bluuebunny/crossref_metadata_2025 huggingface dataset:
Conflict Dynamics in Indian Healthcare: An Exploratory Study on Primers of Conflict in Private Clinical Establishments of Kolkata
Authors: Sengupta Mitali , Ganguly Arnab , Roy Arijit , Chakrabarti Satyajit , Mukhopadhyay Indraneel
Published: April 2024

Healthcare conflicts are complicated and often dysfunctional in nature. The Indian healthcare system, with its thinning workforce, finds it increasingly difficult to meet the demands and expectations of its healthcare service recipients. Healthcare service providers like physicians, nurses, technical and administrative personnel work in a dynamic and stressful environment with resource and manpower limitations. Healthcare service recipients like patients and their families often face challenges regarding access to care, associated costs, time issues and other situational dynamics. These underlying situations often result in different types of conflicts in the workplace. The purpose of this exploratory study is to understand the factors that serve as primers for healthcare conflicts in the Indian scenario. Data were collected from hospital feedback forms for patients/patient families. The top 10 threads indicating the patient satisfaction factors and conflicting grounds were identified through content analysis, and that formed the basis of the semi-structured questionnaire schedules. Fifty semi-structured interviews were done with healthcare service recipients and healthcare service providers (25 in each set) in private clinical establishments of Kolkata, West Bengal. Four main themes and nine subthemes were identified that illustrated the grounds for healthcare conflicts in Indian settings. The identification of the causes of dissatisfaction and understanding their relationship with healthcare conflicts will go a long way in conflict management.
Aqueous Extract of Terminalia bellirica Fruits Improves Insulin Sensitivity, Controls Hyperglycaemia and Improves SIRT1 Expression in High-fat Diet and Streptozotocin-induced Type 2 Diabetes in Rats
Authors: Agrawal Ojaskumar D. , Kulkarni Yogesh A.
Published: April 2024

Background

Plants from the genus “Terminalia” are well known for their various pharmacological and medicinal properties. Terminalia bellirica is considered a vital medicinal plant from the genus Terminalia. It has been reported for its astringent, antipyretic, and purgative effects. It is also used to treat dyspepsia, tropical pulmonary eosinophilia, allergic eruptions, bronchitis, upper respiratory tract infections, and leprosy. The present research study aimed to investigate the antidiabetic activity of T. bellirica in an experimental model of type 2 diabetes in experimental rats.

Materials and Methods

In rats, type 2 diabetes was induced by the alteration in the diet by administration of a high-fat diet for 15 days, followed by the administration of streptozotocin (35 mg/kg, i.p.). The experimental animals were given 500 and 1,000 mg/kg of T. bellirica aqueous fruit extract for six weeks. Liver enzymes and lipid parameters, homeostatic model assessment–insulin resistance, insulin sensitivity index, glycohemoglobin, and oral glucose tolerance tests were performed at the end of the study. Histopathology and immunohistochemical analysis for the SIRT1 expression of pancreatic tissue were also performed.

Results

The selected doses of the aqueous extract of T. bellirica (500 and 1,000 mg/kg) significantly reduced blood glucose ( p < 0.05). The 1,000 mg/kg dose of T. bellirica notably decreased glucose tolerance ( p < 0.001) in experimental animals. A high dose of T. bellirica significantly reduced resistance ( p < 0.001). The lipid profile was improved significantly ( p < 0.01) at both the selected dose levels. Glycohemoglobin concentration was significantly reduced in experimental animals ( p < 0.001) at both dose levels. The extract treatment increased the expression of SIRT1 in the pancreas.

Conclusion

The results of the present study indicate that the extract has significant effects on the management of type 2 diabetes.
Climate Governance Pathway for BRICS in the Post-Paris Era
Authors: Mukhia Anmol , Shen Qi , Xiaolong Zou
Published: April 2024

BRICS countries comprise 41.87% of the world’s population and generate over 42% of the global greenhouse gas emissions. As the largest political cluster in global climate governance, their positions and alignment in the post-Paris Agreement era would determine the future trajectory of climate governance for the international communities. This article aims to ascertain the respective positions of BRICS nations by examining their nationally determined contributions and targets for carbon peak and neutrality. Through this analysis, the article endeavors to consolidate a comprehensive BRICS decarbonization roadmap, providing stakeholders and policymakers with greater clarity. In addition, in-depth case studies from China and India, the two biggest emitters, offer valuable insights into their climate mitigation paths. This would inspire unity among the BRICS countries and encourage them to uphold the stability of their partnership in climate governance collectively.
Rapidly expanding gender-affirming care based on consensus instead of evidence justifies rigorous governance and transparency
Authors: Amos Andrew James
Published: April 2024

Objective

Public services offering gender-affirming care to minors have rapidly expanded across Australia. Despite limited evidence of safety and efficacy, no public information about these services is routinely available. Data from freedom of information requests sent to Australian public gender services for minors is summarised. Gender service numbers increased rapidly in Queensland (2017:190 – 2022:922) and in Victoria (2019:472 – 2023:1290). Limited transparency prevented strong confidence in the number of patients receiving hormone therapy. Staff FTE employed by gender services jumped after 2020 in NSW (to 16.7 across two sites in 2023), Queensland (to 11.4 in 2023), Victoria (to 9.4 in 2022), and WA (to 10.2 in 2023).

Conclusions

Despite low confidence in their safety and efficacy, the number of patients seen by public gender services has expanded rapidly since 2018. Limited transparency makes it difficult to judge the number of patients seen, treatments provided, and outcomes achieved. Safe, effective care of this vulnerable group requires clear treatment goals, and annual reporting.
Trauma-Informed Research With Emerging Adult Survivors of Sexual Violence
Authors: Fraley Hannah E. , Ramos de Oliveira Clariana , Aronowitz Teri , Burton Candace W.
Published: April 2024

Health researchers have had increasing calls to include vulnerable populations in research to tailor inclusive evidence-based practice interventions. The inclusion of vulnerable populations in research is sensitive and complex. Sensitive topics such as dating and sexual violence are especially complex, with emerging adults the highest risk group for all forms of sexual violence and an especially hard-to-reach population for inclusion in research. Impacts of trauma, including physiological and psychological, complex needs of survivors, and potential for revictimization during interactions when participating in research must be considered. Researchers must be equipped with specialized, trauma-informed skills to safely and ethically conduct all aspects of research. Using the trauma-informed framework, the purpose of this paper is to discuss the complexities of conducting research with emerging adult survivors of sexual violence and to explore evidence-based approaches that can safely include this vulnerable population through the application of trauma-informed approaches. The use of evidence-based, trauma-informed research approaches tailored to engage this population in research can further help to develop effective interventions that are context-sensitive to emerging adults.
“We Just Kind of Found Ourselves”: A Narrative Study of First-Generation College Students and Belonging in Music Education
Authors: Jones Sara K. , Bannerman Julie K.
Published: April 2024

As the field of music education explores ways to mitigate barriers for underrepresented populations along the path to becoming a music teacher, the experiences of first-generation college students (FGCSs) in music teacher education programs warrant exploration. The purpose of this narrative study was to explore the lived experiences and perspectives of music educators who were FGCSs. Networks of support and mentoring were key in both the successes and challenges that participants experienced. Belonging was not a given for participants despite shared coursework and requirements with peers. Finding peers with similar backgrounds, accessing supportive relationships with faculty, and perseverance aided participants through college. Recommendations for music teacher educators include building relationships with FGCSs in targeted and strategic ways, starting in students’ first year, providing more intensive and proactive communication and advising structures, and building faculty knowledge of campus resources that may benefit FGCSs.
Reliability control of nonlinear stochastic dynamical system based on discrete data
Authors: Chen Xi , Jin Xiaoling , Huang Zhilong
Published: April 2024

Stochastic optimal control based on reliability plays a crucial role in mitigating structural failure and ensuring safe operation. For general stochastic vibration systems, a data-driven method for reliability-based optimal control is proposed based on random state data. Firstly, the feedback control is split into conservative and dissipative components in coherence with physical intuition, and each component is expanded upon using pre-selected basic functions, resulting in a modified system with undetermined coefficients. Then, from discrete random samples, the expressions for the probability densities of the first-passage time and the stationary response can be identified, explicitly including system and excitation parameters, as well as initial and safety boundary conditions. Finally, a performance index, combining system reliability and control cost, is constructed and can be explicitly expressed in terms of the undetermined coefficients of the control forces. The optimal control problem for determining the optimal control forces is reformulated as an optimization problem for determining the coefficients that minimize the performance index. This unconstrained optimization problem can be easily solved. Three typical nonlinear stochastic systems, a controlled Duffing oscillator, a controlled nonlinear hysteretic system, and a controlled 2-DOF nonlinear dynamical system, are given to illustrate the validity and accuracy of the proposed data-driven method. Additionally, the control performance of the optimal control strategy in improving the system reliability is also discussed.
Alpha-chloralose poisoning in 25 cats: clinical picture and evaluation of treatment with intravenous lipid emulsion
Authors: Lundgren Sandra , Dreimanis Kristoffer , Engdahl Karolina , Windahl Ulrika , Tegner Cecilia
Published: April 2024

Objectives

The aims of this study were to describe the clinical picture and progression in cats with alpha-chloralose (AC) intoxication and to determine if treatment with intravenous (IV) lipid emulsion (ILE) influenced either the serum concentration of AC or the clinical signs.

Methods

Cats with suspected AC poisoning admitted to a university small animal hospital were included. The cats were randomised into two groups: one receiving 20% ILE at a dose of 300 mg/kg as a 2 min bolus, followed by a 1500 mg/kg continuous rate infusion over 30 mins (IL+ group) and the other receiving IV fluid therapy with Ringer’s acetate (IL− group). Serum samples were drawn at 0, 2, 12 and 24 h after admission. Samples were tested for AC with a novel validated, quantitative, ultra-high-performance liquid chromatography-tandem mass spectrometry method. Vital and predefined clinical signs were noted at the times of sampling and patients were scored using a previously described intoxication severity score. Telephone interviews were conducted after discharge to assess outcome.

Results

A total of 25 cats were enrolled: 13 cats in the IL+ group and 12 in the IL− group. The most common clinical signs at presentation were tremor (n = 22, 88.0%), cranial nerve deficits (n = 20, 80.0%) and bradycardia (n = 19, 76.0%). No significant difference in AC concentration or change in intoxication score over time was found between the IL+ and IL− groups at any time point ( P >0.05). All cats recovered within 72 h.

Conclusions and relevance

ILE did not have any effect on the AC serum concentration or clinical signs in AC-poisoned cats. All cats survived until follow-up. In cats with an acute onset of the described neurological signs, AC intoxication is an important differential diagnosis with an excellent prognosis.
Analyzing mechanical properties and loading performance of polypropylene sandwich pipes
Authors: Naeiji Ehsan , Afrasiab Hamed
Published: April 2024

Sandwich pipes are widely used in various piping applications owing to their exceptional pressure resistance and thermal insulation properties. In this paper, the mechanical properties and loading performance of sandwich pipes made of polypropylene material have been investigated under different loading conditions including lateral and axial compression, as well as hydrostatic internal and external pressures. For this purpose, finite element models of sandwich pipes with various designs have been developed. Material properties have been determined through standard experimental tests, and the finite element models have been validated using lateral compression experiments. The results indicate that incorporating annular cores with thinner thickness and greater numbers, along with using a thicker inner pipe in the sandwich pipe structure, improves its properties and performance.
The heterogeneous impact of psychological discourse on (our view of) recognition
Authors: Clavero Sergio R
Published: April 2024

Over the last century, psychological discourse ranks among the main cultural forces in Western societies. As such, it undoubtedly exerts considerable influence on how we express, demand, struggle for, and conceive of recognition. However, since psychology is far from being a monolithic discipline, said influence is exerted in non-univocal, sometimes contradictory ways. In this paper, I explore this heterogeneous impact by contrasting the idea of recognition underlying two popular psychological schools. On the one hand, psychoanalysis’ emphasis on trauma stresses our dependence on being recognized by others, vindicates the importance of communication, and contributes to redefining the status of victim. On the other hand, positive psychology’s advocacy for autonomous self-fulfillment seems to downsize the importance of recognition, and of the struggle for it, based on a statistical, morally-neutral approach.
Water and fluidity in İz Öztat’s heterochronic imaginaries in the aftermath of genocide
Authors: Fresko Madra Lara
Published: April 2024

Between the years 2013–2016, the artist İz Öztat created four distinct bodies of work, all of which engaged aspects of water. This period was marked in Turkey by the heightened tensions around the neoliberal (re)distribution of public space and public resources, which escalated in the aftermath of the Gezi Park Protests of 2013. In this article, the author argues that, beyond its immediate critique of contemporary capitalist appropriation, Öztat’s engagement with water builds relations across time, space, and species to recall histories of the Armenian Genocide, challenging the denials of official historiography. By tapping into the linguistic, cultural, and material imaginaries of water, and learning from the present-day water protection movements, Öztat engages the diverse histories carried across waterways. Water becomes a nexus through which the artist locates and articulates the physical and epistemic violence of modernity, particularly as it indexes community, conscience, and ecology from the late 19th century to the present.
Common Ground: We Can Comprehensively Treat Pediatric Epilepsy and Psychiatric Comorbidities
Authors: Salpekar Jay A. , Ertenu D. Dilara
Published: April 2024

Epilepsy and psychiatric illness have been long studied and today are better accepted as co-occurring than as discrete illnesses that are independent even if associated. Common pathophysiology may not be easily explained, but clearly exists given the significant overrepresentation of psychiatric illness among individuals with epilepsy. Conditions like autism spectrum disorder, anxiety, depression, and attention deficit hyperactivity disorder are prevalent in pediatric epilepsy much more than expected, even in the context of chronic neurologic disease. The interplay between pediatric epilepsy and neuropsychiatric symptoms represents a complex clinical circumstance that is not well subtended by the chasm-like division of labor between psychiatrists and neurologists. The unfortunate result is that children and families often experience care that is fractured and at worst, counterproductive for their quality of life. A neuropsychiatric paradigm is essential to address epilepsy and its intrinsic psychiatric symptoms. Practical strategies will be discussed to address this challenge.
Silent Principal Attrition: A Case Study of District Leadership Without Principal Collaboration and Voice
Authors: Kose Brad W.
Published: April 2024

Given school principals’ significant impact on equitable schools, teaching, and learning, retaining quality principals is vital for district and school success. However, recent studies and evidence have raised concerns about principal attrition that are influenced by a variety of district conditions and factors. In this complex case study, which is constructed from different principal experiences, a district focused on the implementation of a strategic plan while navigating a shifting political landscape experiences a silent exodus of principals. Suggested questions and resources for current or aspiring district and school leaders follow this case study.
Functional and Esthetic Outcomes of Either Surgically or Conservatively Treated Anterior Frontal Sinus Wall Fractures: A Long-Term Follow-Up
Authors: Solmell Oscar , Sunnergren Ola , Qureshi Abdul Rashid , Alinasab Babak
Published: April 2024

Study Design

Retrospective cohort study.

Objective

Frontal sinus fractures (FSFs) can lead to a range of clinical challenges, including facial deformity, impaired facial sensation, cerebrospinal fluid (CSF) leakage, sinus drainage impairment, chronic sinus pain and mucocele formation. The optimal management approach, whether surgical or conservative, remains a topic of ongoing discussion. The aim of this study was to evaluate and compare the functional and esthetic outcomes of patients with surgically and conservatively treated FSFs.

Methods

In this retrospective study, patients treated for FSFs at the Karolinska university hospital 2004 to 2020 were identified in hospital records and invited to participate in a long-term follow-up. Sequelae and satisfaction with the esthetic result were assessed trough questionnaires and physical examinations.

Results

A total of 93 patients were included in the study, with 49 presenting isolated anterior wall fractures and 44 presenting combined anterior and posterior wall fractures. Surgical intervention was performed in 45 cases, while 48 were managed conservatively. Among patients with moderate anterior wall fractures (4-6 mm dislocation), 80% of surgically treated patients compared to 100% of conservatively treated patients expressed satisfaction with their cosmetic outcomes at follow-up ( P = .03). In conservatively treated patients with a forehead impression, the anterior wall fracture dislocation ranged from 5.3 to 6.0 mm ( P < .0001). Approximately 50% of surgically treated patients vs 15% of conservatively treated patients developed impaired forehead sensation at follow-up ( P = .03). Thirty-six percent of surgically treated patients reported dissatisfaction with surgery-related scarring, particularly those who underwent surgery via laceration or bicoronal incision.

Conclusions

This study suggests that anterior FSFs with a dislocation of 5 mm or less can be effectively managed conservatively with high patient satisfaction, low risk of long-term forehead sensation impairment and without potential development of forehead impression. Bicoronal incision or incision via a laceration may be associated with esthetic dissatisfaction and late sequelae such as alopecia.
Works of Art and the Future
Authors: Poli Roberto
Published: April 2024

Will adding an artistic layer to our future exercises eventually improve them? Why? How? Will this supposed improvement contribute to the entire exercise or only to some of its aspects? Moreover, will such an improvement have long-term, stable consequences or only momentary and occasional ones? The research question I would like to unfold may then be summarized by the claim “Works of art as gates to the future.” Unsurprisingly, this claim needs further qualifications, such as works of are always/often/occasionally/rarely/never gates to possible/preferable/obnoxious future. Furthermore, what does it mean to be a “gate to the future”? To make the future visible? To make the future understandable? To pave the way toward the future? This vast array of preliminary qualifications suggests that the question of the connection between works of art and the future is awfully tangled. I would be satisfied if this paper provides a frame to be eventually improved by subsequent works. Specifically, I would be happy to explain the first, basic question: why works of art may eventually improve futures exercises. I will focus primarily on Nicolai Hartmann, and secondarily on Roman Ingarden and Ernst Bloch. The conclusion I shall arrive at is that works of art can definitely improve futures exercises, because both aesthetic objects and the futures are unreal objects and presents irreducible points of indeterminateness.
Structured medication reviews in Parkinson’s disease: pharmacists’ views, experiences and needs – a qualitative study
Authors: Oonk Nicol G. M. , Dorresteijn Lucille D. A. , te Braake Eline , Movig Kris L. L. , van der Palen Job , Nijmeijer Henk-Willem , van Kesteren Mirjam E. , Bode Christina
Published: April 2024

Background:

Executing structured medication reviews (SMRs) in primary care to optimize drug treatment is considered standard care of community pharmacists in the Netherlands. Patients with Parkinson’s disease (PD) often face complex drug regimens for their symptomatic treatment and might, therefore, benefit from an SMR. However, previously, no effect of an SMR on quality of life in PD was found. In trying to improve the case management of PD, it is interesting to understand if and to what extent SMRs in PD patients are of added value in the pharmacist’s opinion and what are assumed facilitating and hindering factors.

Objectives:

To analyse the process of executing SMRs in PD patients from a community pharmacist’s point of view.

Design:

A cross-sectional, qualitative study was performed, consisting of face-to-face semi-structured in-depth interviews.

Methods:

The interviews were conducted with community pharmacists who executed at least one SMR in PD, till data saturation was reached. Interviews were transcribed verbatim, coded and analysed thematically using an iterative approach.

Results:

Thirteen pharmacists were interviewed. SMRs in PD were considered of added value, especially regarding patient contact and bonding, individualized care and its possible effect in the future, although PD treatment is found already well monitored in secondary care. Major constraints were time, logistics and collaboration with medical specialists.

Conclusion:

Although community pharmacist-led SMRs are time-consuming and sometimes logistically challenging, they are of added value in primary care in general, and also in PD, of which treatment occurs mainly in secondary care. It emphasizes the pharmacist’s role in PD treatment and might tackle future drug-related issues. Improvements concern multidisciplinary collaboration for optimized SMR execution and results.
Creating “Safe Places” in Social Media: Japanese Youth’s Tactics of Self-Presentation During the COVID-19 Pandemic
Authors: Kim Kyounghwa Yonnie , Ohashi Kana , Hjorth Larissa
Published: April 2024

This article explores the self-presentation strategies of young Japanese people (aged 19–21) on social media during the COVID-19 pandemic, with a specific focus on their creative resistance to social constraints. Drawing from ethnographic investigations conducted with Japanese college students, we delve into the creative practices undertaken by these individuals to carve out “safe places” within the digital sphere amid the prevailing peer pressure in Japanese culture to rigidly adhere to quarantine rules. Our findings illuminate the diverse strategies employed by Japanese youth to not only project a “socially responsible” self-presentation during the pandemic but also strategically navigate the boundaries between public and private spheres while challenging dominant structures on media platforms and societal norms to assert their agency and autonomy through creativity. These tactics ranged from the management of self-expression on social media to overt acts of defiance against societal expectations. By examining individual cases of Japanese youth, we shed light on the nuanced ways in which individuals leverage hyperconnectivity across various social media platforms to manage their identities and challenge societal norms, thus shaping their experiences of the pandemic. This article also contributes to understanding the dynamic interplay between culture, virtual social networks, and individual agency in times of crisis.
Factors Influencing the Implementation of Infant Warming Devices Among Healthcare Workers in Malawian Hospitals
Authors: Nyondo-Mipando Alinane Linda , Woo Kinshella Mai-Lei , Salimu Sangwani , Chiwaya Brandina , Chikoti Felix , Chirambo Lusungu , Mwaungulu Ephrida , Banda Mwai , Hiwa Tamanda , Vidler Marianne , Molyneux Elizabeth M. , Dube Queen , Mfutso-Bengo Joseph , Goldfarb David M. , Kawaza Kondwani
Published: April 2024

Objectives. Preterm infants are at risk of hypothermia. This study described the available infant warming devices (IWDs) and explored the barriers and facilitators to their implementation in neonates in Malawi. Methods. A qualitative descriptive study was conducted among 19 health care workers in Malawi from January to March 2020. All interviews were digitally recorded, transcribed, and managed using NVivo and analyzed using a thematic approach. Results. The warming devices included radiant warmers, Blantyre hot-cots, wall-mounted heaters, portable warmers, and incubators. Inadequate equipment and infrastructure and gaps in staff knowledge and capacity were reported as the main challenges to optimal IWD implementation. Caregiver acceptance was described as the main facilitator. Strategies to optimize implementation of IWD included continuous practical training and adequate availability of equipment and spare parts. Conclusion. Implementation of warming devices for the management of neonatal hypothermia is effective when there are adequate human and material resources.
Aerial-terrestrial data fusion for fine-grained detection of urban clues
Authors: Gosling-Goldsmith Jessica , Antos Sarah Elizabeth , Triveno Luis Miguel , Benjamin Adam R , Wang Chaofeng
Published: April 2024

Those who work in the design, development, and management of cities are often limited by the scarcity of data. Particularly in the Global South, urban databases may be insufficient, out of date, or simply not available. However, digital technology is making it possible to fill gaps and build substantial datasets using “urban clues,” or attributes, gathered in high-resolution imagery by sky- and street-based cameras. Aided by machine learning, it is possible to detect specific building characteristics (purpose, condition, size, material, and construction)—yielding an array of geolocated details about the built environment. The resulting composite view can be made available, as we have done, in an open-source portal for use in urban management. The insights gained in this way may help address common urban management challenges, such as locating homes vulnerable to hazards such as flooding or earthquakes, identifying urban sprawl and informal housing, prioritizing infrastructure investments, and guiding public program support. This approach has been applied in Colombia, Guatemala, Indonesia, Mexico, Paraguay, Peru, St Lucia, and St Maarten.
Parameter Estimation of a Valve-Controlled Cylinder System Model Based on Bench Test and Operating Data Fusion
Authors: Su Deying , Wang Shaojie , Lin Haojing , Xia Xiaosong , Xu Yubing , Hou Liang
Published: April 2024

The accurate estimation of parameters is the premise for establishing a high-fidelity simulation model of a valve-controlled cylinder system. Bench test data are easily obtained, but it is challenging to emulate actual loads in the research on parameter estimation of valve-controlled cylinder system. Despite the actual load information contained in the operating data of the control valve, its acquisition remains challenging. This paper proposes a method that fuses bench test and operating data for parameter estimation to address the aforementioned problems. The proposed method is based on Bayesian theory, and its core is a pool fusion of prior information from bench test and operating data. Firstly, a system model is established, and the parameters in the model are analysed. Secondly, the bench and operating data of the system are collected. Then, the model parameters and weight coefficients are estimated using the data fusion method. Finally, the estimated effects of the data fusion method, Bayesian method, and particle swarm optimisation (PSO) algorithm on system model parameters are compared. The research shows that the weight coefficient represents the contribution of different prior information to the parameter estimation result. The effect of parameter estimation based on the data fusion method is better than that of the Bayesian method and the PSO algorithm. Increasing load complexity leads to a decrease in model accuracy, highlighting the crucial role of the data fusion method in parameter estimation studies.
Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study
Authors: Meng Yingtong , Zhang Tingting , Ge Xiaohua , Zheng Qingru , Feng Tienan
Published: April 2024

Background

Physical activity (PA) is essential and effective for chronic heart failure (CHF) patients. A greater understanding of the longitudinal change in PA and its influencing factors during the postdischarge transition period may help create interventions for improving PA. The aims of this study were (1) to compare the change in PA, (2) to examine the influencing factors of PA change, and (3) to verify the mediating pathways between influencing factors and PA during the postdischarge transition period in CHF patients.

Methods

A total of 209 CHF patients were recruited using a longitudinal study design. The Chinese version of the International Physical Activity Questionnaire (IPAQ), Patient-reported Outcome Measure for CHF (CHF-PRO), and the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart) were used to assess PA, CHF-related symptoms, and kinesiophobia. The IPAQ score was calculated (1) at admission, (2) two weeks after discharge, (3) two months after discharge, and (4) three months after discharge. Two additional questionnaires were collected during admission. Generalized estimating equation (GEE) models were fitted to identify variables associated with PA over time. We followed the STROBE checklist for reporting the study.

Results

The PA scores at the four follow-up visits were 1039.50 (346.50-1953.00) (baseline/T1), 630.00 (1.00-1260.00) (T2), 693.00 (1-1323.00) (T3) and 693.00 (160.88–1386.00) (T4). The PA of CHF patients decreased unevenly, with the lowest level occurring two weeks after discharge, and gradually improving at two and three months after discharge. CHF-related symptoms and kinesiophobia were significantly associated with changes in PA over time. Compared with before hospitalization, an increase in CHF-related symptoms at two weeks and two months after discharge was significantly associated with decreased PA. According to our path analysis, CHF-related symptoms were positively and directly associated with kinesiophobia, and kinesiophobia was negatively and directly related to PA. Moreover, CHF-related symptoms are indirectly related to PA through kinesiophobia.

Conclusion

PA changed during the postdischarge transition period and was associated with CHF-related symptoms and kinesiophobia in CHF patients. Reducing CHF-related symptoms helps improve kinesiophobia in CHF patients. In addition, the reduction in CHF-related symptoms led to an increase in PA through the improvement of kinesiophobia.

Trial Registration

The study was registered in the Chinese Clinical Trial Registry (11/10/2022 ChiCTR2200064561 retrospectively registered).
Elucidating vaccine efficacy using a correlate of protection, demographics, and logistic regression
Authors: Dudášová Julie , Valenta Zdeněk , Sachs Jeffrey R.
Published: April 2024

Background

Vaccine efficacy (VE) assessed in a randomized controlled clinical trial can be affected by demographic, clinical, and other subject-specific characteristics evaluated as baseline covariates. Understanding the effect of covariates on efficacy is key to decisions by vaccine developers and public health authorities.

Methods

This work evaluates the impact of including correlate of protection (CoP) data in logistic regression on its performance in identifying statistically and clinically significant covariates in settings typical for a vaccine phase 3 trial. The proposed approach uses CoP data and covariate data as predictors of clinical outcome (diseased versus non-diseased) and is compared to logistic regression (without CoP data) to relate vaccination status and covariate data to clinical outcome.

Results

Clinical trial simulations, in which the true relationship between CoP data and clinical outcome probability is a sigmoid function, show that use of CoP data increases the positive predictive value for detection of a covariate effect. If the true relationship is characterized by a decreasing convex function, use of CoP data does not substantially change positive or negative predictive value. In either scenario, vaccine efficacy is estimated more precisely (i.e., confidence intervals are narrower) in covariate-defined subgroups if CoP data are used, implying that using CoP data increases the ability to determine clinical significance of baseline covariate effects on efficacy.

Conclusions

This study proposes and evaluates a novel approach for assessing baseline demographic covariates potentially affecting VE. Results show that the proposed approach can sensitively and specifically identify potentially important covariates and provides a method for evaluating their likely clinical significance in terms of predicted impact on vaccine efficacy. It shows further that inclusion of CoP data can enable more precise VE estimation, thus enhancing study power and/or efficiency and providing even better information to support health policy and development decisions.
Mortality and re-fracture rates in low trauma hip fracture
Authors: Mohseni Vahideh , Fahimfar Noushin , Ansarifar Akram , Masoumi Safdar , Sanjari Mahnaz , Khalagi Kazem , Bagherifard Abolfazl , Larijani Bagher , Janani Leila , Mansourzadeh Mohammad Javad , Ostovar Afshin , Solaymani-Dodaran Masoud
Published: April 2024

Objectives

This study aimed to estimate the incidence rate of re-fracture and all-cause mortality rate in patients with hip fractures caused by minor trauma in the first year following the event.

Materials and methods

This is a retrospective cohort study of patients over 50 years of age conducted in a referral hospital located in Tehran (Shafa-Yahyaian). Using the hospital information system (HIS), all patients hospitalized due to hip fractures caused by minor trauma during 2013–2019 were included in the study. We investigated the occurrence of death and re-fracture in all patients one year after the primary hip fracture.

Results

A total of 945 patients with hip fractures during a 307,595 person-days of follow-up, were included. The mean age of the participants was 71 years (SD = 11.19), and 533 (59%) of them were women. One hundred forty-nine deaths were identified during the first year after hip fracture, resulting in a one-year mortality rate of 17.69% (95% CI: 15.06–20.77). The one-year mortality rate was 20.06% in men and 15.88% in women. Out of all the participants, 667 answered the phone call, of which 29 cases had experienced a re-fracture in the first year (incidence rate = 5.03%, 95% CI: 3.50–7.24). The incidence rates in women and men were 6.07% and 3.65%, respectively.

Conclusion

Patients with low-trauma hip fractures have shown a high rate of mortality in the first year. Considering the increase in the incidence of hip fractures with age, comprehensive strategies are needed to prevent fractures caused by minor trauma in the elderly population.
Explaining the barriers faced by veterinarians against preventing antimicrobial resistance: an innovative interdisciplinary qualitative study
Authors: Toghroli Razie , Hassani Laleh , Aghamolaei Teamur , Sharma Manoj , Sharifi Hamid , Jajarmi Maziar
Published: April 2024

Background

Considering the significance of increased antimicrobial resistance (AMR) and its adverse effects on individual and social health and the important and effective role that veterinarians play in controlling this growing issue worldwide, it is essential to have effective preventive control programs. To this aim, the first step is to identify the factors behind the prevalence of AMR in Iran and the barriers veterinarians face to controlling this problem. Thus, the present study was conducted to explain the barriers veterinarians faced in the prevention of AMR from an Iranian veterinarian’s perspective.

Methods

The present research was done in three cities in Iran in 2021. The data were collected through in-depth interviews with 18 veterinarians selected through purposive and snowball sampling and analyzed using conventional qualitative content analysis.

Results

The data analysis results were classified into 4 main categories and 44 subcategories. The former included: educational factors, administrative/legal factors, client-related factors, and veterinarian-related factors.

Conclusions

The increased AMR can be approached from multiple aspects. Considering the different factors that affect the increased AMR, it is necessary to consider them all through effective planning and policy-making at multi-level and multidisciplinary dimensions. There is special attention needed to scientific and practical interventions at the individual, interpersonal, social, and even political levels. At the same time, measures should be taken to rehabilitate and maintain the health of society to strengthen supervision and attract the full participation of interested organizations.
Risk factors of sleep-disordered breathing and poor asthma control in children with asthma
Authors: Tao Minghui , Zhang Yanping , Ding Ling , Peng Donghong
Published: April 2024

Background

Sleep-disordered breathing (SDB) may lead to poor asthma control in children.

Objective

To identify risk factors of SDB in children with asthma and assess its impact on asthma control.

Methods

In this cross-sectional study, we collected data of outpatients with asthma at the Children’s Hospital of Chongqing Medical University from June 2020 to August 2021. The Pediatric Sleep Questionnaire—Sleep-Related Breathing Disorder and the age-appropriate asthma control tests Childhood Asthma Control Test and Test for Respiratory and Asthma Control in Kids were completed.

Results

We enrolled 397 children with a male-to-female ratio of 1.7:1 and a mean age of 5.70 ± 2.53 years. The prevalence of SDB was 21.6%. Allergic rhinitis (odds ratio OR = 3.316), chronic tonsillitis (OR = 2.246), gastroesophageal reflux (OR = 7.518), adenoid hypertrophy (OR = 3.479), recurrent respiratory infections (OR = 2.195), and a family history of snoring (OR = 2.048) were risk factors for the development of combined SDB in children with asthma (p < 0.05). Asthma was poorly controlled in 19.6% of the children. SDB (OR = 2.391) and irregular medication use (OR = 2.571) were risk factors for poor asthma control (p < 0.05).

Conclusions

Allergic rhinitis, chronic tonsillitis, gastroesophageal reflux, adenoid hypertrophy, recurrent respiratory infections, and a family history of snoring were independent risk factors for the development of SDB in children with asthma. SDB and irregular medication use were independent risk factors for poor asthma control.
Long-lasting effects of the COVID-19 pandemic on lifestyle and body weight: results of representative cross-sectional surveys in adults in Germany
Authors: Hauner Hans , Blanken Carmen P. S. , Holzapfel Christina
Published: April 2024

Background

The COVID-19 pandemic severely affected people’s daily lives and health. Few studies have looked into the persistence of these changes. In the current study, we investigated to what extent changes in lifestyle and body weight were sustained after two years of restrictions.

Methods

We performed two representative online surveys among adults living in Germany. The first survey (S1) was performed in April 2021; the second survey (S2) in June 2022. The questionnaire focused on changes in physical activity, dietary habits, body weight, and mental stress levels. The data were weighted to optimally represent the general population of Germany. Using Chi-square tests, results were compared between the two surveys, and – per survey – between subgroups based on sociodemographic factors and mental stress levels. Furthermore, binomial logistic regression was performed to identify factors associated with weight gain.

Results

A total of 1,001 (S1) and 1,005 (S2) adults completed the survey, of which 50.4% were men and 49.6% were women in both surveys. Mean body mass index (BMI) at the time of the survey was 27.4 ± 6.0 kg/m2 (S1) and 27.1 ± 5.5 kg/m2 (S2). Reduced physical activity was reported by 52% of the participants in S1 and by 40% in S2 (p < .001). Moderate to severe stress was reported by 71% of the participants in S1 and by 62% in S2 (p < .001). Less healthy eating compared to before the pandemic was reported by 16% of the participants in S1 and by 12% in S2 (p = 0.033). Weight gain was reported by 40% of the participants in S1 and by 35% in S2 (p = 0.059). Weight gain was associated with higher BMI, reduced physical activity levels, less healthy nutrition and increased consumption of energy-dense food.

Conclusions

Our results indicate that two years and three months after the start of the COVID-19 pandemic, the adverse effects on health-related lifestyle factors and body weight still existed, albeit to a lesser degree than directly after the first year of the pandemic. Targeted strategies are needed to better support the population subgroups most likely to change their lifestyle in unfavorable ways when faced with disruptions of their everyday lives.
Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery
Authors: Hou Changhao , Luo Zhiqiang , Cao Nailong , Hu Xiaoyong , Song Lujie , Fu Qiang , Zhang Jiong , Huang Jianwen
Published: April 2024

Objective

To evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.

Methods

We retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.

Results

All patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.

Conclusions

US-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.
Influence of extracellular matrix scaffolds on histological outcomes of regenerative endodontics in experimental animal models: a systematic review
Authors: Elnawam Hisham , Abdallah Amr , Nouh Samir , Khalil Nesma Mohamed , Elbackly Rania
Published: April 2024

Background

Decellularized extracellular matrix (dECM) from several tissue sources has been proposed as a promising alternative to conventional scaffolds used in regenerative endodontic procedures (REPs). This systematic review aimed to evaluate the histological outcomes of studies utilizing dECM-derived scaffolds for REPs and to analyse the contributing factors that might influence the nature of regenerated tissues.

Methods

The PRISMA 2020 guidelines were used. A search of articles published until April 2024 was conducted in Google Scholar, Scopus, PubMed and Web of Science databases. Additional records were manually searched in major endodontic journals. Original articles including histological results of dECM in REPs and in-vivo studies were included while reviews, in-vitro studies and clinical trials were excluded. The quality assessment of the included studies was analysed using the ARRIVE guidelines. Risk of Bias assessment was done using the (SYRCLE) risk of bias tool.

Results

Out of the 387 studies obtained, 17 studies were included for analysis. In most studies, when used as scaffolds with or without exogenous cells, dECM showed the potential to enhance angiogenesis, dentinogenesis and to regenerate pulp-like and dentin-like tissues. However, the included studies showed heterogeneity of decellularization methods, animal models, scaffold source, form and delivery, as well as high risk of bias and average quality of evidence.

Discussion

Decellularized ECM-derived scaffolds could offer a potential off-the-shelf scaffold for dentin-pulp regeneration in REPs. However, due to the methodological heterogeneity and the average quality of the studies included in this review, the overall effectiveness of decellularized ECM-derived scaffolds is still unclear. More standardized preclinical research is needed as well as well-constructed clinical trials to prove the efficacy of these scaffolds for clinical translation.

Other

The protocol was registered in PROSPERO database #CRD42023433026. This review was funded by the Science, Technology and Innovation Funding Authority (STDF) under grant number (44426).