Results of Taizhou Integrated Prostate Screening (No 2)
Authors: Zhu Xiao-Liang , Tung Tao-Hsin , Li Haipin , Wu Songjiang , Wang Xianyou , Wang Lijun , Zhang Meixian , Chen Zhixia , Liu Dingyi , Li Feipin
Published: March 2023

The aim of the study was to analyze population-based prostate cancer (PCa) screening and the incidence of PCa among males ≥50 years of age residing in the Luqiao district of Taizhou, China. From October to December 2020, male residents ≥50 years of age were screened for serum total prostate-specific antigen (total-PSA). If t-PSA re-test levels persisted above 4 μg/L, subjects underwent further noninvasive examinations, including digital rectal examination or multiparameter magnetic resonance imaging (mpMRI) of the prostate. Subjects underwent prostate biopsy of pathological tissue based on t-PSA and mpMRI results. A total of 3524 (49.1%) residents participated in this PCa screening study. In total, 285 (8.1%) subjects exhibited t-PSA levels ≥4.0 μg/L and 112 (3.2%) underwent noninvasive examinations. Forty-two (1.2%) residents underwent prostate biopsy, of which 16 (0.45%) were diagnosed with PCa. Of those diagnosed with PCa, three (19%) had localized PCa (cT1-cT2N0M0), six (37%) had locally advanced PCa (cT3a- cT4N0-1M0), and seven (44%) had advanced metastatic PCa (M1). Unfortunately, 3477 (48.5%) residents did not participate in the study, mainly due to lack of awareness of PCa based on feedback from local health centers. Age and t-PSA were used as primary screening indicators and, when further combined with mpMRI and prostate biopsy, confirmed the diagnosis of PCa among participating residents. Although this was a relatively economical and convenient screening method, education and knowledge should be further enhanced to increase the participation rate in PCa screening programs.
Lifestyle Medicine: Overcoming Systemic and Cultural Barriers to Better, More Affordable Care
Authors: Pearl Robert
Published: March 2023

The 6 pillars of lifestyle medicine have strong scientific backing and plenty of supportive evidence to validate their integration into routine clinical practice. However, two barriers stand in the way of their widespread adoption: the system of healthcare and the culture of medicine. This article describes changes necessary to overcome these systemic and cultural obstacles and outlines steps necessary to achieve what traditional healthcare has so-far failed to deliver: higher quality, lower costs, and greater access to care.
Load characterization of the main bearing of a large tunnel boring machine based on dynamic characteristic parameters
Authors: Sun Zhihong , Liu Jinlong , Cheng Yonglong , Wu Yuanke , Sun Wei
Published: March 2023

This research was carried out to solve the problem of the reasonable characterization of the working load of the main bearing of a large tunnel boring machine (TBM) under complex engineering geological conditions and equipment working statuses. A typical telescopic swing main drive system is considered, and a characterization approach based on acquired dynamic characteristic parameters is proposed. First, the axial load Fa, radial load Fr, overturning moment Mk, and torque T are considered as the load indexes of the main bearing. The main drive load model is then developed, and the load indexes are expressed by exploring the relationships between each load index and dynamic characteristic parameters such as the pressures, displacements of the hydraulic cylinders, and torques of the driving motors. Finally, the load indexes are characterized based on a subsea tunnel shield project, representative engineering geologies, and characteristic load inputs. The results indicate that by taking into account the variable attitude of the main drive system, each load index can be expressed as functions of the pressures, displacements of the hydraulic cylinders, and torques of the driving motors. According to the variation of the dynamic characteristic parameters, the load condition of the main bearing during application is accurately characterized. Different geologies are found to correspond to different load levels; the load under the dolomitic limestone and filling karst cave strata is found to be almost 1.5–1.9 times greater than that under diabase, while the torque is almost five times greater. The proposed load characterization approach provides an accurate load input conforming to engineering practice for the design and selection of the main bearing.
The social, psychological, and physical impact of COVID-19 restrictions for institutionalized adults with intellectual and developmental disabilities
Authors: Bösebeck F , Worthmann H , Möller C , Konrad C
Published: March 2023

During the COVID-19 pandemic, drastic measures to interrupt SARS-CoV-2 infection chains were implemented. In our study we investigated the consequences of pandemic related restrictions on the social, psychological, and physical well-being of institutionalized adults with intellectual and developmental disabilities. Methods: Online survey among professional caregivers in 71 residential groups, caring for 848 residents. Findings: (i.) A lack of participation concerning infection protection measures of the residents, their relatives, and their caregivers; (ii.) A 20% increase in doctor contacts during the pandemic; (iii.) A considerable deterioration in at least one item of the subdomains mood (49%), everyday skills (51%), social interaction (29%), exercise and coordination skills (12%), behavior (11%) and cognition and communication (7%); (iv.) A deterioration of the overall condition in 41%; Summery: Intensive attempts should be made to find individual and less categorical contra-infectious measures without questioning the basic everyday needs of people with intellectual and developmental disabilities.
A cross-sectional study on alcohol and contraception use among sexually active women of childbearing age: Implications for preventing alcohol-exposed pregnancies
Authors: Parackal Sherly , Parackal Mathew , Akhtar Sumera Saeed
Published: March 2023

Background:

A high proportion of unwanted or unplanned pregnancies may be alcohol-exposed due to contraception failure or non-use. Nevertheless, data on contraception and alcohol use in the context of the risk of alcohol-exposed pregnancies are sparse.

Objectives:

To describe contraception use and alcohol consumption in sexually active non-pregnant women and investigate the factors associated with less effective contraception methods.

Study Design:

A cross-sectional national survey of women aged 18–35 years.

Methods:

Data from non-pregnant women who were sexually active ( n = 517) were analysed. Descriptive statistics were used to report demographics, consumption, and contraception measures. Logistic regression was used to investigate the factors associated with less effective contraception among drinkers.

Results:

The majority of participants were younger (46%), of NZ European ethnicity (78%), not in a permanent relationship (54%), with some or completed tertiary education (79%), employed (81%) and not users of the community services card (82%). Twenty-five percent of women were smokers, 94% consumed alcohol, and 72% binged at least ‘monthly or less’. Most women used the pill (56%), and 20% of drinking women were using a contraception method with a 10% or more annual failure rate after 1 year of use. Women who binged ‘weekly or more often’ had similar odds of using less effective contraception as women who ‘never’ binged ( p > 0.05). Younger Māori or Pacific women (odds ratio = 5.99; 95% confidence interval of odds 1.15 –31.2; p = 0.033) and women who had no tertiary education (odds ratio = 1.75; 95% confidence interval of odds 0.00 –3.06; p = 0.052) had higher odds of using less effective contraception.

Conclusion:

With 20% of women at risk of an alcohol-exposed pregnancy, public health measures to address alcohol consumption and the effective use of contraception are critical to reducing the risk for alcohol-exposed pregnancies in NZ.
Recreational cycling related injuries at the emergency department
Authors: Kwan Jia Rui , Lim Shiun-Hwa Chantal , Ong Wei Lin Lester , Tan Yong Hui Alvin , Kam Juinn Huar , Pek Jen Heng
Published: March 2023

Introduction

Recreational cycling is gaining popularity in Singapore but there is a lack of literature regarding the spectrum and severity of these injuries and their impact on the utilisation of healthcare resources. We aim to characterise these injuries, as well as to review the healthcare resources required by injured cyclists.

Methods

A retrospective review of patients with recreational cycling-related injuries presenting to the Emergency Department (ED) between August 2018 and December 2020 was performed. Information about demographics, circumstances of injury, injuries sustained, clinical progress, and outcomes were collected and analysed.

Results

There were 214 patients, with an increase in monthly attendance towards the end of the study period. The median age was 48 years old (interquartile range (IQR) 31 to 60) and 165 (77.1%) patients were male. In the ED, 35 (16.4%), 142 (66.4%), and 37 (17.3%) patients were triaged as P1 (emergent), P2 (urgent), and P3 (ambulatory) respectively. Blunt injuries occurred in 210 (98.1%) patients. Soft tissue injuries involving the upper and lower limbs were most common. One hundred and eighty-one (84.6%) patients had a minor to moderate injury classified by an Injury Severity Score of 0 to 8. One hundred twenty-four (57.9%) patients were admitted to the hospital with 40 (18.7%) requiring surgery.

Conclusion

Recreational cycling-related injuries are increasingly encountered in the ED. These injuries are associated with morbidities which require utilisation of healthcare resources. Legislation and education efforts to promote safety in recreational cycling are required to reduce accidents and minimise the impact of the injuries sustained.
Tools for establishing a sustainable safety culture within maternity services. A retrospective case study
Authors: Løland Marianne , Braut Geir Sverre , Lichtenberg Sissel Moe , Egenberg Signe
Published: March 2023

Objective:

This article reports the findings from a single case study on the long-term sustainability of a quality system in a large maternity unit.

Method:

The empirical basis is an analysis of documents related to the development, implementation, maintenance and outcome of the system over two decades. The main elements of the quality system are reported as findings, and the possible effects of the different elements are presented and discussed based on theories on safety management and leadership.

Result:

The findings suggest that the quality system served as the basis for a meaningful workplace community. The structure of meetings, research, training and budget input were all central factors for the development of the system. It resulted in systematic ongoing improvement, participation from all levels of the organization and trust within the organization. The effects of the system may still be seen after the end point of this study.

Conclusions:

It remains the responsibility of the management to ensure an adequate professional standard of services by a continuous internal quality assurance system for enhanced patient safety.
The new civic epistemology of data proof: A case study of knowledge disputes in the formulation of China's fertility policy
Authors: Shang Zhicong , Tian Xiteng , Yan Wenyu
Published: March 2023

A variety of knowledge-related disputes emerged during the formulation of China's fertility policy. As the core epistemological element of policy decision-making, the reliability of data proof was gradually confirmed in this process. In this study, we find that data proof became a crucial consideration when the Chinese government initiated a one-child policy in the 1980s. The government used Song Jian's population cybernetics and the centennial projection of Chinese population growth as decisive support for the promulgation of this policy. The government subsequently planned to introduce a two-child policy in 2011. During this process, fierce competition arose between the knowledge claims advanced by Zhai Zhenwu and Wang Guangzhou, who differed significantly on the measurement of the fertility rate and the willingness of women to bear children. The accuracy of data proof came to be gradually realized by both the government and the public. By drawing on a co-productionist analysis of the interactions among the stakeholders, epistemology and China's agenda in this process, we conclude that a new civic epistemology of data proof for public policymaking was created in the formulation of the two public policies on fertility. This has transformed knowledge production as well as political institutions, identities and representations.
Engaging At-Risk Rural Residents in Secondary Lung Cancer Prevention
Authors: Ziller Erika , Talbot Jean A , Elbaum Martha , Croll Zachariah , Waterston Leo B. , Korsen Neil , Han Paul K. J.
Published: March 2023

Introduction:

Rural residents are at elevated risk for lung cancer and related mortality, yet limited research has explored their perspectives on cancer risk or prevention options, including tobacco treatment and lung cancer screening with low-dose computed tomography (LDCT). This qualitative study examined attitudes and beliefs among rural adults who reported either current or former tobacco use, as well as disengagement from the health care system.

Methods:

We conducted 6 focus groups with rural Maine residents at risk for lung cancer based on age and smoking history (n = 50). Semistructured interviews explored participants’ knowledge, perceptions, and attitudes regarding lung cancer risk, LDCT screening, and patient provider relationships. Inductive qualitative analysis of interview transcripts was conducted to identify key themes.

Results:

Participants were cognizant of their elevated lung cancer risk, yet few were aware of LDCT screening. When informed about LDCT, most participants indicated a willingness to undergo screening, although a substantial minority indicated reluctance related to fear and fatalism. Participants generally expressed the belief that relationships with a primary care provider could support their health and identified several provider factors that influence these relationships, including attention and time for patient concerns; respect and non-judgmental, nonstigmatizing attitudes; treating patients as individuals; and provider empathy and emotional support.

Conclusions:

Rural residents at risk for lung cancer report limited knowledge and substantial ambivalence regarding LDCT screening, but identify provider behaviors that may promote patient-provider relationships and greater engagement with their health. More research is needed to confirm these findings and understand how to help rural residents and healthcare providers work together to reduce lung cancer risk.
Research on Economic Theory Under the Operation of Business Model 4.0
Authors: Chen Chiou-Wen , Huang Chih
Published: March 2023

With the emergence of intelligent technology for cyber-physical systems (CPS), manufacturers’ production has come to the age of Industry 4.0, and the corresponding Business Model 4.0 has been born. Under Business Model 4.0, can consumers and producers obtain instant, sufficient, and transparent product or service information through the Internet in mutually beneficial behaviors? This article examines the economic system under the operation of Business Model 4.0 from the perspective of relevant theories of economics and attempt to analyze the theoretical mechanism of the operation of Business Model 4.0. It is found in the article that under the process of Business Model 4.0, it should be possible to quickly and easily achieve the conditions of Pareto efficient allocation in the economic theory. However, everyone involved in the Internet has to behave in favor of others in this Business Model 4.0. If this factor is lacking, the efficiency of the economic system may disappear.