bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of the New Preoperative Frailty Risk Score in Elderly Patients Undergoing Emergency Surgery
Authors: Lee Sang-Wook , Kim Keon-Sik , Park Sung-Wook , Kim Jaewon , Choi Jeong-Hyun , Lee Sangho , Joung Kyoung-Woon , Choi In-Cheol
Published: May 2022

Background: Predicting preoperative frailty risk in emergency surgery is difficult with limited information because preoperative evaluation is not commonly performed properly. A recent study attempted to predict preoperative frailty risk using only diagnostic and surgical codes that can be extracted from the electronic medical records system. Objective: This study aimed to validate whether the prediction model of preoperative frailty risk presented in the previous study is well applied to other medical hospitals’ data. Methods: This is a retrospective cohort study including 1,557 patients (≥75 years old) who were admitted to a single institution for emergency operations between January 1, 2010, and December 31, 2019, for study analysis. The Charlson comorbidity index, Hospital Frailty Risk Score, and the recently developed Operation Frailty Risk Score (OFRS) were calculated using the patient’s diagnostic and operation codes. The predictive performances of these calculated risk scores and the American Society of Anesthesiologists-Physical Status classification for postoperative 90-day mortality were compared by using the receiver operating characteristic curve analysis. Findings: The predictive performance of the OFRS, Charlson comorbidity index, American Society of Anesthesiologists-Physical Status, and Hospital Frailty Risk Score for postoperative 90-day mortality was 0.81, 0.630, 0.699, and 0.549 on a c-statistics basis, respectively. Conclusions: The OFRS using diagnostic and operation codes may show the best predictive performance for 90-day mortality compared to other risk scores, and it can be the clinically applicable model to evaluate the preoperative frailty risk in elderly patients undergoing emergency surgery.
The First Reported Case of Allogenic Hematopoietic Stem Cell Transplantation for CML Blast Phase (Monocytic Lineage) in the Tyrosine Kinase Inhibitor Era
Authors: Yamada Shinya , Arita Kotaro , Kondo Yukio , Mizuta Shuichi , Okumura Hirokazu
Published: May 2022

Chronic myeloid leukemia (CML) blast phase (monocytic lineage) is extremely rare. A 39-year-old Japanese man was diagnosed with CML blast phase (monocytic lineage). T315I mutation was positive, ponatinib was initially started, and then, allogenic hematopoietic stem cell transplantation (allo-HSCT) was performed. Seven days after allo-HSCT, hyper-acute graft-versus-host disease developed, and medial temporal lobe encephalitis emerged 24 days after allo-HSCT. He was alive for over 1 year after allo-HSCT. This is the first case report of HSCT for CML blast phase (monocytic lineage) in tyrosine kinase inhibitor era. Further cases should be documented for effective treatment regimen and analysis of clinical features.
Geometria olímpica com GeoGebra. v. 2
Authors:   Universidade de São Paulo. Faculdade de Zootecnia e Engenharia de Alimentos, Linares Juan López , Santos João Paulo Martins dos ,   Academia da Força Aérea em Pirassununga/SP, Jesus Alessandro Firmiano de ,   Academia da Força Aérea em Pirassununga/SP
Published: May 2022

Este material didático foi utilizado durante algumas das aulas do curso "Geometria Olímpica com GeoGebra" para professores de Matemática do Ensino Fundamental e Médio de todo o Brasil. A discussão proposta pelo livro é organizada em sete capítulos: Introdução; Congruência de triângulos e aplicações; Relações métricas no triângulo retângulo; Algumas construções envolvendo triângulos semelhantes e congruentes; Quadriláteros inscritíveis, circunscritíveis e biocêntricos; Cores Dinâmicas RGB no GeoGebra e, finalmente, as referências adotadas. O foco da obra são as construções geométricas detalhadas, com a apresentação passo a passo e o compartilhamento dos links interativos para que o leitor possa acompanhar o processo descrito. O diferencial está na utilização do GeoGebra, o qual tem disponibilidade gratuita tanto para utilização online como utilização em computadores ou aplicativos de celulares. As construções geométricas podem ser elaboradas de forma dinâmica e é permitido que o leitor explore diversas configurações de um mesmo problema.
Guia das frutas do campus da Universidade de São Paulo em Ribeirão Preto
Authors:   Universidade de São Paulo. Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Barosela José Ricardo , Rosa Helijone M. Rodrigues ,   Universidade de São Paulo. Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto
Published: May 2022

O Guia das Frutas da Universidade de São Paulo em Ribeirão Preto vem colaborar para a aproximação dos frequentadores do campus de Ribeirão Preto às suas belezas naturais e, como destacam os próprios autores, para “valorizar nossa riqueza de frutas, seja de nativas ou exóticas". Este livro traz informações muito interessantes e úteis sobre os pés de frutas, suas características e localização no campus. Alguns deles são bem comuns, outros menos e ainda outros quase desconhecidos para a maioria de seus frequentadores. Assim, em alguns desses pés é comum se observar apreciadores que, não sem dificuldade, colhem seus frutos de época como os de goiaba, jabuticaba, amora, abacate ou manga. Outros, menos conhecidos, ainda recebem alguma atenção, como atemoia e uvaia. A obra representa um meio de divulgação, cujo objetivo será o de estimular o conhecimento botânico formal e o interesse pelas plantas, tão necessário para uma mudança de comportamento de cidadãos comuns em relação ao meio ambiente. Daí sua importância também na educação informal tão necessária nesse momento em que nossos biomas estão sendo a cada dia mais ameaçados por derrubadas, por queimadas e pela falta de política adequada para a conservação de nossa rica biodiversidade.
Ultrashort Door‐to‐Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019
Authors: Mikulík Robert , Bar Michal , Bělašková Silvie , Černík David , Fiksa Jan , Herzig Roman , Jura René , Jurák Lubomír , Klečka Lukáš , Neumann Jiří , Ostrý Svatopluk , Šaňák Daniel , Ševčík Petr , Škoda Ondřej , Šrámek Martin , Tomek Aleš , Václavík Daniel ,   the Czech Stroke Unit Network
Published: May 2022

Background

The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door‐to‐needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome.

Methods and Results

Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70±13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5–14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT ≤20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12–1.51), 1.33 (95% CI, 1.15–1.54), and 1.15 (95% CI, 1.02–1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45–0.71), 0.76 (95% CI, 0.61–0.94), 0.83 (95% CI, 0.70–0.99), respectively.

Conclusions

Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.
New Evidence on Welfare’s Disincentive for the Youth Using Administrative Panel Data
Authors: Bargain Olivier B. , Jonassen Anders B.
Published: May 2022

We estimate the impact of social assistance on youth employment in Denmark, 2000 to 2006. For childless unmarried individuals, maximum welfare payments increased by 55% at age 25. Using administrative panel data, we find a significant disincentive effect among the low-skilled only, for whom employment fell by 2% to 3% and benefit take-up increased by 10% to 14%. Two-thirds of the effect is attributable to transitions from work to welfare and one-third to reduced labor market entry. Heterogeneous estimates along the earnings distribution show that employment responses are concentrated at very low earnings. We find no evidence of an age discontinuity in criminal activities.
Subjective Job Insecurity and the Rise of the Precariat: Evidence from the United Kingdom, Germany, and the United States
Authors: Manning Alan , Mazeine Graham
Published: May 2022

There is a widespread belief that work is less secure than in the past, that an increasing share of workers are part of the “precariat.” It is hard to find much evidence for this in objective measures of job security, but perhaps subjective measures show different trends. This paper shows that in the United States, the United Kingdom, and Germany, workers feel as secure as they ever have in the past 30 years. This is partly because job insecurity is very cyclical and (pre-COVID) unemployment rates very low, but there is also no clear underlying trend towards increased subjective measures of job insecurity. This conclusion seems robust to controlling for the changing mix of the labor force, and it is true for specific subsets of workers.
Fireside Chats: Communication and Consumers’ Expectations in the Great Depression
Authors: Pedemonte Mathieu
Published: May 2022

This paper shows how policy announcements can be used to manage expectations. Using regional variation in radio exposure, I evaluate the impact of FDR’s 1935 Fireside Chat, in which he showcased the introduction of important social policies, establishing a new expansionary cycle of the New Deal. I document that cities with higher exposure to the announcement exhibited a significant increase in spending on durable goods. The estimated effect is consistent with changes in expectations in line with the policies announced. This paper shows the power of communication as a policy tool.
A Structural Investigation of Quantitative Easing
Authors: Boehl Gregor , Goy Gavin , Strobel Felix
Published: May 2022

Using nonlinear Bayesian methods that fully account for the binding zero lower bound (ZLB), we estimate a large-scale macrofinance DSGE model on U.S. data. Counterfactual analysis suggests that by easing financing conditions, quantitative easing facilitated a net increase in aggregate investment. The resulting expansion of firms’ production capacities lowered their marginal costs. These disinflationary supply side effects dominated over the inflationary effects induced by the stimulus to aggregate demand. At the ZLB, the concomitant rise in real interest rates, in turn, induced a net fall in aggregate consumption.
Elaphoidella longiramus sp. nov. (Copepoda: Harpacticoida, Canthocamptidae), a new species of cave-dwelling copepod from central Thailand
Authors: WATIROYRAM SANTI , JANPONG WONGDUAN , SANOAMUANG LAORSRI
Published: May 2022

A new species of harpacticoid copepod belonging to the genus Elaphoidella is described, based on materials collected from Thae Wa Phithak Cave, Lopburi Province, central Thailand. Specimens of Elaphoidella longiramus sp. nov. were found in a water bucket that was fully filled by dripping water from the cave ceiling. Of the 32 Elaphoidella species recorded from Southeast Asia, E. longiramus sp. nov. is the 14th member of this genus reported from Thailand. The new species is most similar to E. thailandensis by having four well-developed setae on the exopod of the female fifth leg. The endopod of the fourth leg is lacking, and the first leg has a two-segmented endopod in both sexes. However, it is distinguished from E. thailandensis by having elongated caudal rami, the exopod with a seta-like spinule on the inner margin of the female fifth leg, a different setal formula on the third exopod of the second to fourth legs, a different number of teeth on the anal operculum, and a different number of ventral spinules on the anal somite.
Mechanisms of Valley Precipitation Enhancement over Da-Tun Mountain
Authors: Yu Cheng-Ku , Liu Wei-Fan , Cheng Lin-Wen , Lin Chuan-Yao
Published: May 2022

This study explores the mechanisms responsible for valley precipitation enhancement over Da-Tun Mountain under the prevailing northeasterly monsoonal flow. Da-Tun Mountain, located adjacent to the northern coast of Taiwan, is a small-scale (15 km), concave-like terrain feature with two ridge arms and a funnel-shaped valley. A typical valley precipitation enhancement event that occurred on 13 December 2018 was chosen for detailed analyses. Upstream conditions were characterized by the absence of convective available potential energy with a large-Froude-number (>1) flow regime. Observational and modeling results indicate a consistent, important signature of flow splitting due to partial blocking as the low-level northeasterly flow encountered the ridge arms. Fine-scale structures of airflow and precipitation evident from the simulations further reveal that the deflected flows over the two ridge arms interacted with each other to produce lateral convergence and enhanced precipitation inside the valley. The smaller-scale splitting flows tended to occur over the ridge arms as upstream moist Froude number decreased from relatively higher (5–11) to lower (3–5) values due to the temporal change in moist static stability. Quantitative diagnoses of vertical velocities performed over the region of primary precipitation support that upward motions associated with lateral convergence greatly overwhelmed the upslope-forced lifting over the valley region during the valley precipitation enhancement periods. However, vertical motions over the ridge arms with steeper slopes were dominantly contributed by the upslope forcing, but their intensities were also modulated by the flow-splitting-induced divergence.

Significance Statement

Many mountain ranges around the world exhibit a concave-like terrain feature with various spatial scales and orientations. Orographic modulations of rainfall by concave mountains are of great importance to local weather, as torrential rainfall has been frequently reported over these ridges in different geographical locations. This study aims to advance our knowledge of precipitation mechanisms over Da-Tun Mountain, a small-scale concave topography located in northern Taiwan. Observational and modeling analyses reveal evidence of splitting flows over different ridge arms of this mountain barrier. These smaller-scale splitting flows and their interactions play important roles in modulating the intensity of upslope-forced lifting and contributing to valley precipitation enhancement. These identified processes are anticipated to be commonly active over highly three-dimensional, concave-like topography.
Which features of ambulatory healthcare are preferred by people aged 80 and over? Findings from a systematic review of qualitative studies and appraisal of confidence using GRADE-CERQual
Authors: Herrler Angélique , Kukla Helena , Vennedey Vera , Stock Stephanie
Published: May 2022

Background

Despite healthcare providers’ goal of patient-centeredness, current models for the ambulatory (i.e., outpatient) care of older people have not as yet systematically incorporated their views. Moreover, there is no systematic overview of the preferable features of ambulatory care from the perspective of people aged 80 and over. Therefore, the aim of this study was to summarize their specific wishes and preferences regarding ambulatory care from qualitative studies.

Methods

The study was based on qualitative studies identified in a prior systematic review. Firstly, the findings of the qualitative studies were meta-summarized, following Sandelowski and Barroso. Secondly, a list of preferred features of care from the perspective of older people was derived from the included studies’ findings through inductive coding. Thirdly, the review findings were appraised using the GRADE-CERQual tool to determine the level of confidence in the qualitative evidence. The appraisal comprised four domains: methodological limitations, coherence, data adequacy, and data relevance. Two reviewers independently evaluated every review finding in each domain. The final appraisals were discussed and ultimately summarized for the respective review finding (high, moderate, low, or very low confidence).

Results

The 22 qualitative studies included in the systematic review were mainly conducted in Northern and Western Europe (n = 15). In total, the studies comprised a sample of 330 participants (n = 5 to n = 42) with a mean or median age of 80 and over. From the studies’ findings, 23 preferred features of ambulatory care were identified. Eight features concerned care relationships (e.g., “Older people wish to receive personal attention”), and 15 features concerned healthcare structures (e.g., “Older want more time for their care”). The findings emphasized that older people wish to build strong relationships with their care providers. The majority of the review findings reached a moderate or high confidence appraisal.

Conclusions

While the listed features of healthcare structures are common elements of care models for older people (e.g., Geriatric Care Model), aspects of care relationships are somewhat underrepresented or are not addressed explicitly at all. Future research should further explore the identified preferred features and their impact on patient and care outcomes.
Low awareness of oral and injectable PrEP among high-risk adolescent girls and young women in Kampala, Uganda
Authors: Lunkuse Jane Frances , Kamacooko Onesmus , Muturi-Kioi Vincent , Chinyenze Kundai , Kuteesa Monica O. , Price Matt A. , Mayanja Yunia
Published: May 2022

Background

Adolescent girls and young women (AGYW) account for a disproportionate number of new HIV infections worldwide. HIV prevalence among young sex workers in Uganda is 22.5%. Although pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, awareness of PrEP among AGYW in Uganda has not been studied systematically. We aimed to assess awareness of PrEP and factors associated with awareness of PrEP among AGYW who frequently reported paid sex.

Methods

We conducted a cross-sectional study among 14–24-year old AGYW at high risk of HIV infection in Kampala, Uganda from January to October 2019. Participants were screened for PrEP eligibility using a national screening tool of whom 82.3% were eligible. Data on socio-demographics, behavioral and sexual risks were collected by interview. Awareness of oral or injectable PrEP, the latter of which is currently in late-stage trials, was defined as whether an individual had heard about PrEP as an HIV prevention method. Multivariable robust poisson regression model was used to assess factors associated with oral PrEP awareness.

Results

We enrolled 285 participants of whom 39.3% were under 20 years old, 54.7% had completed secondary education, 68.8% had multiple sex partners in the past 3 months, 8.8% were screened as high risk drinkers’/ alcohol dependent (AUDIT tool) and 21.0% reported sex work as main occupation. Only 23.2% were aware of oral PrEP and 3.9% had heard about injectable PrEP. The prevalence of oral PrEP awareness was significantly higher among volunteers screened as alcohol dependents (aPR 1.89, 95% CI 1.08–3.29) and those with multiple sexual partners (aPR 1.84, 95% CI 1.01–3.35), but was lower among those who reported consistent condom use with recent sexual partners (aPR 0.58, 95% CI 0.37–0.91).

Conclusions

Majority of AGYW were not aware of any kind of PrEP. Those with higher risk behavior, i.e. alcohol dependents or multiple sexual partners, were more aware of oral PrEP. Interventions to increase awareness among female youth are needed. Improving PrEP awareness is critical to increasing PrEP uptake among high-risk AGYW in Uganda.
Bromisoval-induced bromism with status epilepticus mimicking Wernicke’s encephalopathy: report of two cases
Authors: Biyajima Masahiro , Satoh Shunichi , Morikawa Takahiro , Morita Yuki , Watanabe Rie , Matsui Daisuke , Konno Masataka , Morimoto Nobutoshi , Yatsu Yuichi , Hirasaki Akihito , Yahikozawa Hiroyuki
Published: May 2022

Background

Bromine compounds are used in several drugs, including over-the-counter drugs. They sometimes cause intoxication known as bromism. Although the acute neurological symptoms and sequelae of bromism vary, few reports have mentioned acute encephalopathy.

Case presentation

We report two cases of bromisoval-induced bromism with status epilepticus. Presence of pseudohyperchloremia and history of over-the-counter medication use guided the diagnosis. In the acute phase, our patients showed bilateral medial thalamic lesions on magnetic resonance imaging. The imaging findings were similar to those of Wernicke’s encephalopathy. Although these findings improved in the chronic phase, neuropsychiatric sequelae, such as confabulation and amnesia, occurred.

Conclusion

Bromism can cause acute encephalopathy, and it is important to differentiate it from Wernicke–Korsakoff syndrome.
Homologous recombination deficiency in diverse cancer types and its correlation with platinum chemotherapy efficiency in ovarian cancer
Authors: Wen Hao , Feng Zheng , Ma Yutong , Liu Rui , Ou Qiuxiang , Guo Qinhao , Shen Yi , Wu Xue , Shao Yang , Bao Hua , Wu Xiaohua
Published: May 2022

Background

Homologous recombination deficiency (HRD) is a molecular biomarker for administrating PARP inhibitor (PARPi) or platinum-based (Pt) chemotherapy. The most well-studied mechanism of causing HRD is pathogenic BRCA1/2 mutations, while HRD phenotype is also present in patients without BRCA1/2 alterations, suggesting other unknown factors.

Methods

The targeted next-generation sequencing (GeneseeqPrime® HRD) was used to evaluate the HRD scores of 199 patients (Cohort I). In Cohort II, a total of 85 Pt-chemotherapy-treated high-grade serous ovarian cancer (HGSOC) patients were included for investigating the role of HRD score in predicting treatment efficacy. The concurrent genomic features analyzed along HRD score evaluation were studied in a third cohort with 416 solid tumor patients (Cohort III).

Results

An HRD score ≥ 38 was predefined as HRD-positive by analyzing Cohort I (range: 0–107). Over 95% of the BRCA1/2-deficient cases of Cohort I were HRD-positive under this threshold. In Cohort II, Pt-sensitive patients have significantly higher HRD scores than Pt-resistant patients (median: 54 vs. 34, p = 0.031) and a significantly longer PFS was observed in HRD-positive patients (median: 548 vs. 343 days, p = 0.003). Furthermore, TP53, NCOR1, and PTK2 alterations were enriched in HRD-positive patients. In Cohort III, impaired homologous recombination repair pathway was more frequently observed in HRD-positive patients without BRCA1/2 pathogenic mutations. The alteration enrichment of TP53, NCOR1, and PTK2 observed in Cohort II was also validated by the ovarian subgroup in Cohort III.

Conclusions

Using an in-house HRD evaluation method, our findings show that overall HRR gene mutations account for a significant part of HRD in the absence of BRCA1/2 aberrations, and suggest that HRD positive status might be a predictive biomarker of Pt-chemotherapy.
Bacteriological profile of conjunctiva bacterial Flora in Northeast China: a hospital-based study
Authors: Xu Shuo , Zhang Hong
Published: May 2022

Purpose

To investigate the distribution and influencing factors of preoperative conjunctival flora from patients undergoing penetrating ocular surgeries in northeast China.

Methods

An observational and cross-sectional study design was used. In 305 eyes of 305 patients without infective eye diseases who underwent ocular surgeries at the First Affiliated Hospital of Harbin Medical University between May 2018 and May 2019, conjunctival sac scrapings were collected on the day before surgery.

Results

The mean age of the participants was 60.73 ± 14.23 years, with the majority being female, married and unemployed with at least primary school education. The positive culture rate was 48.20% (147/305 eyes), and 191 bacterial strains were isolated; two or more strains were isolated from 22.45% (33/147) of positive samples. The most commonly isolated bacteria was Staphylococcus epidermidis (64.92%), surpassing Staphylococcus aureus (5.76%). The culture positive rate of the young (18–40 years) group was different between the females (26.67%) and males (69.23%) (P = 0.024), but in the middle-aged group and the elderly group, the rates between the sexes were similar, with an increasing trend. Patients who visited in summer or autumn presented a higher positive rate than other seasons. Hypertensive women had a higher rate than hypertensive men (58.14% vs. 40%, χ2 = 5.8662, P = 0.0154).

Conclusions

In northeastern China, coagulase-negative Staphylococcus were the most common preoperative conjunctival bacteria. Hypertensive female patients, elderly patients, or those operated on in the summer and autumn should pay more attention to perioperative treatment.

Trial registration

ChiCTR2100044659.
Cementless bipolar hemiarthroplasty compared with proximal femoral nail anti-rotation of unstable intertrochanteric fractures in senile patients with osteoporosis: a retrospective study
Authors: Cai Chengkui , Tian Liying , Chen Zhihui , Sun Pengcheng , Wang Guozhu
Published: May 2022

Background

Implant design for the correction of osteoporotic unstable intertrochanteric fractures in elderly patients is a controversial issue. Our study aims to compare the efficacy of PFNA and cementless bipolar hemiarthroplasty (CBH) in treating osteoporotic unstable intertrochanteric fractures in the elderly.

Methods

We retrospectively assessed 70 elderly patients, aged > 70 years old, with intertrochanteric fractures (AO/OTA 31-A2 fractures) from 2014 to 2019. Among them, 34 patients received PFNA and 36 patients received CBH, accompanied with 2-year follow-ups. Additionally, the efficacy difference between the two implants was compared.

Results

Both groups had similar general variables like age, gender, fracture site, degree of osteoporosis, fracture classification, ASA score, basic diseases, preoperative preparation time, anesthesia mode, amount of postoperative blood loss, hospital length of stay, along with postoperative blood transfusions and postoperative complications (P > 0.05). Conversely, significant differences were observed among intraoperative variables (amount of blood loss, amount of blood transfusions, operative time, number of intraoperative fluoroscopy), postoperative variables (weight-bearing time out of bed), and Harris hip function score within 12 months of operation (P < 0.05).

Conclusions

CBH showed no obvious advantage over PFNA in the perioperative period in elderly patients with osteoporotic unstable intertrochanteric fractures. However, the joint replacement allowed for earlier ambulation after the operation and rapid recovery of the hip joint function.
A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer
Authors: Malhotra Chetna , Bundoc Filipinas , Chaudhry Isha , Teo Irene , Ozdemir Semra , Finkelstein Eric ,   on behalf of COMPASS study group, Dent Rebecca A. , Kumarakulasinghe Nesaretnam Barr , Cheung Yin Bun , Malhotra Rahul , Kanesvaran Ravindran , Yee Alethea Chung Pheng , Chan Noreen , Wu Huei Yaw , Chin Soh Mun , Allyn Hum Yin Mei , Yang Grace Meijuan , Neo Patricia Soek Hui , Harding Richard , Heng Lee Lai
Published: May 2022

Background

Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers’ outcomes.

Methods

We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients’ death regarding their preparedness about patient’s death, regret about patient’s end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life.

Results

69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2–12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients’ death.

Conclusion

Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers’ preparedness for death during the bereavement phase.

Trial registration

NCT02850640.
Personality characteristics of empathy profiles – practical implications for education of medicine students
Authors: Bętkowska-Korpała Barbara , Pastuszak-Draxler Anna , Olszewska-Turek Katarzyna , Sikora-Zych Karolina , Epa Roksana , Starowicz-Filip Anna
Published: May 2022

Background

Empathy plays the key role in the doctor – patient relationship. The research of empathy determinants plays an important role in formulating practical guidelines for the education of medical students. The aim of this study was to analyse personality characteristics of empathy profiles among students of medicine, with consideration of chief personality factors and their subdimensions according to the FFM model.

Methods

During workshops in Clinical Psychological Skills, 153 students (M = 57, F = 96; mean age 23 years) analysed their psychological functioning styles by examining their personality profiles and empathy indicators. Empathic Sensitiveness Scale (ESS) and Personality Inventory (NEO-PI-R) were applied for this purpose. The analyses of empathy indicators were presented by means of cluster analysis. Variance analysis with post hoc Tukey-b test was performed for differences between clusters and to differentiate between personality factors and their components in empathy clusters. This study was approved by the Jagiellonian University Bioethics Committee (approval number: 1072.6120.175.2018 date: 28.06.2018).

Results

The first cluster included students who presented high empathetic concern for others, understood their perspective and needs characterised by medium level of Neuroticism, high levels of other dimensions The second group included students who could understand others very well, yet with lower tendency to react emotionally to suffering, characterised by medium level of Neuroticism, Extraversion, Openness, high Conscientiousness and low Agreeableness. The third cluster included students who react strongly to painful and unpleasant reactions of others, characterised by high Neuroticism and Agreeableness, low Extraversion.

Conclusions

Each empathy profile is manifested in relations with patients in a specific way. Medical education in empathy holds great potential to reduce anxiety, stress, and burnout associated with the medical profession. Discussion of individual results with students, gives an opportunity to talk about how their empathy and personality characteristics may influence their everyday medical practice.
Medical student experiences and perceptions of palliative care in a middle eastern country
Authors: Ibrahim Halah , Lootah Shamsa , Satish Karthyayani Priya , Harhara Thana
Published: May 2022

Introduction

Teaching in palliative care (PC) is an important component of medical education. Yet, studies in many countries document a fragmented and inconsistent approach to PC teaching. The goal of this study is to assess PC education, experience, and comfort levels in providing end-of-life care in recently graduated medical students.

Methods

A survey was distributed to medical student applicants to residency programs at a large academic medical center in the United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies.

Results

Of 226 surveys, 183 were completed (80.7% response). Over half of respondents (104/183, 56.8%) did not receive any formal PC education or training in medical school. General introduction to PC (64%), pain management (68%), and non-pain symptom management (56%) were the most common topics. Only 13% (24/183) of medical students participated in PC rotations. Only 25% of participants (46/183) reported assessment of PC knowledge or skills. Gender differences were noted, with women more comfortable discussing prognosis (Pearson Chi-square value 8.67, df 3, p < 0.013) and assessing decision-making capacity (Pearson Chi-square value 15.02, df 3, p < 0.005). Few students expressed comfort with any aspect of PC. The majority of respondents (174/183, 95%) felt that it is important to receive PC education in medical school.

Conclusions

Most newly graduated medical students reported limited education in PC, with minimal clinical experience. The vast majority described a lack of comfort in providing care for dying patients and their families. Educational reform is necessary to embed PC knowledge and skills into medical school curricula.
Economic assessment of incorporating the hexavalent vaccine as part of the National Immunization Program of Peru
Authors: Seinfeld Janice , Rosales María Laura , Sobrevilla Alfredo , López Yescas Juan Guillermo
Published: May 2022

Background

This study aimed to estimate the economic impact of replacing the current Peruvian primary immunization scheme for infants under 1 year old with an alternative scheme with similar efficacy, based on a hexavalent vaccine.

Methods

A cost-minimization analysis compared the costs associated with vaccine administration, adverse reactions medical treatment, logistical activities, and indirect social costs associated with time spent by parents in both schemes. A budgetary impact analysis assessed the financial impact of the alternative scheme on healthcare budget.

Results

Incorporating the hexavalent vaccine would result in a 15.5% net increase in healthcare budget expenditure ($48,281,706 vs $55,744,653). Vaccination costs would increase by 54.1%, whereas logistical and adverse reaction costs would be reduced by 59.8% and 33.1%, respectively. When including indirect social costs in the analysis, the budgetary impact was reduced to 8.7%. Furthermore, the alternative scheme would enable the liberation of 17.5% of national vaccines storage capacity.

Conclusions

Despite of the significant reduction of logistical and adverse reaction costs, including the hexavalent vaccine into the National Immunization Program of Peru in place of the current vaccination scheme for infants under 1 year of age would increase the public financial budget of the government as it would represent larger vaccine acquisition costs. Incorporating the indirect costs would reduce the budgetary impact demonstrating the social value of the alternative scheme. This merits consideration by government bodies, and future studies investigating such benefits would be informative.
Patient and family experience with telemedicine and in-person pediatric and obstetric ambulatory encounters throughout 2020, during the COVID-19 epidemic: the distance effect
Authors: Marques Sandro , Cruz June Alisson Westarb , da Cunha Maria Alexandra Viegas Cortez , Tuon Felipe Francisco , de Moraes Thyago Proença , Daiane Zdziarski Alaís , Bomher Sean T. , Donnelly Lane F. , Capasso Robson
Published: May 2022

Background

Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team’s knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children’s hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis.

Methods

We aim to evaluate and compare patients’ telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient’s home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children’s hospital during 2020 were included in this study. The percentage of patients who scored the question “Likelihood to recommend practice” with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients’ distance to the hospital.

Results

Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value < 0.01). Patients who live farther displayed higher satisfaction scores regardless of the visit type (p-value < 0.01).

Conclusions

There is a direct relationship between the family experience and the distance from the considered medical center, during year 2020, i.e., patients who live farther from the hospital record higher Top Box proportion for “Likelihood to Recommend” than patients who live closer to the medical center, regardless of the approach, in-person or telemedicine.
Th1 cytokines synergize to change gene expression and promote corticosteroid insensitivity in pediatric airway smooth muscle
Authors: Jackson Devine , Walum Joshua , Banerjee Priyanka , Lewis Brandon W. , Prakash Y. S. , Sathish Venkatachalem , Xu Zhaohui , Britt Rodney D.
Published: May 2022

Background

Corticosteroids remain a key therapy for treating children with asthma. Patients with severe asthma are insensitive, resistant, or refractory to corticosteroids and have poorly controlled symptoms that involve airway inflammation, airflow obstruction, and frequent exacerbations. While the pathways that mediate corticosteroid insensitivity in asthma remain poorly defined, recent studies suggest that enhanced Th1 pathways, mediated by TNFα and IFNγ, may play a role. We previously reported that the combined effects of TNFα and IFNγ promote corticosteroid insensitivity in developing human airway smooth muscle (ASM).

Methods

To further understand the effects of TNFα and IFNγ on corticosteroid sensitivity in the context of neonatal and pediatric asthma, we performed RNA sequencing (RNA-seq) on human pediatric ASM treated with fluticasone propionate (FP), TNFα, and/or IFNγ.

Results

We found that TNFα had a greater effect on gene expression (~ 1000 differentially expressed genes) than IFNγ (~ 500 differentially expressed genes). Pathway and transcription factor analyses revealed enrichment of several pro-inflammatory responses and signaling pathways. Interestingly, treatment with TNFα and IFNγ augmented gene expression with more than 4000 differentially expressed genes. Effects of TNFα and IFNγ enhanced several pro-inflammatory genes and pathways related to ASM and its contributions to asthma pathogenesis, which persisted in the presence of corticosteroids. Co-expression analysis revealed several gene networks related to TNFα- and IFNγ-mediated signaling, pro-inflammatory mediator production, and smooth muscle contractility. Many of the co-expression network hubs were associated with genes that are insensitive to corticosteroids.

Conclusions

Together, these novel studies show the combined effects of TNFα and IFNγ on pediatric ASM and implicate Th1-associated cytokines in promoting ASM inflammation and hypercontractility in severe asthma.
Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis
Authors: Huang Shan , Shi Ke , Ren Yan , Wang Jin , Yan Wei-Feng , Qian Wen-Lei , Yang Zhi-Gang , Li Yuan
Published: May 2022

Background

Weight management is strongly promoted for overweight or obese patients with type 2 diabetes (T2DM) by current guidelines. However, the prognostic impact of weight loss achieved without behavioural intervention on the mortality and cardiovascular (CV) outcomes in diabetic patients is still contested.

Methods

We searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the association of weight loss or weight variability with mortality and CV outcomes. Results of studies that measured weight loss by percentage weight loss from baseline and stratified it as > 10% and 5–10% or studies that computed weight variability were pooled using random effects model. Study quality was evaluated using the Newcastle–Ottawa Scale.

Results

Thirty eligible studies were included in the systematic review and 13 of these were included in the meta-analysis. Large weight loss (> 10%) was associated with increased risk of all-cause mortality (pooled hazard ratio (HR) 2.27, 95% CI 1.51–3.42), composite of major CV events (pooled HR 1.71, 95% CI 1.38–2.12) and CV mortality (pooled HR 1.50, 95% CI 1.27–1.76) among T2DM patients. Moderate weight loss showed no significant association with all-cause mortality (pooled HR 1.17, 95% CI 0.97–1.41) or CV outcomes (pooled HR 1.12, 95% CI 0.94–1.33). Weight variability was associated with high hazard of all-cause mortality (pooled HR 1.54, 95% CI 1.52–1.56).

Conclusions

Large weight loss and large fluctuations in weight are potential markers of increased risk of mortality and CV events in T2DM patients. Maintaining a stable weight may have positive impact in these patients.
COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium
Authors: Nöstlinger Christiana , Van Landeghem Ella , Vanhamel Jef , Rotsaert Anke , Manirankunda Lazare , Ddungu Charles , Reyniers Thijs , Katsuva Deogratias , Vercruyssen Jana , Dielen Stef , Meudec Marie
Published: May 2022

Background

In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. Despite the established importance of community involvement in epidemic preparedness, we lack in-depth understanding of these communities’ experiences with and responses to COVID-19. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities.

Methods

This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and professional community workers. Data were collected between May 2020–May 2021 through key informant-, in-depth interviews and group discussions (N = 71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process.

Results

Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures’ most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status).

Conclusion

Study participants’ narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics. This justifies conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities’ structural vulnerabilities and resilience.
A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review
Authors: Barry Mazin , AlShehri Shahad , alguhani Ahlam , Barry Mohammad , Alhijji Ali , Binkhamis Khalifa , Al-Majid Fahad , Al-Shahrani Fatimah S. , Muayqil Taim
Published: May 2022

Background

Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP–SMX is even more rare.

Case presentation

A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP–SMX and Imipenem–Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died.

Conclusions

This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP–SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.