bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity?
Authors: Boerger Timothy F. , Hyngstrom Allison S. , Furlan Julio C. , Kalsi-Ryan Sukhvinder , Curt Armin , Kwon Brian K. , Kurpad Shekar N. , Fehlings Michael G. , Harrop James S. , Aarabi Bizhan , Rahimi-Movaghar Vafa , Guest James D. , Wilson Jefferson R. , Davies Benjamin M. , Kotter Mark R. N. , Koljonen Paul A.
Published: February 2022

Study Design

Narrative review.

Objective

Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.

Methods

Literature search.

Results

In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed.

Conclusions

We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.
Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]
Authors: Davies Benjamin M. , Mowforth Oliver , Wood Helen , Karimi Zahabiya , Sadler Iwan , Tetreault Lindsay , Milligan Jamie , Wilson Jamie R. F. , Kalsi-Ryan Sukhvinder , Furlan Julio C. , Kawaguchi Yoshiharu , Ito Manabu , Zipser Carl Moritz , Boerger Timothy F , Vaccaro Alexander R. , Murphy Rory K. J. , Hutton Mike , Rodrigues-Pinto Ricardo , Koljonen Paul A. , Harrop James S. , Aarabi Bizhan , Rahimi-Movaghar Vafa , Kurpad Shekar N , Guest James D. , Wilson Jefferson R. , Kwon Brian K. , Kotter Mark R. N. , Fehlings Michael G.
Published: February 2022

Study Design

Literature Review (Narrative)

Objective

To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness.

Methods

Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM.

Results

DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (<2% of Amyotrophic Lateral Sclerosis or Multiple Sclerosis over the last 25 years). The transformation of stroke and acute coronary syndrome services, from a position of best supportive care with occasional surgery over 50 years ago, to avoidable disability today, represents transferable examples of success and potential opportunities for DCM. Central to this is raising awareness.

Conclusion

Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority.
James Lind Alliance Priority Setting Partnership for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM]: An Overview of the Methodology Used to Process and Short-List Research Uncertainties
Authors: Tetreault Lindsay , Mowforth Oliver , Khan Danyal Z. , Gronlund Toto , Garwood Philip , Hazenbiller Olesja , Harrop James S. , Aarabi Bizhan , Rahimi-Movaghar Vafa , Kurpad Shekar N. , Guest James D. , Wilson Jefferson R. , Kwon Brian K. , Fehlings Michael G. , Davies Benjamin M. , Kotter Mark R. N. ,   On behalf of the AO Spine RECODE-DCM Steering Committee and AO Spine RECODE-DCM Consortium
Published: February 2022

Study Design

Overview of the methods used for a James Lind Alliance (JLA) Priority Setting Partnership (PSP).

Objectives

The objectives of this article are to (i) provide a brief overview of the JLA—facilitated PSP process; (ii) outline how research uncertainties were initially processed in the AO Spine RECODE-DCM PSP; and (iii) delineate the methods for interim prioritization and the priority setting workshop.

Methods

A steering group was created to define the scope for the PSP, organize its activities, and establish protocols for decision-making. A survey was created asking what questions on the diagnosis, treatment, and long-term management of DCM should be answered by future research. Results from the survey were sorted into summary questions. Several databases were searched to identify literature that already answered these summary questions. The final list of summary questions was distributed by survey for interim prioritization. Participants were asked to select the top ten most important summary questions. The questions that were ranked the highest were discussed at an in-person consensus workshop.

Results

The initial survey yielded a total of 3404 potential research questions. Of the in-scope submissions, 988 were related to diagnosis, 1324 to treatment, and 615 to long-term management of DCM. A total of 76 summary questions were developed to reflect the original submissions. Following a second survey, a list of the top 26 interim priorities was generated and discussed at the in-person priority setting workshop.

Conclusions

PSPs enable research priorities to be identified that consider the perspectives and interests of all relevant stakeholders.
Impact of the US Dollar Index and Crude Oil on Prices of Arabica and Robusta Varieties of Indian Coffee
Authors: Vijayakumar A. N.
Published: February 2022

Coffee is one of the largest traded agri-plantation commodities consumed as a popular beverage across the globe. India exports 75% of its coffee to Europe, the USA, and other developed countries; however, prices depend upon multiple factors of national and international importance. This study makes an in-depth analysis of the US dollar, crude oil, International Coffee Organisation’s (ICO) coffee spot, and futures on Indian coffee auction prices of Arabica and Robusta. The study adopting causal research method examined cointegration and relative effect by administering Johansen cointegration, vector error correction model under VAR environment, VEC-Granger causality, and block exogeneity Wald test. The study found cointegration and long-run association of the US dollar index and crude oil on Arabica than Robusta coffee. Hence, any change in the prices of ICO spot, Arabica coffee futures, crude oil, and the US $ index leads to long-term change in the Indian Arabica coffee auction prices. Coffee exporter should hedge their currency risk on Arabica export and coffee farmers may anticipate increase in domestic prices against sharp rise in US dollar.
Community Lost? Changes and Stratification in Perceived Neighborhood Social Cohesion among Families with Children
Authors: Campbell Colin , Pearlman Jessica , Verdery Ashton M. , England Kira
Published: February 2022

Neighborhood social cohesion is strongly associated with health and well-being, especially among families with children. However, there is a widespread perception in the media, policy circles, and prominent research traditions that neighborhood social cohesion has decreased in recent decades for the United States as a whole and among certain subpopulations. Unfortunately, the empirical evidence for such trends is thin. In this study, we use data on families with children from two studies, the Survey of Income and Program Participation and the Fragile Families and Child Wellbeing Study, to explore trends in neighborhood social cohesion and how individual- and neighborhood-level characteristics pattern disparities in the experience of neighborhood social cohesion. Counter to popular perceptions, our results show increases in neighborhood social cohesion over recent decades, at least for families with children. However, our results reveal persistent disparities in the experience of neighborhood social cohesion by individual and neighborhood characteristics.
Dalit Muslims and the State: Pasmanda Movement and Struggle for ‘Scheduled Castes Status’
Authors: Alam Shamsher
Published: February 2022

This paper attempts to understand the state’s role in providing Scheduled Castes (SC) status for Arzal or Dalit Muslims, and the struggle of Pasmanda Muslims through the Pasmanda movement for inclusion in the SC list. While doing so, it traces the trajectory of marginalization of Dalit Muslims by the state. It argues that since the inception of SC status in independent India, it was reserved only for the Hindu religion. Later on, it was amended twice: first, in 1956 for the inclusion of Sikh, and second, for neo-Buddhist in 1990. It did not include Dalit from the Muslim community. It also attempts to map the effort of Pasmanda Muslims for SC status. In this context, the paper tries to comprehend the role of the Pasmanda movement along with the struggle of social organizations. Consequently, the paper argues that these organizations fight for SC status; however, unable to make any significant intervention at the policy level. This paper also argues that there is a dissensus and intra-community contestation among Muslims regarding the Pasmanda movement and the demand of SC status for Dalit Muslims.
Traditional Ideas and Institutions of Democracy in India’s North East
Authors: Haokip Thongkholal
Published: February 2022

This article explores the traditional ideas and practices of indigenous democracy among the tribal communities in North East India. Traditional institutions of governance in the region are repudiated today as autocratic and authoritarian, or at best oligarchic. This oversight is imminent unless their cultures and customs, which are closely linked to their institutions of governance, are examined. In most traditional tribal institutions at the grassroot level, there is either a direct participation of all adult male or a representative system in which each clan or sub-clan is represented in the village council. Thus, one finds pre-modern roots of direct and representative democracy in the traditional polity of indigenous communities in the North East. The article identifies ‘consensus’ as the heart of tribal democracy and argues for the strengthening of indigenous democracy for deepening democracy in India. However, more democratic reforms of the traditional institutions are needed to particularly include women and the ‘others’. The findings contribute to the growing literature on the pre-modern roots of modern democracy.
Influence of earthquake damage and repair interventions on expected annual losses of reinforced concrete wall buildings
Authors: Rossi Alberto , Del Vecchio Ciro , Pampanin Stefano
Published: February 2022

Recent devastating earthquakes have shown that existing reinforced concrete (RC) buildings that rely on shear walls may exhibit damage and cracking. The majority of seismic actions are borne by shear walls; hence, the quantification of their residual post-earthquake capacity is critical. Moreover, the repair interventions that are typically implemented in practice may be insufficient to fully restore the original capacity of the undamaged system, particularly in terms of stiffness. This makes it difficult for stakeholders to decide on implementing either building repair or demolition and reconstruction. This article proposes a novel methodology to aid practitioners in quantifying the effect of earthquake damage and repair on the seismic performance of buildings with shear walls within a loss-assessment framework. A refined procedure relying on a validated nonlinear finite element numerical model capable of reproducing the shear response of RC walls is proposed along with an analytical approach. Parametric analyses of an RC case-study building are conducted, and the results are discussed and compared in terms of expected annual losses in the undamaged, damaged, and repaired configurations.
Let’s Measure the Liver Better: A Pilot Study Assessing Inter-Rater Reliability When Measuring the Liver Volume Using Sonography
Authors: Hellmann Rivka , Struk Iryna , Haddash Dalal , Jalloh Fatmata , Pan Emily
Published: February 2022

Objective:

When measuring the liver sonographically, liver volume measurement (LVM) is not routinely performed, though considered the gold standard on CT. The objective of this study is to encourage the sonography community to obtain an LVM instead of a single linear measurement on ultrasound, so as not to subject patients to the potentially harmful radiation exposure of a CT scan when assessing liver size. This study compared the consistency and accuracy between expert and novice sonographers in obtaining an LVM on sonography.

Materials and Methods:

Both groups obtained linear and LVM on 30 participants and calculated LVM using the formula Liver Volume (cc) = 343.71 + (0.84 × ABC).

Results:

Both groups took longer to obtain LVM than linear, P < .0001. Novices and experts obtained an LVM in a similar amount of time. More consistency was observed among experts when scanning participants in the lower BMI ranges. Novice sonographers’ LVMs were consistent with experts’ only in the lowest BMI range of this study.

Conclusion:

Groups acquired LVM in similar amounts of time, showing LVM is easy to teach and learn, and has good inter-rater reliability. Difference for both groups to obtain LVM over linear was only 38 seconds. Consequently, it is prudent to incorporate LVM into abdominal ultrasound protocols.
Severe Hydronephrosis Secondary to Ovarian Serous Carcinoma
Authors: Celano Trina
Published: February 2022

This case study examines a patient with severe hydronephrosis caused by ureteral obstruction, secondary to ovarian serous carcinoma. Gynecologic malignancies, especially advanced ovarian carcinoma, are common extrinsic causes of obstructive hydronephrosis. Sonography is a valuable modality to visualize the kidneys, diagnose hydronephrosis, and determine the grade of hydronephrosis. The treatment of hydronephrosis aims to remove the build-up of urine, prevent permanent kidney damage, and treat the underlying cause. Prolonged or severe cases of hydronephrosis can lead to acute kidney injury.
Full Thickness Achilles Tendon Tears: Two Case Studies
Authors: Carrigan Matthew
Published: February 2022

The Achilles tendon is the largest and strongest tendon in the body. With increasing age and repetitive use, the Achilles tendon is more prone to injury, ranging from a mild injury to a full thickness tear. Achilles tendon injuries are one of the most common sporting injuries, and sonography may be the first imaging modality used to diagnose. Technologists must be familiar and able to recognize partial and full thickness tendon tears to assist in accurately diagnosing these injuries. Both the case studies provided demonstrate patients involved in sporting activities that resulted in complete Achilles tendon ruptures.
Evaluating the cytotoxicity and pathogenicity of multi-walled carbon nanotube through weighted gene co-expression network analysis: a nanotoxicogenomics study
Authors: Salih Shameran Jamal , Ghobadi Mohadeseh Zarei
Published: February 2022

Background

Multi-walled carbon nanotube (MWCNT) is one of the most momentous carbonaceous nanoparticles which is widely used for various applications such as electronics, vehicles, and therapeutics. However, their possible toxicity and adverse effects convert them into a major health threat for humans and animals.

Results

In this study, we employed weighted gene co-expression network analysis (WGCNA) to identify the co-expressed gene groups and dysregulated pathways due to the MWCNT exposure. For this purpose, three weighted gene co-expression networks for the microarray gene expression profiles of the mouse after 1, 6, and 12-month post-exposure to MWCNT were constructed. The module-trait analysis specified the significant modules related to different doses (1, 10, 40, and 80 µg) of MWCNT. Afterward, common genes between co-regulated and differentially expressed genes were determined. The further pathway analysis highlighted the enrichment of genes including Actb, Ube2b, Psme3, Ezh2, Alas2, S100a10, Ypel5, Rhoa, Rac1, Ube2l6, Prdx2, Ctsb, Bnip3l, Gp6, Myh9, Ube2k, Mbnl1, Kbtbd8, Riok3, Itgb1, Rap1a, and Atp5h in immune-, inflammation-, and protein metabolism-related pathways.

Conclusions

This study discloses the genotoxicity and cytotoxicity effects of various doses of MWCNT which also affect the metabolism system. The identified genes can serve as potential biomarkers and therapeutic candidates. However, further studies should be performed to validate them in human cells.
miR-486-5p expression is regulated by DNA methylation in osteosarcoma
Authors: Namløs Heidi M. , Skårn Magne , Ahmed Deeqa , Grad Iwona , Andresen Kim , Kresse Stine H. , Munthe Else , Serra Massimo , Scotlandi Katia , Llombart-Bosch Antonio , Myklebost Ola , Lind Guro E. , Meza-Zepeda Leonardo A.
Published: February 2022

Background

Osteosarcoma is the most common primary malignant tumour of bone occurring in children and young adolescents and is characterised by complex genetic and epigenetic changes. The miRNA miR-486-5p has been shown to be downregulated in osteosarcoma and in cancer in general.

Results

To investigate if the mir-486 locus is epigenetically regulated, we integrated DNA methylation and miR-486-5p expression data using cohorts of osteosarcoma cell lines and patient samples. A CpG island in the promoter of the ANK1 host gene of mir-486 was shown to be highly methylated in osteosarcoma cell lines as determined by methylation-specific PCR and direct bisulfite sequencing. High methylation levels were seen for osteosarcoma patient samples, xenografts and cell lines based on quantitative methylation-specific PCR. 5-Aza-2′-deoxycytidine treatment of osteosarcoma cell lines caused induction of miR-486-5p and ANK1, indicating common epigenetic regulation in osteosarcoma cell lines. When overexpressed, miR-486-5p affected cell morphology.

Conclusions

miR-486-5p represents a highly cancer relevant, epigenetically regulated miRNA in osteosarcoma, and this knowledge contributes to the understanding of osteosarcoma biology.
Metal removal capability of two cyanobacterial species in autotrophic and mixotrophic mode of nutrition
Authors: Ghorbani Elham , Nowruzi Bahareh , Nezhadali Masoumeh , Hekmat Azadeh
Published: February 2022

Background

Cyanobacteria are ecologically significant prokaryotes that can be found in heavy metals contaminated environments. As their photosynthetic machinery imposes high demands for metals, homeostasis of these micronutrients has been extensively considered in cyanobacteria. Recently, most studies have been focused on different habitats using microalgae leads to a remarkable reduction of an array of organic and inorganic nutrients, but what takes place in the extracellular environment when cells are exposed to external supplementation with heavy metals remains largely unknown.

Methods

Here, extracellular polymeric substances (EPS) production in strainsNostocsp. N27P72 andNostocsp. FB71 was isolated from different habitats and thenthe results were compared and reported.

Result

Cultures of both strains, supplemented separately with either glucose, sucrose, lactose, or maltose showed that production of EPS and cell dry weight were boosted by maltose supplementation. The production of EPS (9.1 ± 0.05 μg/ml) and increase in cell dry weight (1.01 ± 0.06 g/l) were comparatively high inNostocsp. N27P72 which was isolated from lime stones.The cultures were evaluated for their ability to remove Cu (II), Cr (III), and Ni (II) in culture media with and without maltose. The crude EPS showed metal adsorption capacity assuming the order Ni (II) > Cu (II) > Cr (III) from the metal-binding experiments.Nickel was preferentially biosorbed with a maximal uptake of 188.8 ± 0.14 mg (g cell dry wt)−1crude EPS. We found that using maltose as a carbon source can increase the production of EPS, protein, and carbohydrates content and it could be a significant reason for the high ability of metal absorbance. FT-IR spectroscopy revealed that the treatment with Ni can change the functional groups and glycoside linkages in both strains. Results of Gas Chromatography-Mass Spectrometry (GC–MS) were used to determine the biochemical composition ofNostocsp. N27P72, showed that strong Ni (II) removal capability could be associated with the high silicon containing heterocyclic compound and aromatic diacid compounds content.

Conclusion

The results of this studyindicatede that strainsNostocsp. N27P72 can be a good candidate for the commercial production of EPS and might be utilized in bioremediation field as an alternative to synthetic and abiotic flocculants.
Comparative physiological and transcriptomic analysis reveal MdWRKY75 associated with sucrose accumulation in postharvest ‘Honeycrisp’ apples with bitter pit
Authors: Sun Chen , Zhang Weiwei , Qu Haiyong , Yan Longfei , Li Lixia , Zhao Yuqi , Yang Hongqiang , Zhang Hua , Yao Gaifang , Hu Kangdi
Published: February 2022

Background

Calcium (Ca) deficiency can cause apple bitter pit, reduce the quality and shelf life. WRKY transcription factors play essential role in plant response to multiple disorders. However, the underlying mechanisms causing bitter pit in apple fruit due to Ca deficiency during storage is extremely limited.

Results

In the present study, the nutritional metabolites and reactive oxygen species (ROS) were compared in Ca-deficient and healthy apple fruit (CK) during storage. Results showed that Ca-deficient apples sustained significantly higher production of ROS, PPO activity, flavonoids, total phenol, total soluble solids (TSS), and sucrose contents, but the contents of Ca, H2O2, titratable acids (TA), glucose and fructose were significantly lower than those of CK during storage. Principal component analysis (PCA) showed that TSS, •O2−, PPO, malondialdehyde (MDA) and Ca were the main factors, and TSS had a positive correlation with sucrose. Furthermore, transcriptome analysis revealed that WRKYs were co-expressed with sucrose metabolism-related enzymes (SWEETs, SS, SPS). qRT-PCR and correlation analysis indicated that MdWRKY75 was correlated positively with MdSWEET1. Moreover, transient overexpression of MdWRKY75 could significantly increase the sucrose content and promote the expression of MdSWEET1 in apple fruit.

Conclusions

Calcium deficiency could decrease antioxidant capacity, accelerate nutritional metabolism and up-regulate the expression of WRKYs in apple with bitter pit. Overexpression of MdWRKY75 significantly increased sucrose accumulation and the expression of MdSWEET1. These findings further strengthened knowledge of the basic molecular mechanisms in calcium deficiency apple flesh and contributed to improving the nutritional quality of apple fruit.
Cultural attributes of suicidal ideation among older immigrants: a qualitative study
Authors: Li Mengting , Bergren Stephanie , Simon Melissa , Dong XinQi
Published: February 2022

Background

Suicide is a large and growing public health problem. Little is known about the attributes of suicidal ideation (SI) in the contexts of immigration. This qualitative study aims to explore immigration- and acculturation-related attributes of SI among older immigrants.

Methods

A qualitative semi-structured interview design. Interview were conducted with 57 older Chinese immigrants in Chicago with self-reported SI in the past month.

Results

In addition to attributes of SI which have been well documented in the literature, we identified immigration- and acculturation-related attributes, including linguistic and cultural barriers of being integrated to the receiving communities, acculturation gaps in intergenerational support, and uselessness.

Conclusions

Findings of the study highlight the intersectionality of race, culture, and aging regarding SI, which are essential to improve recognition and understanding of SI among immigrant populations.
Sarcopenia as a novel prognostic factor in the patients of primary localized gastrointestinal stromal tumor
Authors: Song He , Xiao Xianhao , Liu Gang , Zhou Jianping
Published: February 2022

Background

Sarcopenia predicts poor prognosis of a variety of gastrointestinal malignancies. However, there is a lack of study on the association between skeletal muscle index (SMI) and the prognosis of gastrointestinal stromal tumor (GIST). The aim of this study is to develop a novel nomogram based on sarcopenia for GIST patients to predict overall survival (OS).

Methods

SMI was measured by computed tomography scan of 107 patients who underwent resection for primary localized gastrointestinal stromal tumor (GIST). Sarcopenia was defined by cutoff values for SMI as 40.1 cm2/m2 and 39.8 cm2/m2 using optimum stratification for males and females respectively. Factors were included in the nomogram were specified by univariate and multiple Cox proportional hazard analysis. Concordance index (C-index) and calibration curves were conducted to measure the discrimination and accuracy of the nomogram. The utility of the nomogram was assessed by the decision curve analysis (DCA).

Results

Twenty-eight (26.2%) of 107 patients were sarcopenic. Sarcopenia was correlated significantly with body mass index, albumin, female sex, resection style, mitotic index, rupture status, survival. Sarcopenia was significantly related to decreased overall survival (p = 0.003).The nomogram including sarcopenia status, resection style and mitotic index had an excellent discrimination with C-index 0.794. The calibration curves represented a good accordance between the actual observation and nomogram prediction for overall survival. Decision curve analysis illustrated that the nomogram was helpful in clinic.

Conclusions

We developed a nomogram based on sarcopenia to predict overall survival after resection of GISTs which is an effective and favorable prognostication tool.
Perspectives on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and Ethiopia: A Qualitative Analysis
Authors: Rent Sharla , Bakari Ashura , Aynalem Haimanot Sara , Deribessa Solomie Jebessa , Plange-Rhule Gyikua , Bockarie Yemah , Moyer Cheryl A. , Kukora Stephanie K.
Published: February 2022

Background

In high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants.

Methods

Qualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul’s Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method.

Results

Three discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a duty to the patient, and a duty intrinsic to one’s role as a medical provider. The duty to resuscitate was balanced by the second major theme, an acceptance of futility for many premature infants. Lack of resources, inappropriate staffing, and historically high local neonatal mortality rates were often described. The third theme was a desire to meet global standards of newborn care, including having resources to adopt the 22–25-week thresholds used in high income countries and being able to consistently provide life-saving measures to premature infants.

Conclusions

Neonatal clinicians in Ghana and Ethiopia described respect for all life and desire to meet global standards of newborn care, balanced with an awareness of futility based on local resource limitations. In both countries, clinicians highlighted how wide variations in regional survival outcomes limited their ability to rely on structured resuscitation guidelines based on gestational age and/or birthweight.
Comparing gender-specific suicide mortality rate trends in the United States and Lithuania, 1990–2019: putting one of the “deaths of despair” into perspective
Authors: Lange Shannon , Rehm Jürgen , Tran Alexander , L. Bagge Courtney , Jasilionis Domantas , Kaplan Mark S. , Meščeriakova-Veliulienė Olga , Štelemėkas Mindaugas , Probst Charlotte
Published: February 2022

Introduction

The increase in the suicide mortality rate among middle-aged adults in the United States (US) has been well documented. Aside from a few studies from the United Kingdom, it is unclear whether the suicide mortality rate trend in the US is also occurring in other developed countries. Accordingly, we aimed to compare the suicide mortality rate trends over the past 30 years in the US to a country in the European Union–Lithuania.

Methods

Joinpoint regression analyses were performed to identify secular trends in the gender-specific age-standardized suicide mortality rate among individuals 15 + years of age, as well as middle-aged adults (45–54 years of age), and suicide mortality rate ratio for men-to-women.

Results

Age-standardized suicide mortality rates among middle-aged adults in the US increased annually, on average, by 0.89% (95% CI: 0.66%, 1.12%) among men and 1.21% (95% CI: 0.75%, 1.66%) among women between 1990 and 2019. In contrast to the US, there was an overall downward trend in the suicide mortality rates among middle-aged adults in Lithuania across the study period. The average annual percent change in the suicide mortality rate ratio for men-to-women were not statistically significant for either country.

Conclusion

The suicide mortality rate trend in the US does not appear to be an indicator of an upcoming global trend, but rather should be regarded as a cautionary example of what other countries should strive to avoid.
Effects of the 2018 Japan Floods on long-term care insurance costs in Japan: retrospective cohort study
Authors: Yoshida Shuhei , Kashima Saori , Ishii Shinya , Koike Soichi , Matsumoto Masatoshi
Published: February 2022

Background

Climate change has increased the frequency and severity of torrential rains and floods around the world. Estimating the costs of these disasters is one of the five global research priorities identified by WHO. The 2018 Japan Floods hit western Japan causing extensive destruction and many deaths, especially among vulnerable elderly. Such affected elderly would need long-term care due to the various health problems caused by the disaster. A Long-Term Care Insurance (LTCI) system provides care services in Japan. The aim of this study was to evaluate the effect of the 2018 Japan Floods on LTCI costs and service utilization.

Methods

The participants of this retrospective cohort study were all verified persons utilizing LTCI services in Hiroshima, Okayama and Ehime prefectures. The observation period was from 2 months before to 6 months after the disaster. We used Generalized Estimating Equations (GEEs) to examine the association between disaster status (victims or non-victims) and the monthly total costs of LTCI service (with gamma-distribution/log-link) by residential environment (home or facility). Among home residents, we also examined each service utilization (home-based service, short-stay service and facility service), using the GEEs. After the GEEs, we estimated Average Marginal Effects (AME) over all observation periods by months as the attributable disaster effect.

Results

The total number of participants was 279,578. There were 3024 flood victims. The disaster was associated with significantly higher total costs. The AME for home residents at 2 months after was $214 (Standard Error (SE): 12, p < 0.001), which was the highest through the observation period. Among facility residents, the AME immediately after the disaster increased by up to $850 (SE: 29, p < 0.001). The service utilization among home residents showed a different trend for each service. The AME of home-based services decreased by up to − 15.2% (SE:1.3, p < 0.001). The AME for short-stay service increased by up to 8.2% (SE: 0.9, p < 0.001) and the AME for facility service increased by up to 7.4% (SE: 0.7, p < 0.001), respectively.

Conclusions

The 2018 Japan Floods caused an increase in LTCI costs and the utilization of short-stay and facility services, and a decrease in utilization of home-based services.
Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries – a scoping review
Authors: Hoffmann Stephanie , Sander Lydia , Wachtler Benjamin , Blume Miriam , Schneider Sven , Herke Max , Pischke Claudia R. , Fialho Paula Mayara Matos , Schuettig Wiebke , Tallarek Marie , Lampert Thomas , Spallek Jacob
Published: February 2022

Background

By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children’s health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.

Methods

This review followed the methodology of “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews”. To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator “AND”: (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.

Results

The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent–child conflicts) are identified to have mediating or moderating effects. While families’ living conditions (i.e., TVs in children’s bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities.

Conclusion

Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children’s health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.
Fatal drowning statistics from the Netherlands – an example of an aggregated demographic profile
Authors: Bierens Joost , Hoogenboezem Jan
Published: February 2022

Introduction

Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data.

Methods

This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis.

Results

The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012.

Discussion

Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions.
A controlled pilot intervention on community violence prevention, financial and social capital generation in Dar Es Salaam, Tanzania
Authors: Jansen Louis , Outwater Anne H. , Lowery Wilson Michael , Iseselo Masunga K. , Bärnighausen Till
Published: February 2022

Background

Community violence has been found to be highly prevalent in Dar es Salaam, Tanzania. Increasing socioeconomic inequality has been outlined as one of the main causes of community violence. This controlled pilot trial aimed at evaluating the impact of beekeeping and entrepreneurship training on community violence exposure, financial and social capital generation, and employment structure.

Methods

Poisson regression was used to compare pre- and post-intervention risk ratios for community violence exposure. Linear regression was used to depict change in weekly income and utu scores. Employment rate structures were determined pre- and post-intervention.

Results

This study reports that compared to the Control arm beekeeping and entrepreneurship training appears to have protected young men in Dar es Salaam from exposure to community violence (All = 0.62 (0.40–0.96), Beekeeping = 0.57 (0.30–1.08), Entrepreneurship = 0.62 (0.33–1.17)), while increasing financial (All = 23,145 (− 27,155 – 73,444), Beekeeping = 29,310 (− 26,079 – 84,698), Entrepreneurship = 82,334 (12,274 – 152,293)) and partially also social capital (All = − 0.24 (− 1.35–0.87), Beekeeping = 0.85 (− 0.26–1.96), Entrepreneurship = 0.30 (− 1.16–1.77)). Financial dependency across all arms was reduced from 29.1 to 2.2%.

Conclusions

Our study reports that beekeeping training and entrepreneurship seminars appear to have a protective effect against exposure to community violence among young men in Dar es Salaam, while partially also increasing financial and social capital, as well as reducing financial dependency. We recommend that these results should lay the foundation for an adequately powered randomized trial to confirm the study’s efficacy.

Trial registration

retrospectively registered atClinicalTrials.gov(Identifier: NCT04602416; October 26, 2020).
Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability
Authors: Hung Wei-Chen , Wang Jung-Pan , Huang Yi-Chao , Yin Cheng-Yu , Wu Cheng-Yi , Huang Hui-Kuang
Published: February 2022

Background

Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure.

Methods

Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18–57 years), and the mean duration from injury to operation was 7.8 months (range, 3–25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12–26 months).

Results

All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities.

Conclusions

We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.
The risk matrix approach: a helpful tool weighing probability and impact when deciding on preventive and diagnostic interventions
Authors: Lemmens Stéphanie M. P. , Lopes van Balen Veronica A. , Röselaers Yvonne C. M. , Scheepers Hubertina C. J. , Spaanderman Marc E. A.
Published: February 2022

Background

Clinical guidelines are developed to lower risks, mostly viewed upon as probability. However, in daily practice, risk is perceived as the combination of probability and the impact of desired and adverse events. This combination of probability and impact can be visualized in a risk matrix. We evaluated the effect of interventions and diagnostic thresholds on modeled risk, by using the risk matrix approach (RMA) in a clinical guideline development process, and investigated which additional factors affected choices.

Methods

To improve care outcomes, we developed new guidelines in which care professionals had to decide upon novel interventions and diagnostic thresholds. A risk matrix showed the probability and impact of an intervention, together with the corresponding risk category. First, professionals’ opinion on required performance characteristics on risk were evaluated by a qualitative online survey. Second, qualitative assessment of possible additional factors affecting final decisions, that followed from group discussion and guideline development were evaluated.

Results

Upfront, professionals opinioned that non-invasive interventions should decrease the general population risk, whereas invasive interventions should decrease the risk in high-risk groups. Nonetheless, when making guidelines, interventions were introduced without reaching the predefined threshold of desired risk reduction. Professionals weighed other aspects besides risk reduction, as financial aspects and practical consequences for daily practice in this guideline-making process.

Conclusion

Professionals are willing to change policies at much lower level of anticipated effectiveness than defined upfront. Although objectively presented data structured group discussions, decisions in guideline development are affected by several other factors than risk reduction alone.
Effectiveness of a multi-faceted intervention to deprescribe proton pump inhibitors in primary care: protocol for a population-based, pragmatic, cluster-randomized controlled trial
Authors: Nguyen-Soenen Jérôme , Rat Cédric , Gaultier Aurélie , Schirr-Bonnans Solène , Tessier Philippe , Fournier Jean-Pascal
Published: February 2022

Background

Inappropriately using proton pump inhibitors (PPI) is associated with severe adverse drug reactions and may have major consequences on healthcare costs. Deprescribing (the process by which a healthcare professional supervises the withdrawal of an inappropriate medication, to manage polypharmacy and improve outcomes) should be considered when an inappropriate PPI prescription is identified. Deprescribing interventions directed solely to prescribers have limited efficacy and are rarely targeted to patients. The aim of this trial is to assess the efficacy of a multi-faceted intervention with patients and general practitioners (GPs) to deprescribe PPI.

Methods

We will conduct a pragmatic, cluster-randomized, population-based, controlled trial in two regions of Western France. GPs with practices with over 100 patients, and their adult patient to whom over 300 defined daily doses (DDD) of PPIs have been dispensed in the year before baseline will be included. A total of 1300 GPs and 33,000 patients will be cluster-randomized by GPs practices. Three arms will be compared: i) a multi-faceted intervention associating a) a patient education brochure about PPI deprescribing sent directly to patients (the brochure was designed using a mixed-methods study), and b) a personalized letter with the Bruyere’s PPI deprescribing algorithm sent to their respective GPs, or ii) a single intervention where only the GPs received the letter and algorithm, or iii) no intervention.

The primary outcome will be PPI deprescribing, defined as the proportion of patients achieving at least a 50% decrease in the amount of PPI dispensed to them (DDD/year) at 12 months compared to baseline. Secondary outcomes will include incremental cost-utility ratio (using EQ-5D-5L scale and National Health Insurance’s database), acid rebound (using the Gastroesophageal Reflux Disease Impact Scale), and the patients’ attitudes towards deprescribing (using the French rPATD).

Discussion

Based on previous trials, we anticipate more than 10% “successful PPI deprescribing” in the multi-faceted intervention compared to the single intervention on GPs and the control arm. The study has been funded through a national grant and will be launched in autumn 2020, for early results by the end of 2022.

Trial registration

Clinicaltrials.gov NCT04255823; first registered on February 5, 2020.