bluuebunny/crossref_metadata_2025 huggingface dataset:
When Monument Battles Go Digital: Russian–Ukrainian Conflicts over Material Heritage on Telegram
Authors: Pshenychnykh Anastasiya , Pfoser Alena , Mihelj Sabina
Published: April 2024

In the context of increasing conflicts over material heritage around the world, this article examines the role digital media play in battles over monuments. The rise of digital media brought significant changes to the cultural dynamics of heritage conflicts, which have not been adequately addressed in existing literature. Bringing together work on monuments, (digital) memory conflicts, and digital activism, we identify three key dimensions of monument battles in which the impact of digital media is most clearly visible: (a) participation, democratization, and deterritorialization; (b) reframing and contestation; and (c) mobilization and the online-offline movement of heritage battles. We illustrate these arguments drawing on a critical discourse analysis of monument battles on the messaging application Telegram in the context of Russia’s full-scale invasion of Ukraine, using a sample of 940 posts from both pro-Ukrainian and pro-Russian channels. We demonstrate that despite potentially providing space for alternative memory interpretations, online memory contestations over heritage contributed to the construction of polarized and mutually exclusive worlds.
Association of the Stability Ratio With Postoperative Clinical Function and Recurrence of Instability in Patients With Anterior Shoulder Instability: A Retrospective Cohort Study
Authors: Hu Qingxiang , Zhou Zhekun , Sun Benben , Zhang Guangcheng , Zhu Qi , Zhang Xiaofeng , Wu Di , He Yaohua
Published: April 2024

Background:

The stability ratio (SR) is used to assess the stability of the glenoid in anterior shoulder instability (ASI). However, the association between the SR and postoperative clinical function and instability recurrence after arthroscopic Bankart repair is unknown.

Hypothesis:

Patients with a higher SR would have better postoperative clinical scores and a lower incidence of recurrent instability than patients with a lower SR after arthroscopic Bankart repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 62 patients who underwent arthroscopic Bankart repair for ASI between 2013 and 2019 were enrolled. All patients had at least 2 years of follow-up data. The preoperative SR was calculated via biomechanical testing based on patient-specific 3-dimensional glenoid models, and patients were evenly divided into 2 groups: high SR (≥16.13%) and low SR (<16.13%). Baseline information (patient characteristics, clinical history, bone defect area [BDA], and SR), clinical scores at the final follow-up (Single Assessment Numerical Evaluation, Western Ontario Shoulder Index, and American Shoulder and Elbow Surgeons), and instability recurrence were compared between the 2 groups.

Results:

No significant differences were found in the baseline information between the high- and low-SR groups, except for the BDA (8.5% [high-SR group] vs 11.9% [low-SR group]; P = .01). No patients in the high-SR group had recurrent instability, while 6 patients (19.4%) had recurrent instability in the low-SR group ( P = .02). Patients in the high-SR group had superior clinical outcomes compared with those in the low-SR group in terms of postoperative Western Ontario Shoulder Index scores (median, 205 vs 410, respectively; P = .006) and American Shoulder and Elbow Surgeons scores (median, 98.3 vs 95, respectively; P = .02).

Conclusion:

In the present study, the SR was significantly associated with postoperative clinical function and recurrence of instability after arthroscopic Bankart repair in patients with ASI.
Equity Intersections: Teachers’ Experiences with Student Wellness Support During the COVID-19 Pandemic
Authors: Phillippo Kate L. , Levine Brown Elizabeth , Galib Linda , Fujimoto Ken A. , Iachini Aidyn L. , Brown Naomi , Lennix Crystal , Parker Audra , Childs Tasha M.
Published: April 2024

Teachers often address student wellness concerns such as health and mental health. Yet, this work goes largely unacknowledged and unsupported by professional preparation. COVID-19 intensified these concerns amid disrupted systems of student support and increased student distress. Our national survey (N = 1398) pursued the powerful opportunity present during the pandemic to understand the extent and distribution of demands on teachers to address student wellness and the support they receive for such work. We found that the demand for teachers’ wellness work was inequitably distributed across teachers, varying largely by their schools’ sociodemographic characteristics. Additionally, access to support for this work did not align with demand levels. We discuss these findings’ implications for teacher preparation, support, and workload equity.
Is Use of Psychedelic Drugs a Risk or Protective Factor for Late-Life Cognitive Decline?
Authors: Fearn Kaeleigh , Bhattacharyya Kallol Kumar
Published: April 2024

Objectives: Common age-related health conditions can lead to poor mental health outcomes and deteriorate cognition. Additionally, commonly prescribed medications for various mental/physical health conditions may cause adverse reactions, especially among older adults. Psychedelic therapy has shown positive impacts on cognition and has been successful in treating various mental health problems without long-lasting adversities. The current study examines the association between psychedelic drug usage and cognitive functions in middle-aged and older adults. Methods: Data were from wave 3 (2013–2014) of the Midlife in the United States (MIDUS) study. We used multiple linear regression models examining associations between psychedelic usage and cognitive functions, controlling for covariates of sociodemographic and health factors. Results: We included 2,503 individuals ( Mage = 64 ± 11). After controlling for covariates, the finding revealed that psychedelic usage was independently associated with more favorable changes in executive function (β = .102, SE = 0.047, p = .031) and less depressive symptoms (β = −.090, SE = 0.021, p < .001). The same effect was not found for episodic memory (β = .039, SE = 0.066, p = .553). Discussion: Addressing the mental health implications of physical health conditions in older adults are vital for preventing neurocognitive deterioration, prolonging independence, and improving the quality of life. More longitudinal research is essential utilizing psychedelics as an alternative therapy examining late-life cognitive benefits.
Spectrum of Pediatric Autoimmune Hepatitis in a Cohort of Pakistani Children
Authors: Khan Sabeen Abid , Ali Naurin , Farooq Muhammad Arslan , Hasan Shamama , Malik Munir Iqbal
Published: April 2024

Background. Autoimmune hepatitis (AIH) is increasingly seen in children worldwide and it is more severe in children compared to adults. This study highlights the biochemical and clinical aspect, treatment given and outcome of the disease including pediatric liver transplantation. Study. Retrospective review (2012-2022) was done in Shifa International Hospital, Islamabad. Patients under 18 years diagnosed with AIH were included. Data related to age, gender, clinical features, laboratory investigations including liver function test, liver biopsy findings and imaging modalities were included. Results. Fifteen patients were included 7 (47%) were males and 8 (53%) females. AIH type 1 was the most common type seen in 7 (46%), AIH type 2 in 5 (33%) and seronegative in 3 (20%). Jaundice was the most common symptom. Liver biopsy showed findings characteristic of AIH. Liver transplant performed in 3 patients. Conclusion. The study highlights the varied clinical presentation of AIH in Pakistani children.
Variations in the sleep-related breathing disorder index on polysomnography between men with HIV and controls: a matched case-control study
Authors: Chen Yen-Chin , Chen Chang-Chun , Lin Wen-Kuei , Toh Han Siong , Ko Nai-Ying , Lin Cheng-Yu
Published: April 2024

Background

Both sleep-related breathing disorders (SRBDs) and HIV infection can interfere with normal sleep architecture, and also cause physical and psychological distress. We aimed to understand the differences in the obstructive patterns, sleep architecture, physical and psychological distress when compared between people living with HIV (PLWH) and matched the severity of SRBDs controls.

Methods

A comparative study using matched case-control design was conducted. Men with HIV infection (case group) were enrolled from 2016 to 2019. A control group with HIV seronegative men were matched for SRBDs severity, and were selected from sleep medicine center database for comparison.

Results

The mean age of the 108 men (including 54 cases and 54 matched controls) was 33.75 years. Central-apnea index (CI) was higher in the case group rather than matched controls (mean CI, 0.34 vs. 0.17, p = 0.049). PLWH had a lower mean percentage of stage 3 sleep (10.26% vs. 13.94%, p = 0.034) and a higher percentage of rapid eye movement sleep (20.59% vs. 17.85%, p = 0.011) compared to matched controls. Nocturnal enuresis and sleepiness causing traffic accidents were more frequent complaint in PLWH compared to controls.

Conclusions

Early detected SRBDs and subtypes in PLWH to begin treatment for the underlying cause could reduce the risk of sleepiness-related traffic accidents.
Burden of undiagnosed depression among older adults in India: a population based study
Authors: Devikrishna NB. , Mishra Nand Lal , Singh Abhishek
Published: April 2024

Background

The study explored the levels and associated factors of undiagnosed depression among community-dwelling older Indian adults. It also identified the socio-demographic predictors of undiagnosed depression among the study population at national and state levels.

Methods

The study employed data from the Longitudinal Ageing Study in India wave-I, 2017-18. Based on the data on depression from interviewee’s self-reporting and measurement on Composite International Diagnostic Interview– Short Form (CIDI-SF) and Centre for Epidemiological Studies- Depression scale (CES-D) scales, we estimated undiagnosed depression among older adults (age 60+). We estimated multivariable binary logistic regressions to examine the socio-demographic and health-related predictors of undiagnosed depression among older adults.

Findings

8% (95% CI: 7.8–8.4) of the total older adults had undiagnosed depression on CIDI-SF scale and 5% (95% CI: 4.8–5.3) on the combined CIDI-SF and CES-D. Undiagnosed depression was higher among those who were widowed, worked in the past and currently not working, scheduled castes, higher educated and the richest. Lack of health insurance coverage, presence of any other physical or mental impairment, family history of Alzheimer’s/Parkinson’s disease/ psychotic disorder, lower self-rated health and poor life satisfaction were significant predictors of undiagnosed depression on both CIDI-SF and combined scales.

Conclusion

To improve the health of older adults in India, targeted policy efforts integrating mental health screening, awareness campaigns and decentralization of mental healthcare to primary level is needed. Further research could explore the causal factors behind different levels of undiagnosed depression.
The mediating effect of dispositional mindfulness on the association between UPPS-P impulsivity traits and gaming disorder among Asia-Pacific young adults
Authors: Tang Anson Chui Yan , Lee Regina Lai-Tong , Lee Paul Hong , Tanida Keiko , Chan Shun , Lam Simon Ching , Nailes Jennifer , Malinit Joy P. , Juangco Jose Ronilo G. , Wang Qing , Ligot Jason , Suen Lorna Kwai Ping
Published: April 2024

Background

Little evidence is available to verify the mediating effect of dispositional mindfulness on the association between gaming disorder and various impulsivity traits. The present study aimed to investigate the mediating effect of dispositional mindfulness on the association between the five UPPS-P impulsivity traits and the risk of gaming disorder among young adults.

Methods

It was an inter-regional cross-sectional study using online survey in Australia, Japan, The Philippines and China. Impulsivity measured by the UPPS-P Impulsive Behavior Scale–Short version; dispositional mindfulness measured by the Mindfulness Attention Awareness Scale; and the risk of gaming disorder measured by the Internet Gaming Disorder Scale were collected in the focal regions. Structural equation modeling was performed by SPSS AMOS version 26 to verify the study hypotheses. Bootstrapped 95% confidence interval was reported. Statistical significance was indicated by the p-value below 0.05.

Results

Among the 1,134 returned questionnaires, about 40% of them aged 18–20 years and 21–23 years, respectively. 53.8% were male. 40.7% had been playing digital and video games for over 10 years. The prevalence of gaming disorder was 4.32%. The model fitness indices reflected that the constructed model had an acceptable model fit (χ2(118) = 558.994, p < 0.001; χ2/df = 4.737; CFI = 0.924; TLI = 0.890; GFI = 0.948; RMSEA = 0.058; SRMR = 0.0487). Dispositional mindfulness fully mediated the effect of positive urgency and negative urgency on the risk of gaming disorder. The effect of lack of premeditation on the risk of gaming disorder was partially mediated by dispositional mindfulness. However, dispositional mindfulness did not mediate the effect of sensation seeking on the risk of gaming disorder.

Conclusions

The varied associations between dispositional mindfulness and the five impulsivity traits hints that improving some impulsive traits may increase dispositional mindfulness and so lower the risk of gaming disorder. Despite further studies are needed to verify the present findings, it sheds light on the need to apply interventions on gamers based on their impulsivity profile. Interventions targeting at emotion regulation and self-control such as mindfulness-based interventions seem to be effective to help gamers with dominant features of urgency and lack of premeditation only. Other interventions shall be considered for gamers with high sensation seeking tendency to enhance the effectiveness of gaming disorder prevention.
Definition and characteristics of climate-adaptive cities: a systematic review
Authors: Yari Arezoo , Mashallahi Alireza , Aghababaeian Hamidreza , Nouri Mohsen , Yadav Nidhi , Mousavi Arefeh , Salehi Shiva , Ostadtaghizadeh Abbas
Published: April 2024

Background

Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning.

Methods

This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities.

Results

Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities.

Conclusion

A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.
A comparative ethical analysis of the Egyptian clinical research law
Authors: Martin Sylvia , Ancillotti Mirko , Slokenberga Santa , Matar Amal
Published: April 2024

Background

In this study, we examined the ethical implications of Egypt’s new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients.

Methods

We conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws.

Results

On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones.

Conclusion

The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond.
Association between self-efficacy, spiritual well-being and the willingness to provide spiritual care among nursing staff in Taiwan: a cross-sectional study
Authors: Yang Shu-Hui , Tsan Yu-Tse , Hsu Wan-Ting , Liu Chin-Feng , Ho Wen-Chao , Wu Li-Fen , Lin Cheng-Fu , Chu Wei-Min
Published: April 2024

Background

Spiritual care plays a significant role in holistic patient care, addressing not only physical ailments but also attending to patients’ emotional and spiritual well-being. While the importance of spiritual care in nursing is widely recognized, there is often a gap in understanding nurses’ willingness to provide such care. This cross-sectional study aimed to explore the association between self-efficacy, spiritual well-being, and willingness to provide spiritual care among nursing staff.

Methods

The study conducted a cross-sectional survey of full-time registered nurses at a hospital in Taiwan from January 2019 to December 2019. A sample comprising 168 nurses was selected for participation in the study through a random sampling method. In addition to collecting demographic variables, the assessment tools used in the study include the General Self-Efficacy Scale (GSES) for measuring self-efficacy, the Spiritual Index of Well-Being Chinese Version (SIWB-C) for evaluating spiritual well-being, and the Spiritual Care Needs Inventory (SCNI) to gauge willingness to provide spiritual care.

Results

Most participants in the study were female, accounting for 98.2% (n = 165). The mean age of all 168 nurses was 37.1 ± 9.3 years. Additionally, most participants held a Bachelor’s degree (79.2%,n = 133) and possessed clinical experience was 10.5 ± 9.3 years. Through logistic regression analysis, it was found that regardless of whether participants have received sufficient spiritual care training, both GSES and SIWB-C remain influential factors in determining the provision of spiritual care.

Conclusions

Collaboration between healthcare management and nursing staff is essential for fostering a healthcare environment that not only appreciates the physical and spiritual dimensions of patient care but also prioritizes the enhancement of nurses ' self-efficacy and well-being.
Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting
Authors: Neri Margherita , Mewes Janne C. , de Almeida Fernando Albuquerque , Stoychev Sophia , Minarovic Nadia , Charos Apostolos , Shea Kimberly M. , Steuten Lotte M.G.
Published: April 2024

Objectives

It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated.

Methods

For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results.

Results

In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person.

Conclusions

Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.
The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy
Authors: Bitz Helena C. , Sachpazidis Ilias , Zou Jiadai , Schnell Daniel , Baltas Dimos , Grosu Anca-Ligia , Nicolay Nils H. , Rühle Alexander
Published: April 2024

Purpose

The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy.

Methods

Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3 Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method.

Results

A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2–3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64).

Conclusions

Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.
Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial
Authors: Hassan Halima I. , Kaka Bashir , Bello Fatima , Fatoye Francis , Ibrahim Aminu A.
Published: April 2024

Background

Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage  this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy.

Objectives

To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder.

Methods

This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up.

Discussion

This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice.

Trial Registration: Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.
Short-term and long-term outcomes of on-pump beating-heart coronary artery bypass surgery in dialysis and non-dialysis patients: a retrospective study in a single center
Authors: Lin Chia-Hsun , Chen Yen‐Yang , Yen Yu‐Tong , Kao Patrick Hung‐Ju , Chua Chai-Hock , Chao Hung-Hsing , Lu Ming-Jen
Published: April 2024

Background

This study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG).

Methods

We retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed.

Results

After 1:1 matching, dialysis patients had significantly longer length of stay (14 (11–18) vs. 12 (10–15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups.

Conclusions

OPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.
Clinical validation of a capnodynamic method for measuring end-expiratory lung volume in critically ill patients
Authors: Sanchez Giralt J. A. , Tusman G. , Wallin M. , Hallback M. , Perez Lucendo A. , Sanchez Galindo M. , Abad Santamaria B. , Paz Calzada E. , Garcia Garcia P. , Rodriguez Huerta D. , Canabal Berlanga A. , Suarez-Sipmann Fernando
Published: April 2024

Rationale

End-expiratory lung volume (EELV) is reduced in mechanically ventilated patients, especially in pathologic conditions. The resulting heterogeneous distribution of ventilation increases the risk for ventilation induced lung injury. Clinical measurement of EELV however, remains difficult.

Objective

Validation of a novel continuous capnodynamic method based on expired carbon dioxide (CO2) kinetics for measuring EELV in mechanically ventilated critically-ill patients.

Methods

Prospective study of mechanically ventilated patients scheduled for a diagnostic computed tomography exploration. Comparisons were made between absolute and corrected EELVCO2 values, the latter accounting for the amount of CO2 dissolved in lung tissue, with the reference EELV measured by computed tomography (EELVCT). Uncorrected and corrected EELVCO2 was compared with total CT volume (density compartments between − 1000 and 0 Hounsfield units (HU) and functional CT volume, including density compartments of − 1000 to − 200HU eliminating regions of increased shunt. We used comparative statistics including correlations and measurement of accuracy and precision by the Bland Altman method.

Measurements and main results

Of the 46 patients included in the final analysis, 25 had a diagnosis of ARDS (24 of which COVID-19). Both EELVCT and EELVCO2 were significantly reduced (39 and 40% respectively) when compared with theoretical values of functional residual capacity (p < 0.0001). Uncorrected EELVCO2 tended to overestimate EELVCT with a correlation r2 0.58; Bias − 285 and limits of agreement (LoA) (+ 513 to − 1083; 95% CI) ml. Agreement improved for the corrected EELVCO2 to a Bias of − 23 and LoA of (+ 763 to − 716; 95% CI) ml. The best agreement of the method was obtained by comparison of corrected EELVCO2 with functional EELVCT with a r2 of 0.59; Bias − 2.75 (+ 755 to − 761; 95% CI) ml. We did not observe major differences in the performance of the method between ARDS (most of them COVID related) and non-ARDS patients.

Conclusion

In this first validation in critically ill patients, the capnodynamic method provided good estimates of both total and functional EELV. Bias improved after correcting EELVCO2 for extra-alveolar CO2 content when compared with CT estimated volume. If confirmed in further validations EELVCO2 may become an attractive monitoring option for continuously monitor EELV in critically ill mechanically ventilated patients.

Trial registration: clinicaltrials.gov (NCT04045262).
Relationship between lactate-to-albumin ratio and 28-day mortality in patients with exacerbation of chronic obstructive pulmonary disease admitted to the Intensive Care Unit
Authors: Xie Jun , Liu Hui , He Qian , Li Chong
Published: April 2024

Aim

To explore the predictive value of lactate-to-albumin ratio (LAR) on 28-day mortality in patients with exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to the Intensive Care Unit (ICU).

Methods

According to ICD-9 and ICD-10 diagnosis codes, patients diagnosed with AECOPD in the Medical Information Mart for Intensive Care IV (v.2.2) database were selected. The primary endpoint was 28-day mortality after ICU admission. We used receiver operating characteristic (ROC) curve, Kaplan–Meier (K–M) survival curve, logistic regression analyses and subgroup analysis to assess predictive power of LAR.

Results

606 patients were included in this study. The 28-day mortality was 29.7%. The area under the ROC curves (AUC) for LAR were 0.641 [95% confidence interval (CI) 0.592–0.689], which was comparable with OASIS (AUC: 0.662; 95% CI 0.616–0.709; p = 0.471) and SOFA (AUC: 0.660; 95% CI 0.612–0.708; p = 0.500). The cutoff value of LAR was 0.645 by ROC curve. The high-LAR group showed a bad prognosis in K–M analysis (p < 0.001). Multivariate logistic regression shown that LAR was significantly associated with a poor outcome (odds ratio: 1.77; 95% CI 1.16–2.71; p = 0.008). Subgroup analysis showed no significant interaction of LAR with each subgroup (p for interaction: 0.175–0.775).

Conclusion

LAR is a rational and easily accessible marker, which is remarkably associated with 28-day mortality in ICU patients with AECOPD.
Acceptability and feasibility of FAMS-T1D mHealth intervention to optimize self- and social regulation for emerging adults with type 1 diabetes
Authors: Mayberry Lindsay S. , Wiebe Deborah J. , Parks Makenzie , Campbell MaryJane S. , Beam Aislinn B. , Berg Cynthia A.
Published: April 2024

Background

Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D are unknown.

Methods

Therefore, we adapted FAMS for in a new disease context and developmental stage and then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%), and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c).

Results

Recruitment rates indicate recruitment of emerging adults with T1D (n = 30) and their support persons (n = 20) is feasible — 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context.

Conclusions

Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for an evaluative trial examining effects on self-regulation (self-efficacy, self-management), social regulation (family/friend involvement), and outcomes (diabetes distress, A1c).

Trial registration

We did not register this study on ClinicalTrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes, and that trial will be registered accordingly.
Bio-efficacy of Olyset® Plus, PermaNet® 3.0 and Interceptor® G2 on pyrethroid-resistant populations of Anopheles gambiae s.l. prior to the June 2023 net distribution campaign in Benin, West Africa
Authors: Zoungbédji David Mahouton , Padonou Germain Gil , Sovi Arthur , Konkon Alphonse Keller , Salako Albert Sourou , Azondékon Roseric , Sidick Aboubakar , Ahouandjinou Juvénal Minassou , Towakinou Linda , Ossè Razaki , Aïkpon Rock , Affoukou Cyriaque , Baba-Moussa Lamine , Akogbéto Martin
Published: April 2024

Background

This study investigates the effectiveness of new-generation mosquito nets, like Olyset® Plus and PermaNet® 3.0, and dual-action nets such as Interceptor® G2, against pyrethroid-resistant Anopheles gambiae mosquitoes following the 2023 mass distribution of long-lasting insecticidal nets in Benin.

Methods

We tested wild mosquito populations from six communes in Benin against various pyrethroid (permethrin 0.75%, alphacypermethrin 0.05%, and deltamethrin 0.05%) using WHO tube tests. Additionally, we exposed mosquitoes to chlorfenapyr 100 µg/ml using the CDC bottle bioassay method. A subset of mosquitoes underwent biochemical and PCR tests to check the overexpression of metabolic enzymes and the Kdr L1014F mutation. We evaluated the effectiveness of Olyset® Plus, PermaNet® 3.0, and Interceptor® G2 nets using cone and tunnel tests on both laboratory and field populations of An. gambiae.

Results

Overall, the highest mortality rate was 60% with pyrethroid and 98 to100% with chlorfenapyr. In cone tests, all three types of nets induced mortality rates above 80% in the susceptible laboratory strain of An. gambiae. Notably, Olyset® Plus showed the highest mortality rates for pyrethroid-resistant mosquitoes in cone tests, ranging from 81.03% (95% CI: 68.59–90.13) in Djougou to 96.08% (95% CI: 86.54–99.52) in Akpro-Missérété. PermaNet® 3.0 had variable rates, from 42.5% (95% CI: 27.04–59.11) in Djougou to 58.54% (95% CI: 42.11–73.68) in Porto-Novo. However, revealed good results for Interceptor® G2, with 94% (95% CI: 87.40–97.77) mortality and 89.09% blood sampling inhibition in local populations of An. gambiae. In comparison, Interceptor® had lower rates of 17% (95% CI: 10.23–25.82) and 60%, respectively.

Conclusion

These results suggest that tunnel tests are effective for evaluating dual-active ingredient nets. Additionally, Interceptor® G2 and PBO nets like Olyset® Plus could be considered as alternatives against pyrethroid-resistant mosquitoes.
Stroboscopy and acoustic analysis of voice following endotracheal intubation in otological surgeries
Authors: K. Gowthame , S. Prasanna Kumar , Samuel John
Published: April 2024

Background

Stroboscopy is an endoscopy that is performed with intermittent light at a frequency that approximates the frequency of a moving object so that it appears in slow motion or motionless. It is used to analyze the structure and motion of the vocal fold.

Aim and objective

To compare the stroboscopic findings of various vocal parameters such as symmetry, amplitude, periodicity, mucosal wave of vocal folds, and glottis closure before and after elective endotracheal intubation and to compare acoustic analysis of voice using fundamental frequency, intensity, maximum phonation time, and dysphonia severity index in patients before and after elective intubation, who were undergoing otological surgeries. It also assesses the correlation between changes in these vocal and acoustic parameters and the size of the endotracheal tube, duration of intubation, and number of attempts made during intubation. This study creates awareness and provides insights to avoid intubation-related vocal fold injury.

Methods

This was a prospective cohort study involving 31 patients done in a Tertiary Care Centre. All patients who underwent otological surgeries by elective endotracheal intubation were included. All of them underwent stroboscopic and acoustic evaluation preoperatively, 24 h, and 7 days postoperatively.

Results

Statistically significant changes in mucosal wave pattern score were observed in the 1st postoperative day that reverted to normal by the end of 7th postoperative day and in GRBAS which was significant at the end of both 1st and 7th POD. Other parameters like fundamental frequency, intensity, DSI, MPT, amplitude, symmetry, periodicity, and glottis closure remain unaltered. There was a moderate positive correlation between the duration of intubation (minutes) and mucosal wave 1st POD (P-value: 0.003).

Conclusion

The majority of the patients (61%) had normal laryngeal structures. A total of 39% had evidence of injury, the most common being right vocal fold hemorrhage improved by the end of 7th postoperative day and became normal.
Prevalence and clinical correlates of suicide attempts in patients with first-episode drug-naïve major depressive disorder and comorbid autoimmune thyroiditis
Authors: Luo Yinli , Zhou Yanan , Peng Pu , Yuan Ning , Zhang Xiangyang
Published: April 2024

Background

Autoimmune thyroiditis is closely associated with major depressive disorder (MDD) and suicide attempts. However, few studies have examined this relationship.

Aims

The study aimed to assess the prevalence and correlates of suicide attempts in patients with first-episode drug-naïve (FEDN) MDD and autoimmune thyroiditis.

Method

We recruited 1718 out-patients with FEDN MDD and assessed depressive, anxiety and psychotic symptoms with the Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety (HRSA) and Positive and Negative Syndrome Subscale positive subscale, respectively. The serum levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), antithyroglobulin, thyroid peroxidase antibody (TPOAb) and several other metabolic parameters were assessed. Patients were divided into non-autoimmune thyroiditis, autoimmune thyroiditis only and autoimmune thyroiditis with abnormal TSH groups, based on autoimmune thyroiditis severity. Multiple logistic regression model was applied to identify the correlates of suicide attempts in patients with MDD and autoimmune thyroiditis with abnormal TSH.

Results

Compared with the non-autoimmune thyroiditis group, the autoimmune thyroiditis with abnormal TSH group had a nearly fourfold higher likelihood of reporting a suicide attempt, whereas no difference was found between the non-autoimmune thyroiditis and autoimmune thyroiditis only groups. HRSA score, lnTPOAb and lnTSH were independently associated with suicide attempts in patients with autoimmune thyroiditis with abnormal TSH.

Conclusions

Patients with MDD and autoimmune thyroiditis with abnormal TSH are at higher risk for suicide attempt. TPOAb, TSH and anxiety are all independently associated with suicide attempts in this population, and regular thyroid checks are warranted.
Scalp Nerve Block Alleviates Headaches Associated With Sonication During Transcranial Magnetic Resonance–Guided Focused Ultrasound
Authors: Kadowaki Makoto , Sugiyama Kenji , Nozaki Takao , Yamasaki Tomohiro , Namba Hiroki , Shimizu Mikihiro , Kurozumi Kazuhiko
Published: April 2024

BACKGROUND AND OBJECTIVES:

In magnetic resonance–guided focused ultrasound (MRgFUS) procedures, headache is a frequent symptom and cause of treatment discontinuation. Herein, we assessed the efficacy of scalp nerve block (SNB) for alleviating headache during MRgFUS procedures.

METHODS:

The effect of SNB on intraprocedural headache was examined by retrospectively comparing 2 patient cohorts at a single institution. During the study period from April 2020 to February 2022, an SNB protocol for all patients with a skull density ratio ≤0.55 was instituted on October 6, 2021. The number of patients with a skull density ratio ≤0.55 was 34 before the protocol and 36 afterward. Headache intensity was evaluated using a numerical rating scale (NRS) after each sonication. To evaluate the effect of SNB on headache intensity, multiple regression analysis was performed per patient and per sonication. In the per-patient analysis, the effect of SNB was evaluated using the maximum NRS, mean NRS, and NRS at the first ultrasound exposure that reached 52.5°C. In the per-sonication analysis, the effect of SNB was evaluated not only for the entire sonication but also for sonications classified into ≤9999 J, 10 000 to 29 999 J, and ≥30 000 J energy doses.

RESULTS:

With SNB, headache alleviation was observed in the NRS after the first sonication that reached 52.5°C in each patient (β = −2.40, 95% CI −4.05 to −0.758, P = .00499), in the NRS when all sonications were evaluated (β = −0.647, 95% CI −1.19 to −0.106, P = .0201), and in the NRS when all sonications were classified into 10 000 to 29 999 J (β = −1.83, 95% CI −3.17 to −0.485, P = .00889).

CONCLUSION:

SNB significantly reduced headache intensity during MRgFUS, especially that caused by sonication with a moderate-energy dose. These findings suggest that scalp nerves play a role in headache mechanisms during MRgFUS.
Evidence for Simultaneous Muscle Atrophy and Hypertrophy in Response to Resistance Training in Humans
Authors: VAN VOSSEL KIM , HARDEEL JULIE , VAN DER STEDE THIBAUX , COOLS TOM , VANDECAUTER JONAS , VANHAECKE LYNN , BOONE JAN , BLEMKER SILVIA SALINAS , LIEVENS ELINE , DERAVE WIM
Published: April 2024

Purpose

Human skeletal muscle has the profound ability to hypertrophy in response to resistance training (RT). However, this has a high energy and protein cost and is presumably mainly restricted to recruited muscles. It remains largely unknown what happens with nonrecruited muscles during RT. This study investigated the volume changes of 17 recruited and 13 nonrecruited muscles during a 10-wk single-joint RT program targeting upper arm and upper leg musculature.

Methods

Muscle volume changes were measured by manual or automatic 3D segmentation in 21 RT novices. Subjects ate ad libitum during the study and energy and protein intake were assessed by self-reported diaries.

Results

Posttraining, all recruited muscles increased in volume (range: +2.2% to +17.7%, P < 0.05), whereas the nonrecruited adductor magnus (mean: −1.5% ± 3.1%, P = 0.038) and soleus (−2.4% ± 2.3%, P = 0.0004) decreased in volume. Net muscle growth (r = 0.453, P = 0.045) and changes in adductor magnus volume (r = 0.450, P = 0.047) were positively associated with protein intake. Changes in total nonrecruited muscle volume (r = 0.469, P = 0.037), adductor magnus (r = 0.640, P = 0.002), adductor longus (r = 0.465, P = 0.039), and soleus muscle volume (r = 0.481, P = 0.032) were positively related to energy intake. When subjects were divided into a HIGH or LOW energy intake group, overall nonrecruited muscle volume (−1.7% ± 2.0%), adductor longus (−5.6% ± 3.7%), adductor magnus (−2.8% ± 2.4%), and soleus volume (−3.7% ± 1.8%) decreased significantly (P < 0.05) in the LOW but not the HIGH group.

Conclusions

To our knowledge, this is the first study documenting that some nonrecruited muscles significantly atrophy during a period of RT. Our data therefore suggest muscle mass reallocation, that is, that hypertrophy in recruited muscles takes place at the expense of atrophy in nonrecruited muscles, especially when energy and protein availability are limited.
Household Labor Supply and the Value of Social Security Survivors Benefits
Authors: Coyne David , Fadlon Itzik , Ramnath Shanthi P. , Tong Patricia K.
Published: April 2024

We combine quasi-experimental variation in spousal death and age eligibility for survivors benefits using US tax records to study the effects on American households’ labor supply and the design of social security’s survivors insurance. Benefit eligibility at the exact age of 60 induces sharp reductions in the labor supply of newly widowed households, highlighting the value of survivors benefits and the liquidity they provide following the shock. Among eligible widows, the spousal death event induces no increases in labor supply, suggesting little residual need to self-insure. Using theory, we underscore the program’s protective insurance role and its high valuation among survivors. (JEL D12, D91, G22, G51, H55, J16, J22)