bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensitivity analyses in longitudinal clinical trials via distributional imputation
Authors: Liu Siyi , Yang Shu , Zhang Yilong , Liu Guanghan (Frank)
Published: November 2022

Missing data is inevitable in longitudinal clinical trials. Conventionally, the missing at random assumption is assumed to handle missingness, which however is unverifiable empirically. Thus, sensitivity analyses are critically important to assess the robustness of the study conclusions against untestable assumptions. Toward this end, regulatory agencies and the pharmaceutical industry use sensitivity models such as return-to-baseline, control-based, and washout imputation, following the ICH E9(R1) guidance. Multiple imputation is popular in sensitivity analyses; however, it may be inefficient and result in an unsatisfying interval estimation by Rubin’s combining rule. We propose distributional imputation in sensitivity analysis, which imputes each missing value by samples from its target imputation model given the observed data. Drawn on the idea of Monte Carlo integration, the distributional imputation estimator solves the mean estimating equations of the imputed dataset. It is fully efficient with theoretical guarantees. Moreover, we propose weighted bootstrap to obtain a consistent variance estimator, taking into account the variabilities due to model parameter estimation and target parameter estimation. The superiority of the distributional imputation framework is validated in the simulation study and an antidepressant longitudinal clinical trial.
Acellular Vascular Scaffolds Preloaded With Heparin and Hepatocyte Growth Factor for Small-Diameter Vascular Grafts Might Inhibit Intimal Hyperplasia
Authors: Cai Zhiwen , Tan Zhengli , Tian Ran , Chen Xin , Miao Peng , Yao Chenliang , Wang Cong , Yu Zhengya , Gu Yongquan
Published: November 2022

To develop small-diameter (<6 mm) scaffolds capable of accelerating rapid endothelialization and improving long-term patency rate, we created acellular vascular scaffolds preloaded with heparin and hepatocyte growth factor (HGF). Heparin was conjugated to suppress thrombogenic responses, and HGF was immobilized to induce endothelial cells (ECs) proliferation and migration. The scaffolds immobilized with heparin exhibited highly effective localization and sustained release of HGF for 30 days in vitro. We implanted this modified scaffold into the carotid artery of a rabbit model to investigate the efficacy in vivo. The acellular vascular scaffold with heparin only was used as control. After transplantation, the patency of this modified scaffold was 91.67% at 1, 3, 6, and 12 months, while the patency rate in the group with grafted heparin only was 83.33% at 1, 3, 6, and 12 months. This modified scaffold significantly stimulated ECs proliferation and the endothelium aligned in the direction of flow after 12 months. In addition, intimal hyperplasia was significantly reduced in the grafts coated with HGF compared with the control grafts. The small-diameter vascular grafts with an inner diameter of 2.5 mm preloaded with heparin and HGF may be a substitute for autologous blood vessels in clinic.
Quantifying consultations to medical specialties during psychiatric inpatient admissions in a Queensland tertiary hospital
Authors: Holland Carissa , Hudson-Jessop Pamela
Published: November 2022

Objectives

To identify and characterise medical consultations to psychiatric inpatients.

Method

Retrospective cross-sectional descriptive study of 451 psychiatric inpatients’ electronic medical records between 1 January and 30 June 2021 with descriptive statistics.

Results

Thirty one percent ( n = 131) of inpatients required medical consultation, with 382 total consultations including ward call. Half (57.9%) were telephone advice. Main consulting specialties were general medicine (25%), anaesthetics (12%), neurology (9.9%), cardiology (6.5%) and endocrinology (6.2%). Almost all (99.0%) consultations resulted in documented management plans.

Conclusions

This is the first Australian descriptive study quantifying and characterising psychiatric inpatient consultation requests. Physical and psychiatric healthcare integration requires ongoing efforts, including improved referral pathways.
An Adlerian-Based Narrative Inquiry of Temporal Awareness, Resilience, and Patient-Centeredness Among Emergency Physicians—The Gyroscope Model
Authors: Gabay Gillie , Ben-Asher Smadar
Published: November 2022

Introduction

Although extensive research examined time perceptions among patients in the emergency department (ED), studies on temporal awareness among emergency physicians is scant. Salutogenics is the theoretical anchor.

Methods

The sample comprised ten emergency resident physicians from an Israeli public tertiary hospital. Narrative interviews were conducted. To determine the theme of the study, Adlerian narrative analysis was performed. To identify categories, semantic and content analyses were performed.

Results

Adlerian narrative analysis highlighted temporal awareness as a strong theme across interviews. Semantic and content analyses identified categories within temporal awareness. Analyses revealed a movement among three subcategories: A clinical task in which physicians rapidly shift along seven distinct times, temporal awareness shaping their work experience, and temporal awareness as inhibiting or enabling relationships with patients. Data-analyses identified two groups of physicians, one group driven by the need to control the time to avoid errors, experiencing anxiety and poor wellbeing, and the other, shifting from clinical tasks to patient-centeredness while removing the time factor from their considerations and experiencing resilience through manageability and meaningfulness. We introduce the “gyroscope model” for physicians to illustrate these findings and propose recommendations for practice.

Discussion

Understanding the complexity of the temporal continuum and the influence of shifting from the clinical task to relationships with patients may contribute to resilience of resident physician in the ED and to their self-efficacy, enriching their professional skills and capacity to cope and grow while facing the complexity of the ED
Mercaptopurine induced myelosuppression in a child with a NUDT15 rs116855232 homozygous variant
Authors: Gupta Navya , Magatha Latha Sneha , Jayaraman Dhaarani , Scott Julius Xavier , Antony Sharon Benita , Koshy Teena
Published: November 2022

Introduction

Mercaptopurine (6-MP) is the backbone of the consolidation and maintenance therapy for paediatric acute lymphoblastic leukaemia (ALL). Nevertheless, it can cause critical myelosuppression. Predicting adverse reactions to 6-MP often involves the investigation of pharmacogenetic variants; in particular thiopurine S-methyltransferase ( TPMT) and nudix hydrolase 15 ( NUDT15). Lately, NUDT15 variants have been shown to play a significant pharmacogenetic role in predicting 6-MP intolerance in children of Asian descent.

Case Report

We present a six-year-old male child of Indian origin with persistent cytopenia after treatment. This prompted targeted sequencing of the genes TPMT and NUD15. The results revealed two copies of the variant of NUD15 rs116855232, that is, NUDT15*2 genotype.

Management and Outcome

Since the NUDT15*2 allele classified the patient as a poor metabolizer, he was restarted on a low dose of 6-MP, which he tolerated.

Discussion

Individuals with the NUDT15*2allele (*2/*2 genotype) are poor metabolizers of thiopurines which results in an adverse reaction to 6-MP. About 3.5% of Indians show variations in the TPMT gene as compared to 19.4% variations observed in NUDT15, which makes the latter a more reliable disease marker.
A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource?
Authors: Thanapholsart Jenjiratchaya , Khan Ehsan , Lee Geraldine A.
Published: November 2022

Background

There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients.

Method

A systematic search was conducted.

Result

Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated.

Conclusion

The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.
Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews
Authors: Fricke Julie , Siddique Shazia Mehmood , Douma Caryn , Ladak Alicia , Burchill Christian N. , Greysen Ryan , Mull Nikhil K.
Published: November 2022

Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses’ Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews ( n = 33) were grouped into five main categories: violence toward nurses ( n = 10); violence toward healthcare workers in general ( n = 8); violence in the emergency department ( n = 5); violence related to mental health ( n = 5); and measurement related to workplace violence ( n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.
Initial Single-Center Experience With the Knickerbocker Technique During Thoracic Endovascular Aortic Repair to Block Retrograde False Lumen Flow in Patients With Type B Aortic Dissection
Authors: de Beaufort Hector Willem Livius , Vos Jan Albert , Heijmen Robin H.
Published: November 2022

Objective:

Effectiveness of thoracic endovascular aortic repair in type B aortic dissection is impaired by persistent retrograde false lumen flow via distal re-entry tears. Controlled, stentgraft-assisted balloon dilatation of the true lumen at its lower end, or Knickerbocker technique, may block retrograde false lumen flow and consequently improve effectiveness by inducing immediate thrombosis along the entire descending thoracic aorta.

Materials and Methods:

A single-center retrospective analysis was performed for all consecutive patients with aortic dissection treated with the Knickerbocker technique to block retrograde false lumen flow.

Results:

Eleven patients were included for analysis. Intraoperative control angiography showed successful occlusion of the false lumen at the level of balloon dilatation in 9 out of 11 patients (82%). There was one perioperative mortality (9%), due to stroke. There were 2 early reinterventions, due to retroperitoneal bleeding and due to chyle leakage in the neck after left subclavian artery bypass. Median clinical follow-up duration was 6 (interquartile range [IQR] 2–11] months. There were 2 deaths during follow-up, one at 2 months after TEVAR from unknown cause of death, and one after 11 months due to rupture of an ascending aortic pseudoaneurysm. The Knickerbocker technique led to positive aortic remodeling. At 3 months follow-up, 100% of patients showed complete false lumen thrombosis in the thoracic aorta proximal to the level of balloon dilatation, with decreasing false lumen diameters (100%) and stable (44%) or decreasing (56%) total aortic diameters. In most patients, the false lumen distal to the stentgraft (i.e. at visceral level) remained patent (11% false lumen thrombosis rate), leading to ≥2 mm dilatation at this level (78% of patients) and in the infrarenal abdominal aorta (56% of patients) at 3 months postoperatively. No distal stent-graft-induced new entry tears were noticed during follow-up.

Conclusion:

The Knickerbocker technique is feasible and effective, leading to positive aortic remodeling of the aorta covered by stentgraft in all of a small cohort of patients.

Clinical Impact

Persistent, retrograde false lumen perfusion from distal re-entries following thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection, may lead to progressive, aneurysmal dilatation. Controlled, stent graft-assisted balloon dilatation of the true lumen in the distal descending aorta (i.e. Knickerbocker technique) during TEVAR effectively excludes the false lumen from persistent flow resulting in positive aortic remodeling in our small cohort of patients, and hence potentially eliminates the risk of late post-dissection aneurysm formation in the descending thoracic aorta.
The EEG Features of Four Cases of Subacute Sclerosing Panencephalitis in North China: SSPE EEG Features
Authors: Wang Jiang-Tao , Han Jie , Wang Ming-Guang , Hou Xiao-Hua , Gao Zai-Fen , Zhang Yan-Feng , Liang Jian-Min
Published: November 2022

Objective. To analyze the EEG features of four subacute sclerosing panencephalitis cases in North China. Methods. We retrospectively analyzed the EEG features in four patients with subacute sclerosing panencephalitis and 12 patients in control group from North China. Results. The periodic long-interval diffuse discharges were found in all of the four cases with subacute sclerosing panencephalitis. The morphology and component of periodic complexes were varied in different patients and different wakefulness states. Some EEG parameter settings help to identify periodic long-interval diffuse discharges including the slowed sweep speed, decreased sensitivity and reduced number of montages. In each patient with subacute sclerosing panencephalitis, the periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period were found and none of the patients in the control group had this EEG pattern. The score system based on the periodic discharges and brief episodes also shows that all the patients with SSPE reached score 5 while none of the patients in the control group has a score greater than 3, which suggests that this EEG pattern may have diagnostic value. Conclusions. In subacute sclerosing panencephalitis, the morphology and component of periodic long-interval diffuse discharges were varied in different patients and different wakefulness states. Specific EEG parameter settings help to identify periodic long-interval diffuse discharges. Periodic long-interval diffuse discharges associated with two types of brief episodes (1:1) during awake period may strongly suggest the diagnosis of subacute sclerosing panencephalitis.
Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review
Authors: Ward Leona , Mercer Nathaniel P. , Azam Mohammad T. , Hoberman Alexander , Hurley Eoghan T. , Butler James J. , Ubillus Hugo , Cronin Joseph , Kennedy John G.
Published: November 2022

Background

Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of EPFR in the treatment of plantar fasciitis at mid-term and long-term follow-up.

Methods

A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated regarding level of evidence (LOE) and quality of evidence (QOE) using the modified Coleman methodological score. Clinical outcomes and complications were also evaluated.

Results

Twenty-six studies including 978 feet were included in this systematic review with a weighted mean follow-up of 25.6 ± 21.0 months. Eighteen papers used the American Orthopaedic Foot and Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.66 ± 10.3, and the postoperative score was 89.6 ± 5.2 out of 100. The total number of patients who had complications was 88 of 994 (8.9%). The most common complication was recurrence of pain experienced by 41 patients (4.2%).

Conclusion

Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate (8.9%) and should only be considered following failure of conservative management. Future prospective studies comparing the various endoscopic and open techniques with nonoperative treatment are required to elucidate the most effective management for recalcitrant plantar fasciitis.

Levels of Evidence:

Level I: Systematic review of level IV studies
The political economy of bordering and the reproduction of borders in the case of Frontex
Authors: Winkler Dominik
Published: November 2022

The EU-border agency Frontex is one of the main actors involved in the bordering of the EU. Its practice reaches from the deployment of border police and equipment to the production of knowledge about the border and migration. Departing from a critical analysis of the documentaries "Frontex – Einsatz gegen Flüchtlinge – Festung Europa" (2013) and “Die Frontex-Recherche: Eine EU-Agentur und der Umgang mit Menschenrechtsverletzungen” (2019) on Frontex, this article examines the mutual interrelations of discursive and material bordering. Based on a combined reading of Laclau's work on difference and Mezzadra and Neilsons concept of borders as tools of structuring social reality through difference, the reproduction of the border is discussed. The border becomes the place where the border is enacted and reproduced on a material and discursive level. This practice of bordering is rooted in a reproduction of capital and of racist imaginations of refugees.
Analysis of CRSsNP Proteome Using a Highly Multiplexed Approach in Nasal Mucus
Authors: Pesold Vanessa-Vivien , Wendler Olaf , Morgenthaler Lisa , Gröhn Franziska , Mueller Sarina K.
Published: November 2022

Background

Chronic rhinosinusitis without nasal polyps (CRSsNP) represents a phenotype of CRS, whose immunological mechanisms are still unclear. So far there are neither suitable biomarkers to determine the course of the disease nor an individual therapy.

Objective

The purpose of this study was to characterize the CRSsNP endotype by identifying and validating non-invasive proteomic biomarkers.

Methods

A highly-multiplexed proteomic array consisting of antibodies against 2000 proteins was used to identify proteins that are differentially expressed in the nasal mucus of the CRSsNP and control groups (n = 7 per group). The proteins identified to be most differentially expressed were validated in matched nasal mucus samples using western blots and enzyme-linked immunosorbent assay (ELISA). Validation was also done in a second cohort using western blots (CRSsNP n = 25, control n = 23) and ELISA (n = 30 per group). Additionally, immunohistochemistry in CRSsNP and control tissue samples was performed to characterize the selected proteins further.

Results

Out of the 2000 proteins examined, 7 from the most differentially expressed proteins were chosen to be validated. The validation results showed that 4 proteins were significantly upregulated in CRSsNP mucus, including macrophage inflammatory protein-1beta (MIP-1β), resistin, high mobility group box 1 (HMGB1), and forkhead box protein 3 (FOXP3). Cartilage acidic protein 1 (CRTAC1) was not significantly upregulated. Two proteins were significantly downregulated including scavenger receptor class F member 2 (SCARF2) and P-selectin. All proteins selected are mainly associated with inflammation, cell proliferation/differentiation, apoptosis and cell–cell or cell–matrix interaction.

Conclusion

Proteomic analysis of CRSsNP and control mucus has confirmed known and revealed novel disease-associated proteins that could potentially serve as a new biosignature for CRSsNP. Analysis of the associated pathways will specify endotypes of CRSsNP and will lead to an improved understanding of the pathophysiology of CRSsNP. Furthermore, our data contribute to the development of a reproducible, non-invasive, and quantitative “liquid biopsy” for rhinosinusitis.
The Incidence, Characteristics and Outcomes of Vertebral Artery Injury Associated with Cervical Spine Trauma: A Systematic Review
Authors: Temperley Hugo C. , McDonnell Jake M. , O’Sullivan Niall J. , Waters Caitlin , Cunniffe Gráinne , Darwish Stacey , Butler Joseph S.
Published: November 2022

Study design

Systematic Review

Objectives

Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical suspicion is paramount. The purpose of this review is to elucidate incidence, diagnosis, treatment and outcomes of VAI associated with cervical spine injuries.

Methods

A systematic search of electronic databases was performed using ‘PUBMED’, ‘EMBASE’,‘Medline (OVID)’, and ‘Web of Science, for articles pertaining to traumatic cervical fractures with associated VAI.

Results

24 studies were included in this systematic review. Data was included from 48 744 patients. In regards to the demographics of the focus groups that highlighted information on VAI, the mean average age was 46.6 (32.1-62.6). 75.1% (169/225) were male and 24.9% (56/225) were female. Overall incidence of VAI was 596/11 479 (5.19%). 190/420 (45.2%) of patients with VAI had fractures involving the transverse foramina. The right vertebral artery was the most commonly injured 114/234 (48.7%). V3 was the most common section injured (16/36 (44.4%)). Grade I was the most common (103/218 (47.2%)) injury noted. Collective acute hospital mortality rate was 32/226 (14.2%), ranging from 0-26.2% across studies.

Conclusion

VAI secondary to cervical spine trauma has a notable incidence and high associated mortality rates. The current available literature is limited by a low quality of evidence. In order to optimise diagnostic protocols and treatment strategies, in addition to reducing mortality rates associated with VAI, robust quantitative and qualitative studies are needed.
Trends in Multidiscipline Management Research: Past, Present and Future of FIIB Business Review
Authors: Kaurav Rahul Pratap Singh , Gupta Piyush
Published: November 2022

This study aims to guide scholars on emerging research themes and publication trends by reviewing the published intellectual contributions in the FIIB Business Review (FBR)—a multidisciplined management journal since its inception. FBR has been indexed in Scopus and Academic journal guide (AJG) and continues to achieve new heights. This article has used bibliometric analysis of the leading publication themes of the journal between 2011 and 2022. This work uses the Scopus database to find the publication trend and most impactful papers, main themes and keywords of publication, futuristic themes and target ideas for FBR. In 2021, the average citation value for three years was 2.292 compared to 0.778 in 2020. Journal of Business Research, Journal of Marketing and Journal of Finance are the top three most cited journals in FBR. The journal has shown usefulness for scholars mainly related but not limited to strategic management, marketing, organizational behaviour and finance, among others, by contributing to areas like digital transformation, team problems, organizational conflicts, COVID-19 problems, sustainability and financial crises. Areas of future research and limitations are discussed.
Race Lessons: The Role of Place in Shaping Black Parents’ Racial Learning and Educational Engagement in a Predominantly White Suburb
Authors: Posey-Maddox Linn
Published: November 2022

While a large body of literature examines Black parents’ racial socialization, few studies have employed a sociological lens to explore parents’ own racial learning and how it relates to the implicit and explicit messages they send their children. Based on an ethnographic study of Black parents’ experiences and educational engagement in a predominantly white Midwestern suburb, this article uses a racial learning framework to examine how Black parents’ own racialized, place-based experiences relate to the lessons they attempt to teach their children about race and racism. The research reveals that parents’ racial socialization practices were influenced by their own racial learning and experiences in the predominantly white suburban context, their children’s experiences in the local schools, and for some parents, the things they learned with and from other Black families in school and community organizational spaces. The research findings illustrate the importance of understanding Black parents’ own place-based racial learning and how it shapes and informs their efforts to support their children’s wellbeing and academic success, particularly in predominantly white school districts and communities.
The long-term effects of insulin use in incident cystic fibrosis-related diabetes: a target trial emulated using longitudinal national registry data
Authors: Granger Emily , Keogh Ruth H. , Frost Freddy
Published: November 2022

Introduction

Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis and is associated with deleterious clinical outcomes. Insulin is recommended as a treatment by international guidelines. However, there are scarce clinical trial data to support the use of insulin, and little is known about the long-term outcomes of treatment. The aim of this study was to compare the long-term impacts of insulin useversusnon-use in CFRD.

Methods

We used data from the national UK Cystic Fibrosis Registry and adopted a target trial framework. Eligible individuals included those 12 years and older with a new diagnosis of CFRD. Outcomes were change in % predicted forced expiratory volume in 1 s (FEV1%) and body mass index z-scores (BMI) over a 5-year follow-up period. Treatment strategies were to receive insulin or not for the duration of follow-up. Treatment effect estimates were obtained using two methods to control for confounding: inverse-probability-of-treatment weighted estimation of marginal structural models and the G-formula.

Results

We identified 1613 individuals diagnosed with CFRD between 2008 and 2016 and included 1196 and 1192 in the FEV1% and BMI outcome analyses respectively. We found no evidence of an effect of insulin on FEV1% over the 5-year study period. Similarly, we found no overall effect of insulin on BMI; however, there was some evidence for a positive treatment effect in patients with lower baseline BMI.

Conclusion

Using well-established national registry data, we found no evidence of long-term treatment effects for insulin on FEV1% or BMI in people with incident CFRD.
Proposal for a tiered approach to evaluate the risk of transformation products formed from pesticide residues during drinking water treatment
Authors: Michel Amandine , Armbruster Dominic , Benz-Birck Angelika , Deppermann Nina , Doetzer Reinhard , Flörs Markus , Frericks Markus , Li Shanghua , Gebler Sebastian , Schröder Tom , Seitz Wolfram
Published: November 2022

Oxidative treatment methods are valuable tools for the microbial safety of drinking water. However, the reaction of oxidants with natural substances or anthropogenic contaminants present in the raw water can potentially lead to the formation of harmful transformation products (TPs). The present paper proposes a tiered approach for the risk evaluation of TPs formed from pesticide residues during drinking water treatment. First, the concentrations of pesticide residues in raw water used for drinking water production are evaluated (step 1). Substances with a predicted concentration in raw water above 0.1 µg/L proceed further to a reactivity assessment, examining the behavior in water treatment plants (step 2). Using information available in the scientific literature, prediction of structural elements in the TPs can be made and allow a worst-case assessment based on the Threshold of Toxicological Concern (TTC) (step 3). If concerns remain, experiments may be conducted to simulate water treatment (step 4). Because of their complexity and variability, experiments for the simulation of water treatment should focus on prioritized substances of potential concern. The test conditions should be realistic (i.e., close to EU-representative conditions in waterworks) and ozonation and chlorination should be combined with pre- and post-treatment steps, as is normally the case in European waterworks. As a first screening option, we propose to test the toxicity of the reaction mixture. If the treated water shows an enhanced toxicity, further experiments can be conducted to identify and quantify the major TPs (step 5). We propose to define major TPs as substances present at more than 10% of the initially applied test substance. For major TPs, a tiered dietary risk assessment is conducted, starting with the TTC concept, and continuing with toxicity testing of the TP, according to EFSA and ECHA and internationally agreed guidance.
Patient Clinical Outcomes in Standalone Versus a Combined Ophthalmology-rheumatology Uveitis Clinic
Authors: Ross Bing X. , Habhab Samantha , Syeda Sarah , Baiyasi Ahmad , Benchaala Ilyes , Okeagu Chinwenwa , Barbosa Joshua , Im Jacob , Le Kim , Lin Xihui
Published: November 2022

Background

To evaluate uveitis care outcomes in standalone versus a combined ophthalmology-rheumatology clinic.

Methods

Participants were patients aged 18 years and older with a minimum 12-month history of chronic uveitis prior to being referred to the combined uveitis clinic at Kresge Eye Institute and who were treated in the combined clinic for at least 6 months. Best corrected visual acuity (BCVA), objective markers of inflammation, and achieving targeted dose of immunomodulatory therapy (IMT) were compared in the cohort of uveitis patients 6 months prior to and after the initial evaluation in the combined clinic.

Results

Sixty-six percent of study participants were female with a mean age of 51.5 years. BCVA improved from 0.58 logMAR (Snellen: ~20/74) at the initial combined clinic visit to 0.50 logMAR (Snellen: ~20/63) 6 months after the first combined visit (p = 0.0137). The establishment of the combined uveitis clinic led to higher frequency of patients at target dose of IMT: an increase from 49.0% at 6 months prior to the combined visit to 70.1.4% and 79.8% at the initial combined visit and 6 months after the combined visit, respectively.

Conclusion

A combined model of management for chronic uveitis patients wherein rheumatological services are coupled with ophthalmic care leads to improvement in patient clinical outcomes and achieving target therapy.
Unveiling a hotspot of genetic diversity in southern Italy for the endangered Hermann’s tortoise Testudo hermanni
Authors: Chiocchio Andrea , Zampiglia Mauro , Biaggini Marta , Biello Roberto , Di Tizio Luciano , Leonetti Francesco Luigi , Olivieri Oliviero , Sperone Emilio , Trabalza-Marinucci Massimo , Corti Claudia , Canestrelli Daniele
Published: November 2022

Background

Hotspots of intraspecific genetic diversity represent invaluable resources for species to cope with environmental changes, and their identification is increasingly recognized as a major goal of conservation ecology research. However, even for iconic and endangered species, conservation strategies are often planned without thorough information on the geographic patterns of genetic variation. Here, we investigated the spatial patterns of genetic variation of the endangered Hermann’s tortoise Testudo hermanni in the Italian Peninsula by genotyping 174 individuals at 7 microsatellite loci, with the aim to contribute to planning effective conservation strategies.

Results

Ordination-based and Bayesian clustering analyses consistently identified three main genetic clusters, one spread in the central and northern part of the peninsula, and two restricted to southern Italy and Sicily, respectively. The highest levels of genetic diversity were found in populations of the southern cluster and, in particular, at the northern edges of its distribution (He > 0.6, Ar > 2.8 ), that correspond to areas of putative secondary contact and admixture between distinct lineages. Our results clearly identify a hotspot of genetic diversity for the Hermann’s tortoise in southern Italy.

Conclusion

We inferred the evolutionary history and the spatial patterns of genetic variation of the Hermann’s tortoise in the Italian Peninsula. We identified three main genetic clusters along the peninsula and a hotspot of intraspecific diversity in southern Italy. Our results underline the urgent need for conservation actions to warrant the long-term persistence of viable tortoise populations in this area. Furthrmore, these data add further evidence to the role of southern Italy as a biodiversity hotspot for temperate fauna, claiming for higher consideration of this area in large scale conservation programs.
Prevalence of Hepatitis B Virus infection in the Gulf Cooperation Council: a systematic review and meta-analysis
Authors: Alali Ali A. , Abo-Shehada Mahmoud N.
Published: November 2022

Background

Hepatitis B virus (HBV) infection is a global public-health problem. Since the introduction of an effective vaccine, the epidemiology of HBV infection is changing. We aimed to estimate the prevalence of HBV infection in the Gulf Cooperation Council (GCC) region and delineate any variation in member-countries, special sub-groups, and over time.

Methods

This is a systematic review and meta-analysis to review studies of HBV prevalence in the GCC region. Databases were searched and all studies from inception to July 31st, 2021, were considered for inclusion. The pooled HBV prevalence was analyzed using the random-effect model after assessment for heterogeneity. True prevalence was adjusted using the Rogan-Gladen estimator. Pre-defined subgroup analysis was performed, and publication bias was assessed.

Results

Overall, 99 studies (n = 1,944,200 participants) met the inclusion criteria. The overall HBV apparent prevalence was 3.05% (95% CI 2.60, 3.52) and the true prevalence was 1.67% (95% CI 1.66, 1.68). The apparent prevalence varied between subgroups. Over time, the apparent prevalence of HBV infection has declined from 9.38% (95% CI 7.26, 11.74) before 1990 to 1.56% (95% CI 1.07, 2.12) during the period 2010 to 2020.

Conclusion

Over the last four decades the overall prevalence of HBV infection in the GCC region has decreased from high- to low-endemicity level. However, due to poor methodology of the included studies, further high-quality community-based studies are needed to obtain more precise estimate of HBV infection in this region.
Visual outcomes of epiretinal membrane removal after diffractive-type multifocal intraocular lens implantation
Authors: Kim Hyungil , Jeon Sohee
Published: November 2022

Background

To assess visual outcomes of epiretinal membrane (ERM) removal in multifocal intraocular lens (MIOL)-implanted eyes, according to ERM stage.

Methods

Retrospective chart reviews were undertaken in patients with diffractive-type MIOL implants, each undergoing pars plana vitrectomy and ERM removal between February 2018 and November 2020 at Gyeongju St. Mary's Eye Clinic and KEYE Eye Center. Assessments focused on monocular uncorrected and corrected values of distant visual acuity (UDVA and CDVA) and uncorrected near visual acuity (UNVA) at postoperative 12 months according to the stage of ERM.

Results

The present study included a total of 49 MIOL-implanted eyes from 49 enrollees, 25 undergoing pars plana vitrectomy for ERM removal (11 eyes with Stage 2 and 14 eyes with Stage 3), and 24 acting as age-matched controls. There was a significant difference in UDVA and UNVA between control and Stage 3 ERM (UDVA; 0.01 ± 0.04 for control, and 0.07 ± 0.08 for stage 3 ERM, p = 0.035, UNVA; 0.03 ± 0.05 for control, and 0.13 ± 0.16 for Stage 3 ERM, p = 0.029). There were no significant differences in CDVA between groups (p = 0.121, ANOVA test).

Conclusions

Eyes with Stage 3 ERM did not achieve visual acuity comparable to control eyes, suggesting the necessity of an early intervention for ERM in eyes with diffractive type MIOL. A meticulous preoperative retinal evaluation for ERM development is mandatory when planning diffractive-type MIOL implantation.
School water, sanitation, and hygiene (WaSH) intervention to improve malnutrition, dehydration, health literacy, and handwashing: a cluster-randomised controlled trial in Metro Manila, Philippines
Authors: Sangalang Stephanie O. , Lemence Allen Lemuel G. , Ottong Zheina J. , Valencia John Cedrick , Olaguera Mikaela , Canja Rovin James F. , Mariano Shyrill Mae F. , Prado Nelissa O. , Ocaña Roezel Mari Z. , Singson Patricia Andrea A. , Cumagun Ma. Lourdes , Liao Janine , Anglo Maria Vianca Jasmin C. , Borgemeister Christian , Kistemann Thomas
Published: November 2022

Background

The impacts of multicomponent school water, sanitation, and hygiene (WaSH) interventions on children’s health are unclear. We conducted a cluster-randomized controlled trial to test the effects of a school WaSH intervention on children’s malnutrition, dehydration, health literacy (HL), and handwashing (HW) in Metro Manila, Philippines.

Methods

The trial lasted from June 2017 to March 2018 and included children, in grades 5, 6, 7, and 10, from 15 schools. At baseline 756 children were enrolled. Seventy-eight children in two clusters were purposively assigned to the control group (CG); 13 clusters were randomly assigned to one of three intervention groups: low-intensity health education (LIHE; two schools, n = 116 children), medium-intensity health education (MIHE; seven schools, n = 356 children), and high-intensity health education (HIHE; four schools, n = 206 children). The intervention consisted of health education (HE), WaSH policy workshops, provision of hygiene supplies, and WaSH facilities repairs. Outcomes were: height-for-age and body mass index-for-age Z scores (HAZ, BAZ); stunting, undernutrition, overnutrition, dehydration prevalence; HL and HW scores. We used anthropometry to measure children’s physical growth, urine test strips to measure dehydration, questionnaires to measure HL, and observation to measure HW practice. The same measurements were used during baseline and endline. We used multilevel mixed-effects logistic and linear regression models to assess intervention effects.

Results

None of the interventions reduced undernutrition prevalence or improved HAZ, BAZ, or overall HL scores. Low-intensity HE reduced stunting (adjusted odds ratio [aOR] 0.95; 95% CI 0.93 to 0.96), while low- (aOR 0.57; 95% CI 0.34 to 0.96) and high-intensity HE (aOR 0.63; 95% CI 0.42 to 0.93) reduced overnutrition. Medium- (adjusted incidence rate ratio [aIRR] 0.02; 95% CI 0.01 to 0.04) and high-intensity HE (aIRR 0.01; 95% CI 0.00 to 0.16) reduced severe dehydration. Medium- (aOR 3.18; 95% CI 1.34 to 7.55) and high-intensity HE (aOR 3.89; 95% CI 3.74 to 4.05) increased observed HW after using the toilet/urinal.

Conclusion

Increasing the intensity of HE reduced prevalence of stunting, overnutrition, and severe dehydration and increased prevalence of observed HW. Data may be relevant for school WaSH interventions in the Global South. Interventions may have been more effective if adherence was higher, exposure to interventions longer, parents/caregivers were more involved, or household WaSH was addressed.

Trial registration number

DRKS00021623.
Changes in self-reported and accelerometer-measured physical activity among pregnant TRICARE Beneficiaries
Authors: Pebley Kinsey , Farage Gregory , Hare Marion E. , Bursac Zoran , Andres Aline , Chowdhury Sultana Mubarika Rahman , Talcott G. Wayne , Krukowski Rebecca A.
Published: November 2022

Background

Physical activity is recommended for all pregnant individuals and can prevent excessive gestational weight gain. However, physical activity has not been assessed among military personnel and other TRICARE beneficiaries, who experience unique military lifestyles. The current study assessed physical activity among pregnant TRICARE beneficiaries, both active duty and non-active duty, as measured by accelerometry and self-report data to examine potential predictors of physical activity engagement in the third trimester, and if self-report data was consistent with accelerometry data. We expected having a lower BMI, being active-duty, and having higher baseline physical activity engagement to be associated with higher physical activity at 32-weeks. We also hypothesized that accelerometry data would show lower physical activity levels than the self-reported measure.

Methods

Participants were 430 TRICARE adult beneficiaries (204 Active Duty; 226 non-Active Duty) in San Antonio, TX who were part of a randomized controlled parent study that implemented a stepped-care behavioral intervention. Participants were recruited if they were less than 12-weeks gestation and did not have health conditions precluding dietary or physical activity changes (e.g., uncontrolled cardiovascular conditions) or would contribute to weight changes. Participants completed self-report measures and wore an Actical Activity Monitor accelerometer on their wrist to collect physical activity data at baseline and 32-weeks gestation.

Results

Based on the accelerometer data, 99% of participants were meeting moderate physical activity guidelines recommending 150 min of moderate activity per week at baseline, and 96% were meeting this recommendation at 32-weeks. Based on self-report data, 88% of participants at baseline and 92% at 32-weeks met moderate physical activity recommendations. Linear regression and zero-inflated negative binomial models indicated that baseline physical activity engagement predicted moderate physical activity later in pregnancy above and beyond BMI and military status. Surprisingly, self-reported data, but not accelerometer data, showed that higher baseline activity was associated with decreased vigorous activity at 32-weeks gestation. Additionally, self-report and accelerometry data had small correlations at baseline, but not at 32-weeks.

Conclusions

Future intervention efforts may benefit from intervening with individuals with lower pre-pregnancy activity levels, as those who are active seem to continue this habit.

Trial Registration

The trial is registered on clinicaltrials.gov (NCT 03057808).
Prognostic factors in the treatment of gastric mucosal atypical hyperplasia by endoscopic submucosal dissection
Authors: Hong Yongping , Chen Xingxing , Li Guofeng
Published: November 2022

Background

Endoscopic submucosal dissection (ESD) is becoming increasingly popular as a treatment for precancerous lesions and early cancers of the stomach. However, there have been few studies on the factors associated with the recurrence of precancerous lesions after ESD.

Methods

To investigate the prognostic factors of gastric intraepithelial neoplasia, we retrospectively analyzed 115 patients who were treated with ESD between February 2018 and January 2020. Chi-square test and Fisher’s extract test were used to select factors for further investigation, and prognostic analysis was carried out with the Kaplan–Meier method and a Cox regression model.

Results

Platelet counts (P = 0.027) and albumin levels (P = 0.011) were both lower in patients with recurrence than in patients without recurrence of gastric mucosal atypical hyperplasia after ESD.

Conclusions

This study reveals that low platelet counts and albumin levels were probably unfavorable prognostic factors in mucosal atypical hyperplasia of the stomach.
Challenges and opportunities for general practice specific CME in Europe – a narrative review of seven countries
Authors: Löffler Christin , Altiner Attila , Blumenthal Sandra , Bruno Pascale , De Sutter An , De Vos Bart J. , Dinant Geert-Jan , Duerden Martin , Dunais Brigitte , Egidi Günther , Gibis Bernhard , Melbye Hasse , Rouquier Frederic , Rosemann Thomas , Touboul-Lundgren Pia , Feldmeier Gregor
Published: November 2022

Background

Several changes have led to general practitioners (GPs) working in a more differentiated setting today and being supported by other health professions. As practice changes, primary care specific continuing medical education (CME) may also need to adapt. By comparing different primary care specific CME approaches for GPs across Europe, we aim at identifying challenges and opportunities for future development.

Methods

Narrative review assessing, analysing and comparing CME programs for general practitioners across different north-western European countries (UK, Norway, the Netherlands, Belgium (Flanders), Germany, Switzerland, and France). Templates containing detailed items across seven dimensions of country-specific CME were developed and used. These dimensions are role of primary care within the health system, legal regulations regarding CME, published aims of CME, actual content of CME, operationalisation, funding and sponsorship, and evaluation.

Results

General practice specific CME in the countries under consideration are presented and comparatively analysed based on the dimensions defined in advance. This shows that each of the countries examined has different strengths and weaknesses. A clear pioneer cannot be identified. Nevertheless, numerous impulses for optimising future GP training systems can be derived from the examples presented.

Conclusions

Independent of country specific CME programs several fields of potential action were identified: the development of curriculum objectives for GPs, the promotion of innovative teaching and learning formats, the use of synergies in specialist GP training and CME, the creation of accessible yet comprehensive learning platforms, the establishment of clear rules for sponsorship, the development of new financing models, the promotion of fair competition between CME providers, and scientifically based evaluation.