bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 and government trust: A spiral of silence analysis in South America
Authors: Croucher Stephen M , Spencer Anthony , Bustamante Sandra , Nguyen Thao , Gomez Oscar
Published: May 2023

The COVID-19 pandemic has uncovered prejudices, systemic inequities and critical feelings about governmental institutions around the globe. Since the start of the pandemic, the 12 nations that make up South America have had more than 67 million cases and 1.3 million fatalities. Public trust in and willingness to speak out about government responses to COVID-19 in each nation have differed vastly. Using spiral of silence, this study ( n  =  1248) explored support for governmental COVID-19 response and willingness to speak out about that response in four South American nations: Argentina, Brazil, Chile and Peru. Results revealed Chileans are more likely to speak out on government response to COVID-19 than other South American participants. In addition, climate of opinion and support for government response positively predict willingness to speak. These results further our international and cross-cultural understanding of spiral of silence.
The Conditional Influence of Poverty, Inequality, and Severity of Poverty on Economic Growth in Sub-Saharan Africa
Authors: Asongu Simplice A. , Eita Joel Hinaunye
Published: May 2023

Poverty and inequality represent major policy syndromes that are relevant in the achievement of most United Nations’ Sustainable Development Goals (SDGs) in sub-Saharan Africa (SSA), while economic growth is also essential for the achievement of attendant SDGs. This study extends existing literature by assessing the conditional influence of poverty, income inequality, and severity of poverty on economic growth. The focus is on 42 countries in SSA with data from 1980 to 2019. The Gini index is used to measure income inequality. Poverty is measured in terms of the poverty headcount ratio, while the severity of poverty is computed as the squared of the poverty gap index. The empirical evidence is based on quantile regressions to assess how income inequality and poverty dynamics affect economic growth throughout the conditional distribution of economic growth. Our main finding shows that the negative response of economic growth to poverty is a decreasing function of economic growth. In other words, the incidence of poverty in reducing economic growth decreases with increasing levels of economic growth. In two specifications, the effect of inequality is negative in bottom quantiles and positive in top quantiles of the conditional distribution of economic growth. Policy implications are discussed, especially as it pertains to (1) the relevance of poverty in mitigating economic growth in SSA contingent on initial levels of economic growth and (2) comparative incidences of poverty and inequality in affecting economic growth.
Endoscopic-Modified Medial Maxillectomy for the Nonfunctioning Maxillary Sinus
Authors: Seresirikachorn Kachorn , Png Lu Hui , Kondo Mickey , Kalish Larry , Campbell Raewyn G. , Alvarado Raquel , Harvey Richard J.
Published: May 2023

Background

Middle meatal antrostomy (MMA) is the traditional intervention for chronic maxillary sinusitis but often fails to correct a nonfunctioning maxillary sinus that has lost its capability for mucociliary clearance. Endoscopic-modified medial maxillectomy (EMMM) can reshape the maxillary sinus and avoid a “sumping” effect, preventing secondary bacterial colonization, encouraging dependent drainage, and promoting effective nasal irrigation.

Objectives

We describe a modification of the EMMM surgical technique in patients with recalcitrant maxillary sinusitis and perioperative outcomes.

Methods

Consecutive adult patients with nonfunctioning maxillary sinuses managed with EMMM were assessed. Primary outcomes were the resolution of the presenting symptom and the absence of mucostasis. Secondary outcomes were early (<90 days) and late (>90 days) morbidity.

Results

Fifty-seven patients (51.7  ±  17.5 years, 56.1% female) were assessed. Fifty-two patients had complete resolution of their presenting symptom (91.2% [95% CI: 80.7–97.1]) and 52 patients had an absence of mucostasis (91.2% [95% CI: 80.7–97.1]). Those with persistent crusting were also those with symptoms. Early morbidities included temporary dysesthesia (3.2%), bleeding (1.1%), and pain (3.2%), with no late morbidities.

Conclusion

EMMM is a robust approach for salvaging a nonfunctioning maxillary sinus. The procedure enhances nasal irrigation, supplants mucociliary clearance, and discourages dependent mucus retention.
Biological properties of active compounds from Ageratina adenophora
Authors: SUN Wei , LIU Shan-shan , ZHAO Chen-chen
Published: May 2023

Ageratina adenophora is an invasive weed with widespread distribution. During the last several decades, many biologically active secondary metabolites have been isolated and characterized from A. adenophora, some of them having inspired the research and development of new therapeutic agents. This review mainly focuses on biological properties of A. adenophora, including the toxicity, antibacterial, antifungal, insecticidal, antiviral activities and others. In addition, the current limits and potentials of A. adenophora and its extracts are also discussed.
Early detection of cold stress to prevent hypothermia: A narrative review
Authors: Kyokan Michiko , Bochaton Nathalie , Jirapaet Veena , Pfister Riccardo E
Published: May 2023

Temperature monitoring is essential for assessing neonates and providing appropriate neonatal thermal care. Thermoneutrality is defined as the environmental temperature range within which the oxygen and metabolic consumptions are minimum to maintain normal body temperature. When neonates are in an environment below thermoneutral temperature, they respond by vasoconstriction to minimise heat losses, followed by a rise in metabolic rate to increase heat production. This condition, physiologically termed cold stress, usually occurs before hypothermia. In addition to standard axillary or rectal temperature monitoring by a thermometer, cold stress can be detected by monitoring peripheral hand or foot temperature, even by hand-touch. However, this simple method remains undervalued and generally recommended only as a second and lesser choice in clinical practice. This review presents the concepts of thermoneutrality and cold stress and highlights the importance of early detection of cold stress before hypothermia occurs. The authors suggest systematic clinical determination of hand and foot temperatures by hand-touch for early detection of physiological cold stress, in addition to monitoring core temperature for detection of established hypothermia, particularly in low-resource settings.
Modification of the Warden Procedure for Surgical Repair of Partial Anomalous Pulmonary Venous Connection
Authors: Danton Mark H D , Kesieme Emeka B
Published: May 2023

Warden procedure is a popular technique for repairing partial anomalous pulmonary venous connection. We describe a modification of this technique for surgical repair of this condition by raising both a superior vena cava (SVC) flap and right atrial appendage flap to create a tension-free SVC-RA continuity (neo-SVC). The anomalous pulmonary veins are routed via the remanent of proximal SVC and baffled to the left atrium across a surgically created or enlarged atrial septal defect using autologous pericardium.
Designing Field Experiments to Integrate Research on Costs
Authors: Bowden A. Brooks
Published: May 2023

Although experimental evaluations have been labeled the “gold standard” of evidence for policy (U.S. Department of Education, 2003), evaluations without an analysis of costs are not sufficient for policymaking (Monk, 1995; Ross et al., 2007). Funding organizations now require cost-effectiveness data in most evaluations of effects. Yet, there is little guidance on how to integrate research on costs into efficacy or effectiveness evaluations. As a result, research proposals and papers are disjointed in the treatment of costs, implementation, and effects, and studies often miss opportunities to integrate what is learned from the cost component into what is learned about effectiveness. To address this issue, this paper uses common evaluation frameworks to provide guidance for integrating research on costs into the design of field experiments building on the ingredients method (Levin et al., 2018). The goal is to improve study design, resulting in more cohesive, efficient, and higher-quality evaluations.
The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals
Authors: Bragadóttir Helga , Kalisch Beatrice J. , Flygenring Birna G. , Tryggvadóttir Gudný Bergthóra
Published: May 2023

Introduction

Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified.

Objective

To identify the level of nursing teamwork in hospitals in Iceland and its relationship with job satisfaction.

Methods

This was a quantitative descriptive cross-sectional study. Data were collected with the Nursing Teamwork Survey administered to nursing staff in medical, surgical, and intensive care units in hospitals in Iceland. This study is based on data from 567 participants.

Results

A logistic regression analysis indicated that work experience on current unit and perceived staffing adequacy contributes to job satisfaction and when controlling for unit type, role, experience on current unit and staffing adequacy, those reporting better teamwork are significantly more likely to be satisfied with their current position. With an additional unit for overall nursing teamwork, participants are almost five times likelier to be satisfied with their current position.

Conclusion

Study findings show that there is a significant relationship between nursing teamwork and job satisfaction. The findings of this study confirm the importance of adequate staffing and good teamwork for nurses’ job satisfaction. Staffing however, will remain the most challenging part of the equation as lack of nursing staff is foreseen globally in the coming decades turning the spotlight to teamwork. All stakeholders, including clinical nurse leaders, administrators, and instructors, need to emphasize on strengthening nursing teamwork. Good teamwork with increased job satisfaction may prevent turnover and shortage of nurses, an issue expected to grow during and following the COVID-19 pandemic. Facilitating good teamwork should be one of the priorities of every nurse leader.
Systems and Complexity Thinking to Master Leadership Challenges in Interprofessional Health Professionals Education
Authors: Pesut Daniel J , Headrick Linda A , Holmboe Eric , Moore Shirley M
Published: May 2023

The purpose of this article is to propose that knowledge, understanding, and application of systems and complexity thinking can improve assessment, implementation, and evaluation of interprofessional education (IPE). Using a case story, the authors describe and explain a meta-model of systems and complexity thinking to support leaders in implementing and evaluating IPE initiatives. The meta-model incorporates the use of several important, interrelated frameworks that tackle issues of sense making, systems, and complexity thinking as well as polarity management at different levels of scale in an organization. Combined, these theories and frameworks support recognition and management of cross-scale interactions and help leaders make sense of distinctions among simple, complicated, complex, and chaotic situations among IPE issues associated with healthcare disciplines within institutions. The application and use of Liberating Structures and polarity management practices enable leaders to engage people and gain insight into the complexities involved in successful implementation of IPE programs.
Calcifications in Cerebral Infarcts: Report of Two Cases
Authors: Bharath Jayaram , Reddy Vendoti Nitheesha , Nagarajan Krishnan , Adithan Subathra , Pillai Vivekanandan M.
Published: May 2023

Calcification in cerebral infarcts has been reported as an uncommon finding. CT hyperdensity in an infarct can also be due to hemorrhagic transformation and in MRI can be mimicked by cortical laminar necrosis seen as gyriform T1 hyper and T2 hypointensities. Susceptibility-weighted imaging (SWI) with phase image has been reported to differentiate calcification and hemorrhage. We report 2 cases of cerebral infarcts with a review of the literature. The first patient showed early gyriform calcification 10 days after the onset and showed partial resolution of the calcification on follow-up. The second patient showed plaque-like calcification within perisylvian infarct that was confirmed by SWI phase imaging.
School leaders leading anti-racism and inclusion: Evidence from schools in England
Authors: Miller Paul
Published: May 2023

Since the murder of George Floyd, there has been much more focus on tackling racism and other forms of structural and institutional inequities in ways not seen before by many. This moment of reckoning has, for the first time in recent history, resulted in individual and institutions grappling, with structures, systems, policies and processes that mimic and perpetuate unequal experiences and outcomes. A consequence of these grapplings has been individual and institutional galvanising, aimed at reducing gaps in experiences and removing barriers to equitable outcomes. This paper presents evidence from one primary and four secondary schools, of leaders contending with racism through people, processes, policies and systems to improve experiences and outcomes for staff and students between May 2020 and December 2022.
Lessons from the first two years of a new out-of-hospital airway registry in New South Wales
Authors: Nichols Martin , Fouche Pieter Francsois , McPherson Thomas , Evens Tom , Bendall Jason
Published: May 2023

Background

Advanced airway interventions, including endotracheal intubation (ETI) and supraglottic airway devices (iGel®), are used for airway management. Advanced airway proficiency is critical to maintain patient safety. Airway registries are commonly used quality assurance tools that can drive system-level improvement. This study analyses the first two years of data from a new prehospital airway registry.

Methods

This is a retrospective review of the first two years of an airway registry for Intensive Care Paramedics in New South Wales Ambulance spanning 8 August 2020 to 8 August 2022. Changes in airway management effectiveness were examined as a time series and analysis proceeded regression using Newey–West standard errors. Additionally, a machine learning algorithm (generalised boosted model) was used to predict successful ETI.

Results

There were 872 unique advanced airway episodes suitable for analysis. Of 705 patients that had received ETI, 655 were successful resulting in an overall success rate of 92.9%. Intubation was achieved on the first attempt in 573 out of 705 (81.3%) patients. Supraglottic airway insertion was successful in 193 of 222 patients (86.9%). The first-pass success for the iGel® supraglottic device was 183 of 222 (82.4%). Considerable increases in ETI and iGel® first-pass success were observed over time. A machine learning analysis demonstrated that factors predicting success for endotracheal intubation included airway-grade, patient age, the use of video laryngoscopy, patient weight and the use of external laryngeal manipulation/bi-manual laryngoscopy.

Conclusions

This prehospital airway registry analysis demonstrates increasing advanced airway success over the first two years of registry implementation. These increases may be explained in part by the reflective feedback and awareness of airway management that results from the registry, training and the increased use of video laryngoscopy.
All the King’s Horses and All the King’s Men: Falling Into Moral Injury, During the COVID-19 Pandemic
Authors: Evans Kevin D. , Bloom Isaiah W. , Sommerich Carolyn M.
Published: May 2023

Health care providers who experienced giving care or abbreviating those services, during the COVID-19 pandemic, risked experiencing a sense of moral injury. Moral injury is a term to describe incidents where a health care provider knows the right thing to do, but constraints make it exceedingly difficult or impossible to execute the right course of action. These incidents likely also were present for sonographers and vascular technologists, and it is vital that these compromises for patients are recognized, and healing strategies offered to those suffering from moral injury. Some suggestions for treatment of moral injury are to recognize these experiences, seek solutions, provide empathy for patients and resources for health care providers. It may also be beneficial to allow employees and employers to forgive the mistakes made during the pandemic and focus on solutions to prevent future incidents of moral injury.
geneHapR: an R package for gene haplotypic statistics and visualization
Authors: Zhang Renliang , Jia Guanqing , Diao Xianmin
Published: May 2023

Background

Together with application of next-generation sequencing technologies and increased accumulation of genomic variation data in different organism species, an opportunity for effectively identification of superior alleles of functional genes to facilitate marker-assisted selection is emerging, and the clarification of haplotypes of functional genes is becoming an essential target in recent study works.

Results

In this paper, we describe an R package ‘geneHapR’ developed for haplotypes identification, statistics and visualization analysis of candidate genes. This package could integrate genotype data, genomic annotating information and phenotypic variation data to clarify genotype variations, evolutionary-ship, and morphological effects among haplotypes through variants visualization, network construction and phenotypic comparison. ‘geneHapR’ also provides functions for Linkage Disequilibrium block analysis and visualizing of haplotypes geo-distribution.

Conclusions

The R package ‘geneHapR’ provided an easy-to-use tool for haplotype identification, statistic and visualization for candidate gene and will provide useful clues for gene functional dissection and molecular-assistant pyramiding of beneficial alleles of functional locus in future breeding programs.
Nitrogen fixation by common beans in crop mixtures is influenced by growth rate of associated species
Authors: Singh Akanksha , Schöb Christian , Iannetta Pietro P. M.
Published: May 2023

Background

Legumes can fix atmospheric nitrogen (N) and facilitate N availability to their companion plants in crop mixtures. However, biological nitrogen fixation (BNF) of legumes in intercrops varies largely with the identity of the legume species. The aim of our study was to understand whether BNF and concentration of plant nutrients by common bean is influenced by the identity of the companion plant species in crop mixtures. In this greenhouse pot study, common beans were cultivated with another legume (chickpea) and a cereal (Sorghum). We compared BNF, crop biomass and nutrient assimilation of all plant species grown in monocultures with plants grown in crop mixtures.

Results

We found beans to exhibit low levels of BNF, and to potentially compete with other species for available soil N in crop mixtures. The BNF of chickpeas however, was enhanced when grown in mixtures. Furthermore, biomass, phosphorous and potassium values of chickpea and Sorghum plants were higher in monocultures, compared to in mixtures with beans; suggesting competitive effects of beans on these plants. Concentration of calcium, magnesium and zinc in beans was higher when grown with chickpeas than with Sorghum.

Conclusions

It is generally assumed that legumes benefit their companion plant species. Our study highlights the contrary and shows that the specific benefits of cereal-legume mixtures are dependent on the growth rate of the species concerned. We further highlight that the potential of legume-legume mixtures is currently undervalued and may play a strong role in increasing N use efficiency of intercrop-based systems.
Cognitive-behavioral rehabilitation in patients with cardiovascular diseases: a randomized controlled trial (CBR-CARDIO, DRKS00029295)
Authors: Bethge Matthias , Thome-Soós Friederike , Rašo Luka Marko , Weier Lisa , Benninghoven Dieter
Published: May 2023

Background

Depression, generalized and cardiac anxiety, and posttraumatic stress disorder negatively affect disease severity, participation, and mortality in patients with cardiovascular disease. Psychological treatments within cardiac rehabilitation may improve the outcomes of these patients. We therefore developed a cognitive-behavioral rehabilitation program for patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. In Germany, similar programs are well established in musculoskeletal rehabilitation and cancer rehabilitation. However, no randomized controlled trials have evaluated if such programs achieve better outcomes in patients with cardiovascular disease compared with standard cardiac rehabilitation.

Methods

Our randomized controlled trial compares cognitive-behavioral cardiac rehabilitation with standard cardiac rehabilitation. The cognitive-behavioral program complements standard cardiac rehabilitation with additional psychological and exercise interventions. Both rehabilitation programs last for four weeks. We enroll 410 patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion aged 18 to 65 years. Half of the individuals are randomly assigned to cognitive-behavioral rehabilitation and the other half to standard cardiac rehabilitation. Our primary outcome is cardiac anxiety 12 months after the end of rehabilitation. Cardiac anxiety is assessed with the German 17-item version of the Cardiac Anxiety Questionnaire. Secondary outcomes cover outcomes assessed by clinical examinations and medical assessments and a range of patient-reported outcome measures.

Discussion

This randomized controlled trial is designed to determine the effectiveness of cognitive-behavioral rehabilitation at decreasing cardiac anxiety in patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion.

Trial registration

German Clinical Trials Register (DRKS00029295, June 21, 2022).
Impact of COVID-19-adapted guidelines using different airway management strategies on resuscitation quality in out-of-hospital-cardiac-arrest – a randomised manikin study
Authors: Scholz Sean S. , Linder Sissy , Latka Eugen , Bartnick Tobias , Karla Daniel , Thaemel Daniel , Wolff Marlena , Sauzet Odile , Rehberg Sebastian W. , Thies Karl-Christian , Jansen Gerrit
Published: May 2023

Background

Although airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes.

Methods

In this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants‘ subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3.

Results

A total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8).

Conclusions

COVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers.
Improving the readiness and clinical quality of antenatal care – findings from a quasi-experimental evaluation of a performance-based financing scheme in Burkina Faso
Authors: Appel Inke , Lohmann Julia , De Allegri Manuela , Koulidiati Jean-Louis , Somda Serge , Robyn Paul Jacob , Badolo Hermann , Brenner Stephan
Published: May 2023

Background

While maternal mortality has declined globally, it remains highest in low-income countries. High-quality antenatal care (ANC) can prevent or decrease pregnancy-related complications for mothers and newborns. The implementation of performance-based financing (PBF) schemes in Sub-Saharan Africa to improve primary healthcare provision commonly includes financial indicators linked to ANC service quality indicators. In this study, we examine changes in ANC provision produced by the introduction of a PBF scheme in rural Burkina Faso.

Methods

This study followed a quasi-experimental design with two data collection points comparing effects on ANC service quality between primary health facilities across intervention and control districts based on difference-in-differences estimates. Performance scores were defined using data on structural and process quality of care reflecting key clinical aspects of ANC provision related to screening and prevention pertaining to first and follow-up ANC visits.

Results

We found a statistically significant increase in performance scores by 10 percent-points in facilities’ readiness to provide ANC services. The clinical care provided to different ANC client groups scored generally low, especially with respect to preventive care measures, we failed to observe any substantial changes in the clinical provision of ANC care attributable to the PBF.

Conclusion

The observed effect pattern reflects the incentive structure implemented by the scheme, with a stronger focus on structural elements compared with clinical aspects of care. This limited the scheme’s overall potential to improve ANC provision at the client level after the observed three-year implementation period. To improve both facility readiness and health worker performance, stronger incentives are needed to increase adherence to clinical standards and patient care outcomes.
Noninvasive prenatal testing, ultrasonographic findings and poor prenatal diagnosis rates for twin pregnancies: a retrospective study
Authors: Yuan Xiying , Wang Weinan , Dai Lei , Yong Wenjing , Pei Chenlin , Li Jingzhi , Wu Lingqian
Published: May 2023

Background

Noninvasive prenatal testing (NIPT) is increasingly used in the clinical prenatal screening of twin pregnancies, and its screening performance for chromosomal abnormalities requires further evaluation. For twin pregnancies with indications for prenatal diagnosis, there is a lack of clinical data to assess the prenatal diagnosis rate (PDR). The aim of this study was to evaluate the screening performance of NIPT for foetal chromosomal abnormalities in twin pregnancies and the PDR in the second and third trimesters.

Methods

Ultrasound scans were carried out for all twin pregnancies between 11 and 13+ 6gestational weeks. For twin pregnancies with nuchal translucency thickness˂3.0 mm and no foetal structural malformations, NIPT was performed after blood sampling, followed by routine ultrasound monitoring. Women with twin pregnancies who underwent NIPT at the prenatal diagnostic centre of Xiangya Hospital from January 2018 to May 2022 were included in the study. Genetic counselling was offered to each pregnant woman when the NIPT result indicated a high risk of abnormalities or abnormal ultrasonographic (USG) findings were detected. We followed up twin pregnancies for NIPT results, USG findings, prenatal diagnosis results and pregnancy outcomes.

Results

In 1754 twin pregnancies, the sensitivity, specificity and positive predictive value of NIPT for trisomy 21 were 100%, 99.9% and 75%, and the corresponding values for sex chromosome aneuploidy (SCA) were 100%, 99.9% and 50%, respectively. For the 14 twin pregnancies for which the NIPT results indicated a high risk of abnormalities, the PDR was 78.6% (11/14). For the 492 twin pregnancies for which the NIPT results indicated a low risk of abnormalities, the rate of USG findings in the second and third trimesters was 39.4% (194/492); of these pregnancies, prenatal diagnosis was recommended for 16.7% (82/492), but it was actually performed in only 8.3% (41/492), and the PDR was 50% (41/82). There was no significant difference in the PDR between the NIPT high-risk and low-risk groups.

Conclusions

The screening performance of NIPT for SCA in twin pregnancies needs to be further evaluated. When abnormal NIPT results or USG findings are used as the main prenatal diagnostic indicator in the second and third trimesters, the PDR is poor.
Prevalence and associated risk factors of dry eye disease in Hotan, Xinjiang: a cross-sectional study
Authors: Li Xiaolong , Wang Zhen , Mu Jingyu , Puerkaiti Hamila , Nulahou Ayinu , Zhang Jie , Zhao Yong , Sun Qi , Li Yuanyuan , Wang Yan , Gao Yunxian
Published: May 2023

Objectives

To assess the prevalence of dry eye disease (DED) in the Uyghur population in Hotan, Xinjiang, and to identify risk factors associated with this disorder.

Methods

Between January and September of 2020, 5,121 Uyghur subjects aged 18 − 98 years from 105 villages were selected and studied cross-sectionally using a whole-group random sampling method in the Hotan area, Xinjiang, China. The Ocular Surface Disease Index questionnaire was used to collect subjective symptoms of DED and examine tear-film break-up times. The break up time and Schirmer’s test were used to collect objective signs, to determine the prevalence of DED and its risk factors.

Results

A total of 5,121 subjects aged 18 − 98 years were recruited from the Uyghur population in the Hotan region of Xinjiang, China, for eye examinations and questionnaire surveys. A total of 40.6% (2,078/5,121) were diagnosed with DED, of which 38.3% were male and 41.9% were female. The prevalence of DED was the highest in subjects ≥ 65 years of age, with 47.8% in males and 53.3% in females. The lowest occurrence was in subjects 18 − 44 years of age, with 32.5% in males and 33.7% in females. Older age, tea drinking, and staying awake late were risk factors affecting the severity of DED prevalence (p < 0.05), but there was no significant difference in sex, presence of diabetes, or presence of hypertension (p > 0.05).

Conclusion

The prevalence of DED in the study population was 40.6%, and its prevalence was higher in females, when compared with males. The prevalence of dry eye also increased with age, and at an advanced age, female sex, smoking, staying awake late, and not exercising were risk factors for DED.
The efficacy and safety of tranexamic acid in rheumatoid arthritis patients undergoing simultaneous bilateral total knee arthroplasty: a multicenter retrospective study
Authors: Cao Guorui , Zhang Shaoyun , Wang Yixuan , Xu Hong , Quan Songtao , Cai Litao , Feng Wei , Yao Junna , Tan Honglue , Pei Fuxing
Published: May 2023

Background

The efficacy and safety of tranexamic acid (TXA) in reducing blood loss following total knee arthroplasty (TKA) in patients with osteoarthritis have been widely confirmed. However, there is still a paucity of the evidences regarding the effectiveness of TXA in patients with rheumatoid arthritis (RA). The purpose of the study is to explore the efficacy and safety of intravenous TXA on blood loss and transfusion risk following simultaneous bilateral TKA (SBTKA) in patients with RA.

Methods

As a multicenter retrospective study, a total of 74 patients diagnosed with RA who underwent SBTKA were assigned into TXA group (15 mg/kg intravenous TXA before skin incision, n = 50) and control group (no TXA use, n = 24). The primary outcomes were total blood loss (TBL) and intraoperative blood loss (IBL). The secondary outcomes were hemoglobin (Hb) and hematocrit (Hct) drop on postoperative day 3, transfusion rate and volume, ambulation time, length of stay, hospitalization expenses and the incidence of complications.

Results

The mean TBL, IBL and transfusion volume in TXA group were significantly lower than those in control group. The Hb and Hct drop on postoperative day 3 in control group were higher than those in TXA group (p<0.05). The similar trend was detected on transfusion rate, ambulation time and length of stay. The incidence of complications and hospitalization expenses did not differ significantly between the two groups (p>0.05).

Conclusions

TXA could effectively reduce blood loss, decrease transfusion risk, shorten ambulation time and length of stay following SBTKA in patients with RA, without increasing the risk of complications.
Three-dimensional (3D) quantitative evaluation of the morphological changes of the upper anterior alveolar bone after retraction of a maxillary incisor
Authors: Liu Hong , Xi Xun , Liu Dongxu
Published: May 2023

Background

The purpose of this study was to assess morphological changes of the upper anterior alveolus after retraction of a maxillary incisor by applying three-dimensional (3D) superimposition of pretreatment (T1) and posttreatment (T2) cone-beam computed tomography (CBCT) data.

Methods

The study group was comprised of 28 patients with skeletal Class II malocclusion who underwent incisor retraction. CBCT data were acquired before (T1) and after (T2) orthodontic treatment. Labial and palatal alveolar thickness were assessed at the crestal, midroot and apical levels of the retracted incisors. Following three-dimensional (3D) cranial base superimposition, we performed surface modeling and inner remodeling of the labial and palatal alveolar cortex of the maxillary incisors. Paired t-tests were used to compare T0 and T1 bone thickness and volume measurements. Comparisons between labial and palatal surface modeling, inner remodeling and outer surface modeling were performed with paired t-tests in SPSS 20.0 version.

Results

We observed controlled tipping retraction of the upper incisor. After treatment, the alveolar thickness on the labial sides increased and the palatal alveolar thickness decreased. The labial cortex showed a wider range of modeling area with a larger bending height and a smaller bending angle than the palatal side. The extent of inner remodeling was more prominent than the outer surface on both the labial and palatal sides.

Conclusions

Adaptive alveolar surface modeling occurred in response to incisor tipping retraction on both the lingual and labial sides although these changes occurred in an uncoordinated manner. Tipping retraction of the maxillary incisors led to a reduction in alveolar volume.
Effects of metformin on human gingival fibroblasts: an in vitro study
Authors: Alshibani Nouf , AlKattan Reem , Allam Eman , Alshehri Fahad A. , Shalabi Manal Matouq , Almuhanna Nada , Almarshad Houriah , Aljamili Anfal
Published: May 2023

Objective

To investigate the effects of metformin (MF) treatment on the matrix metalloproteinases (MMPs) and proinflammatory cytokines production from lipopolysaccharide (LPS) - stimulated human gingival fibroblasts (HGFs).

Methods

HGFs were obtained from subcultures of biopsies from clinically healthy gingival tissues of patients undergoing oral surgeries. Cell cytotoxicity assay was used to determine the effect of different concentrations of MF on viability of HGFs. HGFs were then incubated and treated with different concentrations of MF and Porphyromonas gingivais (Pg) LPS. MMP-1, MMP-2, MMP-8, MMP-9, IL-1β, and IL-8 expression analysis was performed using xMAP technology (Luminex 200, Luminex, Austin, TX, USA). Student’s t-test for a single sample was used to compare the mean values of the study groups with the control value. A p-value of <0.05 and 95% confidence intervals were used to report the statistical significance and precision of mean values.

Results

Concentrations of 0.5, 1- and 2-mM MF had a minimal non-significant cytotoxic effect on the HGFs and caused statistically significant reduction of MMP-1, MMP-2, MMP-8 and IL-8 expressed by the LPS-stimulated HGFs.

Conclusion

The results of the present study confirm that MF suppresses MMP-1, MMP-2, MMP-8 and IL-8 in LPS-stimulated HGFs suggesting an anti-inflammatory effect of MF and potential adjunct therapeutic role in the treatment of periodontal diseases.
Clinical and microbiological outcomes of subgingival instrumentation supplemented with high-dose omega-3 polyunsaturated fatty acids in periodontal treatment – a randomized clinical trial
Authors: Stańdo-Retecka Mirella , Piatek Paweł , Namiecinska Magdalena , Bonikowski Radosław , Lewkowicz Przemyslaw , Lewkowicz Natalia
Published: May 2023

Purpose

This study aimed to evaluate the impact of dietary supplementation with omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined with scaling and root planing (SRP) in untreated periodontitis stage III and IV.

Methods

Forty patients were randomly assigned to the test group receiving SRP plus omega-3 PUFAs (n = 20) or control group receiving SRP alone (n = 20). Clinical changes of pocket probing depths (PD), clinical attachment level (CAL), bleeding on probing (BOP) and rates of closed pockets (PPD ≤ 4 mm without BOP) were evaluated at baseline and after 3 and 6 months. Phorphyromonas gingivalis, Tanarella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans counts were analysed at baseline and at 6 months. Serum was subjected to lipid gas chromatography/mass spectrometry analysis at baseline and at 6 months.

Results

Significant improvement of all clinical parameters at 3 and 6 months was observed in both groups. For the primary outcome “change of mean PD,” no significant difference was detected between the groups. Patients treated with omega-3 PUFAs demonstrated significantly lower rates of BOP, higher gain of CAL and higher number of closed pockets at 3 months in comparison to the control group. After 6 months, no clinical differences between the groups were found, with the exception of lower BOP rates. Moreover, in the test group, the number of key periodontal bacteria was significantly lower than in the control group at 6 months. Increased proportions of serum n-3 PUFAs and decreased proportions of n-6 PUFAs were detected at 6 months in the patients from the test group.

Conclusion

High-dose omega-3 PUFA intake during non-surgical treatment of periodontitis results in short-term clinical and microbiological benefits.

The study protocol was approved by the ethical committee of Medical University of Lodz (reference number RNN/251/17/KE) and registered at clinicaltrials.gov (NCT04477395) on 20/07/2020.
Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey
Authors: Sserwanja Quraish , Nuwabaine Lilian , Kamara Kassim , Musaba Milton W.
Published: May 2023

Background

The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country.

Methods

We analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Participants were young women aged 15–24 years, who were using a family planning method (n = 1,506). Good quality family planning counselling was defined a composite variable that included; a woman being told about side effects, how to deal with side effects, and the availability of other family planning methods/options. Logistic regression was performed using SPSS software version 25.

Results

Out of 1,506 young women, 955 (63.4%, 95% CI: 60.5–65.3) received good quality family planning counselling services. Of the 36.6% that received inadequate counselling, 17.1% received no counselling at all. Good quality family planning counselling services was positively associated with receiving family planning services from government health facilities (aOR: 2.50, 95% CI: 1.83–3.41), having no major challenges with distance to access healthcare (aOR: 1.45, 95% CI: 1.10–1.90), having visited a health facility (AOR: 1.93, 95% CI: 1.45–2.58), and having been visited by a health field worker within the last 12 months (aOR: 1.67, 95% CI: 1.24–2.26) while residing in the southern region ( aOR: 0.39, 95% CI: 0.22–0.69) and belonging to the richest wealth quintile (aOR: 0.49, 95% CI: 0.24–0.98) were associated with less odds of receiving good quality family planning counselling services.

Conclusion

About 37% of the young women in Sierra Leone do not receive good quality family planning counselling services of which 17.1% received none. Based on the study’s findings, it is important to emphasize the need to ensure that all young women have access to proper counselling services especially for those receiving these services from private health units, from the southern region and richest wealth quintile. Ensuring easier access through increasing affordable and friendly access points and strengthening field health workers’ capacity in providing family planning services could also help improve access to good quality family planning services.
Situational vulnerability within mental healthcare – a qualitative analysis of ethical challenges during the COVID-19 pandemic
Authors: Faissner Mirjam , Werning Anna , Winkelkötter Michael , Foullois Holger , Löhr Michael , Gather Jakov
Published: May 2023

Background

Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions. The situation of users and patients in different psychosocial settings during the COVID-19 pandemic has not yet been comprehensively considered and ethically analyzed under the aspect of situational vulnerability.

Methods

We present the results of a retrospective qualitative analysis of a survey of ethical challenges in different mental healthcare facilities of a large regional mental healthcare provider in Germany. We evaluate them ethically using a dynamic and situational understanding of vulnerability.

Results

Difficulties in implementing infection prevention measures, restrictions of mental health services in favor of infection prevention, social isolation, negative health effects on mental healthcare users and patients, and challenges in implementing regulations on state and provider levels within the local specificities emerged across different mental healthcare settings as ethically salient topics.

Conclusions

Applying a situational and dynamic understanding of vulnerability allows the identification of specific factors and conditions that have contributed to an increased context-dependent vulnerability for mental healthcare users and patients. These factors and conditions should be considered on the level of state and local regulations to reduce and address vulnerability.
Impact of the value driven outcomes program among cataract surgery patients in Singapore: an interrupted time series analysis
Authors: Hoong Jian Ming , Gibbons Brent , Loh Benedict , Tan Clement , Chen Cynthia
Published: May 2023

Background

Healthcare cost is increasing rapidly in Singapore. Moving towards a value-based healthcare framework enables a sustainable health system. The National University Hospital (NUH) implemented the Value Driven Outcome (VDO) Program for cataract surgery due to its high volume and cost variability. We aimed to evaluate the association between VDO program implementation and costs and quality outcomes for cataract surgery in NUH.

Methods

We conducted an interrupted time-series analysis for cataract surgery episodes between January 2015 and December 2018. Using segmented linear regression models, we estimate the changes in levels and trends of cost and quality outcomes post-program implementation. We adjusted for autoregression and various confounders.

Results

Following VDO program implementation, the total cost of cataract surgery had a significantly decreased by $327.23 (95% CI: -$421.04 to -$233.43; p < 0.01) and the trend significantly decreased by $13.75 per month (95% CI: -$23.19 to -$4.30 per month; p < 0.01). There was a small improvement in the combined quality outcome score (0.028, 95% CI: 0.016 to 0.040; p < 0.01), but the trend remained unchanged.

Conclusion

The VDO program was associated with a reduction in cost without compromising on quality outcomes. The program provides a structured methodology to measure performances, and through these data, initiatives were implemented to improve value. There are benefits to providing a data reporting system to physicians to understand actual care costs and quality outcomes achieved by individual patients with defined clinical conditions.