bluuebunny/crossref_metadata_2025 huggingface dataset:
Time to Moderate and Severe Hyperglycemia and Ketonemia Following an Insulin Pump Occlusion
Authors: Klonoff David C. , Ayers Alessandra T. , Ho Cindy N. , Fabris Chiara , Villa-Tamayo María Fernanda , Allen Eleanor , Cengiz Eda , Ekhlaspour Laya , Wong Jenise C. , Heineman Lutz , Kohn Michael A.
Published: September 2024

Introduction:

Insulin pump therapy can be adversely affected by interruption of insulin flow, leading to a rise in blood glucose (BG) and subsequently of blood beta-hydroxybutyrate (BHB) ketone levels.

Methods:

We performed a PubMed search for English language reports (January 1982 to July 2024) estimating the rate of rise in BG and/or BHB after ≥ 60 minutes of interruption of continuous subcutaneous insulin infusion (CSII) in persons with type 1 diabetes (PwT1D). We also simulated the rise in BG in a virtual population of 100 adults with T1D following suspension of continuous subcutaneous insulin infusion.

Results:

We identified eight relevant studies where BG and BHB (seven of these eight studies) were measured following suspension of CSII as a model for occlusion. After 60 minutes post-suspension, the mean extracted rates of rise averaged 0.62 mg/dL/min (37 mg/dL/h) for BG and 0.0038 mmol/L/min (0.20 mmol/L/h) for BHB. Mean estimated time to moderately/severely elevated BG (300/400 mg/dL) or BHB (1.6/3.0 mmol/L) was, respectively, 5.8/8.5 and 8.0/14.2 hours. The simulation model predicted moderately/severely elevated BG (300/400 mg/dL) after 9.25/12, 6.75/8.75, and 4.75/5.75 hours in the virtual subjects post-interruption with small (5th percentile), medium (50th percentile), and large (95th percentile) hyperglycemic changes.

Discussion:

Clinical studies and a simulation model similarly predicted that, following CSII interruption, moderate/severe hyperglycemia can occur within 5-9/6-14 hours, and clinical studies predicted that moderate/severe ketonemia can occur within 7-12/13-21 hours. Patients and clinicians should be aware of this timing when considering the risks of developing metabolic complications after insulin pump occlusion.
Vasorelaxant Effects of Ethanolic Extract from Cydonia oblonga Mill. Leaves on Isolated Rat Thoracic Aorta and Potential Mechanism of Action
Authors: Krasniqi Donjeta , Uka Albina , Rexhbeqaj Era , Beretta Giangiacomo , Petreska Stanoeva Jasmina , Qazimi Bujar , Daci Armond
Published: September 2024

Objective: Cydonia oblonga Mill . leaves ethanolic extract (CydOL-EE) has shown different cardioprotective effects. However, no previous studies investigated its direct effect on the vascular smooth muscle tone. Therefore, the study aimed to test the potential vasodilator activity of CydOL-EE in ex-vivo rat thoracic aorta preparations with an additional investigation of its mechanistic effects. Methods: CydOL-EE phytochemical profile was first investigated by HPLC-DAD-ESI-MS/MS and then tested for the vasorelaxation/vasoreactivity effects in rat aortic rings. The NO synthase inhibitor N(ω)-nitro-L-arginine methyl ester (L-NAME) and cyclic guanosine monophosphate inhibitor 1H-[1,2,4]Oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) were used to explore of the involvement of NO-dependent pathways. Results: Chromatographic analysis of CydOL-EE revealed the presence of six flavonols and seven hydroxycinnamic acids. Moreover, CydOL-EE showed a decrease in vasoreactivity caused by dose-dependent phenylephrine (PE) (Control, Emax = 104.29 ± 3.67 vs CydOL-EE, Emax = 70.73 ± 3.67, P < .0001) and a direct relaxing activity to precontraction with PE (Emax = 79.63 ± 3.67%). These responses were abolished during e-NOS inhibition, demonstrating that the mechanism of action was predominately controlled by the participation of an endothelium-dependent system. Conclusion: The results of our study show that CydO-EE demonstrates vasorelaxation and reduction of vasoreactivity through a NO-dependent pathway. These findings provide scientific evidence for further understanding of CydOL-EE use in the treatment of cardiovascular disease.
Hotel Employee Engagement During the Pandemic: A Mixed-Method Approach
Authors: Xu Shi (Tracy) , Ashton Mark , Li Yanning , Staunton Gregor , Li Yu (Kevin)
Published: September 2024

Many hotel organizations were helping their employees remain engaged in the workplace during the pandemic. From the perspective of social exchange theory, the antecedents and outcome of this engagement were explored in two studies. A qualitative interview investigation of U.K. hotel employee engagement as reported by Senior Managers ( n = 9) was carried out in Study 1 from which a theoretical model to investigate the antecedents and outcome of this engagement was developed, and tested with U.K. hotel employees ( n = 163) in Study 2, with both studies conducted sequentially during the pandemic. Study 1 found that the emergence of new methods and styles of communication, the provision of and increased access to training, and employees’ adaptation to changes positively facilitated employee engagement through the pandemic. Results of Study 2 suggested that employee resilience, perceived communication quality, and workplace health and safety training are positively related to employee engagement, which in turn improves employee performance. This research enhances the theoretical understanding of the personal factor (i.e., employee resilience) and situational factors (i.e., perceived communication quality, and workplace health and safety training) that help enhance employee engagement and ultimately improve performance. The practical implications of the study propose means of effective communication with employees, mechanisms to bolster employee resilience and proactive health and safety training and reinduction of employees ahead of their return to work with guests during times of extreme turbulence.
Friendships Without Friendships: Traversing the Contours of Relationality Through Reading/Writing
Authors: Varga Bretton A. , Adams Erin C.
Published: September 2024

This article engages with the intersections of reading, writing, and friendship (between the two authors). Specifically, we (re)trace conversations, presentations, notes, and text messages that have emerged since we (e.g., authors) have become thinking-friends and how we think about reading and its irrevocable relationship to writing. Using a range of books and a suite of theories associated with post-qualitative research, this article tempts readers/writers to consider—and perhaps (re)frame—reading/writing in three distinct ways: reading/writing as haunted, reading/writing as invitation, and reading/writing as provocation. Ultimately, we view this nomadic w(a/o)ndering about each register (e.g., reading, writing, and friendship) as being always-already emergent and not limited to strict temporal demarcations.
The Effects of Ketogenic Diets and Ketone Supplements on the Aerobic Performance of Endurance Runners: A Systematic Review
Authors: Sun Kexin , Choi Yee Tung , Yu Clare Chung Wah , Nelson Edmund Anthony Severn , Goh Jorming , Dai Siyu , Hui Lai Ling
Published: September 2024

Context:

Ketogenic diets and ketone supplements have gained popularity among endurance runners given their purported effects: potentially delaying the onset of fatigue by enabling the increased utilization of the body’s fat reserve or external ketone bodies during prolonged running.

Objective:

This systematic review was conducted to evaluate the effects of ketogenic diets (>60% fat and <10% carbohydrates/<50 g carbohydrates per day) or ketone supplements (ketone esters or ketone salts, medium-chain triglycerides or 1,3-butadiol) on the aerobic performance of endurance runners.

Data Sources:

A systematic search was conducted in PubMed, Web of Science, Pro Quest, and Science Direct for publications up to October 2023.

Study Selection:

Human studies on the effects of ketogenic diets or ketone supplements on the aerobic performance of adult endurance runners were included after independent screening by 2 reviewers.

Study Design:

Systematic review.

Level of Evidence:

Level 3.

Data Extraction:

Primary outcomes were markers of aerobic performance (maximal oxygen uptake [VO2max], race time, time to exhaustion and rate of perceived exertion).

Results:

VO2max was assessed by incremental test to exhaustion. Endurance performance was assessed by time trials, 180-minute running trials, or run-to-exhaustion trials; 5 studies on ketogenic diets and 7 studies on ketone supplements involving a total of 132 endurance runners were included. Despite the heterogeneity in study design and protocol, none reported benefits of ketogenic diets or ketone supplements on selected markers of aerobic performance compared with controls. Reduction in bodyweight and fat while preserving lean mass and improved glycemic control were reported in some included studies on ketogenic diets.

Conclusion:

This review did not identify any significant advantages or disadvantages of ketogenic diets or ketone supplements for the aerobic performance of endurance runners. Further trials with larger sample sizes, more gender-balanced participants, longer ketogenic diet interventions, and follow-up on metabolic health are warranted.
Sustainability champions: A proactive perspective on the inter-organizational job design dynamics of sustainability implementation
Authors: Pekaar Keri A. , Demerouti Evangelia , van Gool Piet J. R.
Published: September 2024

Implementing sustainability is a complex and challenging process that requires the collaboration and commitment of multiple stakeholders within supply chains. Existing research has largely overlooked the role of individual employees who can act as change agents and proactively initiate and facilitate sustainability initiatives. In this paper, we propose a proactive job design perspective to understand how these sustainability champions can balance the demands and resources related to sustainability in and across organizations. We suggest that they can use a combination of self- and partner-focused sustainability regulation strategies to influence the sustainability resources of their supply chain partners and create inter-organizational Job Demands-Resources dynamics that can enhance or hinder sustainability implementation. We develop a set of propositions that can guide future research on this topic and offer practical implications for organizations that want to foster employee proactivity and sustainability in their supply chains.
Optimizing Subsequent CARdiovascular Medication Reintroduction in the Intensive Care Unit
Authors: Dahel Hadjer , Tabbara Najla , Burry Lisa , Hornstein Gabrielle , Williamson David , Wang Han Ting
Published: September 2024

Importance:

Hospital admission for a critical illness episode creates communication breakpoints and can lead to medication discrepancies during hospital stays. Due to the patient’s underlying condition and the care setting, chronic medications such as cardiovascular medication are often held, discontinued, or changed to alternative administration routes. Unfortunately, data on the optimal timing of cardiovascular drug reinitiation among intensive care unit (ICU) survivors are lacking.

Objective:

The primary objective of this study was to describe the prevalence of chronic cardiovascular medication taken before hospital admission and discontinued at ICU discharge and hospital discharge for critically ill patients. A secondary objective was to assess factors associated with medication discontinuation.

Design setting and participants:

We conducted a multicentered retrospective cohort study at 2 tertiary academic hospitals in Canada. All adult patients taking cardiovascular medication before ICU admission and surviving to hospital discharge between April 1, 2016, and April 1, 2017, were eligible.

Main outcomes and measures:

The main outcome of the study was the discontinuation of cardiovascular medication prescribed before ICU admission. The outcome was assessed through participants’ chart review.

Results:

We included 352 patients with a median age of 71.0 years. A total of 155 patients (44.03%) had at least 1 cardiovascular medication discontinued during their stay. Our adjusted model uncovered 3 factors associated with cardiovascular medication discontinuation: male sex (odds ratio [OR] = 0.564, 95% confidence interval [CI] = 0.346-0.919), number of cardiovascular medications taken preadmission (OR = 1.669, 95% CI = 1.003-2.777 for 2 medications and OR = 3.170, 95% CI = 1.325-7.583), and the use of vasopressors (OR = 1.770, 95% CI = 1.045-2.997).

Conclusion:

Our study uncovered that cardiovascular medication discontinuation for ICU patients is frequent, especially for renin-angiotensin system (RAS) blockers. Data from our study could be used to reinforce site-specific protocols of medication reconciliation and optimization, as well as inform future protocols aimed at RAS blocker reinitiation follow-up.
Disease characteristics influence the privacy calculus to adopt electronic health records: A survey study in Germany
Authors: von Kalckreuth Niklas , Feufel Markus A.
Published: September 2024

Background

The electronic health record (EHR) is integral to improving healthcare efficiency and quality. Its successful implementation hinges on patient willingness to use it, particularly in Germany where concerns about data security and privacy significantly influence usage intention. Little is known about how specific characteristics of medical data influence patients’ intention to use the EHR.

Objective

This study aims to validate the privacy calculus model (PCM) regarding EHRs and to assess how personal and disease characteristics, namely disease-related stigma and disease time course, affect PCM predictions.

Methods

An online survey was conducted to empirically validate the PCM for EHR, incorporating a case vignette varying in disease-related stigma (high/low) and time course (acute/chronic), with N = 241 participants, aged 18 years and older residing in Germany with no previous experience with the diseases mentioned in the respective medical reports. Participants were randomized (single-blinded) into four groups in parallel: high stigma and acute time course ( n = 74), high stigma and chronic time course ( n = 56), low stigma and acute time course ( n = 62) and low stigma and chronic time course ( n = 49). The data were analyzed using structural equation modeling with partial least squares.

Results

The model explains R² = 71.8% of the variance in intention to use. The intention to use is influenced by perceived benefits, data privacy concerns, trust in the provider, and social norms. However, only the disease's time course, not stigma, affects this intention. For acute diseases, perceived benefits and social norms are influential, whereas for chronic diseases, perceived benefits, privacy concerns, and trust in the provider influence intention.

Conclusions

The PCM validation for EHRs reveals that personal and disease characteristics shape usage intention in Germany. The need for tailored EHR adoption strategies that address specific needs and concerns of patients with different disease types. Such strategies could lead to a more successful and widespread implementation of EHRs, especially in privacy-conscious contexts.
Digital health technologies and artificial intelligence in cardiovascular clinical trials: A landscape of the European space
Authors: Lampreia Fabio , Madeira Catarina , Dores Hélder
Published: September 2024

The recent pandemic ushered in a marked surge in the adoption of digital health technologies (DHTs), necessitating remote approaches aiming to safeguard both patient and healthcare provider well-being. These technologies encompass an array of terms, including e-health, m-health, telemedicine, wearables, sensors, smartphone apps, digital therapeutics, virtual and augmented reality, and artificial intelligence (AI). Notably, some DHTs employed in critical healthcare decisions may transition into the realm of medical devices, subjecting them to more stringent regulatory scrutiny. Consequently, it is imperative to understand the validation processes of these technologies within clinical studies. Our study summarizes an extensive examination of clinical trials focusing on cardiovascular (CV) diseases and digital health (DH) interventions, with particular attention to those incorporating elements of AI. A dataset comprising 107 eligible trials, registered on clinicaltrials.gov and International Clinical Trials Registry Platform (ICTRP) databases until 19 June 2023, forms the basis of our investigation. We focused on clinical trials employing DHTs in the European context, revealing a diverse landscape of interventions. Devices constitute the predominant category (45.8%), followed by behavioral interventions (17.8%). Within the CV domain, trials predominantly span pivotal or confirmatory phases, with a notable presence of smaller feasibility and exploratory studies. Notably, a majority of trials exhibit randomized, parallel assignment designs. When analyzing the multifaceted landscape of trial outcomes, we identified various categories such as physiological and functional measures, diagnostic accuracy, CV events and mortality, patient outcomes, quality of life, treatment adherence and effectiveness, quality of hospital processes, and usability/feasibility measures. Furthermore, we delve into a subset of 15 studies employing AI and machine learning, describing various study design features, intended purposes and the validation strategies employed. In summary, we aimed to elucidate the diverse applications, study design features, and objectives of the evolving CV-related DHT clinical trials field.
Feasibility and acceptability of a dengue self-monitoring system to reduce treatment delay in Malaysia: A single-centre pilot randomised controlled trial
Authors: Ng Wei Leik , Ng Chirk Jenn , Teo Chin Hai , Ang Tan Fong , Lee Yew Kong , Abdul Hadi Haireen , Chiang De Min , Mohd Noor Mohd Khairi , Syed Omar Sharifah Faridah , Ong Hang Cheng , Wong Pui Li , Kukreja Anjanna , Chiew Thiam Kian , Ong Sim Ying , Noor Azhar Abdul Muhaimin
Published: September 2024

Objective

Most dengue cases are managed in an outpatient setting, where patients are advised to return to the clinic daily for monitoring. Some patients can develop severe dengue at home and fail to recognise the deterioration. An application called DengueAid was designed as a self-monitoring tool for patients to reduce delay in seeking timely treatment. This study aimed to assess the feasibility of conducting a randomised controlled trial to determine the effectiveness of the DengueAid application.

Methods

Dengue patients were recruited from a public health clinic in Malaysia and randomised to either use the DengueAid application plus standard care for dengue or receive only the standard care. The outcomes evaluated were the (1) feasibility of recruitment, data collection and follow-up procedures; (2) preliminary clinical outcome measures; and (3) acceptability of DengueAid. Qualitative interviews were conducted for participants in the intervention arm to assess the acceptability of DengueAid.

Results

Thirty-seven patients were recruited with 97% ( n = 36) retention rates. The recruitment rate was low (63% refusal rate, n = 62/99) with difficulty in data collection and follow-up due to the variable interval of care for dengue in an outpatient setting. DengueAid application was acceptable to the participants, but preliminary clinical outcomes and qualitative data suggested limited utility of the application. Unwell conditions of patients and limited access to healthcare are important factors impacting the application's utility.

Conclusion

The feasibility trial uncovered issues with recruitment, data collection and follow-up processes. Further research and modification to the application are needed to improve its utility and usability.
Chinese colposcopists' attitudes toward the colposcopic artificial intelligence auxiliary diagnostic system (CAIADS): A nation-wide, multi-center survey
Authors: Wang Huike , Ye Zichen , Zhang Peiyu , Cui Xiaoli , Chen Mingyang , Wu Aiyuan , Riggs Sara Lu , Xue Peng , Qiao Youlin
Published: September 2024

Objective

The objective of this study was to assess the attitudes toward the Colposcopic Artificial Intelligence Auxiliary Diagnostic System (CAIADS) of colposcopists working in mainland China.

Methods

A questionnaire was developed to collect participants' sociodemographic information and assess their awareness, attitudes, and acceptance toward the CAIADS.

Results

There were 284 respondents from 24 provinces across mainland China, with 55% working in primary care institutions. Participant data were divided into two subgroups based on their colposcopy case load per year (i.e. ≥50 cases; <50 cases). The analysis showed that participants with higher loads had more experience working with CAIADS and were more knowledgeable about CAIADS and AI systems. Overall, in both groups, about half of the participants understood the potential applications of big data and AI-assisted diagnostic systems in medicine. Although less than one-third of the participants were knowledgeable about CAIADS and its latest developments, more than 90% of the participants were open with the idea of using CAIADS.

Conclusions

While a related lack of acknowledgement of CAIADS exists, the participants in general had an open attitude toward CAIADS. Practical experience with colposcopy or CAIADS contributed to participants' awareness and positive attitudes. The promotion of AI tools like CAIADS could help address regional health inequities to improve women's well-being, especially in low- and middle-income countries.
Managing the Pandemic in Digitized Spaces: Assessing the Social Media Approaches of Scandinavian Public Health Authorities
Authors: Hasselström Anna Elisabeth , Larsson Anders Olof
Published: September 2024

In response to the COVID-19 pandemic, health- and civil-contingency agencies—referred to here as public health authorities (PHAs)—in Sweden, Norway, and Denmark turned to social media to disseminate pandemic recommendations and information. This study explores the social media crisis management strategies employed by Scandinavian PHAs. Specifically, we apply a multiplatform research approach to assess communication objectives (Instruct, Support, Manage Reputation, and Solicit Interaction) across three social media platforms—Facebook, Instagram, and Twitter (currently known as X). Introducing a series of hypotheses based on previous scholarship, we detail the prevalence of different objectives across platforms and countries. The results indicate prominent use of reputational management, particularly on Twitter, while instructive information emerged as a highly used communication objective in Sweden and Denmark. Overall, the communicative trends remained parallel across nations, despite Sweden implementing a more relaxed crisis management strategy. The main distinction in Sweden’s approach manifested in a relatively lower emphasis on the pandemic by its PHAs compared to Denmark and Norway. National differences in crisis communication objectives indicate that Norwegian PHAs stand out in terms of using reputational management, while Sweden stands out in employing more supportive information on Instagram.
Diversity in Action: Unveiling Flipkart’s Path to Inclusion and Excellence
Authors: Sanehi Ishaan , Kataria Vrinda , Jena Lalatendu Kesari
Published: September 2024

This comprehensive case study explores the journey of Flipkart India Pvt. Ltd., tracing its trajectory from its inception to its current position as a pioneering force in the Indian e-commerce landscape. The study aims to outline the company’s exponential growth and potential by highlighting its pivotal milestones, strategic shifts, acquisitions, and the adaptive measures that have been instrumental in its evolutionary course. With a particular focus on the transformative influence of diversity, equity, and inclusion (DE&I) initiatives within Flipkart’s organizational framework, the study emphasizes the changing needs of the workforce and their need for inclusion in the workplace. By analyzing how DE&I efforts intersect with diverse operational domains, the study underscores their pivotal role in empowering a dynamic workforce and propelling societal progress. Flipkart’s journey as a pioneer of DE&I in the e-commerce industry has set a benchmark for enhancing workforce potential and demonstrating its direct impact on the business altogether. The authors of the study have drawn insights from a range of secondary and publicly available sources that offer a comprehensive view of the symbiotic relationship between corporate growth and DE&I initiatives, an imperative for businesses aspiring to expand, distinguish their brand, and foster innovation.
Predicting the Recovery of Isokinetic Knee Strength 6 Months After Anterior Cruciate Ligament Reconstruction
Authors: Wenning Markus , Sofack Ghislain N. , Zöller Daniela , Mauch Marlene , Heitner Albrecht H. , Paul Jochen , Zahn Peter , Ritzmann Ramona
Published: September 2024

Background:

The limb symmetry index (LSI) is a metric of strength restoration. It is key to successfully return to sports after anterior cruciate ligament (ACL) reconstruction. The threshold for return to sports is generally considered an LSI of ≥85%.

Purpose:

To develop a statistical model for predicting the recovery of knee extension and flexion strength (with LSI ≥85%) at 6 months after ACL reconstruction.

Study Design:

Case-control study; Level of evidence: 3.

Methods:

Patients who underwent arthroscopic ACL reconstruction between November 2015 and December 2020 were included. The patients were classified into 2 groups: “pass” if the LSI at 6 months postoperatively was ≥85% and “fail” if the LSI was <85%. Factors in 25 categories with 74 levels, including patient characteristics, periarticular procedures, intra-articular lesions and treatment, and perioperative management, were collected. A multivariable logistic regression combined with backward variable elimination was used to determine the predictive parameters for recovery of knee extension and flexion strength.

Results:

A total of 948 patients were included. Graft site, preoperative isokinetic strength, treatment of meniscal injury, and injured side (left vs right) were identified as general predictors for both knee extension and flexion strength. For knee extension strength, age at injury and partial weightbearing duration were identified as additional predictors. For knee flexion strength, type of meniscal injury, surgeon volume, cartilage procedures, and periarticular procedures were identified as additional predictors. The Nagelkerke R2 of the final model was 0.178, and the c-statistic was 0.716 (95% CI, 0.676-0.754). The Hosmer-Lemeshow test indicated good calibration ( P = .879).

Conclusion:

Several factors including preoperative isokinetic strength, treatment of meniscal injuries, left vs. right side and graft site were found to predict recovery of ≥85% LSI in knee extension and flexion strength. Despite the numerous factors that were analyzed, the predictive power was moderate (c-statistic = 0.716), indicating there were other nonincluded factors that significantly influence strength performance at 6 months postoperatively.
Outcomes of Surgical Treatment for Multiligament Knee Injuries in a Cohort Including Competitive Athletes With Long-Term Follow-Up
Authors: Mussell Eric A. , Crawford Anna E. , Ithurburn Matthew P. , Layton Branum O. , Fleisig Glenn S. , Rothermich Marcus A. , Emblom Benton A. , Ryan Michael K. , Dugas Jeffrey R. , Andrews James R. , Cain E. Lyle
Published: September 2024

Background:

There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature.

Purpose:

To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period.

Study Design:

Case series; Level of evidence, 4.

Methods:

We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression.

Results:

Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up.

Conclusion:

Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.
Iron Deficiency Anemia and Dental Caries: A Systematic Review and Meta-Analysis
Authors: Aguirre-Ipenza Rubén , Nieto-Gutiérrez Wendy , Contreras Winnie , Contreras Pavel J. , Curioso Walter H.
Published: September 2024

Objective. To evaluate the evidence regarding the association between iron deficiency anemia (IDA) and dental caries in children and adolescents. Methods. Searches were conducted in 4 international databases from the beginning of records until October 2023. Studies evaluating the association between IDA and dental caries in individuals aged 6 months to 18 years were included. Risk of bias was assessed using the Newcastle Ottawa Scale. Quantitative synthesis was performed using the inverse variance or Mantel-Haenzel method, depending on the type of outcome analyzed. Measures of association included odds ratios and mean differences, employing a random-effects model with a 95% confidence interval. Results. A total of 1161 studies were identified, of which 12 were selected for qualitative review and 9 for meta-analysis. A significant association was found between IDA and dental caries (odds ratio of 3.54; 95% CI: 2.54-4.94) and a higher rate of dental caries in the presence of IDA (mean difference of 1.96; 95% CI: 1.07-2.85). The certainty of evidence according to GRADE was rated as very low. Conclusions. Despite the limited certainty, the findings indicate a significant association between IDA and dental caries. It is prudent to interpret these results with caution, considering the methodological limitations of the studies. However, given the potential relevance of this association for public health, recommending oral health strategies, including preventive and corrective dental interventions, for anemia control programs underlines the importance of more rigorous future research to strengthen the certainty of the evidence and guide the implementation of these strategies.
Voices of the Future: Junior Physicians’ Experiences of Discussing Life-Sustaining Treatments With Hospitalized Patients
Authors: Müller Michael Andreas , Gamondi Claudia , Truchard Eve Rubli , Sterie Anca-Cristina
Published: September 2024

OBJECTIVES

Life-sustaining treatments (LST) aim to prolong life without reversing the underlying medical condition. Being associated with a high risk of developing unwanted adverse outcomes, decisions about LST are routinely discussed with patients at hospital admission, particularly when it comes to cardiopulmonary resuscitation. Physicians may encounter many challenges when enforcing shared decision-making in this domain. In this study, we map out how junior physicians in Southern Switzerland refer to their experiences when conducting LST discussions with hospitalized patients and their learning strategies related to this.

METHODS

In this qualitative exploratory study, we conducted semi-directive interviews with junior physicians working at the regional public hospital in Southern Switzerland and analyzed them with an inductive thematic analysis.

RESULTS

Nine physicians participated. We identified 3 themes: emotional burden, learning strategies and practices for conducting discussions. Participants reported feeling unprepared and often distressed when discussing LST with patients. Factors associated with emotional burden were related to the context and to how physicians developed and managed their emotions. Participants signaled having received insufficient education to prepare for discussing LST. They reported learning to discuss LST essentially through trial and error but particularly appreciated the possibility of mentoring and experiential training. Explanations that physicians gave about LST took into account patients’ frequent misconceptions. Physicians reported feeling under pressure to ensure that decisions documented were medically indicated and being more at ease when patients decided by themselves to limit treatments. Communication was deemed as an important skill.

CONCLUSIONS

Junior physicians experienced conducting LST discussions as challenging and felt caught between advocating for medically relevant decisions and respecting patients’ autonomy. Participants reported a substantive emotional burden and feeling unprepared for this task, essentially because of a lack of adequate training. Interventions aiming to ameliorate junior physicians’ competency in discussing LST can positively affect their personal experiences and decisional outcomes.
Association of support group leader experience with Scleroderma Patient-centered Intervention Network Support group Leader EDucation Program outcomes: Secondary analysis of a two-arm parallel partially nested randomized controlled trial
Authors: Thombs Brett D , Levis Brooke , Carrier Marie-Eve , Dyas Laura , Konrad Violet , Sauvé Maureen , Benedetti Andrea ,   SPIN-SSLED Support Group Advisory Team
Published: September 2024

Introduction/Objective:

The Scleroderma Patient-centered Intervention Network Support group Leader EDucation Program was found in a randomized controlled trial to substantially improve leader self-efficacy. Whether the program is effective for leaders with different levels of experience, including candidate leaders with no prior experience and leaders with ⩽3 years experience or ⩾4 years experience, is not known. The objective of the present post hoc secondary analysis was to evaluate outcomes by leader experience, age, and education.

Methods:

The trial was a pragmatic, two-arm partially nested randomized controlled trial with 1:1 allocation to intervention or waitlist control. Eligible participants were existing or candidate support group leaders. The 13-session leader training was delivered in groups of five to six participants weekly via videoconference in 60- to 90-min sessions. The primary outcome was leader self-efficacy, measured by the Support Group Leader Self-efficacy Scale (SGLSS) immediately post-intervention. Secondary outcomes were Support Group Leader Self-efficacy Scale scores 3 months post-intervention and emotional distress, leader burnout, and volunteer satisfaction post-intervention and 3 months post-intervention. Leaders were classified as having no experience, ⩽3 years experience, or ⩾4 years experience.

Results:

A total of 148 participants were randomized to intervention (N = 74) or waitlist (N = 74). Compared to leaders with ⩾4 years of experience, Support Group Leader Self-efficacy Scale scores were non-statistically significantly higher post-intervention for leaders with 0–3 years experience and lower for leaders with no experience. The 3 months post-intervention Support Group Leader Self-efficacy Scale scores were significantly lower for leaders without experience and similar for leaders with 0–3 years to those with ⩾4 years experience. There were no differences by experience on other outcomes or by age and education on any outcomes.

Conclusion:

Support group leader education improved leader self-efficacy but was most effective for leaders with experience prior to initiating the program.

Trial Registration:

NCT03965780; registered on May 29, 2019.
Enacting the border multiple in the post-welfare state: Registration of foreign-born persons in Finland
Authors: Kynsilehto Anitta , Alastalo Marja
Published: September 2024

This article analyses border practices that are enacted through an array of migrants’ residence registration procedures in Finland. These practices extend to the country of departure and also take place upon arrival and settlement within a municipality, and they are intimately tied with the person’s access to social rights in the country. Building on critical border studies and Annemarie Mol’s idea of multiple ontologies we examine migrant stories, collected via multi-sited ethnography, that simultaneously testify to being targeted by diverse border practices and of being compelled to take part in doing the border. We address regulatory practices that modify and, indeed, reinforce inequalities between migrants. We argue that residence registration as a scattered border practice not only enacts different statuses for migrants but orders them hierarchically depending, for example, on the person’s migration status and nationality (EU/TCN). Furthermore, multiple regimes of knowledge production such as statistics on migrant population draw on the data recorded in the population register during the municipal registration process, which further extends the impact of this data. We show how the welfare state system, claimed to be universal, is highly conjunctural depending on the information the person receives from different interlocutors, and on the presumably apolitical “policy on the fly” enacted at the registration desk.
The Life Course Perspective on Older Adults’ Health Trajectories: Risk and Protective Factors
Authors: Carr Cary , King Lindsey Marie , Salinas-Miranda Abraham A. , Wilson Karina , Berry Estrellita Lo , Austin Deborah , Wilson Roneé E. , Scarborough Kenneth , Briscoe Richard , King Georgette , Cox Lillian , Hepburn Carrie , Best Evangeline , Burpee Conchita , Salihu Hamisu M.
Published: September 2024

According to the life course perspective (LCP), optimal human development and healthy aging are key goals that must start preconceptionally and continue later in life. However, older adult health and family health across generations have received very little attention in maternal and child health (MCH). Community-based participatory research (CBPR) is an important strategy for putting the LCP into action by engaging those communities most affected by health disparities. We conducted six CBPR focus groups using the LCP as the theoretical framework to capture community members’ perspectives of risk and protective factors for older adult health. Perceived protective factors for older adults included socialization, support systems, and practicing wellness. Perceived risk factors included caretaking responsibilities, isolation, medical issues, and lack of support. The identified risk and protective factors for older adult health must be considered when developing public health interventions that promote health equity in aging and MCH.
Learning About Neurodiversity at School: A feasibility study of a new classroom programme for mainstream primary schools
Authors: Alcorn Alyssa M. , McGeown Sarah , Mandy William , Aitken Dinah , Fletcher-Watson Sue
Published: September 2024

Neurodivergent children educated in mainstream classrooms too often face poor outcomes compared to neurotypical peers. These may be caused, or exacerbated, by the negative attitudes and actions of classmates. One way to address these poor outcomes could be to educate all children about neurodiversity and neurodivergence, and how these differences manifest in school. The LEANS programme is a comprehensive, whole-classroom resource for teaching about neurodiversity concepts. In this feasibility study, LEANS was trialled in seven classrooms in Scotland. Measures captured pupil knowledge of neurodiversity, and their attitudes and intended actions in relation to their classmates. Approximately 140 children took part in the programme, of which 62 (about 40%) had parent consent to submit data for analysis. Quantitative analyses were pre-registered. Children who participated scored significantly above chance in their knowledge of neurodiversity at outcome (mean = 5.08 correct answers) and increased their scores on the Attitudes and Actions Questionnaire (mean difference = 1.14, p < .001). Qualitative data revealed good feasibility and low risk of harms. The LEANS programme can successfully teach children terminology and ideas about neurodiversity and neurodivergence, and this also increases positive attitudes and intended actions. This feasibility study should be followed up with a fully powered evaluation in a more diverse sample, which also captures long-term impacts of LEANS.
Paeoniflorin protects hepatocytes from APAP-induced damage through launching autophagy via the MAPK/mTOR signaling pathway
Authors: Deng Xinyu , Li Yubing , Chen Yuan , Hu Qichao , Zhang Wenwen , Chen Lisheng , Lu Xiaohua , Zeng Jinhao , Ma Xiao , Efferth Thomas
Published: September 2024

Background

Drug-induced liver injury (DILI) is gradually becoming a common global problem that causes acute liver failure, especially in acute hepatic damage caused by acetaminophen (APAP). Paeoniflorin (PF) has a wide range of therapeutic effects to alleviate a variety of hepatic diseases. However, the relationship between them is still poorly investigated in current studies.

Purpose

This work aimed to explore the protective effects of PF on APAP-induced hepatic damage and researched the potential molecular mechanisms.

Methods

C57BL/6J male mice were injected with APAP to establish DILI model and were given PF for five consecutive days for treatment. Aiming to clarify the pharmacological effects, the molecular mechanisms of PF in APAP-induced DILI was elucidated by high-throughput and other techniques.

Results

The results demonstrated that serum levels of ALP, γ-GT, AST, TBIL, and ALT were decreased in APAP mice by the preventive effects of PF. Moreover, PF notably alleviated hepatic tissue inflammation and edema. Meanwhile, the results of TUNEL staining and related apoptotic factors coincided with the results of transcriptomics, suggesting that PF inhibited hepatocyte apoptosis by regulated MAPK signaling. Besides, PF also acted on reactive oxygen species (ROS) to regulate the oxidative stress for recovery the damaged mitochondria. More importantly, transmission electron microscopy showed the generation of autophagosomes after PF treatment, and PF was also downregulated mTOR and upregulated the expression of autophagy markers such as ATG5, ATG7, and BECN1 at the mRNA level and LC3, p62, ATG5, and ATG7 at the protein level, implying that the process by which PF exerted its effects was accompanied by the occurrence of autophagy. In addition, combinined with molecular dynamics simulations and western blotting of MAPK, the results suggested p38 as a direct target for PF on APAP. Specifically, PF-activated autophagy through the downregulation of MAPK/mTOR signaling, which in turn reduced APAP injury.

Conclusions

Paeoniflorin mitigated liver injury by activating autophagy to suppress oxidative stress and apoptosis via the MAPK/mTOR signaling pathway. Taken together, our findings elucidate the role and mechanism of paeoniflorin in DILI, which is expected to provide a new therapeutic strategy for the development of paeoniflorin.

Graphical abstract
Genetic diversity analysis and DNA fingerprint construction of Zanthoxylum species based on SSR and iPBS markers
Authors: Zhang Xiaoxi , Chen Wei , Yang Zhiwu , Luo Chengrong , Zhang Weiwei , Xu Feng , Ye Jiabao , Liao Yongling
Published: September 2024

Zanthoxylum is a versatile economic tree species utilized for its spice, seasoning, oil, medicinal, and industrial raw material applications, and it has a lengthy history of cultivation and domestication in China. This has led to the development of numerous cultivars. However, the phenomenon of mixed cultivars and confusing names has significantly obstructed the effective utilization of Zanthoxylum resources and industrial development. Consequently, conducting genetic diversity studies and cultivar identification on Zanthoxylum are crucial. This research analyzed the genetic traits of 80 Zanthoxylum cultivars using simple sequence repeat (SSR) and inter-Primer Binding Site (iPBS) molecular markers, leading to the creation of a DNA fingerprint. This study identified 206 and 127 alleles with 32 SSR markers and 10 iPBS markers, respectively, yielding an average of 6.4 and 12.7 alleles (Na) per marker. The average polymorphism information content (PIC) for the SSR and iPBS markers was 0.710 and 0.281, respectively. The genetic similarity coefficients for the 80 Zanthoxylum accessions ranged from 0.0947 to 0.9868 and from 0.2206 to 1.0000, with mean values of 0.3864 and 0.5215, respectively, indicating substantial genetic diversity. Cluster analysis, corroborated by principal coordinate analysis (PCoA), categorized these accessions into three primary groups. Analysis of the genetic differentiation among the three Zanthoxylum (Z. bungeanum, Z. armatum, and Z. piperitum) populations using SSR markers revealed a mean genetic differentiation coefficient (Fst) of 0.335 and a gene flow (Nm) of 0.629, suggesting significant genetic divergence among the populations. Molecular variance analysis (AMOVA) indicated that 65% of the genetic variation occurred within individuals, while 35% occurred among populations. Bayesian model-based analysis of population genetic structure divided all materials into two groups. The combined PI and PIsibs value of the 32 SSR markers were 4.265 × 10− 27 and 1.282 × 10− 11, respectively, showing strong fingerprinting power. DNA fingerprints of the 80 cultivars were established using eight pairs of SSR primers, each assigned a unique numerical code. In summary, while both markers were effective at assessing the genetic diversity and relationships of Zanthoxylum species, SSR markers demonstrated superior polymorphism and cultivar discrimination compared to iPBS markers. These findings offer a scientific foundation for the conservation and sustainable use of Zanthoxylum species.