bluuebunny/crossref_metadata_2025 huggingface dataset:
Representations of Naya Pakistan: A corpus-based study of Pakistani media discourses
Authors: Afzaal Muhammad , Naqvi Swaleha Bano , Raees Gul Rukh
Published: June 2022

The study investigates how Pakistani media discourses represented the populist political rhetoric of Pakistan Tehreek-e-Insaaf (PTI) between 2016 and 2018. Applying the theoretical lens of corpus-based critical discourse analysis to a specially constructed corpus, the study examines how PTI's populist political rhetoric was co-opted by the media to garner public support for it prior to the 2018 elections and then to criticize its performance following electoral victory. The selected corpus comprised news, articles, and headlines published in English newspapers between 2016 and 2018. Based on the analysis, the study identifies linguistic devices and strategies in the media discourses covering PTI's run-up to the elections and ascent to power. It also sheds light on the types of populism exercised by the media in depicting political messages to move from promotion of PTI's vision and rhetoric to critique of its perceived post-election failure to fulfil its promises. Concordance lines and collocation analysis furnish evidence of a shift in the media discourses from pre-election optimism and ideological valorization of the PTI agenda to failure and loss of hope in the PTI government following its assumption of leadership.
Association of Early and Late Hospital Readmissions with a Novel Housing-Based Socioeconomic Measure
Authors: Zurek Kaitlyn I. , Boswell Christopher L. , E. Miller Nathanial , L. Pecina Jennifer , D. Decker Matthew , I. Wi Chung , Garrison Gregory M.
Published: June 2022

Background

While socioeconomic status has been linked to hospital readmissions for several conditions, reliable measures of individual socioeconomic status are often not available. HOUSES, a new measure of individual socioeconomic status based upon objective public data about one's housing unit, is inversely associated with overall hospitalization rate but it has not been studied with respect to readmissions.

Purpose

To determine if patients in the lowest HOUSES quartile are more likely to be readmitted within 30 days (short-term) and 180 days (long-term).

Methods

A retrospective cohort study of 11 993 patients having 21 633 admissions was conducted using generalized linear mixed-effects models.

Results

HOUSES quartile did not show any significant association with early readmission. However, when compared to the lowest HOUSES quartile, the second quartile (OR = 0.90, 95%CI 0.83-0.98) and the third quartile (OR = 0.91, 95%CI 0.83-0.99) were associated with lower odds of late readmission while the highest quartile (OR = 0.91, 95%CI 0.82-1.01) was not statistically different.

Conclusion

HOUSES was associated with late readmission, but not early readmission. This may be because early readmissions are influenced by medical conditions and hospital care while late readmissions are influenced by ambulatory care and home-based factors. Since HOUSES relies on public county assessor data, it is generally available and may be used to focus interventions on those at highest risk for late readmission.
Anchoring IgG-degrading enzymes to the surface of platelets selectively neutralizes antiplatelet antibodies
Authors: Lynch Donald R. , Stringham Emily N. , Zhang Boya , Balbin-Cuesta Ginette , Curtis Brian R. , Palumbo Joseph S. , Greineder Colin F. , Tourdot Benjamin E.
Published: June 2022

Immune thrombocytopenia (ITP) is an acquired bleeding disorder characterized by immunoglobulin G (IgG)–mediated platelet destruction. Current therapies primarily focus on reducing antiplatelet antibodies using immunosuppression or increasing platelet production with thrombopoietin mimetics. However, there are no universally safe and effective treatments for patients presenting with severe life-threatening bleeding. The IgG-degrading enzyme of Streptococcus pyogenes (IdeS), a protease with strict specificity for IgG, prevents IgG-driven immune disorders in murine models, including ITP. In clinical trials, IdeS prevented IgG-mediated kidney transplant rejection; however, the concentration of IdeS used to remove pathogenic antibodies causes profound hypogammaglobulinemia, and IdeS is immunogenic, which limits its use. Therefore, this study sought to determine whether targeting IdeS to FcγRIIA, a low-affinity IgG receptor on the surface of platelets, neutrophils, and monocytes, would be a viable strategy to decrease the pathogenesis of antiplatelet IgG and reduce treatment-related complications of nontargeted IdeS. We generated a recombinant protein conjugate by site-specifically linking the C-terminus of a single-chain variable fragment from an FcγRIIA antibody, clone IV.3, to the N-terminus of IdeS (scIV.3-IdeS). Platelets treated with scIV.3-IdeS had reduced binding of antiplatelet IgG from patients with ITP and decreased platelet phagocytosis in vitro, with no decrease in normal IgG. Treatment of mice expressing human FcγRIIA with scIV.3-IdeS reduced thrombocytopenia in a model of ITP and significantly improved the half-life of transfused platelets expressing human FcγRIIA. Together, these data suggest that scIV.3-IdeS can selectively remove pathogenic antiplatelet IgG and may be a potential treatment for patients with ITP and severe bleeding.
Improvements in allogeneic hematopoietic cell transplantation outcomes for adults with ALL over the past 3 decades
Authors: Nishiwaki Satoshi , Akahoshi Yu , Morita-Fujita Mari , Shimizu Hiroaki , Uchida Naoyuki , Ozawa Yukiyasu , Fukuda Takahiro , Tanaka Masatsugu , Ikegame Kazuhiro , Ota Shuichi , Katayama Yuta , Takahashi Satoshi , Kawakita Toshiro , Ara Takahide , Onizuka Makoto , Kimura Takafumi , Tanaka Junji , Atsuta Yoshiko , Arai Yasuyuki
Published: June 2022

Allogeneic hematopoietic cell transplantation (allo-HCT) is a promising treatment for adult acute lymphoblastic leukemia (ALL), an intractable hematological malignancy. The trends in allo-HCT outcomes over the past 30 years were examined to verify the efficacy of evolving treatment methods and to identify further challenges. We analyzed data from a registry database that included 8467 adult ALL patients who underwent their first allo-HCT between 1990 and 2019. The period was divided into three 10-year intervals for analysis. Five-year overall survival improved from 48.2% to 70.2% in the first complete remission (CR1), from 25.6% to 44.1% in subsequent CR, and from 10.0% to 22.7% in non-CR. Nonrelapse mortality improved over the 3 decades in each disease stage. However, the relapse rate only improved in CR1 every decade (26.3% to 15.9% in CR1, 33.4% to 32.8% in subsequent CR, and 53.6% to 54.8% in non-CR). Although there were continual improvements in adjusted survival for Philadelphia chromosome (Ph)-positive patients, the improvement was inadequate for Ph− patients with t(4;11), t(8;14), t(14;18), or hypodiploidy. Allo-HCT outcomes for adults with ALL have improved over the past 30 years. Improved outcomes in the future will require more effective prevention of relapse in patients with ALL not in CR1 and in those with high-risk chromosomal abnormalities.
Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 – changing paradigms?
Authors: Stojanovic Zoran , Gonçalves-Carvalho Filipe , Marín Alicia , Abad Capa Jorge , Domínguez Jose , Latorre Irene , Lacoma Alicia , Prat-Aymerich Cristina
Published: June 2022

Respiratory tract infections (RTIs) are one of the most common reasons for seeking healthcare, but are amongst the most challenging diseases in terms of clinical decision-making. Proper and timely diagnosis is critical in order to optimise management and prevent further emergence of antimicrobial resistance by misuse or overuse of antibiotics. Diagnostic tools for RTIs include those involving syndromic and aetiological diagnosis: from clinical and radiological features to laboratory methods targeting both pathogen detection and host biomarkers, as well as their combinations in terms of clinical algorithms. They also include tools for predicting severity and monitoring treatment response. Unprecedented milestones have been achieved in the context of the COVID-19 pandemic, involving the most recent applications of diagnostic technologies both at genotypic and phenotypic level, which have changed paradigms in infectious respiratory diseases in terms of why, how and where diagnostics are performed. The aim of this review is to discuss advances in diagnostic tools that impact clinical decision-making, surveillance and follow-up of RTIs and tuberculosis. If properly harnessed, recent advances in diagnostic technologies, including omics and digital transformation, emerge as an unprecedented opportunity to tackle ongoing and future epidemics while handling antimicrobial resistance from a One Health perspective.
Demographic and clinical characteristics of patients with α1-antitrypsin deficiency genotypes PI*ZZ and PI*SZ in the Spanish registry of EARCO
Authors: Torres-Durán María , López-Campos José Luis , Rodríguez-Hermosa Juan Luis , Esquinas Cristina , Martínez-González Cristina , Hernández-Pérez José María , Rodríguez Carlota , Bustamante Ana , Casas-Maldonado Francisco , Barrecheguren Miriam , González Cruz , Miravitlles Marc
Published: June 2022

Background

The Spanish registry of α1-antitrypsin deficiency (AATD) integrated in the European Alpha-1 Research Collaboration (EARCO) provides information about the characteristics of patients, in particular those with the PI*SZ genotype, which is frequent in Spain.

Method

Individuals with severe AATD defined as proteinase inhibitor (PI) genotypes PI*ZZ, PI*SZ and other rare deficient variants were included from February 1, 2020, to February 1, 2022. The analysis focused on a comparison of the characteristics of PI*ZZ and PI*SZ patients.

Results

409 patients were included (53.8% men) with a mean±sdage of 53.5±15.9 years. Genotypes were PI*ZZ in 181 (44.7%), PI*SZ in 163 (40.2%), PI*SS in 29 (7.2%) and other in 32 (7.9%). 271 (67.4%) had lung disease: 175 chronic obstructive pulmonary disease (43.5%), 163 emphysema (40.5%) and 83 bronchiectasis (20.6%). Patients with the PI*SZ genotype were younger, more frequently non-index cases and had a lower frequency of respiratory diseases except asthma compared with PI*ZZ patients. Among patients with respiratory diseases, PI*SZ individuals were significantly older both at onset of symptoms and at diagnosis; only asthma was more frequent in PI*SZ than in PI*ZZ individuals. Twelve PI*SZ patients (15.4%) received augmentation therapy compared with 94 PI*ZZ patients (66.2%; p<0.001).

Conclusions

There is a high prevalence of PI*SZ in Spain. Patients with the PI*SZ genotype were older at symptom onset and diagnosis and had less severe lung disease compared with PI*ZZ patients. The prevalence of asthma was higher in PI*SZ, and up to 15% of PI*SZ patients received augmentation therapy.
Control of Magnetic Particle Size in Ferrofluid and Its Effect on Rheological Properties
Authors: Chen Siyu , Li Decai
Published: June 2022

Rheological properties are the theoretical basis and the key to common problems in ferrofluid applications, therefore they are expected to be adjustable to satisfy different technical requirements through altering the microstructure of ferrofluid during the process of preparation. In this paper, Four ferrofluid samples with different magnetic particle size were prepared by controlling the concentration of precursor solution during co-precipitation process and the rheological properties of these samples were investigated. These samples exhibited field-controlled rheological properties. Eternal magnetic field would enhance the formation of microstructures, resulting in an increase of viscosity. While with the increase of shear rate, microstructures tended to be destroyed, causing viscosity to decrease. There were two opposing mechanisms of the influence of precursor solution concentration. On one hand, the reduction of the precursor solution concentration would produce primary magnetic particles of smaller size. But on the other hand, the surfactant became insufficient to completely coat the magnetic particles because of an increased specific surface area, causing the magnetic particles to aggregate and form secondary clustering structures which strongly enhanced the magnetoviscous effect and weakened the viscoelastic effect.
A Shakedown Strength Based Parametric Optimization Technique and Its Application on an Airtight Module
Authors: Huang Songhua , Xu Yugong , Zhang Lele , Chen Geng , Liu Feng
Published: June 2022

In aerospace engineering, design and optimization of mechanical structures are usually performed with respect to elastic limit. Besides causing insufficient use of the material, such design concept fails to meet the ever growing needs of the light weight design. To remedy this problem, in the present study, a shakedown theory based numerical approach for performing parametric optimization is presented. Within this approach, strength of the structure is measured by its shakedown limit calculated from the direct method. The numerical method developed for the structural optimization consists of nested loops: the inner loop adopts the interior point method to solve shakedown problems pertained to fixed design parameters, while the outer loop employs the genetic algorithm to find optimal design parameters leading to the greatest shakedown limit. The method established is first verified by the classic plate-with-a-circular-hole example, and after that it is applied to an airtight module for determining few key design parameters. By carefully analyzing results generated during the optimization process, it is convinced that the approach can become a viable means for designing similar aerospace structures.
Ophthalmic manifestation after SARS-CoV-2 vaccination: a case series
Authors: Murgova Snezhana , Balchev Georgi
Published: June 2022

Background

The aim of this report is to describe ocular side effects in patients who received one of the two COVID-19 vaccines – Astra Zeneca or Pfizer-Biontech and to contribute to the common understanding of the COVID-19 vaccination process.

Results

Three patients reactivated underlying herpetic disease and developed uveitis and keratitis. Two of them were vaccinated with Pfizer and one was with Astra Zeneca. Two patients were vaccinated with Pfizer-Biontech and had thrombosis on the 8th and 10th days following the day of vaccination. The man has diagnosed with nonarteritic anterior ischemic optic neuropathy and the woman had a subarachnoid haemorrhage, ptosis of upper eyelid and deviated eyeball.

Conclusion

There is a causal relationship between vaccines and the underlying disease. For more details, further large studies are necessary.
The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso)
Authors: Toure Amadou Oury , Balde Mamadou Dioulde , Diallo Aissatou , Camara Sadan , Soumah Anne Marie , Sall Alpha Oumar , Kourouma Karifa , Camara Bienvenu Salim , Bocoum Fadima Yaya , Kouanda Seni
Published: June 2022

Background

Chronic renal failure can lead to dialysis and/or a kidney transplant in the final stage. The number of patients under dialysis has increased considerably in the world and particularly in sub-Saharan Africa. Dialysis is a very expensive care. This is the reason why this study on the costs of dialysis management was initiated in Burkina Faso. The objective of the study is to determine the direct medical and non-medical costs of managing chronic renal failure among dialysis patients in Ouagadougou in 2020.

Methods

An analytical cross-sectional study was conducted. Data were collected in the hemodialysis department of three public university hospitals in Ouagadougou, Burkina Faso. All dialysis patients with chronic renal failure were included in the study. Linear regression was used to investigate the determinants of the direct medical and non-medical cost of hemodialysis.

Results

A total of 290 patients participated in this study, including children, adults, and the elderly with extremes of 12 and 82 years. Almost half of the patients (47.5%) had no income. The average monthly total direct cost across all patients was 75842 CFA or US$134.41.The average direct medical cost was 51315 CFA or US$90.94 and the average direct non-medical cost was 24 527 CFA or US$43.47. Most of the patients (45.2%) funded their hemodialysis by their own source.

The multivariate analysis showed that the presence of an accompanying person during treatment, residing in a rural area, ambulatory care, use of personal cars, and treatment at the dialysis center of Yalgado Teaching Hospital were associated with higher direct costs.

Conclusion

The average cost of dialysis services borne by the patient and his family is very high in Burkina Faso, since it is 2.1 times higher than the country's minimum interprofessional wage (34664 CFA or US$61.4). It appears that the precariousness of the means of subsistence increases strongly with the onset of chronic renal failure requiring dialysis. Thus, to alleviate the expenses borne by dialysis patients, it would be important to extend the government subsidy scheme to the cost of drugs and to promote health insurance to ensure equitable care for these patients.
Identification and clinical validation of NUSAP1 as a novel prognostic biomarker in ovarian cancer
Authors: Gou Rui , Zheng Mingjun , Hu Yuexin , Gao Lingling , Wang Shuang , Liu Ouxuan , Li Xiao , Zhu Liancheng , Liu Juanjuan , Lin Bei
Published: June 2022

Background

Nucleolar and spindle-associated protein 1 (NUSAP1) was shown to be involved in cell cycle regulation in cancer. However, its prognostic value and underlying mechanism in ovarian cancer remain unclear.

Methods

Oncomine, TCGA, CCLE, and UALCAN databases were used to analyze the expression level of NUSAP1 in ovarian cancer. The Kaplan–Meier plotter database was used to evaluate its prognostic value. The results from these analyses were further validated using immunohistochemical assay. The potential molecular mechanism ofNUSAP1in ovarian cancer was assessed with respect to homologous recombination repair, mismatch repair, and immunology using different databases.

Results

Database analyses and experimental results demonstrated that NUSAP1 was highly expressed in ovarian cancer, its levels being correlated with the FIGO stage. High NUSAP1 expression was an independent risk factor affecting the prognosis of patients with epithelial ovarian cancer. Moreover,NUSAP1was associated with cell cycle, DNA replication, homologous recombination, and p53 signaling pathway. A positive correlation was identified between the expression ofNUSAP1andBRCA1/2in ovarian cancer. In addition,NUSAP1was associated with the expression of DNA mismatch repair genes and immune cell infiltration.

Conclusions

NUSAP1 may be a valuable prognostic marker, as well as a novel biomarker for evaluating the response to immunotherapy of patients with ovarian cancer.
Brachial flow—mediated dilation and carotid intima—media thickness in glaucoma patients
Authors: Bojic Lovro , Rogosic Veljko , Markovic Domagoj , Rogosic Lucija Vanjaka , Glavas Duska
Published: June 2022

Background

The purpose of the study was to assess the ultrasound measurements of the brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT) and their relationship in glaucoma patients.

Methods

Thirty-seven patients with glaucoma and thirty-one healthy controls were included in the study. All glaucoma patients and controls underwent ultrasound measurement of FMD of the brachial artery and ultrasound measurement of IMT of the carotid artery.

Results

The mean values of brachial FMD were significantly lower among the glaucoma compared with controls (16.4 ± 10.6% vs 20.3 ± 8.5%, p = 0.034). No significant difference was found in carotid IMT (1.2 ± 0.4 vs. 1.1 ± 0.4, p = 0.3), and brachial artery diameter at rest (4.7 ± 0.6 vs. 4.9 ± 0.3, p = 0.2) between the glaucoma patients and controls. The significant difference in brachial artery diameter in hyperemia between the glaucoma patients and controls (5.5 ± 0.6 vs. 5.9 ± 0.4 p = 0.002) was found. A negative correlation among brachial FMD and carotid IMT as well as among brachial FMD and brachial artery diameter at rest was found.

Conclusions

Impaired brachial FMD indicates presence of systemic vascular endothelial dysfunction in glaucoma; glaucoma patients with lower values of the brachial FMD are at increased risk of having thickened carotid IMT.
LUNCH—Lung Ultrasound for early detection of silent and apparent aspiratioN in infants and young CHildren with cerebral palsy and other developmental disabilities: study protocol of a randomized controlled trial
Authors: Fiori S , Scaramuzzo RT , Moretti E , Amador C , Controzzi T , Martinelli A , Filippi L , Guzzetta A , Gargagni L
Published: June 2022

Background

Children with neurological impairment may have dysphagia and/or gastro-esophageal reflux disease (GERD), which predispose to complications affecting the airways, increasing risk for aspiration-induced acute and chronic lung disease, or secondarily malnutrition, further neurodevelopmental disturbances, stressful interactions with their caregivers and chronic pain. Only multidisciplinary clinical feeding evaluation and empirical trials are applied to provide support to the management of feeding difficulties related to dysphagia or GERD, but no standardized feeding or behavioral measure exists at any age to assess aspiration risk and support the indication to perform a videofluoroscopic swallowing study (VFSS) or a fibre-optic endoscopic examination of swallowing (FEES), in particular in newborns and infants with neurological impairments. Lung ultrasound (LUS) has been proposed as a non-invasive, radiation-free tool for the diagnosis of pulmonary conditions in infants, with high sensitivity and specificity.

Methods

A RCT will be conducted in infants aged between 0 and 6 years having, or being at risk for, cerebral palsy, or other neurodevelopmental disease that determines abnormal muscular tone or motor developmental delay assessed by a quantitative scale for infants or if there is the suspicion of GERD or dysphagia based on clinical symptoms. Infants will be allocated in one of 2 groups: 1) LUS-monitored management (LUS-m); 2) Standard care management (SC-m) and after baseline assessment (T0), both groups will undergo an experimental 6-months follow-up. In the first 3 months, infants will be evaluated a minimum of 1 time per month, in-hospital, for a total of 3 LUS-monitored meal evaluations. Primary and secondary endpoint measures will be collected at 3 and 6 months.

Discussion

This paper describes the study protocol consisting of a RCT with two main objectives: (1) to evaluate the benefits of the use of LUS for monitoring silent and apparent aspiration in the management of dysphagia and its impact on pulmonary illness and growth and (2) to investigate the impact of the LUS management on blood sample and bone metabolism, pain and interaction with caregivers.

Trial registration

Trial registration date 02/05/2020; ClinicalTrials.gov Identifier: NCT04253951.
Exploring the facilitators and barriers to high-risk behaviors among school transportation drivers: a qualitative study
Authors: Fathizadeh Shadi , Karimy Mahmood , Tavousi Mahmoud , Zamani-Alavijeh Fereshteh
Published: June 2022

Background

School transportation (ST) crashes are associated with serious adverse consequences, particularly for students in developing countries. High-risk behaviors (HRBs) of ST drivers are a major factor contributing to ST crashes. This study aimed at exploring the facilitators and barriers to HRBs among ST drivers.

Methods

This qualitative study was conducted in 2019–2020. Participants were ST drivers, students, parents, and school staff purposively selected from Tehran, Iran. Data were collected through in-depth semi-structured interviews and focus group discussions and were concurrently analyzed through conventional content analysis.

Findings

Participants were fifteen ST drivers with a mean age of 45 ± 10.2 years and 24 students, parents, and school staff with a mean age of 28.62 ± 16.08 years. The facilitators and barriers to HRBs came into five main categories, namely previous experiences of HRBs, perceived gains and risks of HRBs, motivating and inhibiting feelings and emotions, positive and negative subjective norms, and perceived mastery in driving.

Conclusion

A wide range of facilitators and barriers can affect HRBs among ST drivers. Strategies for preventing HRBs among ST drivers should be multidimensional and individualized and should focus on strengthening the barriers and removing the facilitators to HRBs.
A scoping review of strategies to support public health recovery in the transition to a “new normal” in the age of COVID-19
Authors: Belita Emily , Neil-Sztramko Sarah E. , Miller Alanna , Anderson Laura N. , Apatu Emma , Bellefleur Olivier , Kapiriri Lydia , Read Kristin , Sherifali Diana , Tarride Jean-Éric , Dobbins Maureen
Published: June 2022

Background

During the COVID-19 pandemic, the public health workforce has experienced re-deployment from core functions such as health promotion, disease prevention, and health protection, to preventing and tracking the spread of COVID-19. With continued pandemic deployment coupled with the exacerbation of existing health disparities due to the pandemic, public health systems need to re-start the delivery of core public health programming alongside COVID-19 activities. The purpose of this scoping review was to identify strategies that support the re-integration of core public health programming alongside ongoing pandemic or emergency response.

Methods

The Joanna Briggs Institute methodology for scoping reviews was used to guide this study. A comprehensive search was conducted using: a) online databases, b) grey literature, c) content experts to identify additional references, and d) searching reference lists of pertinent studies. All references were screened by two team members. References were included that met the following criteria: a) involved public health organizations (local, regional, national, and international); b) provided descriptions of strategies to support adaptation or delivery of routine public health measures alongside disaster response; and c) quantitative, qualitative, or descriptive designs. No restrictions were placed on language, publication status, publication date, or outcomes. Data on study characteristics, intervention/strategy, and key findings were independently extracted by two team members. Emergent themes were established through independent inductive analysis by two team members.

Results

Of 44,087 records identified, 17 studies were included in the review. Study designs of included studies varied: descriptive (n = 8); qualitative (n = 4); mixed-methods (n = 2); cross-sectional (n = 1); case report (n = 1); single-group pretest/post-test design (n = 1). Included studies were from North America (n = 10), Africa (n = 4), and Asia (n = 3) and addressed various public health disasters including natural disasters (n = 9), infectious disease epidemics (n = 5), armed conflict (n = 2) and hazardous material disasters (n = 1). Five emergent themes were identified on strategies to support the re-integration of core public health services: a) community engagement, b) community assessment, c) collaborative partnerships and coordination, d) workforce capacity development and allocation, and e) funding/resource enhancement.

Conclusion

Emergent themes from this study can be used by public health organizations as a beginning understanding of strategies that can support the re-introduction of essential public health services and programs in COVID-19 recovery.
Ultrasonographic assessment of entheseal sites of upper and lower extremities in hemodialysis patients using Madrid Sonography Enthesitis Index
Authors: Sabry Reham , Tharwat Samar , Nassar Mohammed Kamal , Eltoraby Ehab E.
Published: June 2022

Background

There is no much information about the entheseal involvement among hemodialysis (HD) patients. The aim of this study was to assess the frequency and distribution of ultrasonographic (US) entheseal alterations in HD patients and to evaluate the association between US abnormalities and both clinical and laboratory data.

Methods

This study was conducted on 41 HD patients and 23 sex- and age- matched controls. All participants were evaluated clinically for any signs of enthesopathy. Six entheses sites were scanned bilaterally using grey scale (GS) and power Doppler (PD) US and were scored using Madrid Sonography Enthesitis Index (MASEI) scoring system.

Results

In HD patients, at least one clinical sign suggestive of enthesopathy was found in 69 (14%) of 492 entheses. HD patients had statistically significant higher scores of structural tendon abnormalities (p < 0.001), enthesis thickening (p < 0.001), bone erosions (p < 0.001) and calcification (p = 0.037) than the healthy controls. Total MASEI score was higher in HD patients than healthy controls (median;18 vs 8, p < 0.001), also, MASEI-inflammatory (median;11 vs 3, p < 0.001) and damage scores (median;6 vs 0, p < 0.001). There was a statistically significant positive association between total MASEI score and both age (p = 0.032) and duration of HD (p = 0.037). Duration of HD was predictive for both MASEI-damage component (p = 0.004) and total MASEI score (p = 0.014).

Conclusion

There is a high prevalence of subclinical enthesopathy in HD patients. The entheseal US alterations is much higher in HD patients than in healthy subjects. The duration of HD is the significant predictor of enthesopathy in HD patients.
Long-term patient satisfaction and removal rate after essure sterilization: a follow-up study
Authors: Žegura Andrić Branka , Rosič Maja , Serdinšek Tamara , Šumak Rok
Published: June 2022

Background

The objective of our study was to assess the rate and causes for Essure® micro-insert system removal and patients’ long term satisfaction rate with the procedure.

Methods

All patients who underwent Essure® hysteroscopic sterilization at our tertiary centre between years 2007 and 2018 were included in this follow-up study. A questionnaire was sent to all patients per standard mail. Patients who did not respond to questionnaires per mail, were called by phone. The satisfaction with the Essure® sterilization, as well as any additional procedures after the insertion or insertion-related complications were analysed.

Results

From the year 2007 to 2018, we performed 427 Essure® hysteroscopic sterilizations and of these, 329 patients responded to the questionnaire (response rate 77%). Ten patients (3%) had Essure® removal, two of them due to pain (0.6%). Patients were very satisfied with the procedure (9.5 on scale 0–10). Most patients (95.3%) would recommend the procedure to their friend.

Conclusions

Essure® hysteroscopic sterilization is a procedure with a very high satisfaction rate and a very low removal rate due to sterilization-related complications.

Trial registration Institutional review board of University medical centre Maribor approved the study, approval number UKC-MB-KME-73/19.
Ellagic acid effects on testis, sex hormones, oxidative stress, and apoptosis in the relative sterility rat model following busulfan administration
Authors: Rostami Amirabbas , Vakili Sina , Koohpeyma Farhad , Jahromi Bahia Namavar , Aghajari Ziba Afshari , Mahmoudikohani Fatemeh , Saki Forough , Mahmoodi Marzieh , Jaberi Khojaste Rahimi , Movahedpour Ahmad , Khorchani Majid Jafari , Noroozi Saam
Published: June 2022

Background

Busulfan is an antineoplastic medication that is broadly utilized for cancer treatment. It affects the testicular function and leads to sterility. The present study aimed to evaluate the effects of ellagic acid on testicular tissue changes, sexual hormones, antioxidant defense system, and caspase-9 and Bcl2 gene expression in the busulfan-induced relative sterile rat model.

Methods

This is an interventional-experimental animal study that was performed on 65 Adult male rats; they were randomly divided into five groups including control (1 ml of 0.9% normal saline), ellagic acid (50 mg/kg); busulfan (10 mg/kg); and busulfan plus ellagic acid (10 mg/kg and 50 mg/kg). At the end of the experiment, blood samples were collected, and plasma levels of sex hormones, antioxidant system, apoptosis-related genes, and testis histology were assessed.

Results

Busulfan reduced the levels of serum testosterone, total antioxidant capacity, gene expression of Bcl2, testicular volume, seminiferous tubule, germinal epithelium, interstitial tissue volume, and the number of spermatogonia, spermatocyte, round spermatid, elongated spermatid, Sertoli cells and Leydig cells (p < 0.05). Busulfan administration resulted in a significant increase (p < 0.05) in the level of LH, FSH, malondialdehyde, and caspase 9. Busulfan + ellagic acid (50 mg/kg) showed higher serum levels of testosterone, gene expression of Bcl-2 and antioxidant markers, and lower LH, FSH levels, and gene expression of caspase 9 compared to the Busulfan-treated rats (p < 0.05). Stereological parameters were also ameliorated in the group treated with Busulfan+ 50 mg/kg ellagic acid (p < 0.05).

Conclusion

In conclusion, the consumption of ellagic acid may have beneficial effects on the antioxidant defense system, sexual hormone abnormality, and testicular tissue damage induced by busulfan.
Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study
Authors: Alharbi Fahad , Alwadei Saleh H. , Alwadei Abdurahman , Asiri Saeed , Alwadei Farhan , Alqerban Ali , Almuzian Mohammed
Published: June 2022

Background

Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies.

Objective

To investigate dental students’ learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method.

Methods

A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively.

Results

There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions.

Conclusion

Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment.

Trial registration

NCT04692142, 31/12/2020.
Assessed and discharged – diagnosis, mortality and revisits in short-term emergency department contacts
Authors: Al-Mashat Hassan , Lindskou Tim A. , Møller Jørn M. , Ludwig Marc , Christensen Erika F. , Søvsø Morten B.
Published: June 2022

Background

Emergency departments (EDs) experience an increasing number of patients. High patient flow are incentives for short duration of ED stay which may pose a challenge for patient diagnostics and care implying risk of ED revisits or increased mortality. Four hours are often used as a target time to decide whether to admit or discharge a patient.

Objective

To investigate and compare the diagnostic pattern, risk of revisits and short-term mortality for ED patients with a length of stay of less than 4 h (visits) with 4–24 h stay (short stay visits).

Methods

Population-based cohort study of patients contacting three EDs in the North Denmark Region during 2014–2016, excluding injured patients. Main diagnoses, number of revisits within 72 h of the initial contact and mortality were outcomes. Data on age, sex, mortality, time of admission and ICD-10 diagnostic chapter were obtained from the Danish Civil Registration System and the regional patient administrative system. Descriptive statistics were applied and Kaplan Meier mortality estimates with 95% CI were calculated.

Results

Seventy-nine thousand three hundred forty-one short-term ED contacts were included, visits constituted 60%. Non-specific diagnoses (i.e. symptoms and signs and other factors) were the most frequent diagnoses among both visits and short stay visits groups (67% vs 49%). Revisits were more frequent for visits compared to short stay visits (5.8% vs 4.2%). Circulatory diseases displayed the highest 0–48-h mortality within the visits and infections in the short stay visits (11.8% (95%CI: 10.4–13.5) and (3.5% (95%CI: 2.6–4.7)). 30-day mortality were 1.3% (95%CI: 1.2–1.5) for visits and 1.8% (95%CI: 1.7–2.0) for short stay visits. The 30-day mortality of the ED revisits with an initial visit was 1.0% (0.8–1.3), vs 0.7% (0.7–0.8) for no revisits, while 30-day mortality nearly doubled for ED revisits with an initial short stay visit (2.5% (1.9–3.2)).

Conclusions

Most patients were within the visit group. Non-specific diagnoses constituted the majority of diagnoses given. Mortality was higher among patients with short stay visits but increased for both groups with ED revisits. This suggest that diagnostics are challenged by short time targets.
The cost-effectiveness of a proportionate parenting programme for primary caregivers and their child: an economic evaluation using evidence from the E-SEE Trial
Authors: Cox Edward , Walker Simon , Blower Sarah , Sampaio Filipa , Bywater Tracey , Richardson Gerry
Published: June 2022

Background

Behavioural and mental disorders have become a public health crisis; averting mental ill-health in early years can achieve significant longer-term health benefits and cost savings. This study assesses whether the Enhancing Social-Emotional Health and Wellbeing in the Early Years (E-SEE-Steps)—a proportionate universal delivery model comprising the Incredible Babies book (IY-B) and the Incredible Years Infant (IY-I) and Toddler (IY-T) parenting programmes is cost-effective compared to services as usual (SAU) for the primary caregiver, child and dyad.

Methods

Using UK data for 339 primary caregivers from the E-SEE trial, we conducted a within-trial economic evaluation assessing the cost-effectiveness of E-SEE Steps. Health outcomes were expressed in quality-adjusted life-years (QALY) and costs in UK pounds sterling (2018–19). Missing data were populated via multiple imputation and costs and QALYs discounted at 3.5% per annum. Cost-effectiveness results were conducted for primary caregivers, children and dyad using econometric modelling to control for patient co-variables. Uncertainty was explored through scenario and sensitivity analyses.

Results

The average cost of E-SEE Steps intervention was £458.50 per dyad. E-SEE Steps was associated with modest gains in primary caregiver HRQoL but minor decrements in child HRQoL compared to SAU. For primary caregivers, E-SEE Steps was more effective (0.034 QALYs) and more costly (£446) compared to SAU, with a corresponding incremental cost-effectiveness ratio (ICER) of £13,011 per QALY. In children, E-SEE Steps was strictly dominated with poorer outcomes (-0.005 QALYs) and greater costs (£178) relative to SAU. QALY gains in primary caregivers exceeded those QALY losses found in children, meaning E-SEE Steps was more effective (0.031 QALYs) and costly (£621) for the dyad (ICER: £20,062 per QALY). All scenario analyses found E-SEE Steps cost-effective for the dyad at a £30,000 per QALY threshold. Sensitivity analyses found significant cost reductions from expansions in programme delivery and attendance.

Conclusions

E-SEE Steps achieved modest health gains in primary caregivers but small negative effects on children and was more costly than SAU. E-SEE Steps appears cost-effective for the dyad, but the results should be interpreted with caution given the potential detrimental impact on children.

Trial registration

ISRCTN11079129; Pre participant trial enrolment, 11/05/2015
Influenza a virus triggers acute exacerbation of chronic obstructive pulmonary disease by increasing proinflammatory cytokines secretion via NLRP3 inflammasome activation
Authors: Ji Shuang , Dai Meng-Yuan , Huang Yun , Ren Xiang-Chun , Jiang Meng-Long , Qiao Jin-Ping , Zhang Wen-Ying , Xu Yuan-Hong , Shen Ji-Long , Zhang Ren-Quan , Fei Guang-He
Published: June 2022

Background

Influenza A virus (IAV) triggers acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the molecular mechanisms remain unclear. In this study, we investigated the role of IAV induced NLRP3 inflammasome activation to increase airway inflammation response in the progression of AECOPD.

Methods

Human bronchial epithelial cells were isolated and cultured from normal and COPD bronchial tissues and co-cultured with IAV. The NLRP3 inflammasome associated genes were identified using RNA sequencing, and the expressions of NLRP3 inflammasome components were measured using qRT-PCR and western blot after cells were transfected with siRNA and treated with MCC950. Moreover, IAV-induced COPD rat models were established to confirm the results; 37 AECOPD patients were included to measure the serum and bronchoalveolar lavage fluid (BALF) of interleukin (IL)-18 and IL-1β.

Results

Increased levels of NLRP3 inflammasome components were not seen until 6 h post-inoculation in normal cells. However, both cell groups reached peak NLRP3 level at 12 h post-inoculation and maintained it for up to 24 h. ASC, Caspase-1, IL-1β and IL-18 were also elevated in a similar time-dependent pattern in both cell groups. The mRNA and protein expression of the NLRP3 inflammasome components were decreased when COPD cells treated with siRNA and MCC950. In COPD rats, the NLRP3 inflammasome components were elevated by IAV. MCC950 alleviated lung damage, improved survival time, and reduced NLRP3 inflammasome components expression in COPD rats. Additionally, the serum and BALF levels of IL-1β and IL-18 were increased in AECOPD patients.

Conclusions

NLRP3 inflammasome is activated in COPD patients as a pre-existing condition that is further exacerbated by IAV infection.
Work-related factors affecting the retention of medical officers in the preventive health sector in Sri Lanka
Authors: Arnold Mahendra , Fernando Dinusha , Wickramanayake Kapila , Karunapema Palitha , Wickramatilake Sepali , Fernando Yamuna , Denawaka Chandani , Mahesh Pasyodun Koralage Buddhika , Pandithrathna Sujeewa
Published: June 2022

Background

Retention of human resources in the healthcare system, particularly doctors at district level is a great challenge faced by the decentralized health systems in poorly resourced countries. Medical Officers of Health (MOH), medical doctors who provide preventive health services, are a particularly important human resource in the preventive health sector in Sri Lanka. This study explores the relative importance of different factors affecting the retention of MOHs in the preventive health sector of Sri Lanka.

Methods

A descriptive cross-sectional study was carried out among Medical Officers of Health in the Colombo district with 18 MOH Offices with 74 medical officers. A pre-tested self-administered questionnaire was used as the study instrument. Data were analyzed using descriptive statistics, correlation and regression analyses.

Results

Of the 74 medical officers 64 responded with a response rate of response rate of 86.5%. Regression analysis showed that all four variables; recognition, work schedule, remuneration and responsibility are positively and significantly correlated with retention of Medical Officers of Health in the preventive health sector. The variable ‘work schedule’ showed the highest impact on the retention of Medical Officers of Health.

Conclusions

In order to retain trained Medical Officers of Health in the Sri Lankan preventive health sector, health authorities should address the factors identified in this study. If policymakers fail to address these factors, preventive health services will face negative implications due to the shortage of key service providers.
Pregnancy and childbirth outcomes among indigenous adolescents in Guatemala: a cohort study
Authors: Gómez Noe , Del Risco Sánchez Odette , Pinho-Pompeu Maira , Machado Helymar , Bahamondes Luis , Surita Fernanda
Published: June 2022

Objective

To assess some characteristics and outcomes associated with pregnancy among Indigenous adolescents and compare them with other women who gave birth in a public hospital in Guatemala.

Methods

We conducted a retrospective cohort study of 8048 cases. Sociocultural variables, gynecological and obstetric history, childbirth, and perinatal outcomes were compared among women who gave birth at San Juan De Dios Hospital between January 2018 and June 2019. They were classified into four groups according to age and ethnicity. Indigenous adolescents (819/10.2%) were compared with Nonindigenous adolescents (813/10.1%), Indigenous adult women (3324/41.3%), and Nonindigenous adult women (3092/38.4%). Bivariate analysis and multiple logistic regression were applied.

Results

We found that Indigenous adolescents who gave birth in the public hospital had fewer years of schooling than Nonindigenous adolescents (p < 0.001), Indigenous adults (p < 0.001), and Nonindigenous adults (p < 0.001). Indigenous adolescents were more likely to have an unplanned pregnancy than Nonindigenous adolescents (p = 0.038) and Nonindigenous adults (p < 0.001) and were more likely to be single (p < 0.001) and use less previous contraception than Indigenous and Nonindigenous adult women (p = 0.007 and p = 0.013, respectively). More than one-third of Indigenous adolescents and adults did not attend antenatal care; Indigenous adolescents had fewer antenatal care visits than Nonindigenous adults (p < 0.001), and the results were borderline in comparison to Nonindigenous adolescents (p = 0.051). Indigenous and Nonindigenous adult women underwent episiotomy less often than Indigenous adolescents (OR: 0.60 [95% CI 0.49–0.74] and OR: 0.56 [95% CI 0.45–0.70], respectively) and received less local anesthesia than Indigenous adolescents (OR: 0.59 [95% CI 0.46–0.76] and OR: 0.77 [95% CI 0.60–0.99], respectively). Nonindigenous adults received more analgesia than Indigenous adolescents (OR: 1.36 [95% CI 1.07–1.73]). Nonindigenous adolescents had more newborns with low birth weight than Indigenous adolescents (OR: 1.44 [95% CI 1.10–1.87]).

Conclusion

Indigenous adolescents who gave birth in a public hospital in Guatemala were more likely to be single during pregnancy and attend fewer years of school than Nonindigenous adolescents. Unplanned pregnancies were more common among Indigenous adolescents, and some of them underwent not recommended obstetric practices during childbirth, such as episiotomy. Police should be enforced ensuring equal opportunities for different ethnic and age groups regarding pregnancy.