bluuebunny/crossref_metadata_2025 huggingface dataset:
Indications of Community College Virtual International Exchange Outcomes: Global Perspective-Taking and Self-Efficacy
Authors: Whatley Melissa , Aldrich Casey , De Angelis Adeline
Published: April 2024

This study explored student learning outcomes related to virtual international exchange, namely global perspective-taking and self-efficacy, among a sample of 76 community college students in the United States. Viewing virtual exchange as a possible high-impact educational practice, we anticipated that participation would have a positive relationship with these two outcomes. To test this hypothesis, we used survey data collected from students attending two community colleges in the US Southeast. Using a pre-test/post-test design, we estimated linear regression models to explore the relationship between virtual exchange participation and these two outcomes, measured using the Global Perspectives Inventory and the New General Self-efficacy Scale. Counter to expectation, we found that virtual exchange was not generally significantly related to changes in students’ global perspective-taking or sense of self-efficacy. We hypothesize these null findings relate to characteristics of virtual exchange programs and differences between virtual exchange and other international experiences like study abroad.
Do People Feel Healthier After Holding Sports Mega-Events? Evidence from the 2010 Guangzhou Asian Games
Authors: Wang Yangjie , Sun Cuicui , Wang Jinxian , Mao Xiaoyan
Published: April 2024

The assessment of environmental and health impacts stemming from sports mega-events plays an important role in evaluating the overall cost–benefit of the events. This study utilizes microdata sourced from the China Household Income Project in conjunction with a time-varying difference-in-differences methodology. Through this approach, we estimated the impact of the 2010 Guangzhou Asian Games on both air quality and public health conditions within China. The results reveal the following: (1) The Games wield substantial and favorable effects on self-perceived health; (2) The primary avenue through which the Games improve self-perceived health is by mitigating air pollution levels in the cities associated with the Games; (3) The cost–benefit analysis unveils that hosting the Games has led to a reduction of 1103.12 million RMB in residents’ medical expenses, with the improved air quality accounting for 20.15% of the cost reduction.
The legal classification of volunteers: A cross-European case law comparison
Authors: Hiessl Christina
Published: April 2024

This contribution provides a structural analysis of the case law of national courts in the EU, EEA and UK confronted with questions on the classification of volunteers. It explores the criteria and rationales used by courts to decide whether workers hired as volunteers should be reclassified as employees. These are put into perspective by reference to more recent evolutions of court approaches to employee status, particularly in the context of the platform economy. Given the societal relevance of voluntary work, a particular focus lies on the question of whether the operation of volunteer organisations might face challenges due to the tendency to broadening the concept of worker.
The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries
Authors: Bambra Clare
Published: April 2024

This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that—as with income inequalities—health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920–1950; the Trente Glorieuse, 1950–1980; Neoliberalism, 1980–2010; and the Crisis Age, 2010–present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.
Increased CX3CL1 in cerebrospinal fluid and ictal serum t-tau elevations in migraine: results from a cross-sectional exploratory case-control study
Authors: Süße Marie , Kloetzer Christine , Strauß Sebastian , Ruhnau Johanna , Overeem Lucas Hendrik , Bendig Merle , Schulze Juliane , Reuter Uwe , Vogelgesang Antje , Fleischmann Robert
Published: April 2024

Background

To date, migraine is diagnosed exclusively based on clinical criteria, but fluid biomarkers are desirable to gain insight into pathophysiological processes and inform clinical management. We investigated the state-dependent profile of fluid biomarkers for neuroaxonal damage and microglial activation as two potentially relevant aspects in human migraine pathophysiology.

Methods

This exploratory study included serum and cerebrospinal fluid (CSF) samples of patients with migraine during the headache phase (ictally) (n = 23), between attacks (interictally) (n = 16), and age/sex-matched controls (n = 19). Total Tau (t-Tau) protein, glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NfL) were measured with the Neurology 4-plex kit on a Single Molecule Array SR-X Analyzer (Simoa® SR-X, Quanterix Corp., Lexington, MA). Markers of microglial activation, C-X3-C motif chemokine ligand 1 (CX3CL1) and soluble triggering receptor expressed on myeloid cells 2 (sTREM2), were assessed using an immunoassay.

Results

Concentrations of CX3CL1 but not sTREM2 were significantly increased both ictally and interictally in CSF but not in serum in comparison to the control cohort (p = 0.039). ROC curve analysis provided an AUC of 0.699 (95% CI 0.563 to 0.813, p = 0.007). T-Tau in serum but not in CSF was significantly increased in samples from patients taken during the headache phase, but not interictally (effect size: η2 = 0.121, p = 0.038). ROC analysis of t-Tau protein in serum between ictal and interictal collected samples provided an AUC of 0.729 (95% CI 0.558 to 0.861, p = 0.006). The other determined biomarkers for axonal damage were not significantly different between the cohorts in either serum or CSF.

Discussion

CX3CL1 in CSF is a novel potential fluid biomarker of migraine that is unrelated to the headache status. Serum t-Tau is linked to the headache phase but not interictal migraine. These data need to be confirmed in a larger hypothesis-driven prospective study.
Developing an ensembled machine learning model for predicting water quality index in Johor River Basin
Authors: Sidek L. M. , Mohiyaden H. A. , Marufuzzaman M. , Noh N. S. M. , Heddam Salim , Ehteram Mohammad , Kisi Ozgur , Sammen Saad Sh.
Published: April 2024

Currently, the Water Quality Index (WQI) model becomes a widely used tool to evaluate surface water quality for agriculture, domestic and industrial. WQI is one of the simplest mathematical tools that can assist water operator in decision making in assessing the quality of water and it is widely used in the last years. The water quality analysis and prediction is conducted for Johor River Basin incorporating the upstream to downstream water quality monitoring station data of the river. In this research, the numerical method is first used to calculate the WQI and identify the classes for validating the prediction results. Then, two ensemble and optimized machine learning models including gradient boosting regression (GB) and random forest regression (RF) are employed to predict the WQI. The study area selected is the Johor River basin located in Johor, Peninsular Malaysia. The initial phase of this study involves analyzing all available data on parameters concerning the river, aiming to gain a comprehensive understanding of the overall water quality within the river basin. Through temporal analysis, it was determined that Mg, E. coli, SS, and DS emerge as critical factors affecting water quality in this river basin. Then, in terms of WQI calculation, feature importance method is used to identify the most important parameters that can be used to predict the WQI. Finally, an ensemble-based machine learning model is designed to predict the WQI using three parameters. Two ensemble ML approaches are chosen to predict the WQI in the study area and achieved a R2 of 0.86 for RF-based regression and 0.85 for GB-based ML technique. Finally, this research proves that using only the biochemical oxygen demand (BOD), the chemical oxygen demand (COD) and percentage of dissolved oxygen (DO%), the WQI can be predicted accurately and almost 96 times out of 100 sample, the water class can be predicted using GB ensembled ML algorithm. Moving forward, stakeholders may opt to integrate this research into their analyses, potentially yielding economic reliability and time savings.
Physiological and transcriptomic comparisons shed light on the cold stress response mechanisms of Dendrobium spp
Authors: Li Zhiyuan , Lu Shunjiao , Yi Shuangshuang , Mo Shunjin , Yu Xiaoyun , Yin Junmei , Zhang Changqing
Published: April 2024

Background

Dendrobium spp. comprise a group of tropical orchids with ornamental and medicinal value. Dendrobium spp. are sensitive to low temperature, and the underlying cold response regulatory mechanisms in this group are unclear. To understand how these plants respond to cold stress, we compared the transcriptomic responses of the cold-tolerant cultivar ‘Hongxing’ (HX) and the cold-sensitive cultivar ‘Sonia Hiasakul’ (SH) to cold stress.

Results

Chemometric results showed that the physiological response of SH in the later stages of cold stress is similar to that of HX throughout the cold treatment. Orthogonal partial least squares discriminant analysis (OPLS–DA) revealed that soluble protein content and peroxidase activity are key physiological parameters for assessing the cold tolerance of these two Dendrobium spp. cultivars. Additionally, weighted gene co-expression network analysis (WGCNA) results showed that many cold response genes and metabolic pathways significantly associated with the physiological indices were enriched in the 12 detected modules. The Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene ontology (GO) enrichment analyses of the 105 hub genes showed that Dendrobium spp. adapt to cold stress by regulating signal transduction, phytohormones, transcription factors, protein translation and modification, functional proteins, biosynthesis and metabolism, cell structure, light, and the circadian clock. Hub genes of the cold stress response network included the remorin gene pp34, the abscisic acid signaling pathway-related genes PROTEIN PHOSPATASE 2 C (PP2C), SNF1-RELATED PROTEIN KINASE 2 (SnRK2), ABRE-BINDING FACTOR 1 (ABF1) and SKI-INTERACTING PROTEIN 17 (SKIP17), the Ca2+ signaling-related GTP diphosphokinase gene CRSH1, the carbohydrate-related gene STARCH SYNTHASE 2 (SS2), the cell wall biosynthesis gene CINNAMYL ALCOHOL DEHYDROGENASE (CAD7), and the endocytosis-related gene VACUOLAR PROTEIN SORTING-ASSOCIATED PROTEIN 52 A (VPS52A).

Conclusions

The cold-responsive genes and metabolic pathways of Dendrobium spp. revealed in this study provide important insight to enable the genetic enhancement of cold tolerance in Dendrobium spp., and to facilitate cold tolerance breeding in related plants.
Insight into the phylogeny and responses of species from the genus Sergia (Campanulaceae) to the climate changes predicted for the Mountains of Central Asia (a world biodiversity hotspot)
Authors: Vintsek Lizaveta , Klichowska Ewelina , Nowak Arkadiusz , Nobis Marcin
Published: April 2024

Background

Together with other elevated areas, the Mountains of Central Asia are significantly threatened by ongoing climate change. The presence of refuges during the glaciations makes the region extremely rich in species, especially endemic ones. However, the limited potential for colonisation of other habitats makes rocky-related species with ‘island‐like’ distribution, particularly vulnerable to climate change. To understand the processes underlying species response to climate warming, we assessed differences in ecological niches and phylogenetic relationship of two geographically disjunctive alpine species belonging to the genus Sergia. The taxa are considered Tertiary relicts, endemic to the Tian Shan and Pamir-Alai Mountains. To illustrate range dynamics and differences in occupied niches of Sergia species, we used Ecological Niche Modelling of current and future distribution. Whereas, to reconstruct the phylogenetic relationship within and between Sergia and other related Campanulaceae species from the region we used molecular data (ITS, cpDNA, DArTseq-derived SNPs).

Results

The results reveal that the genus Sergia is a polyphyletic group, and its representatives differ geographically, ecologically and genetically. Both S. regelii and S. sewerzowii constitute a common clade with Asyneuma group, however, S. sewerzowii is more closely related to Campanula alberti (a species that has never previously been considered closely related to the genus Asyneuma or Sergia) than to S. regelii. Sergia sewerzowii is adapted to lower elevations with higher temperatures, while S. regelii prefers higher elevations with lower temperatures. The future distribution models demonstrate a dramatic loss of S. regelii range with a shift to suitable habitats in higher elevations, while the potential range of S. sewerzowii increases and shifts to the north.

Conclusions

This study shows that S. regelii and S. sewerzowii have a long and independent evolution history. Sergia regelii and S. sewerzowii significantly differ in realised niches. These differences are mirrored in the response of the studied endemics to future climate warming. As suitable habitats shrink, rapid changes in distribution can lead to species' range loss, which is also directly related to declines in genetic variability. The outcomes of this paper will help to more precisely assess the impact of climate changes on rocky-related plant species found in this world’s biodiversity hotspot.
Impact of the early phase of the COVID-19 pandemic on emergency department-to-intensive care unit admissions in Korea: an interrupted time-series analysis
Authors: Lee Kyung-Shin , Han Changwoo , Min Hye Sook , Lee Jeehye , Youn Seok Hwa , Kim Younghwan , Moon Jae Young , Lee Young Seok , Kim Su Jin , Sung Ho Kyung
Published: April 2024

Background

The coronavirus disease 2019 (COVID-19) pandemic resulted in significant disruptions to critical care systems globally. However, research on the impact of the COVID-19 pandemic on intensive care unit (ICU) admissions via the emergency department (ED) is limited. Therefore, this study evaluated the changes in the number of ED-to-ICU admissions and clinical outcomes in the periods before and during the pandemic.

Methods

We identified all adult patients admitted to the ICU through level 1 or 2 EDs in Korea between February 2018 and January 2021. February 2020 was considered the onset point of the COVID-19 pandemic. The monthly changes in the number of ED-to-ICU admissions and the in-hospital mortality rates before and during the COVID-19 pandemic were evaluated using interrupted time-series analysis.

Results

Among the 555,793 adult ED-to-ICU admissions, the number of ED-to-ICU admissions during the pandemic decreased compared to that before the pandemic (step change, 0.916; 95% confidence interval [CI] 0.869–0.966], although the trend did not attain statistical significance (slope change, 0.997; 95% CI 0.991–1.003). The proportion of patients who arrived by emergency medical services, those transferred from other hospitals, and those with injuries declined significantly among the number of ED-to-ICU admissions during the pandemic. The proportion of in-hospital deaths significantly increased during the pandemic (step change, 1.054; 95% CI 1.003–1.108); however, the trend did not attain statistical significance (slope change, 1.001; 95% CI 0.996–1.007). Mortality rates in patients with an ED length of stay of ≥ 6 h until admission to the ICU rose abruptly following the onset of the pandemic (step change, 1.169; 95% CI 1.021–1.339).

Conclusions

The COVID-19 pandemic significantly affected ED-to-ICU admission and in-hospital mortality rates in Korea. This study’s findings have important implications for healthcare providers and policymakers planning the management of future outbreaks of infectious diseases. Strategies are needed to address the challenges posed by pandemics and improve the outcomes in critically ill patients.
A randomized feasibility trial of medium chain triglyceride-supplemented ketogenic diet in people with Parkinson's disease
Authors: Choi Alexander H. , Delgado Melanie , Chen Kong Y. , Chung Stephanie T. , Courville Amber , Turner Sara A. , Yang Shanna , Airaghi Kayla , Dustin Irene , McGurrin Patrick , Wu Tianxia , Hallett Mark , Ehrlich Debra J.
Published: April 2024

Background

A ketogenic diet (KD) may benefit people with neurodegenerative disorders marked by mitochondrial depolarization/insufficiency, including Parkinson’s disease (PD).

Objective

Evaluate whether a KD supplemented by medium chain triglyceride (MCT-KD) oil is feasible and acceptable for PD patients. Furthermore, we explored the effects of MCT-KD on blood ketone levels, metabolic parameters, levodopa absorption, mobility, nonmotor symptoms, simple motor and cognitive tests, autonomic function, and resting-state electroencephalography (rsEEG).

Methods

A one-week in-hospital, double-blind, randomized, placebo-controlled diet (MCT-KD vs. standard diet (SD)), followed by an at-home two-week open-label extension. The primary outcome was KD feasibility and acceptability. The secondary outcome was the change in Timed Up & Go (TUG) on day 7 of the diet intervention. Additional exploratory outcomes included the N-Back task, Unified Parkinson’s Disease Rating Scale, Non-Motor Symptom Scale, and rsEEG connectivity.

Results

A total of 15/16 subjects completed the study. The mean acceptability was 2.3/3, indicating willingness to continue the KD. Day 7 TUG time was not significantly different between the SD and KD groups. The nonmotor symptom severity score was reduced at the week 3 visit and to a greater extent in the KD group. UPDRS, 3-back, and rsEEG measures were not significantly different between groups. Blood ketosis was attained by day 4 in the KD group and to a greater extent at week 3 than in the SD group. The plasma levodopa metabolites DOPAC and dopamine both showed nonsignificant increasing trends over 3 days in the KD vs. SD groups.

Conclusions

An MCT-supplemented KD is feasible and acceptable to PD patients but requires further study to understand its effects on symptoms and disease.

Trial Registration

Trial Registration Number NCT04584346, registration dates were Oct 14, 2020 – Sept 13, 2022.
Stabilizing time and its predictors among 1–59 months old children managed for severe acute malnutrition during the humanitarian crisis in Tigray regional state of Ethiopia, 2023: a prospective cohort study
Authors: Tesfay Wagnew , Abay Mebrahtu , Teklehaimanot Berhane Fseha , Gebremedhin Ataklti
Published: April 2024

Background

Higher rate of acute malnutrition is observed in emergencies compared to non-emergency settings and severe acute malnutrition upsurges alarmingly and become deadly in humanitarian crises due to lack of food, lack of quality water supply and insufficient healthcare. Research is one learning tool by identifying strength and areas of improvement. However, little is known about outcomes of therapeutic feeding programmes in comparison with the standard indicators set in humanitarian setting.

Methods

Health facility based prospective cohort study was conducted using routinely collected programme data of children hospitalized to the inpatient therapeutic feeding center in suhul general hospital from January 1st, 2023 to June 30, 2023. Data was collected using a form developed relating to the federal ministry of health standard management protocols for severe acute malnutrition then it was cleaned, coded and entered to EpiData version 4.2.0 and then exported to SPSS version 25 for analysis.

Results

From 184 children, 96.2% were stabilized while the remaining 3.8% were censored with overall median stabilizing time of 8 days. Weight gain was used as one of the discharging criteria for infants less than six months and their mean weight gain found to be 12.89 g per kilogram daily. Appetite test (AHR = 0.338; 95% CI: 0.221–0.518), blood transfusion (AHR = 5.825; 95% CI: 2.568–13.211), IV fluid resuscitation (AHR = 2.017; 95% CI: 1.094–3.717), IV antibiotics (AHR = 2.288; 95% CI: 1.164-4.500) and NG tube feeding (AHR = 1.485; 95% CI: 1.065–2.071) were identified as significant predictors of stabilizing time.

Conclusion

All the outcome indicators for stabilization center are consistent with the SPHERE association set of standards during humanitarian intervention. The hospital and other concerned humanitarian organizations should focus on sustaining these achievements as suhul hospital is the main treatment center for children suffering from severe acute malnutrition in the northwest zone of Tigray regional state. Further pre-post experimental studies which compare the stabilizing time before and after crisis are recommended.
Blood donation projections using hierarchical time series forecasting: the case of Zimbabwe’s national blood bank
Authors: Chideme Coster , Chikobvu Delson , Makoni Tendai
Published: April 2024

Background

The discrepancy between blood supply and demand requires accurate forecasts of the blood supply at any blood bank. Accurate blood donation forecasting gives blood managers empirical evidence in blood inventory management. The study aims to model and predict blood donations in Zimbabwe using hierarchical time series. The modelling technique allows one to identify, say, a declining donor category, and in that way, the method offers feasible and targeted solutions for blood managers to work on.

Methods

The monthly blood donation data covering the period 2007 to 2018, collected from the National Blood Service Zimbabwe (NBSZ) was used. The data was disaggregated by gender and blood groups types within each gender category. The model validation involved utilising actual blood donation data from 2019 and 2020. The model's performance was evaluated through the Mean Absolute Percentage Error (MAPE), uncovering expected and notable discrepancies during the Covid-19 pandemic period only.

Results

Blood group O had the highest monthly yield mean of 1507.85 and 1230.03 blood units for male and female donors, respectively. The top-down forecasting proportions (TDFP) under ARIMA, with a MAPE value of 11.30, was selected as the best approach and the model was then used to forecast future blood donations. The blood donation predictions for 2019 had a MAPE value of 14.80, suggesting alignment with previous years' donations. However, starting in April 2020, the Covid-19 pandemic disrupted blood collection, leading to a significant decrease in blood donation and hence a decrease in model accuracy.

Conclusions

The gradual decrease in future blood donations exhibited by the predictions calls for blood authorities in Zimbabwe to develop interventions that encourage blood donor retention and regular donations. The impact of the Covid-19 pandemic distorted the blood donation patterns such that the developed model did not capture the significant drop in blood donations during the pandemic period. Other shocks such as, a surge in global pandemics and other disasters, will inevitably affect the blood donation system. Thus, forecasting future blood collections with a high degree of accuracy requires robust mathematical models which factor in, the impact of various shocks to the system, on short notice.
The impact of housing prices on residents’ health: a systematic review
Authors: Grewal Ashmita , Hepburn Kirk J. , Lear Scott A. , Adshade Marina , Card Kiffer G.
Published: April 2024

Background

Rising housing prices are becoming a top public health priority and are an emerging concern for policy makers and community leaders. This report reviews and synthesizes evidence examining the association between changes in housing price and health outcomes.

Methods

We conducted a systematic literature review by searching the SCOPUS and PubMed databases for keywords related to housing price and health. Articles were screened by two reviewers for eligibility, which restricted inclusion to original research articles measuring changes in housing prices and health outcomes, published prior to June 31st, 2022.

Results

Among 23 eligible studies, we found that changes in housing prices were heterogeneously associated with physical and mental health outcomes, with multiple mechanisms contributing to both positive and negative health outcomes. Income-level and home-ownership status were identified as key moderators, with lower-income individuals and renters experience negative health consequences from rising housing prices. This may have resulted from increased stress and financial strain among these groups. Meanwhile, the economic benefits of rising housing prices were seen to support health for higher-income individuals and homeowners – potentially due to increased wealth or perception of wealth.

Conclusions

Based on the associations identified in this review, it appears that potential gains to health associated with rising housing prices are inequitably distributed. Housing policies should consider the health inequities born by renters and low-income individuals. Further research should explore mechanisms and interventions to reduce uneven economic impacts on health.
Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaraş earthquake; a section from Gaziantep Nurdağı district
Authors: Tomak Leman , Demirel Tolga , Demir Ibrahim
Published: April 2024

Background

An earthquake with a magnitude of 7.7 occurred in Pazarcık District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaraş Earthquake and who were living in Nurdağı District of Gaziantep after the earthquake.

Methods

Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdağı District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims.

Results

The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05).

Conclusion

General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.
Folate-modified liposomes mediate the co-delivery of cisplatin with miR-219a-5p for the targeted treatment of cisplatin-resistant lung cancer
Authors: Wu Yuanlin , Zhang Jiandong , Zhao Junjun , Wang Bin
Published: April 2024

Cisplatin (DDP) resistance, often leading to first-line chemotherapy failure in non-small cell lung cancer (NSCLC), poses a significant challenge. MiR-219a-5p has been reported to enhance the sensitivity of human NSCLC to DDP. However, free miR-219a-5p is prone to degradation by nucleases in the bloodstream, rendering it unstable. In light of this, our study developed an efficient nanodrug delivery system that achieved targeted delivery of DDP and miR-219a-5p by modifying liposomes with folate (FA). Based on the results of material characterization, we successfully constructed a well-dispersed and uniformly sized (approximately 135.8 nm) Lipo@DDP@miR-219a-5p@FA nanodrug. Agarose gel electrophoresis experiments demonstrated that Lipo@DDP@miR-219a-5p@FA exhibited good stability in serum, effectively protecting miR-219a-5p from degradation. Immunofluorescence and flow cytometry experiments revealed that, due to FA modification, Lipo@DDP@miR-219a-5p@FA could specifically bind to FA receptors on the surface of tumor cells (A549), thus enhancing drug internalization efficiency. Safety evaluations conducted in vitro demonstrated that Lipo@DDP@miR-219a-5p@FA exhibited no significant toxicity to non-cancer cells (BEAS-2B) and displayed excellent blood compatibility. Cellular functional experiments, apoptosis assays, and western blot demonstrated that Lipo@DDP@miR-219a-5p@FA effectively reversed DDP resistance in A549 cells, inhibited cell proliferation and migration, and further promoted apoptosis. In summary, the Lipo@DDP@miR-219a-5p@FA nanodrug, through specific targeting of cancer cells and reducing their resistance to DDP, significantly enhanced the anti-NSCLC effects of DDP in vitro, providing a promising therapeutic option for the clinical treatment of NSCLC.
Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis
Authors: De Mauro D. , Balato G. , Festa E. , Di Cristo A. , Marasco L. , Loffredo G. , Di Lauro P. , Di Gennaro D. , Maccauro G. , Rosa D.
Published: April 2024

Background

Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS.

Methods

Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach.

Results

The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975).

Conclusions

The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.
Cost-effectiveness of Transforaminal epidural steroid injections for patients with ACUTE sciatica: a randomized controlled trial
Authors: ter Meulen Bastiaan C. , Maas Esther T. , van der Vegt Rien , Haumann Johan , Weinstein Henry C. , Ostelo Raymond W. J. G. , van Dongen Johanna M.
Published: April 2024

Background

Transforaminal epidural injections with steroids (TESI) are increasingly being used in patients sciatica. The STAR (steroids against radiculopathy)-trial aimed to evaluate the (cost-) effectiveness of TESI in patients with acute sciatica (< 8 weeks). This article contains the economic evaluation of the STAR-trial.

Methods

Participants were randomized to one of three study arms: Usual Care (UC), that is oral pain medication with or without physiotherapy, n = 45); intervention group 1: UC and transforaminal epidural steroid injection (TESI) 1 ml of 0.5% Levobupivacaine and 1 ml of 40 mg/ml Methylprednisolone and intervention group 2: UC and transforaminal epidural injection (TEI) with 1 ml of 0,5% Levobupivacaine and 1 ml of 0.9% NaCl (n = 50). The primary effect measure was health-related quality of life. Secondary outcomes were pain, functioning, and recovery. Costs were measured from a societal perspective, meaning that all costs were included, irrespective of who paid or benefited. Missing data were imputed using multiple imputation, and bootstrapping was used to estimate statistical uncertainty.

Results

None of the between-group differences in effects were statistically significant for any of the outcomes (QALY, back pain, leg pain, functioning, and global perceived effect) at the 26-weeks follow-up. The adjusted mean difference in total societal costs was €1718 (95% confidence interval [CI]: − 3020 to 6052) for comparison 1 (intervention group 1 versus usual care), €1640 (95%CI: − 3354 to 6106) for comparison 2 (intervention group 1 versus intervention group 2), and €770 (95%CI: − 3758 to 5702) for comparison 3 (intervention group 2 versus usual care). Except for the intervention costs, none of the aggregate and disaggregate cost differences were statistically significant. The maximum probability of all interventions being cost-effective compared to the control was low (< 0.7) for all effect measures.

Conclusion

These results suggest that adding TESI (or TEI) to usual care is not cost-effective compared to usual care in patients with acute sciatica (< 8 weeks) from a societal perspective in a Dutch healthcare setting.

Trial registration

Dutch National trial register: NTR4457 (March, 6th, 2014).
Association between smartphone addiction and myofascial trigger points
Authors: Yaşarer Özden , Mete Emel , Kaygusuz Benli Reyhan , Kılıç Berivan Beril , Doğan Halis , Sarı Zübeyir
Published: April 2024

Background

The purpose of this study was to clarify the relationship between smartphone addiction and miyafascial trigger points in university students.

Methods

A cross-sectional study of university students was conducted for the purpose of this study. The participants were assessed based on age, gender, dominant side, the amount of time they spent on their smartphones, the purpose of their use, and their posture. The Smartphone Addiction Scale Short Form (SAS-SF) was used to determine addictes and non-addicts. The cut-off value of SAS-SF is 31 and above for male and 33 and above for female.

Results

There were 136 participants in the study. The posture score for addicts and non-addicts ones was not significantly different (p > 0,05), but the number of trigger points, maximal bending posture and trigger points in the right levator scapula and right cervical erector muscles were significantly higher in the smartphone addict participants (p < 0,05).

Conclusions

Smartphone addiction in university students is associated with postural changes and trigger points in the bilateral levator scapula and right cervical erector muscles. Public health programs should be developed to raise awareness about smartphone addiction, encourage screen breaks, and emphasize physical activity and exercise regularly.
Midwives’ lived experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini: a qualitative study
Authors: Temane Annie M. , Magagula Fortunate N. , Nolte Anna G. W.
Published: April 2024

Background

Midwives encounter various difficulties while aiming to achieve excellence in providing maternity care to women with mobility disabilities. The study aimed to explore and describe midwives’ experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini.

Methods

A qualitative, exploratory, descriptive, contextual research design with a phenomenological approach was followed. Twelve midwives working in maternal health facilities in the Hhohho and Manzini regions in Eswatini were interviewed. Purposive sampling was used to select midwives to participate in the research. In-depth phenomenological interviews were conducted, and Giorgi’s descriptive phenomenological method was used for data analysis.

Results

Three themes emerged from the data analysis: midwives experienced physical and emotional strain in providing maternity care to women with mobility disabilities, they experienced frustration due to the lack of equipment to meet the needs of women with mobility disabilities, and they faced challenges in providing support and holistic care to women with mobility disabilities during pregnancy, labour and puerperium.

Conclusions

Midwives experienced challenges caring for women with mobility disabilities during pregnancy, labour and the puerperium in Eswatini. There is a need to develop and empower midwives with the knowledge and skill to implement guidelines and enact protocols. Moreover, equipment and infrastructure are required to facilitate support and holistic maternity care for women with mobility disabilities.
An exploration of service use pattern changes and cost analysis following implementation of community perinatal mental health teams in pregnant women with a history of specialist mental healthcare in England: a national population-based cohort study
Authors: Tassie Emma , Langham Julia , Gurol-Urganci Ipek , van der Meulen Jan , Howard Louise M , Pasupathy Dharmintra , Sharp Helen , Davey Antoinette , O’Mahen Heather , Heslin Margaret , Byford Sarah
Published: April 2024

Background

The National Health Service in England pledged >£365 million to improve access to mental healthcare services via Community Perinatal Mental Health Teams (CPMHTs) and reduce the rate of perinatal relapse in women with severe mental illness. This study aimed to explore changes in service use patterns following the implementation of CPMHTs in pregnant women with a history of specialist mental healthcare in England, and conduct a cost-analysis on these changes.

Methods

This study used a longitudinal cohort design based on existing routine administrative data. The study population was all women residing in England with an onset of pregnancy on or after 1st April 2016 and who gave birth on or before 31st March 2018 with pre-existing mental illness (N = 70,323). Resource use and costs were compared before and after the implementation of CPMHTs. The economic perspective was limited to secondary mental health services, and the time horizon was the perinatal period (from the start of pregnancy to 1-year post-birth, ~ 21 months).

Results

The percentage of women using community mental healthcare services over the perinatal period was higher for areas with CPMHTs (30.96%, n=9,653) compared to areas without CPMHTs (24.72%, n=9,615). The overall percentage of women using acute care services (inpatient and crisis resolution teams) over the perinatal period was lower for areas with CPMHTs (4.94%, n=1,540 vs. 5.58%, n=2,171), comprising reduced crisis resolution team contacts (4.41%, n=1,375 vs. 5.23%, n=2,035) but increased psychiatric admissions (1.43%, n=445 vs. 1.13%, n=441). Total mental healthcare costs over the perinatal period were significantly higher for areas with CPMHTs (fully adjusted incremental cost £111, 95% CI £29 to £192, p-value 0.008).

Conclusions

Following implementation of CPMHTs, the percentage of women using acute care decreased while the percentage of women using community care increased. However, the greater use of inpatient admissions alongside greater use of community care resulted in a significantly higher mean cost of secondary mental health service use for women in the CPMHT group compared with no CPMHT. Increased costs must be considered with caution as no data was available on relevant outcomes such as quality of life or satisfaction with services.
Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review
Authors: Clark Emily C. , Burnett Trish , Blair Rebecca , Traynor Robyn L. , Hagerman Leah , Dobbins Maureen
Published: April 2024

Background

Achievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health.

Methods

A systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings.

Results

Thirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management.

Conclusion

This review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success.

Review registration

PROSPERO CRD42022318994.
Significance of hepatitis B virus capsid dephosphorylation via polymerase
Authors: Chang Chih-Hsu , Shih Chiaho
Published: April 2024

Background

It is generally believed that hepatitis B virus (HBV) core protein (HBc) dephosphorylation (de-P) is important for viral DNA synthesis and virion secretion. HBV polymerase contains four domains for terminal protein, spacer, reverse transcriptase, and RNase H activities.

Methods

HBV Polymerase mutants were transfected into HuH-7 cells and assayed for replication and HBc de-P by the Phos-tag gel analysis. Infection assay was performed by using a HepG2-NTCP-AS2 cell line.

Results

Here, we show that a novel phosphatase activity responsible for HBc de-P can be mapped to the C-terminal domain of the polymerase overlapping with the RNase H domain. Surprisingly, while HBc de-P is crucial for viral infectivity, it is essential for neither viral DNA synthesis nor virion secretion. The potential origin, significance, and mechanism of this polymerase-associated phosphatase activity are discussed in the context of an electrostatic homeostasis model. The Phos-tag gel analysis revealed an intriguing pattern of “bipolar distribution” of phosphorylated HBc and a de-P HBc doublet.

Conclusions

It remains unknown if such a polymerase-associated phosphatase activity can be found in other related biosystems. This polymerase-associated phosphatase activity could be a druggable target in clinical therapy for hepatitis B.
The safety and potential efficacy of exosomes overexpressing CD24 (EXO-CD24) in mild-moderate COVID-19 related ARDS
Authors: Grigoropoulos Ioannis , Tsioulos Georgios , Kastrissianakis Artemis , Shapira Shiran , Green Orr , Rapti Vasiliki , Tsakona Maria , Konstantinos Thomas , Savva Athina , Kavatha Dimitra , Boumpas Dimitrios , Syrigos Konstantinos , Xynogalas Ioannis , Leontis Konstantinos , Ntousopoulos Vasileios , Sakka Vissaria , Sardelis Zafeiris , Fotiadis Andreas , Vlassi Lamprini , Kontogianni Chrysoula , Levounets Anastasia , Poulakou Garyfalia , Gaga Mina , MacLoughlin Ronan , Stebbing Justin , Arber Nadir , Antoniadou Anastasia , Tsiodras Sotirios
Published: April 2024

Introduction

EXO-CD24 are exosomes genetically manipulated to over-express Cluster of Differentiation (CD) 24. It consists of two breakthrough technologies: CD24, the drug, as a novel immunomodulator that is smarter than steroids without any side effects, and exosomes as the ideal natural drug carrier.

Methods

A randomized, single blind, dose-finding phase IIb trial in hospitalized patients with mild to moderate Coronavirus disease 2019 (COVID-19) related Acute Respiratory Distress Syndrome (ARDS) was carried out in two medical centers in Athens. Patients received either 109or 1010exosome particles of EXO-CD24, daily, for five consecutive days and monitored for 28 days. Efficacy was assessed at day 7 among 91 patients who underwent randomization. The outcome was also compared in a post-hoc analysis with an income control group (n = 202) that fit the inclusion and exclusion criteria.

Results

The mean age was 49.4 (± 13.2) years and 74.4% were male. By day 7, 83.7% showed improved respiratory signs and 64% had better oxygen saturation (SpO2) (p < 0.05). There were significant reductions in all inflammatory markers, most notably in C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, fibrinogen and an array of cytokines. Conversely, levels of the anti-inflammatory cytokine Interleukin-10 (IL-10) were increased (p < 0.05). Of all the documented adverse events, none were considered treatment related. No drug-drug interactions were noted. Two patients succumbed to COVID-19. Post-hoc analysis revealed that EXO-CD24 patients exhibited greater improvements in clinical and laboratory outcomes compared to an observational income control group.

Conclusions

EXO-CD24 presents a promising therapeutic approach for hyper-inflammatory state and in particular ARDS. Its unique combination of exosomes, as a drug carrier, and CD24, as an immunomodulator, coupled with inhalation administration, warrants further investigation in a larger, international, randomized, quadri-blind trial against a placebo.