bluuebunny/crossref_metadata_2025 huggingface dataset:
Total Anomalous Pulmonary Venous Connection Repair: Single-Center Outcomes in a Lower-Middle Income Region
Authors: Bayya Praveen Reddy , Varghese Shruti , Jayashankar Jessin Puliparambil , Sudhakar Abish , Balachandran Rakhi , Kottayil Brijesh Parayaru , Srimurugan Balaji , Varma Praveen Kerala , Neema Praveen Kumar , Krishna Kumar R.
Published: June 2022

Background

The management of total anomalous pulmonary venous connection (TAPVC) in neonates and infants is resource-intensive. We describe early and follow-up outcomes after surgical repair of isolated TAPVC at a single institution in a resource-limited setting.

Methods

The data of 316 consecutive patients with isolated TAPVC undergoing repair (January 2010-September 2020) were reviewed. The study setting was a tertiary hospital in southern India that provides subsidized or charitable care. Standard surgical technique was used for repair, circulatory arrest was avoided, and suture-less anastomosis was reserved for small or stenotic pulmonary veins. Surgical and postoperative strategies were directed toward minimizing intensive care unit (ICU) stay.

Results

302 (95.6%) patients were infants and 128 patients (40.5%) were neonates; median weight was 3.3 kg (IQR 2.8-4.0 kg). Obstruction of the TAPVC was seen in 176 patients (56%) and pulmonary hypertension in 278 patients (88%). Seventeen (5.4%) underwent delayed sternal closure. The median postoperative ICU stay was 120 h (IQR 96-192 h), mechanical ventilation was 45 h (IQR 24-82 h), and hospital stay was 13 days (IQR 9-17 days). There were three in-hospital deaths (0.9%). Over a median follow-up period of 53.3 months (IQR 22.9-90.4), pulmonary vein restenosis was seen in 32 patients (10.1%) after a mean of 2.2 months (1-6 months). No perioperative risk factors for restenosis were identified.

Conclusions

Using specific perioperative strategies, it is possible to correct TAPVC with excellent surgical outcomes in low-resource environments. Late pulmonary vein restenosis remains an important complication.
Ten Years of Data Verification: The European Congenital Heart Surgeons Association Congenital Database Audits
Authors: Herbst Claudia , Tobota Zdzislaw , Urganci Erhan , Sarris George , Jacobs Jeffrey P. , Kansy Andrzej , Maruszewski Bohdan
Published: June 2022

Background

Congenital heart surgery databases are tools for internal programmatic evaluation, benchmarking institutional results to multi-institutional aggregate data, and research. Therefore, it is essential to ensure the completeness and accuracy of data. This study analyzes the results of ten years of on-site source data verification of the European Congenital Heart Surgeons Association Congenital Heart Surgery Database (ECHSA CHSD).

Methods

All data forms verified between 2009 and 2018 were analyzed. The data form consists of 12 data elements: dates of birth, admission, surgery, discharge, and death; weight; case category; cardiopulmonary bypass time; aortic cross-clamp time; validation rules; diagnoses; and procedures. Descriptive data calculation and rates of completeness and accuracy were determined. The trend of error rate of seven centers with ≥5 visits was analyzed.

Results

Sixty-nine on-site verification visits took place at 17 centers. A total of 26,245 cases were verified; 2,841 of these 26,245 cases (10.8%) showed an error. The total mean error rate of centers for all years was 12.3 ± 2.1%. Rates of completeness and accuracy were 99% and 89.2%, respectively. Coded diagnoses and procedure analysis revealed that 716 (2.7%) and 456 (1.7%) datasets were incorrect, respectively. Rates of completeness and accuracy of dates were 100%, and 97.1%, respectively. Validation fields showed no errors.

Conclusion

Source data verification is an appropriate tool to determine completeness and accuracy of data. The ECHSA CHSD verification analysis of a ten-year period showed a high level of completeness and accuracy. The verified data of the ECHSA CHSD are well-suited for benchmarking and research.
A Little “Edutainment” Goes a Long Way: Leveraging Among Us®, a Popular Multiplayer Game, to Teach Persuasion Virtually
Authors: Sackett Esther , Amoroso Lisa M.
Published: June 2022

Challenged by COVID-19, we sought ways to increase engagement in the virtual classroom, capitalizing on a popular multiplayer game to teach persuasion to undergraduate students. In the game Among Us ®, players (“Crewmates”) work together to repair their spaceship before it explodes while being attacked by other players (“Impostors”). The structure of the game lends itself to the use of persuasion and influence tactics and provides the basis for a fun, applied learning activity, designed to take 1 hour. We provide detailed instructions for preparing students for the game, running the game, and debriefing. While the constraints resulting from COVID-19 inspired the adoption of this activity for the classroom, we believe it can work well in both virtual and face-to-face classrooms.
Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy
Authors: Prasad Ayush , Kobsa Jessica , Kodali Sreeja , Bartolome David , Begunova Liza , Quispe-Orozco Darko , Farooqui Mudassir , Zevallos Cynthia , Ortega-Gutiérrez Santiago , Anadani Mohammad , Almallouhi Eyad , Spiotta Alejandro M , Giles James A , Keyrouz Salah G , Kim Joon-Tae , Maier Ilko L , Liman Jan , Psychogios Marios-Nikos , Riou-Comte Nolwenn , Richard Sébastien , Gory Benjamin , Quintero Wolfe Stacey , Brown Patrick A , Fargen Kyle M , Mistry Eva A , Fakhri Hiba , Mistry Akshitkumar , Wong Ka-Ho , Nascimento Fábio A , Kan Peter , de Havenon Adam , Sheth Kevin N , Petersen Nils H
Published: June 2022

Introduction:

Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized.

Patients and methods:

We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns.

Results:

Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2–3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT ( p < 0.001).

Discussion and conclusions:

Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.
Lymphocyte-Predominant Esophagitis Rarely Improves With Proton Pump Inhibitor Therapy
Authors: Lee Michelle E. , Ghosh Gaurav , Yantiss Rhonda , Katz Philip O.
Published: June 2022

Lymphocyte-predominant esophagitis (LPE) refines the diagnosis of lymphocytic esophagitis using the criteria of >20 intraepithelial lymphocytes/HPF and excluding those with known causes of secondary lymphocytosis (gastroesophageal reflux disease and motility disorders). The primary aim of this study was to assess response of LPE to treatment. From 2008 to 2019, 62 LPE patients were identified. Demographics, symptoms, endoscopic findings, histology, and treatment responses were reviewed. Only 24% of LPE patients treated with proton pump inhibitors (PPI) reported symptom improvement and only 17% had endoscopic improvement. All LPE patients with autoimmune disease treated with steroids had symptom improvement and resolution of LPE. In this retrospective series LPE was frequently associated with autoimmune disease, and had limited response to PPIs but frequent response to steroids and/or treatment of the underlying disease.
From the shabars of the Indian Sundarbans: Everyday empirics through photography
Authors: Bandyopadhyay Aishik , Ghosh Raktima , Mukherjee Jenia , Pathak Souradip
Published: June 2022

Predominantly built upon collective practices and complex relations among different actors, the dried fish organizations of the Indian Sundarbans present everyday narratives of lives, experiences and challenges that are shaped by vulnerable social and ecological architecture of the region. This photo essay is a representation of practices, processes and situational complexities inherent in the dried fish camps – or shabars, as they are known in the Bengali dialect – the photos carving out ‘storylines’ focusing on the socially, culturally and historically induced interactions among people, place and entities of the evolving delta.
Lecture, Online, Flipped, and Blended: A Mixed-Methods Study on Ultrasound Student Outcomes and Perceptions
Authors: Custer Tanya , Wampler Kathryn , Lambing Lea , Sayles Harlan , Michael Kim
Published: June 2022

Objective:

The purpose of this study was to examine the effects of course delivery methods on examination grades and student perceptions in a sonography course.

Materials and Methods:

The participant included all sonography students (n = 103), enrolled at a Midwestern university, during the academic years (AY) of 2010–2021. A retrospective, convergent mixed-methods design was used to collect and analyze data, related to the course delivery method.

Results:

The highest overall mean examination score and course satisfaction rating resulted from the blended learning format and the lowest mean examination scores and course satisfaction resulted from the flipped learning format.

Conclusion:

Health professions students are a diverse group of learners. Pedagogical practices should include course design and delivery methods which educate all learners. Courses that balance both face-to-face learning with opportunities for self-directed learning improve student satisfaction which could lead to improved student outcomes and provide the foundation for students to become competent health care professionals.
ISM1 suppresses LPS-induced acute lung injury and post-injury lung fibrosis in mice
Authors: Nguyen Ngan , Xu Simin , Lam Terence Yin Weng , Liao Wupeng , Wong W. S. Fred , Ge Ruowen
Published: June 2022

Background

Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) are clinical syndromes characterized by acute lung inflammation, pulmonary edema and hypoxemia, with up to 50% mortality rate without effective pharmacological therapy. Following the acute inflammation, repair and remodeling occurs which in some cases resulting in lung fibrosis. The pathophysiology of ALI/ARDS remains incompletely understood. Lipopolysaccharide (LPS)-induced ALI in mice have been widely used as a model to study human ALI/ARDS. Isthmin 1 (ISM1) is a secreted protein highly abundant in mouse lung. We have previously reported that upon intratracheal LPS instillation, ISM1 expression in the lung is further upregulated. Recently, we also reported that ISM1 is an anti-inflammatory protein in the lung with Ism1-/- mice presenting spontaneous chronic low-grade lung inflammation and obvious emphysema at young adult stage. However, what role ISM1 plays in ALI/ARDS and lung fibrosis remain unclear.

Methods

Using Ism1-/- mice and intratracheal LPS-induced ALI, and local delivery of recombinant ISM1 (rISM1), we investigated the role ISM1 plays in ALI and post-ALI lung fibrosis using flow cytometry, Western blot, antibody array, immunohistochemistry (IHC), immunofluorescent and other histological staining.

Results

We reveal that ISM1 deficiency in mice led to an intensified acute lung inflammation upon intratracheal LPS challenge, with a heightened leukocyte infiltration including neutrophils and monocyte-derived alveolar macrophages, as well as upregulation of multiple pro-inflammatory cytokines/chemokines including tumor necrosis factor α (TNF-α). Although innate immune cells largely subsided to the baseline by day 7 post-LPS challenge in both wild-type and Ism1−/− mice, Ism1−/− lung showed increased post-ALI fibrosis from day 9 post-LPS treatment with increased myofibroblasts, excessive collagen accumulation and TGF-β upregulation. The heightened lung fibrosis remained on day 28 post-LPS. Moreover, intranasal delivered recombinant ISM1 (rISM1) effectively suppressed LPS-induced acute lung inflammation and ALI, and rISM1 suppressed LPS-induced NF-κB activation in cultured mouse alveolar macrophages.

Conclusion

Together with our previous report, this work further established ISM1 as an endogenous anti-inflammation protein in the lung, restraining excessive host inflammatory response to LPS-triggered ALI and suppressing post-ALI lung fibrosis likely through suppressing NF-κB activation and pro-inflammatory cytokine/chemokine production.
An Initial Residual Stress Inference Method by Incorporating Monitoring Data and Mechanism Model
Authors: Wang Shuguo , Li Yingguang , Liu Changqing , Zhao Zhiwei
Published: June 2022

Initial residual stress is the main reason causing machining deformation of the workpiece, which has been deemed as one of the most important aspects of machining quality issues. The inference of the distribution of initial residual stress inside the blank has significant meaning for machining deformation control. Due to the principle error of existing residual stress detection methods, there are still challenges in practical applications. Aiming at the detection problem of the initial residual stress field, an initial residual stress inference method by incorporating monitoring data and mechanism model is proposed in this paper. Monitoring data during machining process is used to represent the macroscopic characterization of the unbalanced residual stress, and the finite element numerical model is used as the mechanism model so as to solve the problem that the analytic mechanism model is difficult to establish; the policy gradient approach is introduced to solve the gradient descent problem of the combination of learning model and mechanism model. Finally, the initial residual stress field is obtained through iterative calculation based on the fusing method of monitoring data and mechanism model. Verification results show that the proposed inference method of initial residual stress field can accurately and effectively reflect the machining deformation in the actual machining process.
Development of a Wearable Upper Limb Rehabilitation Robot Based on Reinforced Soft Pneumatic Actuators
Authors: Chen Xinbo , Zhang Shuai , Cao Kaibin , Wei Chunjie , Zhao Wumian , Yao Jiantao
Published: June 2022

Dyskinesia of the upper limbs caused by stroke, sports injury, or traffic accidents limits the ability to perform the activities of daily living. Besides the necessary medical treatment, correct and scientific rehabilitation training for the injured joint is an important auxiliary means during the treatment of the effected upper limb. Conventional upper-limb rehabilitation robots have some disadvantages, such as a complex structure, poor compliance, high cost, and poor portability. In this study, a novel soft wearable upper limb rehabilitation robot (SWULRR) with reinforced soft pneumatic actuators (RSPAs) that can withstand high pressure and featuring excellent loading characteristics was developed. Driven by RSPAs, this portable SWULRR can perform rehabilitation training of the wrist and elbow joints. In this study, the kinematics of an SWULRR were analyzed, and the force and motion characteristics of RSPA were studied experimentally. The results provide a reference for the development and application of wearable upper limb rehabilitation robots. An experimental study on the rotation angle of the wrist and the pressure of the RSPA was conducted to test the effect of the rehabilitation training and verify the rationality of the theoretical model. The process of wrist rehabilitation training was tested and evaluated, indicating that SWULRR with RSPAs will enhance the flexibility, comfort, and safety of rehabilitation training. This work is expected to promote the development of wearable upper-limb rehabilitation robots based on modular reinforced soft pneumatic actuators.
Identification and expression analysis of GARP superfamily genes in response to nitrogen and phosphorus stress in Spirodela polyrhiza
Authors: Zhao Xuyao , Yang Jingjing , Li Xiaozhe , Li Gaojie , Sun Zuoliang , Chen Yan , Chen Yimeng , Xia Manli , Li Yixian , Yao Lunguang , Hou Hongwei
Published: June 2022

Background

GARP transcription factors perform critical roles in plant development and response to environmental stimulus, especially in the phosphorus (P) and nitrogen (N) sensing and uptake. Spirodela polyrhiza (giant duckweed) is widely used for phytoremediation and biomass production due to its rapid growth and efficient N and P removal capacities. However, there has not yet been a comprehensive analysis of the GRAP gene family in S. polyrhiza.

Results

We conducted a comprehensive study of GRAP superfamily genes in S. polyrhiza. First, we investigated 35 SpGARP genes which have been classified into three groups based on their gene structures, conserved motifs, and phylogenetic relationship. Then, we identified the duplication events, performed the synteny analysis, and calculated the Ka/Ks ratio in these SpGARP genes. The regulatory and co-expression networks of SpGARPs were further constructed using cis-acting element analysis and weighted correlation network analysis (WGCNA). Finally, the expression pattern of SpGARP genes were analyzed using RNA-seq data and qRT-PCR, and several NIGT1 transcription factors were found to be involved in both N and P starvation responses.

Conclusions

The study provides insight into the evolution and function of GARP superfamily in S. polyrhiza, and lays the foundation for the further functional verification of SpGARP genes.
Real-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: a prospective, randomized, superiority trial
Authors: Pakpirom Jatuporn , Thatsanapornsathit Kanthida , Kovitwanawong Nalinee , Petsakul Suttasinee , Benjhawaleemas Pannawit , Narunart Kwanruthai , Boonchuduang Somrutai , Karmakar Manoj Kumar
Published: June 2022

Background

Thoracic epidural placement (TEP) using the conventional anatomic landmark-based technique is technically challenging, may require multiple attempts, and is associated with a high failure rate (12–40%). We hypothesized that real-time ultrasound guidance would be superior in the “first-pass” success rate of TEP, when compared with the conventional technique.

Methods

This prospective, randomized, superiority trial was conducted in a University hospital, and recruited 96 patients undergoing elective major abdominal or thoracic surgery and scheduled to receive a TEP for postoperative analgesia. Patients were randomly allocated to receive TEP using either the conventional technique (Gp-Conv, n = 48) or real-time ultrasound guidance (Gp-Usg, n = 48). The success of TEP was defined as eliciting loss of resistance technique and being able to insert the epidural catheter. The primary outcome variable was the “first-pass success rate” meaning the successful TEP at the first needle insertion without redirection or readvancement of the Tuohy needle. The secondary outcomes included the number of skin punctures, number of attempts, the overall success rate, TEP time, and total procedure time.

Results

The first-pass success rate of TEP was significantly higher (p = 0.002) in Gp-Usg (33/48 (68.8%); 95%CI 55.6 to 81.9) than in Gp-Conv (17/48 (35.4%); 95%CI 21.9 to 49.0). There was no statistically significant difference (p = 0.12) in the overall success rate of TEP between the 2 study groups (Gp-Usg; 48/48 (100%) vs. Gp-Conv; 44/48 (91.7%); 95%CI 83.9 to 99.5). Ultrasound guidance reduced the median number of skin punctures (Gp-Usg; 1 [1, 1] vs Gp-Conv; 2 [1, 2.2], p < 0.001) and attempts at TEP (Gp-Usg; 1 [1, 2] vs Gp-Conv; 3 [1, 7.2], p < 0.001) but the procedure took longer to perform (Gp-Usg; 15.5 [14, 20] min vs Gp-Conv; 10 [7, 14] min, p < 0.001).

Conclusions

This study indicates that real-time ultrasound guidance is superior to a conventional anatomic landmark-based technique for first-pass success during TEP although it is achieved at the expense of a marginally longer total procedure time. Future research is warranted to evaluate the role of real-time ultrasound guidance for TEP in other groups of patients.

Trial registration

Thai Clinical Trials Registry; http://www.thaiclinicaltrials.org/; Trial ID: TCTR20200522002, Registration date: 22/05/2020.
Prognostic value of plasma level of superoxide dismutase in HBV-related acute-on-chronic liver failure
Authors: Yao Naijuan , He Yajuan , Wu Yuchao , Wang Fei , Tian Zhen
Published: June 2022

Background

Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is the most prevalent type of ACLF in China. The mortality rate of HBV-ACLF has decreased in recent years due to advances in treatment therapies; however, it is still above 50%. Many cases of HBV-ACLF are caused by HBV reactivation due to discontinuation of nucleoside analog treatment. The present study focused on plasma levels of superoxide dismutase (SOD) in HBV-ACLF patients and investigated whether the plasma level of SOD is a useful biomarker in assessing disease severity and predicting outcomes of HBV-ACLF patients, including patients treated with Entecavir (ETV) and patients who were withdrawn from ETV treatment.

Methods

Plasma samples and clinical data from 200 HBV-ACLF patients and from age- and sex-matched cirrhotic and healthy controls were collected and analyzed. Plasma levels of SOD were measured using an ELISA commercial kit.

Results

Among the HBV-ACLF patients, in the ETV withdrawal group, the mortality rate was higher than in the ETV group (69.95% vs 46.71%, P < 0.05). Moreover, HBV-DNA and SOD plasma levels were higher in the ETV withdrawal group than in the ETV group (Log10(HBV-DNA): 6.49 ± 0.24 vs 4.79 ± 0.14, P < 0.01; SOD: 463.1 ± 27.61 U/mL vs 397.2 ± 10.97 U/mL, P < 0.05). The mortality and liver transplantation rates were significantly higher in HBV-ACLF patients with plasma levels of SOD > 428 U/mL than in patients with plasma SOD levels ≤ 428 U/mL.

Conclusions

Reactivation of HBV and elevated oxidative stress caused by discontinuation of ETV treatment are crucial factors in the pathogenesis of HBV-ACLF. Plasma level of SOD may serve as a useful biomarker in estimating disease severity and predicting outcomes of HBV-ACLF patients who stop ETV treatment.
Comparison of factors influencing fall recurrence in the young-old and old-old: a cross-sectional nationwide study in South Korea
Authors: Kim Mi Young , Kim Yujeong
Published: June 2022

Background

Recurrent falls are a concerning problem in the elderly. Elderly people aged > 65 years who are prone to fall often require medical treatment for severe fall-related injuries, which is associated with a substantial financial burden. Therefore, this study aimed to identify factors related to recurrent falls in the community-dwelling young-old (65–74 years old) and old-old (≥ 75 years) in South Korea.

Methods

This study used a cross-sectional, correlation design. Data from the 2017 National Survey of Older Koreans were used, and 5,838 young-old and 4,205 old-old elderly people were included in the analysis. The questionnaire included general characteristics, fall experience, physical status, mental status, and presence of chronic diseases. The data were analyzed using the chi-square test, one-way analysis of variance, and logistic regression analysis.

Results

In the young-old elderly people, limitations in activities of daily living (p < .001), use of visual aids (p = .002), cognitive function (p < .001), presence of suicidal ideations (p = .005), number of chronic diseases (p < .001), and number of prescribed medications used (p = .006) associated with fall recurrence. In the old-old elderly people, having a spouse (p = .034), being a beneficiary of the National Basic Livelihood Security System (p = .025), less exercise (p = .003), limitations in activities of daily living (p < .001), visual aid use (p = .002), presence of suicidal ideations (p = .015), number of chronic diseases (p < .001), and presence of Parkinson's disease (p < .001) associated with fall recurrence.

Conclusions

This study identified differences in factors related to fall recurrence between the young-old and old-old elderly. The results of this study indicate that it is necessary to implement an intervention program to prevent fall recurrence by age group in consideration of the risk factors for fall recurrence in each elderly people group.
Prescribing Alzheimer’s Disease treatments by provider type and geographic region: a comparison among physicians, nurse practitioners, and physician assistants
Authors: Park Jenny Y. , Veenstra David L. , Wallick Christopher J. , Marcum Zachary A.
Published: June 2022

Background

The estimated increase in Alzheimer’s Disease (AD) caseload may present a logistical challenge to the US healthcare system. While nurse practitioners (NPs) and physician assistants (PAs) are increasingly delivering primary care to patients with chronic diseases, the nature of their prescribing of AD medications is largely unknown. The primary objective of this study was to compare the prescribing of AD medications across provider types (physician, NP, and PA) and geographic regions.

Methods

We conducted a retrospective cohort study using IBM MarketScan® commercial and Medicare supplemental claims to examine unique AD prescriptions prescribed between January 1, 2016, and December 31, 2019. Parallel analysis of prescriptions for another geriatric condition, osteoporosis (OP), was also conducted for comparison.

Results

A total of 103,067 AD prescriptions and 131,773 OP prescriptions were included in analyses. Physicians prescribed most AD prescriptions (95.65%), followed by NPs (3.37%) and PAs (0.98%). Small differences were identified among individual AD medications prescribed by physicians compared to NP/PAs. NPs/PAs prescribed a significantly higher proportion of AD prescriptions in rural as compared to urban areas (z = 0.023, 95%CI [0.018, 0.028]).

Conclusion

Minimal variation exists in AD prescribing among physicians, NPs, and PAs, but NPs/PAs prescribe more AD prescriptions in rural areas. NPs/PAs, especially in rural areas, may play critical roles in alleviating projected workforce constraints. Further research assessing AD care, health outcomes, and costs by provider type and region is necessary to better guide healthcare workforce planning for AD care.
Residents’ perspectives of mobile X-ray services in support of healthcare-in-place in residential aged care facilities: a qualitative study
Authors: Dollard Joanne , Edwards Jane , Yadav Lalit , Gaget Virginie , Tivey David , Inacio Maria , Maddern Guy , Visvanathan Renuka
Published: June 2022

Background

Mobile X-ray services (MXS) could be used to investigate clinical issues in aged care residents within familiar surroundings, reducing transfers to and from emergency departments and enabling healthcare to be delivered in residential aged care facilities. There is however little research exploring consumer perspectives about such services. The objective of this research was to explore the perspectives and preferences of residents about the provision of MXS in residential aged care facilities, including their knowledge about the service, perceived benefits, and factors that require consideration for effective implementation.

Methods

A qualitative study design was used. The setting for the study included four residential aged care facilities of different sizes from different parts of a South Australian city. Purposive sampling was used to recruit participants. 16 residents participated in semi-structured interviews that were audio-recorded and transcribed verbatim. Data were inductively derived using thematic analysis.

Results

Participants had a mean age of 85 years, 56% were female, 25% had dementia and 25% had had a mobile X-ray in the last 12 months. Four themes were developed. Participants preferred mobile X-rays, provided as healthcare-in-place, to improve accessibility to them and minimize physical and psychological discomfort. Participants had expectations about the processes for receiving mobile X-rays. Costs of X-rays to people, family and society were a consideration. Decision making required residents be informed about mobile X-rays.

Conclusions

Residents have positive views of MXS as they can receive healthcare-in-place, with familiar people and surroundings. They emphasised that MXS delivered in residential aged care facilities need to be of equivalent quality to those found in other settings. Increased awareness of mobile X-ray services is required.
Comorbidities and COVID-19 status influence the survival rate of geriatric patients in intensive care units: a prospective cohort study from the Indonesian Society of Anaesthesiology and Intensive Therapy
Authors: Rehatta Nancy Margarita , Chandra Susilo , Sari Djayanti , Lestari Mayang Indah , Senapathi Tjokorda Gde Agung , Nurdin Haizah , Wirabuana Belindo , Pramodana Bintang , Pradhana Adinda Putra , Isngadi Isngadi , Anggraeni Novita , Sikumbang Kenanga Marwan , Halimi Radian Ahmad , Jasa Zafrullah Khany , Nasution Akhyar Hamonangan , Mochamat Mochamat , Purwoko Purwoko
Published: June 2022

Background

With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting.

Methods

We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis.

Results

We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p < 0.005). Based on linear correlation analysis, the more comorbidities the geriatric patients in the ICU had, the higher chance of mortality in 30 days (p < 0.005, R coefficient 0.22).

Conclusion

Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.
Measurement of epicardial adipose tissue using non-contrast routine chest-CT: a consideration of threshold adjustment for fatty attenuation
Authors: Yin Lekang , Yan Cheng , Yang Chun , Dong Hao , Xu Shijie , Li Chenwei , Zeng Mengsu
Published: June 2022

Background

Epicardial adipose tissue (EAT) is known as an important imaging indicator for cardiovascular risk stratification. The present study aimed to determine whether the EAT volume (EV) and mean EAT attenuation (mEA) measured by non-contrast routine chest CT (RCCT) could be more consistent with those measured by coronary CT angiography (CCTA) by adjusting the threshold of fatty attenuation.

Methods

In total, 83 subjects who simultaneously underwent CCTA and RCCT were enrolled. EV and mEA were quantified by CCTA using a threshold of (N30) (− 190 HU, − 30 HU) as a reference and measured by RCCT using thresholds of N30, N40 (− 190 HU, − 40 HU), and N45 (− 190 HU, − 45 HU). The correlation and agreement of EAT metrics between the two imaging modalities and differences between patients with coronary plaques (plaque ( +)) and without plaques (plaque ( −)) were analyzed.

Results

EV obtained from RCCT showed very strong correlation with the reference (r = 0.974, 0.976, 0.972 (N30, N40, N45), P < 0.001), whereas mEA showed a moderate correlation (r = 0.516, 0.500, 0.477 (N30, N40, N45), P < 0.001). Threshold adjustment was able to reduce the bias of EV, while increase the bias of mEA. Data obtained by CCTA and RCCT both demonstrated a significantly larger EV in the plaque ( +) group than in the plaque ( −) group (P < 0.05). A significant difference in mEA was shown only by RCCT using a threshold of N30 (plaque ( +) vs ( −): − 80.0 ± 4.4 HU vs − 78.0 ± 4.0 HU, P = 0.030). The mEA measured on RCCT using threshold of N40 and N45 showed no significant statistical difference between the two groups (P = 0.092 and 0.075), which was consistent with the result obtained on CCTA (P = 0.204).

Conclusion

Applying more negative threshold, the consistency of EV measurements between the two techniques improves and a consistent result can be obtained when comparing EF measurements between groups, although the bias of mEA increases. Threshold adjustment is necessary when measuring EF with non-contrast RCCT.
Prognostic importance of systemic inflammation and insulin resistance in patients with cancer: a prospective multicenter study
Authors: Ruan Guo-Tian , Xie Hai-Lun , Gong Yi-Zhen , Ge Yi-Zhong , Zhang Qi , Wang Zi-Wen , Zhang Xi , Zhang He-Yang , Tang Meng , Song Meng-Meng , Zhang Xiao-Wei , Yang Ming , Chen Yong-Bing , Yu Kai-Ying , Deng Li , Wang Kun-Hua , Cong Ming-Hua , Shi Han-Ping
Published: June 2022

Background

Systemic inflammation and insulin resistance (IR) are often associated with poor prognosis in cancer. This study aimed to investigate the prognostic value of surrogate systemic inflammation and IR indices in patients with cancer.

Methods

This multicenter prospective study included 5,221 patients with cancer, with a mean age of 59.41±11.15 years, of whom 3,061 (58.6%) were male. The surrogate IR indices included low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LHR) ratio, total cholesterol to high-density lipoprotein cholesterol (TC/ HDL-c) ratio, triglyceride to high-density lipoprotein cholesterol (TG/HDL-c) ratio, and fasting triglyceride glucose (TyG). Prognostic receiver operator characteristic (ROC) curves and C-indices were used to select a better surrogate IR index in patients with cancer. The prognostic value of the indicators was evaluated using univariate and multivariate survival analyses.

Results

In this study, the median survival time of patients was 44.5 (40.5–51.4) months, and the overall mortality in the 12-month period was 1,115 (53.7%), with 196 mortality events per 1,000 patient-years of patients’ follow-up. The prognostic ROC curve and C-index suggested that the prognostic value of LHR was better than that of the other IR indices. The multivariate-adjusted hazard ratios (HRs) for overall survival (OS) were higher in patients with high C-reactive protein (CRP) (HR, 1.51; 95% confidence interval [CI]: 1.38–1.65) and high LHR (HR, 1.20; 95% CI: 1.06–1.37), respectively. The mortality rate of patients with both high CRP and LHR was 1.75-fold higher than that of patients with both low CRP and LHR.

Conclusion

Both CRP and LHR showed good survival predictions in patients with cancer. CRP combined with LHR can improve the predictive power of patients with cancer.
Isolated central nervous system relapses in patients with high-risk neuroblastoma -clinical presentation and prognosis: experience of the Polish Paediatric Solid Tumours Study Group
Authors: Wieczorek Aleksandra , Stefanowicz Joanna , Hennig Marcin , Adamkiewicz-Drozynska Elzbieta , Stypinska Marzena , Dembowska-Baginska Bozenna , Gamrot Zuzanna , Woszczyk Mariola , Geisler Julia , Szczepanski Tomasz , Skoczen Szymon , Ussowicz Marek , Pogorzala Monika , Janczar Szymon , Balwierz Walentyna
Published: June 2022

Although isolated central nervous system (CNS) relapses are rare, they may become a serious clinical problem in intensively treated patients with high-risk neuroblastoma (NBL). The aim of this study is the presentation and assessment of the incidence and clinical course of isolated CNS relapses. Retrospective analysis involved 848 NBL patients treated from 2001 to 2019 at 8 centres of the Polish Paediatric Solid Tumours Study Group (PPSTSG). Group characteristics at diagnosis, treatment and patterns of relapse were analysed. Observation was completed in December 2020. We analysed 286 high risk patients, including 16 infants. Isolated CNS relapse, defined as the presence of a tumour in brain parenchyma or leptomeningeal involvement, was found in 13 patients (4.5%; 8.4% of all relapses), all of whom were stage 4 at diagnosis. Isolated CNS relapses seem to be more common in young patients with stage 4 MYCN amplified NBL, and in this group they may occur early during first line therapy. The only or the first symptom may be bleeding into the CNS, especially in younger children, even without a clear relapse picture on imaging, or the relapse may be clinically asymptomatic and found during routine screening. Although the incidence of isolated CNS relapses is not statistically significantly higher in patients after immunotherapy, their occurrence should be carefully monitored, especially in intensively treated infants, with potential disruption of the brain-blood barrier.
Assessment of preoperative axillary nodal disease burden: breast MRI in locally advanced breast cancer before, during and after neoadjuvant endocrine therapy
Authors: Reis Joana , Boavida Joao , Tran Hang T. , Lyngra Marianne , Reitsma Laurens Cornelus , Schandiz Hossein , Melles Woldegabriel A. , Gjesdal Kjell-Inge , Geisler Jürgen , Geitung Jonn Terje
Published: June 2022

Background

Axillary lymph node (LN) metastasis is one of the most important predictors of recurrence and survival in breast cancer, and accurate assessment of LN involvement is crucial. Determining extent of residual disease is key for surgical planning after neoadjuvant therapy. The aim of the study was to evaluate the diagnostic reliability of MRI for nodal disease in locally advanced breast cancer patients treated with neoadjuvant endocrine therapy (NET).

Methods

Thirty-three clinically node-positive locally advanced breast cancer patients who underwent NET and surgery were prospectively enrolled. Two radiologists reviewed the axillary nodes at 3 separate time points MRI examinations at baseline (before the first treatment regimen), interim (following at least 2 months after the first cycle and prior to crossing-over), and preoperative (after the final administration of therapy and immediately before surgery). According to LN status after surgery, imaging features and diagnostic performance were analyzed.

Results

All 33 patients had a target LN reduction, the greatest treatment benefit from week 8 to week 16.

There was a positive correlation between the maximal diameter of the most suspicious LN measured by MRI and pathology during and after NET, being highest at therapy completion (r = 0.6, P ≤ .001). Mean and median differences of maximal diameter of the most suspicious LN were higher with MRI than with pathology. Seven of 33 patients demonstrated normal posttreatment MRI nodal status (yrN0). Of these 7 yrN0, 3 exhibited no metastasis on final pathology (ypN0), 2 ypN1 and 2 ypN2. Reciprocally, MRI diagnosed 3 cases of ypN0 as yrN + . Diffusion -weighted imaging (DWI) was the only axillary node characteristic significant when associated with pathological node status (χ2(4) = 8.118, P = .072).

Conclusion

Performance characteristics of MRI were not completely sufficient to preclude surgical axillary staging. To our knowledge, this is the first study on MRI LN assessment following NET in locally advanced breast cancer, and further studies with larger sample sizes are required to consolidate the results of this preliminary study.

Trial Registration

Institutional Review Board approval was obtained (this current manuscript is from a prospective, open-label, randomized single-center cohort substudy of the NEOLETEXE trial). NEOLETEXE, a phase 2 clinical trial, was registered on March 23rd, 2015 in the National trial database of Norway and approved by the Regional Ethical Committee of the South-Eastern Health Region in Norway; registration number: REK-SØ-84–2015.
Perception of worry of harm from air pollution: results from the Health Information National Trends Survey (HINTS)
Authors: Ammons Samantha , Aja Hayley , Ghazarian Armen A. , Lai Gabriel Y. , Ellison Gary L.
Published: June 2022

Background

Air pollution exposure has been associated with a multitude of diseases and poses a significant concern to public health. For targeted environmental risk communication and interventions to be effective, it is important to correctly identify characteristics associated with worry of harm from air pollution.

Methods

Using responses from 3,630 participants of the Health Information National Trends Survey 4 Cycle 2, we assessed worry of harm from exposure to indoor (IAP) and outdoor (OAP) air pollution separately. Multinomial logistic regression models were used to calculate odds ratios and 95% confidence intervals.

Results

Hispanics were more likely to worry about harm from IAP and OAP compared to non-Hispanic whites. Participants who lived in metropolitan counties were more likely to worry about harm from IAP and OAP compared to those who lived in rural counties. Finally, those who believed their chance of getting cancer was high were more likely to worry about harm from IAP and OAP compared to those who thought their likelihood of getting cancer was low.

Conclusions

Worry of harm from IAP and OAP varied across sociodemographic and cancer-related characteristics. Public health professionals should consider these characteristics when developing targeted environmental risk communication and interventions.
Spatial clustering of heroin-related overdose incidents: a case study in Cincinnati, Ohio
Authors: Choi Jung Im , Lee Jinha , Yeh Arthur B. , Lan Qizhen , Kang Hyojung
Published: June 2022

Background

Drug overdose is one of the top leading causes of accidental death in the U.S., largely due to the opioid epidemic. Although the opioid epidemic is a nationwide issue, it has not affected the nation uniformly.

Methods

We combined multiple data sources, including emergency medical service response, American Community Survey data, and health facilities datasets to analyze distributions of heroin-related overdose incidents in Cincinnati, Ohio at the census block group level. The Ripley’s K function and the local Moran’s I statistics were performed to examine geographic variation patterns in heroin-related overdose incidents within the study area. Then, conditional cluster maps were plotted to examine a relationship between heroin-related incident rates and sociodemographic characteristics of areas as well as the resources for opioid use disorder treatment.

Results

The global spatial analysis indicated that there was a clustered pattern of heroin-related overdose incident rates at every distance across the study area. The univariate local spatial analysis identified 7 hot spot clusters, 27 cold spot clusters, and 1 outlier cluster. Conditional cluster maps showed characteristics of neighborhoods with high heroin overdose rates, such as a higher crime rate, a high percentage of the male, a high poverty level, a lower education level, and a lower income level. The hot spots in the Southwest areas of Cincinnati had longer distances to opioid treatment programs and buprenorphine prescribing physicians than the median, while the hot spots in the South-Central areas of the city had shorter distances to those health resources.

Conclusions

Our study showed that the opioid epidemic disproportionately affected Cincinnati. Multi-phased spatial clustering models based on various data sources can be useful to identify areas that require more policy attention and targeted interventions to alleviate high heroin-related overdose rates.
Water pipe smoking among public versus private university students in Ankara, Turkey: an online survey
Authors: Caner Asena , Özcebe Hilal
Published: June 2022

Background

Water pipe smoking has become a global public health problem as its popularity increased over time, especially among youth. The objective of our study was to estimate water pipe tobacco smoking prevalence and to assess socioeconomic factors associated with ever water pipe smoking by public and private university students in Ankara, Turkey.

Methods

This descriptive study was based on a survey conducted among public (n=2685) and private (n=2485) university students via an online questionnaire on demographics and water pipe consumption patterns. For every student in the sample, a socioeconomic status index was calculated using principal component analysis. Binary logistic regressions for the outcome variable of ever-using water pipe yielded estimates of adjusted odds ratios (aORs) for the associated factors such as the respondent’s age, gender, university type, and socioeconomic status.

Results

The prevalence of ever use of water pipe was 69.1% (95% CI: 67.2-70.9%) among private and 59.1% (95% CI: 57.2-60.9%) among public university students. A substantial share of ever users were current users (25.5% in private versus 21.6% in public, p=0.008). On average, private university students had higher socioeconomic status than public university students (for example, access to a car (51.7% versus 35.8%, p=0.008), financial support from family (71.5% versus 65.1%, p<0.001)), also demonstrated by a higher socioeconomic status index. Being a private university student (aOR 1.57, 95% CI: 1.38-1.79), older (aORs 1.50 to 2.39, p<0.001), male (aOR 2.36, 95% CI:2.06-2.70), as well as having greater financial resources, such as having access to a car (aOR 1.24, 95% CI:1.07-1.42), or having income support from family (aOR 1.32, 95% CI:1.13-1.54), were associated with ever-using water pipe. A higher SES index was significantly associated with higher odds of ever using water pipe among both private (aOR 1.13, 95% CI:1.06,1.20) and public university (aOR 1.12, 95% CI:1.06,1.19) students.

Conclusions

Water pipe smoking was common in both public and private universities; however, private university students had higher odds of ever using water pipe. There is an urgent need to implement evidence-based interventions, taking into account the socioeconomic status of young adults, to prevent them from water pipe smoking.