bluuebunny/crossref_metadata_2025 huggingface dataset:
Draping in Dermatology: A Physician’s Perspective
Authors: Gresham Louise , Melkis Justina , Choi Bohmyi , Cyr Janelle , Huang Christina M. , Beecker Jennifer
Published: August 2023

Background

Patient dignity is a core component of medicine and health care, yet maintaining patient dignity can be challenging in clinical settings in dermatology, specifically during a total body skin examinations (TBSE) for appropriate assessment and diagnosis. A recent study evaluated patient perspectives in dermatology. The purpose of this study was to investigate current draping practices and perspectives from a physicians’ perspective.

Methods

A cross-sectional study was performed with the use of study-specific questionnaire distributed to staff dermatologists and dermatology residents across Canada.

Results

A total of 117 physicians were included (84 attending dermatologists and 33 dermatology residents). Nearly all staff and resident dermatologists (90.6%) indicated that draping was important. Specific practices differed between residents and staff ( P = .03). Only 3.1% of residents indicated that they did not receive any form of teaching on draping during their training compared to 21.4% of attending physicians ( P = .03).

Discussion

This study confirms that draping practices in dermatology are perceived as important by dermatologists, consistent with other reports emphasizing approaches to protect patient privacy and dignity. There is a shared value for draping and consistent integration of this within current practice of Canadian dermatologists. Formal and informal education incorporated in medical education and dermatology training is becoming more prominent. Major study limitations include sampling bias, convenience bias and nonresponse bias.

Conclusion

This is the first study to evaluate physician perspectives on draping in dermatology or other areas in medicine. Findings from this study support a focus on draping in medical education.
Music, literature, and community: Reflections on a framework for learning through and from Aboriginal and Torres Strait Islander music
Authors: Fienberg Thomas
Published: August 2023

Inspired by a desire to explore ways in which non-Indigenous Australians can meaningfully connect with Aboriginal and Torres Strait Islander peoples, this article reflects on my doctoral studies and the role educators can have in holding space for First Nations peoples to directly contribute toward the creation of mutually rewarding teaching and learning experiences. It specifically evaluates the processes involved in establishing and implementing a project centered on my senior secondary music class as the students engaged in the collaborative reworking of two songs shared by Ngiyampaa composer and dancer, Peter Williams. The article is intentionally reflexive as it interrogates the journey and motivations behind conducting the study. As a non-Indigenous teacher-researcher, I table three foundational pillars behind my personal growth in understanding Aboriginal and Torres Strait Islander histories and cultures: the music, the academic literature, and most importantly, the local community. The article then discusses the challenges and factors that lead to the success of the musical interactions in the doctoral study—a process understood as co-composition—and critically, the transformative learning experiences gained as reciprocal relationships were forged during various stages of the project. Rather than promoting co-composition as a pedagogical strategy, this article encourages a heuristic approach to increased and effective inclusion of Aboriginal and Torres Strait Islander music in secondary music classes. By setting out in autoethnographic form the experience of implementing a considered, decolonial, and ethical approach to learning from and through Aboriginal and Torres Strait Islander music, I hope to encourage educators to imagine themselves in a narrative of their own, one that includes their students and members of the local First Nations community, leading to rich and rewarding musical collaborations and ongoing fruitful relationships.
Acts of offensive behaviour and risk of disability pension in Danish female eldercare workers: prospective cohort with 11-year register follow-up
Authors: Clausen Thomas , Pihl-Thingvad Jesper , Villadsen Ebbe , Andersen Lars L.
Published: August 2023

Objectives:

To investigate whether acts of offensive behaviour (threats, violence, workplace bullying and sexual harassment) in the workplace and type of perpetrator (internal or external to the workplace) of the offensive behaviours predicted risk of disability pension in Danish eldercare workers.

Methods:

We merged survey responses from 8731 female eldercare workers with a national register on social transfer payments (Danish Register for Evaluation of Marginalisation (DREAM)), including all types of disability benefits. Using Cox proportional hazards models, we investigated the prospective association between self-reported exposures at baseline and the risk of receiving disability pension (any type of disability benefit payment) during 11 years of follow-up, while adjusting for potential confounders.

Results:

Self-reported exposure to threats (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.00–1.32), violence (HR 1.16; 95% CI 1.00–1.35) and bullying (HR 1.44; 95% CI 1.22–1.71) predicted increased risk of disability pension during follow-up, when adjusted for age and educational attainment. When further adjusted for psychosocial working conditions only bullying remained a statistically significant (HR 1.39; 95% CI 1.16–1.67) predictor of disability pension. The results indicated no elevated risk for participants reporting sexual harassment. Moreover, we observed stronger associations between self-reported exposure to threats, violence and workplace bullying and risk of disability pension when the perpetrator was internal to the workplace (i.e. colleagues, managers and/or subordinates), than when the perpetrator was reported to be external to the workplace (i.e. service users, and/or relatives of service users).

Conclusions:

Results indicate that prevention of work-related exposure to threats, violence and workplace bullying may contribute to reduce involuntary early retirement in female eldercare workers.
Connecting in the Gulf: digital inclusion for Aboriginal families on Mornington Island
Authors: Rogers Jessa
Published: August 2023

This essay visually describes an Indigenous research project exploring digital inclusion with Aboriginal families on Mornington Island, a remote Aboriginal community in Queensland, Australia. Yarning, an Indigenous storytelling and conversational research method, was combined with photography (some participant photography, but primarily researcher photography) in a new method termed ‘show and yarn’. This method allowed community members space to show us their devices, have images taken of these devices and then use these images as a prompt for yarns about their experiences using the internet, mobile phones and technology.

The author is an Indigenous researcher, who had existing connections with Mornington Island residents and it was through these relationships that the community came to be a partner in this research.
The Acromiohumeral Center-Edge Angle and Risk of Rotator Cuff Tear: A Plain Radiograph and MRI Study
Authors: Alqahtani Saad M. , Elyahia Sulaiman A. , Abu-Amara Talal B. , AlOraini Lama I. , Alsubaie Shayma S. , Hegazi Tarek M. , Alzahrani Mohammad M.
Published: August 2023

Introduction:

The acromiohumeral center-edge angle (ACEA) is a parameter that can be measured on plain shoulder radiographs and has been found to be associated with increased risk of sustaining a rotator cuff tear.

Purpose:

The aim of this study was to investigate this association using plain radiographs and to explore its applicability on shoulder magnetic resonance imaging (MRI) in the same patients.

Methods:

This retrospective study compared 45 patients who underwent rotator cuff repair between September 2021 and April 2022 and 41 patients with normal shoulders. The ACEA was measured by 2 independent observers on anteroposterior radiographs and shoulder MRI. The collected data were analyzed and P values of <.05 were considered statistically significant.

Results:

The ACEA was found to be higher in patients with rotator cuff tears (23.48° ± 7.11°) when compared with the control group (15.54° ± 4.4°). On shoulder MRI assessment, a higher ACEA was also seen in the rotator cuff tear group (18.93° ± 6.7°) than in the control group (13.79° ± 4.9°). The ACEA measurement on MRI showed strong intrarater reliability (0.965), but weak interrater reliability (0.251).

Conclusion:

This retrospective study found an association between increased ACEA and risk of rotator cuff tear when measured on plain radiographs. In addition, we found an association between increased ACEA measurement on shoulder MRI and rotator cuff tears, thus suggesting the applicability of ACEA measurement on shoulder MRI.
SALUDIVERSEX: A quality of life and sexual health intervention for adults with mild intellectual disabilities
Authors: Gil-Llario María Dolores , Morell-Mengual Vicente , Fernández-García Olga , Estruch-García Verónica , Ballester-Arnal Rafael
Published: August 2023

Individuals with intellectual disabilities need an affective and sexual education adapted to their characteristics. There are few interventions that meet these objectives and offer empirical evidence of their efficacy. To respond to the limitations of existing interventions, an evidence-based affective-sexual educational intervention for adults with a mild degree of intellectual disability is proposed: SALUDIVERSEX. Participants will be randomly assigned to an intervention group that will receive the SALUDIVERSEX program or to a waiting list group. The intervention will be implemented by educators of occupational centers after a thorough training phase. Our main hypothesis is that the SALUDIVERSEX program will improve the sexual health and quality of life, through the joint action built into three components: the acquisition of basic information, the development of skills and strategies and the achievement of healthy attitudes towards the experience and expression of sexuality. The results of this approach could have important implications for optimizing the quality of life and self-determination of individuals with Intellectual disability by contributing to the development of healthy sexuality.
Curved sprinting in soccer: The influence of radius
Authors: Altmann Stefan , Ruf Ludwig , Fílter Alberto , Härtel Sascha , Naujoks Tobias , Rauprich Marvin , Seyler Claudia , Baydoun Hussein , Woll Alexander
Published: August 2023

The aims of this study were (i) to compare the sprint times between linear-sprint (LS) and curved-sprint (CS) tests of different radii, and (ii) to examine the relationships between sprint times in these tests in soccer players. Nineteen elite youth male soccer players (age, 18.6 ± 0.6 years) completed an LS test and three CS tests with different radii both from the left and the right side (11.15-m radius = CSwide, 9.15-m radius = CSmedium and 7.15-m radius = CSnarrow), each with a distance of 17 m. Differences in sprint times were examined using analysis of variance with Bonferroni-corrected pairwise comparisons and Cohen's d effect sizes (ES). Relationships between sprint times were determined by Pearson's product-moment correlations (r). Significantly lower sprint times were evident for LS compared to all three CS tests ( p < .001, MD = 0.08–0.16 s, ES = 0.83–1.49), for CSwide compared to CSnarrow ( p = .02, MD = 0.04 s, ES = 0.47) and for CSmedium compared to CSnarrow ( p < .001, MD = 0.07 s, ES = 0.82). Very large correlations ( p < .001, r = 0.75–0.80) were found between sprint times in LS and the three CS tests. Very large to nearly perfect correlations ( p < .001, r = 0.79–0.91) were found within the three CS tests. Practitioners should be aware that sprint times are lower in LS compared to CS of different radii and that CS times are higher at narrower angles compared to wider angles. Given the high correlations within three CS tests, the application of only one CS (e.g., CSmedium) during a test battery may be sufficient if using different CS is not possible. Results of the correlation analysis also suggest that LS contributes to CS performance, however, to slightly different extents depending on the radius of the CS. Consequently, both LS and CS drills might be incorporated into sprint training practices of elite youth soccer players.
Incidence of Repeat Elbow Capsular Release After Arthroscopic Elbow Capsular Release
Authors: Hall Anya T. , Paul Ryan W. , Lencer Adam , Smith Brandon , Ciccotti Michael G. , Tjoumakaris Fotios P. , Erickson Brandon J.
Published: August 2023

Background:

Elbow capsular release can be performed arthroscopically or through an open method to improve range of motion (ROM). However, it is unclear how frequently patients require an open capsular release after unsatisfactory results from an arthroscopic release.

Purpose/Hypothesis:

The purpose of this study was to determine the percentage of patients who underwent an arthroscopic elbow release for loss of motion who then required a repeat elbow capsular release or other subsequent surgery on the same elbow. It was hypothesized that patients who underwent arthroscopic elbow release would rarely (<5%) require a subsequent elbow release.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who underwent arthroscopic elbow capsular release from January 1, 2010, to December 31, 2019, were identified by chart review and procedure code. Demographic parameters, pre- and postoperative ROM, and surgical history were collected by chart review. Follow-up data included patient satisfaction and the Timmerman-Andrews (TA) elbow score. Data were compared between patients who did and those who did not require subsequent elbow surgery.

Results:

Overall, of 140 study patients (116 male, 24 female; mean age, 49.6 years), 18 (12.9%) required subsequent surgery, including 6 capsular releases (4.3%; 1 open and 5 arthroscopic). The most common follow-up procedure was ulnar nerve releases/transpositions (n = 7). Total arc of elbow motion (flexion to extension) improved by a mean of 51.4°. The mean TA score was 76.5 ± 20.4 at a mean of 5.25 years postoperatively. Mean satisfaction score was 77.6 ± 26.3. In this study, 82.4% of patients stated that their symptoms either improved or resolved completely. Patients who required subsequent surgery had a significantly lower preoperative total arc of elbow motion versus those who did not require subsequent surgery ( P = .046). There was no difference between the groups in symptom resolution, satisfaction, ROM, or TA score ( P ≥ .279 for all).

Conclusion:

After arthroscopic elbow release, <5% of patients required a repeat elbow capsular release, 12.9% required some form of follow-up elbow surgery, and 4.3% had a new injury of the elbow. Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release.
Caste, Religion and Otherness: Probing the Aporia of the Dalit–Muslim Question in Omprakash Valmiki’s Short Story ‘Salaam’ and Mohandas Naimishraya’s Autobiography Apne Apne Pinjare (Cages of Our Own)
Authors: Bairva Mukesh Kumar
Published: August 2023

Dalit texts generally foreground the question of marginality in the context of caste-based discrimination, exclusion and violence. Interestingly, Mohan Das Naimishraya’s Apne Apne Pinjare ( Cages of Our Own) and Omprakash Valmiki’s ‘Salaam’ go beyond the scope of exploring the dialectics of dominance and resistance by probing the complexity of otherness. The appropriation of the Dalit subject by the neo-Brahmanical forces us to rethink the notion of marginality. The aversion and hatred of Dalits against Muslims and the identification of Dalits as Hindus by Muslims obfuscate the power dynamics in a communal and casteist socius. The complex Dalit–Muslim relationship re-configures the power relations underpinning untouchability and propels us to re-interpret the troubled category of the ‘Other’. This article explores the epistemological and ontological uncertainty about the marginal categories which entail the historical experience of violence, disenfranchisement and oppression. The two Dalit texts problematize the identity of the Dalit as an ‘Other’ vis-a-vis the Muslim subject and thus highlight the liminality of the subaltern subject. This article seeks to decode the aporia of Dalit–Muslim question in the casteist and communally fractured social order.
Experiences of Scheduled Caste Community on Welfare Schemes: A Study of Ramai Aawas Yojana in Maharashtra
Authors: Damodar Vinay
Published: August 2023

The government has created numerous schemes for the benefit of the Scheduled Caste and Scheduled Tribe populations, yet their lifestyles have not seen significant improvement. Policymakers frequently do not consider the opinions of the target audience when drafting schemes, which causes target audiences to suffer as a result of accessing such schemes. When any plans or policies are created, the opinions of Scheduled Caste and Scheduled Tribe Communities must be taken into consideration. The major goals of this paper are to have a theoretical discussion on this, as well as to look at the rights-based approach in social work and properly comprehend its difficulty in practice. Housing schemes have been given considerable precedence in welfare programmes for disadvantaged people like Scheduled Caste and Scheduled Tribes. This research report is based on investigations made to learn about the experiences of the Scheduled Caste Community with Maharashtrian welfare schemes like the Ramai Aawas Yojana. The study’s primary goals are to investigate the difficulties beneficiaries encounter when claiming benefits from the scheme and the changes they notice in their lives as a result. It will also look at the administrative framework for scheme implementation, such as municipalities. The article aims to examine the difficulties faced by the Scheduled Caste group and their perspectives on (a) the Ramai Aawas Yojana Welfare Scheme and (b) the difficulties they encountered in receiving the Scheme’s benefits. (c) How their lives have altered as a result of using the housing program’s advantages. It is founded on an exploratory research design and qualitative approach.
Genetic screening in a Brazilian cohort with inborn errors of immunity
Authors: Ferreira Cristina Santos , Francisco Junior Ronaldo da Silva , Gerber Alexandra Lehmkuhl , Guimarães Ana Paula de Campos , de Carvalho Flavia Amendola Anisio , dos Reis Bárbara Carvalho Santos , Pinto-Mariz Fernanda , de Souza Monica Soares , de Vasconcelos Zilton Farias Meira , Goudouris Ekaterini Simões , Vasconcelos Ana Tereza Ribeiro
Published: August 2023

Background

Inherited genetic defects in immune system-related genes can result in Inborn Errors of Immunity (IEI), also known as Primary Immunodeficiencies (PID). Diagnosis of IEI disorders is challenging due to overlapping clinical manifestations. Accurate identification of disease-causing germline variants is crucial for appropriate treatment, prognosis, and genetic counseling. However, genetic sequencing is challenging in low-income countries like Brazil. This study aimed to perform genetic screening on patients treated within Brazil's public Unified Health System to identify candidate genetic variants associated with the patient’s phenotype.

Methods

Thirteen singleton unrelated patients from three hospitals in Rio de Janeiro were enrolled in this study. Genomic DNA was extracted from the peripheral blood lymphocytes of each patient, and whole exome sequencing (WES) analyses were conducted using Illumina NextSeq. Germline genetic variants in IEI-related genes were prioritized using a computational framework considering their molecular consequence in coding regions; minor allele frequency ≤ 0.01; pathogenicity classification based on American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) guidelines gathered from the VarSome clinical database; and IEI-related phenotype using the Franklin tool. The genes classification into IEI categories follows internationally recognized guidelines informed by the International Union of Immunological Societies Expert Committee. Additional methods for confirmation of the variant included Sanger sequencing, phasing analysis, and splice site prediction.

Results

A total of 16 disease-causing variants in nine genes, encompassing six different IEI categories, were identified. X-Linked Agammaglobulinemia, caused by BTK variations, emerged as the most prevalent IEI disorder in the cohort. However, pathogenic and likely pathogenic variants were also reported in other known IEI-related genes, namely CD40LG, CARD11, WAS, CYBB, C6, and LRBA. Interestingly, two patients with suspected IEI exhibited pathogenic variants in non-IEI-related genes, ABCA12 and SLC25A13, potentially explaining their phenotypes.

Conclusions

Genetic screening through WES enabled the detection of potentially harmful variants associated with IEI disorders. These findings contribute to a better understanding of patients' clinical manifestations by elucidating the genetic basis underlying their phenotypes.
Trade-off in genome turnover events leading to adaptive evolution of Microcystis aeruginosa species complex
Authors: Zhang Xian , Xiao Lijun , Liu Jiahui , Tian Qibai , Xie Jiaqi
Published: August 2023

Background

Numerous studies in the past have expanded our understanding of the genetic differences of global distributed cyanobacteria that originated around billions of years ago, however, unraveling how gene gain and loss drive the genetic evolution of cyanobacterial species, and the trade-off of these evolutionary forces are still the central but poorly understood issues.

Results

To delineate the contribution of gene flow in mediating the hereditary differentiation and shaping the microbial evolution, a global genome-wide study of bloom-forming cyanobacterium, Microcystis aeruginosa species complex, provided robust evidence for genetic diversity, reflected by enormous variation in gene repertoire among various strains. Mathematical extrapolation showed an ‘open’ microbial pan-genome of M. aeruginosa species, since novel genes were predicted to be introduced after new genomes were sequenced. Identification of numerous horizontal gene transfer’s signatures in genome regions of interest suggested that genome expansion via transformation and phage-mediated transduction across bacterial lineage as an evolutionary route may contribute to the differentiation of Microcystis functions (e.g., carbohydrate metabolism, amino acid metabolism, and energy metabolism). Meanwhile, the selective loss of some dispensable genes at the cost of metabolic versatility is as a mean of adaptive evolution that has the potential to increase the biological fitness.

Conclusions

Now that the recruitment of novel genes was accompanied by a parallel loss of some other ones, a trade-off in gene content may drive the divergent differentiation of M. aeruginosa genomes. Our study provides a genetic framework for the evolution of M. aeruginosa species and illustrates their possible evolutionary patterns.
Dementia awareness among elderly at risk for developing mild cognitive impairment: a cross sectional study at a university-based primary care clinic
Authors: Ali Mohd Fairuz , Ja’afar Nur Iman Suraiya , Krishnan Thayaletchumy Gophala , Zulkifle Mohamad Azizi Mohamad , Khaidzir Nur Khairunnisa , Jamil Teh Rohila , Man Zuraidah Che , Aziz Aznida Firzah Abdul
Published: August 2023

Background

The number of people living with dementia in Malaysia is expected to increase with the nation’s growing elderly population and increased lifespan. The lack of public awareness of dementia is partly compounded by low personal health literacy, while scarce research on local patient awareness further impacts the execution of optimised healthcare services in Malaysia. Patients with chronic disease have an elevated risk of developing mild cognitive impairment (MCI). This study aimed to assess the level of awareness of basic knowledge on dementia among the elderly, especially those at risk of developing mild cognitive impairment and its associated factors.

Methods

A total of 207 elderly patients aged 60 years and above with chronic diseases attending a university-based primary care clinic were recruited via a systematic randomised sampling method from the clinic patient attendance registry. Respondents were assessed using self-administered online questionnaires distributed via mobile devices. The questionnaire assessed awareness, i.e. ability to correctly answer a self-reported questionnaire on basic dementia knowledge; (adapted from Northern Ireland Life and Times Survey 2010), risk of MCI; (using Towards Useful Aging (TUA)-WELLNESS screening questionnaire) and help-seeking behaviour. Bivariate analysis was used to determine factors associated with dementia awareness.

Results

The response rate was 77.1%, with the majority of participants were females, Chinese and had secondary school education. 39.1% of participants were categorised as high risk of developing MCI. The majority (92.8%) had low dementia awareness and had never shared their concerns regarding dementia (93.2%) nor had any discussion (87.0%) on cognitive impairment with their physicians. Three factors had an association with total dementia awareness score, i.e., younger age group, higher risk of MCI and presence of cardiovascular diseases have significantly lower awareness score (p < 0.05).

Conclusion

Awareness of dementia is low among elderly patients with potentially high risk of developing MCI. Efforts to improve awareness on dementia should focus on primary care doctors engaging with at-risk elderly patients to initiate discussion regarding dementia risk while managing modifiable risk factors i.e. hypertension control, diabetes, dyslipidaemia and obesity.
Combined influence of depression and low-grade inflammation on mortality in peritoneal dialysis patients
Authors: Zhang Yanxia , Chen Jiexin , Tang Ruiying , Deng Jihong , Guo Huankai , Wu Xianfeng , Xu Qingdong
Published: August 2023

Background

The relationship between depression and systemic inflammation as risk factors for mortality is not well understood and requires further investigation.

Methods

Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) between July 01, 2015 to December 31, 2019, were analyzed and followed up until December 31, 2020. According to their status of depression (PHQ-9 score ≥ 5) and low-grade inflammation (hs-CRP level ≥ 3 mg/L), patients were divided into four groups (G1, without depression, nor inflammation; G2, with depression, without inflammation; G3, with inflammation, without depression; G4, with both depression and inflammation). We performed Kaplan–Meier and multivariable Cox proportional analyses of mortality for the combined influence of depression and systemic inflammation in this cohort.

Results

During the mean follow-up of 36.3 ± 14.8 months, 73 deaths were recorded in 358 participants. Compared with patients in group G1, patients in group G2 and G3 carried 137% {hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.06—5.23, p = 0.035} and 140% (HR: 2.40, 95% CI: 1.01—5.69, p = 0.048) higher risk of mortality. Patients in group G4 (with both depression and inflammation) showed the highest risks of all-cause mortality with 276% higher mortality risk (HR: 3.76, 95% CI: 1.73—8.15, p = 0.001), respectively.

Conclusion

The combined of depression and inflammation is associated with all-cause mortality in peritoneal dialysis patients, suggesting a need for further study of depression and low-grade inflammation in PD patients and potential relationship between them.
The effects of environmental factors associated with childhood urbanicity on brain structure and cognition
Authors: Zhang Xiao , Yan Hao , Yu Hao , Zhang Yuyanan , Tan Hao Yang , Zhang Dai , Yue Weihua
Published: August 2023

Urbanization is a trend lasting for more than one century worldwide. Four hundred ninety male and female adult Chinese Han participants with different urban and rural childhoods were included in this study. Early-life urban environment was found benefit for total grey matter volume (GMV), dorsolateral prefrontal cortex (DLPFC) GMV, temporal pole (TP) GMV and cognition function, and negatively correlated with medial prefrontal cortex (MPFC) GMV. Regression analysis showed that maternal education was a protective factor for total and DLPFC GMVs, while having siblings was better for MPFC GMV. Total, DLPFC and TP GMVs acts mediation effects between childhood urbanicity and different cognitive domains. These findings may suggest some pros and cons on brain structure associated with childhood urbanicity and related environmental factors.
Experiences of Egypt as a destination and transit country for Syrian refugee healthcare workers: a qualitative study
Authors: Ghobrial Andrew , Rayes Diana , Sabouni Ammar , Bdaiwi Yamama , Janoudi Saad , Howard Natasha , Abbara Aula
Published: August 2023

Background

Refugee healthcare workers (HCWs) can make important contributions in host countries, particularly in the wake of the ongoing COVID-19 pandemic, which has exacerbated existing shortages of frontline HCWs. However, refugee HCWs often face challenges entering the labour markets of such countries even where needs exist. Syria’s decade-long conflict has forced thousands of HCWs from their homes; however, data on this population are limited, impeding the formation of policies that can support them. This study explores the experiences of Syrian refugee HCWs in Egypt.

Methods

Key informants (KIs) were selected using purposive and snowball sampling method and semi-structured interviews were conducted in person in Cairo and remotely from the UK during July 2019. Interviews were conducted in Arabic and analysed using a combined deductive and inductive thematic analysis framework after transcription into English.

Results

Fifteen KI interviews were analysed. The main emerging themes from the qualitative interviews are those relating to 1. Education, training, and licensing 2. Politics and bureaucracy 3. Societal factors 4. Economic factors. Political changes in Egypt altered opportunities for Syrian HCWs over time; however, refugee HCWs broadly reported acceptance among Egyptian patients and colleagues. Bureaucratic factors which impede the ability of Syrian refugee HCWs to obtain a full license to practice and leave to remain and the absence of clearly defined policies were reported as barriers. Economic factors including the risk of economic exploitation e.g. in the informal sector and financial insecurity were noted to have a negative psychosocial impact.

Conclusions

This is the first qualitative research study which explores the experiences of Syrian refugee HCWs in Egypt. It adds to the sparse literature on the topic of Syrian refugee HCWs but provides evidence for further discussions on how to support refugee HCWs in Egypt and in other host countries in the region. Though interviews were conducted before the COVID-19 pandemic, the pandemic itself lends urgency to the discussion around refugee HCWs on an international level.
Early vascular aging as an index of cardiovascular risk in healthy adults: confirmatory factor analysis from the EVasCu study
Authors: Saz-Lara Alicia , Cavero-Redondo Iván , Pascual-Morena Carlos , Martínez-García Irene , Rodríguez-Gutiérrez Eva , Lucerón-Lucas-Torres Maribel , Bizzozero-Peroni Bruno , Moreno-Herráiz Nerea , Martínez-Rodrigo Arturo
Published: August 2023

Background

The concept of early vascular aging (EVA) represents a potentially beneficial model for future research into the pathophysiological mechanisms underlying the early manifestations of cardiovascular disease. For this reason, the aims of this study were to verify by confirmatory factor analysis the concept of EVA on a single factor based on vascular, clinical and biochemical parameters in a healthy adult population and to develop a statistical model to estimate the EVA index from variables collected in a dataset to classify patients into different cardiovascular risk groups: healthy vascular aging (HVA) and EVA.

Methods

The EVasCu study, a cross-sectional study, was based on data obtained from 390 healthy adults. To examine the construct validity of a single-factor model to measure accelerated vascular aging, different models including vascular, clinical and biochemical parameters were examined. In addition, unsupervised clustering techniques (using both K-means and hierarchical methods) were used to identify groups of patients sharing similar characteristics in terms of the analysed variables to classify patients into different cardiovascular risk groups: HVA and EVA.

Results

Our data show that a single-factor model including pulse pressure, glycated hemoglobin A1c, pulse wave velocity and advanced glycation end products shows the best construct validity for the EVA index. The optimal value of the risk groups to separate patients is K = 2 (HVA and EVA).

Conclusions

The EVA index proved to be an adequate model to classify patients into different cardiovascular risk groups, which could be valuable in guiding future preventive and therapeutic interventions.
The tyrosine kinase inhibitor Dasatinib reduces cardiac steatosis and fibrosis in obese, type 2 diabetic mice
Authors: Gu Yue , Avolio Elisa , Alvino Valeria V , Thomas Anita C , Herman Andrew , Miller Poppy J , Sullivan Niall , Faulkner Ashton , Madeddu Paolo
Published: August 2023

Background

Cardiac steatosis is an early yet overlooked feature of diabetic cardiomyopathy. There is no available therapy to treat this condition. Tyrosine kinase inhibitors (TKIs) are used as first or second-line therapy in different types of cancer. In cancer patients with diabetes mellitus, TKIs reportedly improved glycemic control, allowing insulin discontinuation. They also reduced liver steatosis in a murine model of non-alcoholic fatty liver disease. The present study aimed to determine the therapeutic effect of the second-generation TKI Dasatinib on lipid accumulation and cardiac function in obese, type 2 diabetic mice. We also assessed if the drug impacts extra-cardiac fat tissue depots.

Methods

Two studies on 21-week-old male obese leptin receptor mutant BKS.Cg-+Leprdb/+Leprdb/OlaHsd (db/db) mice compared the effect of Dasatinib (5 mg/kg) and vehicle (10% DMSO + 90% PEG-300) given via gavage once every three days for a week or once every week for four weeks. Functional and volumetric indices were studied using echocardiography. Post-mortem analyses included the assessment of fat deposits and fibrosis using histology, and senescence using immunohistochemistry and flow cytometry. The anti-adipogenic action of Dasatinib was investigated on human bone marrow (BM)-derived mesenchymal stem cells (MSCs). Unpaired parametric or non-parametric tests were used to compare two and multiple groups as appropriate.

Results

Dasatinib reduced steatosis and fibrosis in the heart of diabetic mice. The drug also reduced BM adiposity but did not affect other fat depots. These structural changes were associated with improved diastolic indexes, specifically the E/A ratio and non-flow time. Moreover, Dasatinib-treated mice had lower levels of p16 in the heart compared with vehicle-treated controls, suggesting an inhibitory impact of the drug on the senescence signalling pathway. In vitro, Dasatinib inhibited human BM-MSC viability and adipogenesis commitment.

Conclusions

Our findings suggest that Dasatinib opposes heart and BM adiposity and cardiac fibrosis. In the heart, this was associated with favourable functional consequences, namely improvement in an index of diastolic function. Repurposing TKI for cardiac benefit could address the unmet need of diabetic cardiac steatosis.
Kinetics of COVID-19 mRNA primary and booster vaccine-associated neutralizing activity against SARS-CoV-2 variants of concern in long-term care facility residents: a prospective longitudinal study in Japan
Authors: Kakugawa Tomoyuki , Doi Keiko , Ohteru Yuichi , Kakugawa Hiroyuki , Oishi Keiji , Kakugawa Masahiro , Hirano Tsunahiko , Mimura Yusuke , Matsunaga Kazuto
Published: August 2023

Background

Coronavirus disease 2019 (COVID-19) remains a threat to vulnerable populations such as long-term care facility (LTCF) residents, who are often older, severely frail, and have multiple comorbidities. Although associations have been investigated between COVID-19 mRNA vaccine immunogenicity, durability, and response to booster vaccination and chronological age, data on the association of clinical factors such as performance status, nutritional status, and underlying comorbidities other than chronological age are limited. Here, we evaluated the anti-spike IgG level and neutralizing activity against the wild-type virus and Delta and Omicron variants in the sera of LTCF residents, outpatients, and healthcare workers before the primary vaccination; at 8, 12, and 24 weeks after the primary vaccination; and approximately 3 months after the booster vaccination. This 48-week prospective longitudinal study was registered in the UMIN Clinical Trials Registry (Trial ID: UMIN000043558).

Results

Of 114 infection-naïve participants (64 LTCF residents, 29 outpatients, and 21 healthcare workers), LTCF residents had substantially lower anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant than outpatients and healthcare workers over 24 weeks after the primary vaccination. In LTCF residents, booster vaccination elicited neutralizing activity against the wild-type virus and Delta variant comparable to that in outpatients, whereas neutralizing activity against the Omicron variant was comparable to that in outpatients and healthcare workers. Multiple regression analyses showed that age was negatively correlated with anti-spike IgG levels and neutralizing activity against the wild-type virus and Delta variant after the primary vaccination. However, multivariate regression analysis revealed that poor performance status and hypoalbuminemia were more strongly associated with a lower humoral immune response than age, number of comorbidities, or sex after primary vaccination. Booster vaccination counteracted the negative effects of poor performance status and hypoalbuminemia on the humoral immune response.

Conclusions

LTCF residents exhibited suboptimal immune responses following primary vaccination. Although older age is significantly associated with a lower humoral immune response, poor performance status and hypoalbuminemia are more strongly associated with a lower humoral immune response after primary vaccination. Thus, booster vaccination is beneficial for older adults, especially those with a poor performance status and hypoalbuminemia.
Combinatorial engineering of betalain biosynthesis pathway in yeast Saccharomyces cerevisiae
Authors: Babaei Mahsa , Thomsen Philip Tinggaard , Dyekjær Jane Dannow , Glitz Christiane Ursula , Pastor Marc Cernuda , Gockel Peter , Körner Johann Dietmar , Rago Daniela , Borodina Irina
Published: August 2023

Background

Betalains, comprising red–violet betacyanins and yellow–orange betaxanthins, are the hydrophilic vacuolar pigments that provide bright coloration to roots, fruits, and flowers of plants of the Caryophyllales order. Betanin extracted from red beets is permitted quantum satis as a natural red food colorant (E162). Due to antioxidant activity, betanin has potential health benefits.

Results

We applied combinatorial engineering to find the optimal combination of a dozen tyrosine hydroxylase (TyH) and 4,5-dopa-estradiol-dioxygenase (DOD) variants. The best-engineered Saccharomyces cerevisiae strains produced over six-fold higher betaxanthins than previously reported. By genome-resequencing of these strains, we found out that two copies of DOD enzyme from Bougainvillea glabra together with TyH enzymes from Abronia nealleyi, Acleisanthes obtusa, and Cleretum bellidiforme were present in the three high-betaxanthin-producing isolates. Next, we expressed four variants of glucosyltransferases from Beta vulgaris for betanin biosynthesis. The highest titer of betanin (30.8 ± 0.14 mg/L after 48 h from 20 g/L glucose) was obtained when completing the biosynthesis pathway with UGT73A36 glucosyltransferase from Beta vulgaris. Finally, we investigated betalain transport in CEN.PK and S288C strains of Saccharomyces cerevisiae and identified a possible role of transporter genes QDR2 and APL1 in betanin transport.

Conclusions

This study shows the potential of combinatorial engineering of yeast cell factories for the biotechnological production of betanin.
Usefulness of NT-proBNP in dogs with heartworm: could this biomarker be useful to evaluate pulmonary hypertension?
Authors: Costa-Rodríguez Noelia , García-Rodríguez Sara N. , Matos Jorge I. , Falcón-Cordón Yaiza , Morchón Rodrigo , Montoya-Alonso José A. , Carretón Elena
Published: August 2023

Background

In recent years, the usefulness of echocardiography and serum biomarkers in the diagnosis of pulmonary hypertension (PH) in dogs with heartworm disease has been studied. Previously, N-terminal pro B-type natriuretic peptide (NT-proBNP) has shown high concentrations in dogs with heart disease and/or PH as well as its usefulness as a prognostic indicator, but it has never been evaluated in the diagnosis and prognosis of PH in dogs with heartworm disease. The aim was to evaluate the serum concentrations of NT-proBNP in dogs infected by Dirofilaria immitis to determine its usefulness as a tool to detect precapillary PH.

Methods

NT-proBNP was determined in 50 heartworm-infected dogs. Presence/absence of PH was determined echocardiographically, using the Right Pulmonary Artery Distensibility Index (RPAD Index) and the systolic flow of tricuspid regurgitation mainly, together with other echocardiographic measurements following the guidelines of the American College of Veterinary Internal Medicine (ACVIM) for the diagnosis of PH. Other epidemiological parameters (breed, age, sex, status: client-owned or shelter dogs) and clinical parameters (microfilaremia, parasite burden, presence of symptoms, body condition) were collected as well.

Results

Moderate-severe PH was present in 40% of the dogs (RPAD Index < 29.5%), NT-proBNP concentrations being significantly higher compared with dogs that did not have PH. A cutoff for NT-proBNP of ≥ 1178.45 pmol/l showed a sensitivity of 64.3% and a specificity of 95.5% for the presence of moderate-severe PH. Older dogs and dogs from shelters showed significantly higher NT-proBNP concentrations. Dogs with symptoms and low body condition presented significantly higher NT-proBNP concentrations as well.

Conclusions

The determination of NT-pro-BNP concentration can be a useful tool in the diagnostic work-up of dogs with heartworm disease and associated PH and can help to identify animals in the more advanced stage of this disorder.

Graphical abstract
Racial disparity and regional variance in healthcare utilization among patients with lung cancer in US hospitals during 2016–2019
Authors: Chang Jongwha , Medina Mar , Shin Dong Yeong , Kim Sun Jung
Published: August 2023

Background

Lung cancer health disparities are related to various patient factors. This study describes regional differences in healthcare utilization and racial characteristics to identify high-risk areas. This study aimed to identify regions and races at greater risk for lung cancer health disparities based on differences in healthcare utilization, measured here by hospital charges and length of stay.

Methods

The National Inpatient Sample of the United States was used to identify patients with lung cancer (n = 92,159, weighted n = 460,795) from 2016 to 2019. We examined the characteristics of the patient sample and the association between the racial and regional variables and healthcare utilization, measured by hospital charges and length of stay. The multivariate sample weighted linear regression model estimated how racial and regional variables are associated with healthcare utilization.

Results

Out of 460,795 patients, 76.4% were white, and 40.2% were from the South. The number of lung cancer patients during the study periods was stable. However, hospital charges were somewhat increased, and the length of stay was decreased during the study period. Sample weighted linear regression results showed that Hispanic & Asian patients were associated with 21.1% and 12.3% higher hospital charges than White patients. Compared with the Northeast, Midwest and South were associated with lower hospital charges, however, the West was associated with higher hospital charges.

Conclusion

Minority groups and regions are at an increased risk for health inequalities because of differences in healthcare utilization. Further differences in utilization by insurance type may exacerbate the situation for some patients with lung cancer. Hospital managers and policymakers working with these patient populations in identified areas should strive to address these disparities through special prevention programs and targeted financial assistance.
Predictors of 72-h unscheduled return visits with admission in patients presenting to the emergency department with abdominal pain
Authors: Lin Li-Tsung , Lin Sheng-Feng , Chao Chun-Chieh , Lin Hui-An
Published: August 2023

Background

Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality.

Objective

We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission (URVAs) from URVs without admission (URVNAs).

Methods

This retrospective study included adult patients who visited the ED of Taipei Medical University Hospital because of abdominal pain and revisited in 72 h over a 5-year period (January 1, 2014, to December 31, 2018). Multivariable logistic regression analysis was employed to identify risk factors for URVAs and receiver operating characteristic (ROC) curve analysis was performed to determine the efficacy of variables predicting URVAs and the optimal cut-off points for the variables. In addition, a classification and regression tree (CART)-based scoring system was used for predicting risk of URVA.

Results

Of 702 eligible patients with URVs related to abdominal pain, 249 had URVAs (35.5%). In multivariable analysis, risk factors for URVAs during the index visit included execution of laboratory tests (yes vs no: adjusted odds ratio [AOR], 4.32; 95% CI 2.99–6.23), older age (≥ 40 vs < 40 years: AOR, 2.10; 95% CI 1.10–1.34), Level 1–2 triage scores (Levels 1–2 vs Levels 3–5: AOR, 2.30; 95% CI 1.26–4.19), and use of ≥ 2 analgesics (≥ 2 vs < 2: AOR, 2.90; 95% CI 1.58–5.30). ROC curve analysis results revealed the combination of these 4 above variables resulted in acceptable performance (area under curve: 0.716). The above 4 variables were used in the CART model to evaluate URVA propensity.

Conclusions

Elder patients with abdominal pain who needed laboratory workup, had Level 1–2 triage scores, and received ≥ 2 doses of analgesics during their index visits to the ED had higher risk of URVAs.