bluuebunny/crossref_metadata_2025 huggingface dataset:
The struggle is real—A mixed qualitative methods synthesis of challenges in nursing care in activities of daily living
Authors: Cremer Svenja , de Man‐van Ginkel Janneke M. , Zwakhalen Sandra M. G. , Willems Jules , Metzelthin Silke F. , Veenstra Marja Y. , Bleijlevens Michel H. C.
Published: June 2023

Introduction

Supporting care receivers in Activities of Daily Living (ADL), irrespective of diagnosis, setting, or cultural background, lies at the heart of fundamental nursing care. The pursuit of quality ADL care becomes increasingly challenging with the changing complexity of care needs. ADL care delivery is often undervalued and is considered a low‐status task despite its crucial importance to care receivers. This study aims to synthesize challenges in ADL care irrespective of the care setting.

Methods

In the mixed qualitative methods study, we used expert panel consultations, world café sessions, and a rapid literature review. For data analysis, we simultaneously analyzed the three data sets using inductive and deductive inquiry.

Results

We identified four challenges and their corresponding subthemes. They are (1) Undervalued common‐sense work versus complex, high‐skilled care provision; (2) Limitations in professional reflective clinical decision‐making; (3) Missed opportunities for shared ADL decisions; and (4) Meeting ADL care needs in a high‐throughput system.

Conclusion

These challenges reveal the complexity of ADL care and how its paradoxical narrative relates to the conditions in which nursing professionals struggle to create opportunities, for reflective clinical reasoning and shared ADL decisions, by facing organizational and environmental barriers.

Clinical Relevance

This study is relevant to nursing professionals, care organizations, policymakers, and researchers aiming to improve ADL care and provide insights into challenges in ADL care. This study forms the starting point for a changing narrative on ADL nursing care and subsequent quality improvements in the form of, for example, guidelines for nursing professionals.
Systematic review and meta‐analysis of the prevalence of the retrotransverse foramen of the atlas
Authors: Pękala Jakub R. , Tempski Jonasz , Krager Eirik , Johansen Jacob , Łazarz Dominik P. , Walocha Jerzy A. , Tubbs R. Shane , Tomaszewski Krzysztof A.
Published: June 2023

The retrotransverse foramen (RTF) is a nonmetric variant of the atlas vertebra that can accommodate an anastomotic vertebral vein and occipital nerve. An understanding of this variation and its occurrence is crucial, as it could aid in explanation of the unidentified cause of the high prevalence of variability in this region. The aim of this meta‐analysis was to obtain data on the prevalence of the RTF and its variations according to anatomy, sex, and ethnicity. A large‐scale search was conducted through the major online databases to establish and determine the pool of studies reporting data relevant to the RTF. No date or language restrictions were applied. The data collection was categorized by prevalence, type (incomplete/complete), side, sex, ethnicity, laterality, and diameter. A total of 17 studies (n = 1979 subjects) were incorporated into our analysis. The overall pooled prevalence for a complete RTF was 11.4% and the overall pooled prevalence of an incomplete (partial) RTF was 9.6%. A complete RTF was most prevalent in Africa (Sub‐Saharan population) (12.1%), followed by Europe (11.8%) and Asia (9.7%). As this variant occurs in a significant number of patients in all of the aforementioned populations, recognition, and awareness, especially with thorough investigation with computer tomography angiography (CTA) should be implemented, as it is the only possible way to visualize the possible contents of RTF.
Transcriptome‐wide profile of 1α,25 dihydroxyvitamin D3 in HTR‐8/SVneo cells
Authors: Luo Jiahuan , Tang Li , Zhang Ruopeng , Lv Mengxin , You Dingyun , Yuan Qian
Published: June 2023

Aim

Vitamin D3 has been implicated in multiple reproductive events, whereas the effect of its bioactive metabolite 1α, 25 dihydroxyvitamin D3 (1,25(OH) 2D3) on transcriptome profile of the placenta is unclear. The aim of this article is to determine transcriptome‐wide profile caused by 1,25(OH) 2D3 in human placental trophoblast cells.

Methods

We performed RNA sequencing after stimulation of HTR‐8/SVneo cells with 0.1, 1, 10, and 100 nM 1,25(OH)2D3 for 24 h, identified differentially expressed genes by edgeR package (version 3.38.4), and analyzed Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways by webtool Metascape. Also, common genes and specific genes in different concentrations of 1,25(OH) 2D3 were identified.

Results

There were 180, 158, 161, and 174 differentially expressed genes after 0.1, 1, 10, and 100 nM 1,25(OH) 2D3 stimulation, respectively. KEGG pathway analysis displayed that “lipid and atherosclerosis” were significantly enriched at 0.1 and 1 nM 1,25(OH)2D3, while “cytokine‐cytokine receptor interaction,” “TGF‐beta signaling pathway” and “hippo signaling pathway” were significantly enriched in 1, 10, and 100 nM 1,25(OH)2D3. CYP24A1 was a significantly expressed common gene. UCP3 was significantly expressed in low concentrations and might affect energy metabolism. TCF24, EIF3CL, ABCD2, EPHA7, CRLF1, and SECTM1 were specific genes at physiological concentration. Similarly, SPDYE1, IQUB, IL18R1, and ZNF713 were considered as specific genes at supraphysiological concentration.

Conclusions

1,25(OH)2D3 mainly affected the expression of CYP24A1 gene in HTR‐8/SVneo cells. Specific genes accounted for the majority of differentially expressed genes at different concentrations. However, their functions need to be further confirmed.
Emergence of Hybrid CSR Models as a Conflict‐Driven Communicative Process in a Nordic Welfare State
Authors: Moisander Johanna , Eräranta Kirsi , Fahy Kathryn M. , Penttilä Visa
Published: June 2023

This paper offers an understanding of how hybrid models of corporate social responsibility (CSR) – models combining society‐centric mandatory (implicit) and business‐centric voluntary (explicit) approaches to CSR – are communicatively constructed through institutional struggles over the roles and responsibilities of business in society, in the context of a Nordic welfare state. We develop a model of hybridization as a dialectical process of communicative activity, framing and counter‐framing, in which conflict and contestation over normative understandings about CSR drive the process. The model explains the emergence of hybrid models of CSR in terms of gradually evolving issue development and frame changes that are driven by discursive struggles over moral obligations of business in society, appropriate configuration of legitimacy relationships, and appropriate institutional arrangements for CSR governance. In contrast to prevailing accounts, which tend to theorize hybridization as resulting from isomorphic, mimetic, and normative pressures, our account explicitly attends to the politics of hybridization.
Building design as a dynamic capability: A model for design integration
Authors: Sahakian Julie , BenMahmoud Jouini Sihem
Published: June 2023

A growing number of firms have integrated design in order to foster innovation and growth. Recent literature acknowledges design as a capability leading to differentiation and competitive advantage. However, how such a capability is built within companies with no past experience in design has not been fully addressed. Our objective is to bridge this gap. Indeed, most existing contributions focus on design intervention, that is, using design in projects, rather than design integration, that is, its systematic use and long‐term engagement as an embedded practice in the organization. Based on a longitudinal case study of an insurance company, complemented with an investigation of five other firms from other sectors, we offer a model for building design as a dynamic capability: Triggered by strategic orientations, firms acquire design resources and deploy them in activities such as projects in order to produce tangible results. Capitalizing on what they have learned in these projects, they progressively consolidate this knowledge in an expertise, which is then shared and diffused, thereby renewing the firm's resources. Therefore, our model highlights a reinforcement dimension: In addition to an operational capability (designing, spreading, and managing design), it is also a regenerative capability that consists in building the design expertise, advocating for it, anchoring, and renewing it. We thus have two contributions: (i) We conceptualize design as a dynamic capability enabling the development of new offerings, processes, and strategies that lead to organizations' competitiveness and transformation, and (ii) we propose a model for building such a capability.
Survey to evaluate the proficiency in the use of antibacterial drugs in shrimp farming in the state of Sonora, Mexico
Authors: Estrada‐San Agustín Enrique , Hernández‐López Jorge , De Blas Ignacio , Sumano Héctor
Published: June 2023

Antibiotic drugs (ABD) are often used in shrimp farms to treat the disease when a bacterial diagnosis is presumed. This scenario was the impetus to carry out a field survey to define how ABD are employed in the State of Sonora, the second largest producer of shrimp in Mexico. Twenty‐nine farms were surveyed through their general managers. According to interviews conducted, the most frequent bacterial diseases that were treated with antibiotics in 2020 were: Acute Hepatopancreatic Necrosis Disease (65%), vibriosis (51%), and Necrotizing hepatopancreatitis bacterium (41%). The most common ABDs were enrofloxacin, oxytetracycline and florfenicol, and drug preparations employed were often intended for non‐aquaculture species, mainly poultry, and pigs. The main criteria for selecting a given antibiotic was a direct recommendation, followed by the market price. Neither pharmacokinetics nor pharmacodynamics nor harvesting withdrawal time were taken into account. The absence of protocols to safeguard the health and integrity of workers was detected, training programs for the responsible use of ABD were not encountered, and no data on bacterial resistance to ABD is available in this region. It is concluded that at least formal studies to define the pharmacokinetics of antibiotics are needed to rationalize their use in shrimp production.
Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!
Authors: Deng You , Hui Yangyang , Cui Binxin , Xie Wen , Sun Chao
Published: June 2023

Frailty corresponds to an emerging construct in the hepatology which is originally introduced as a validated geriatric syndrome regarding increased vulnerability to pathophysiological stressors. As for patients with cirrhosis, the presence of frailty is indicative of debilitating conditions that subjects are prone to deleterious acute insults and have difficulties to restore even if the underlying liver function partially returned to normal levels. Since this conceptual development, a variety of tools assessing frailty have been proposed and evaluated in the context of cirrhosis. A recent performance‐based metric for frailty, designated as Liver Frailty Index, has broadly been applied in patients with cirrhosis and exhibited acceptable predictive ability in relation to disease progression, mortality and hospitalization. However, those functional tests measuring frailty may be impossible to perform in circumstance that patients are critically ill or undergoing detrimental events. An interesting modality indicates the use of alternative tests to evaluate frailty, which may be more adaptable and of choice for specific subgroups. The interrelation between frailty and various cirrhosis‐associated pathological entities is of clinical importance and implication. Noticeably, it is imperative to clarify these complex linkages to highlight novel therapeutic targets or interventional endpoints. The efficient and effective management of frailty is still challenging, but many attempts have been made to overcome barriers of affordability and availability. Some clinical trials on small scale revealed that home‐based exercise and individualized nutrition therapy show benefits in patients with cirrhosis, and high adherence to the treatment regimen may direct better efficacy and performance.
Platonic qua predication
Authors: Barney Rachel
Published: June 2023

Platonic arguments often have premises of a particular form which is misunderstood. These sentences look like universal generalizations, but in fact involve an implicit qua phrase which makes them a fundamentally different kind of predication. Such general implicit redoubled qua predications (girqps) are not an expression of Plato's proprietary views; they are also very common in everyday discourse. Seeing how they work in Plato can help us to understand them.
Global indicators and AI policy: Metrics, policy scripts, and narratives
Authors: Erkkilä Tero
Published: June 2023

Artificial intelligence (AI) has become a global policy issue that is actively governed by international actors producing governance indicators. This article argues that despite the arguments about disruptions to governance and policy due to AI, the global rankings increasingly constitute a strong path dependence on AI policy, leading to conformity with existing policies and institutional practices of economic competitiveness. By analyzing the composition and data sources of global indices in competitiveness, innovation, human capital, and artificial intelligence, I will show how the global rankings now evolve by sharing data and concepts. Consequently, these metrics and related policy scripts promote the seeming continuity of current activities of global competitiveness. AI is discussed as a “revolution” but framed as a matter of “competitiveness,” “openness,” and “talent competition,” implying standard perceptions of economic competitiveness and innovation. There is also a narrative element in the policy script, as the future policies on AI are promoted with references to history that also project the past into the future. My article concludes that while path‐dependent policy indicators and related future narratives give a sense of orientation, they are problematic as they portray a seeming continuity of activities in times of disruptions, delimiting policy alternatives such as AI ethics.
Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder
Authors: Schermann Haggai , Schiffmann Nathan , Ankory Ran , Shlaifer Amir , Yavnai Nirit , Yoffe Victoria , Natapov Lena
Published: June 2023

Objective

To assess the effect and dose‐response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder.

Participants and methods

This retrospective study comprises a cohort of military recruits aged 18–25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period.

Results

Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose‐response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009])

Conclusions

Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).
The challenging management of Moebius syndrome using orthodontic camouflage: A case report
Authors: Duggal Isha , Zere Edlira , Kumar Chaudhari Prabhat , Duggal Ritu , Singh Rana Shailendra , Chauhan Anuj
Published: June 2023

Moebius syndrome (MS) is a rare congenital neuromuscular disorder characterized by weakness or paralysis (palsy) of abducens and facial nerves, or other cranial nerves which may be affected. Diagnosis, treatment, and dental management of MS patients are focused on treating manifestations like malocclusion, while catering to associated extraoral (neurologic, dermatologic, ocular) complications, aiming to improve their quality of life. Here, we report the case of a 9‐year‐old female patient with MS who underwent orthodontic camouflage using combined orthopedic‐orthodontic therapy using a high‐pull chin cup and fixed orthodontic appliance to improve skeletal mal‐relation and facial appearance. The outcome displayed great improvement in function and better esthetics, improving not only the patient's but also the family's quality of life. A year's follow‐up showed successful maintenance of the achieved results. A multidisciplinary approach in MS not only helps in overcoming the treatment challenges but also provides great psychosocial benefits to these patients.
From Serendipity to Sustainability: Exploring the Content Creation and Sharing Experiences of Local Travel Influencers in China
Authors: Ding Jianwei , Md Syed Md Azalanshah , Shamshudeen Rosya Izyanie
Published: June 2023

The study explored content creation and sharing experiences of local travel influencers in Meishan City, China. A qualitative phenomenological methodology was used to conduct in-depth interviews with 15 local travel influencers based on social exchange theory and its reciprocal principles. Thematic content analysis was used to analyse data. Study findings showed that being a local travel influencer was an emerging occupation requiring comprehensive competence in specific contextual and cultural backgrounds. Although travel influencers’ initial rise to popularity was often serendipitous, supportive policies from the local tourism community could assist travel influencers in achieving sustainable tourism. Local travel influencers face several challenges including staying authentic, monetizing content, dealing with the COVID-19 pandemic, avoiding homogenous content, and managing work load. Local travel influencers could serve as a significant liaison between tourists and the local tourism community by collaborating with local tourism stakeholders, building a local multi-layer media matrix, co-creating promotional content, and live-streaming e-commerce. Study findings have theoretical and practical implications for tourism stakeholders in integrating regional tourism community development with local influencer networks.
What if muscle spindles were also involved in the sense of effort?
Authors: Monjo Florian , Allen Trevor
Published: June 2023

Effort perception is widely acknowledged to originate from central processes within the brain, mediated by the integration of an efference copy of motor commands in sensory areas. However, in this topical review, we aim to challenge this perspective by presenting evidence from neural mechanisms and empirical studies that suggest that reafferent signals from muscle spindles also play a significant role in effort perception. It is now imperative for future research (a) to investigate the precise mechanisms underlying the interactions between the efference copy and reafferent spindle signals in the generation of effort perception, and (b) to explore the potential for altering spindle sensitivity to affect perceived effort during ecological physical exercise and, subsequently, influence physical activity behaviours.

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Eco-Technoeconomic Analyses of Natural Gas-Powered SOFC/GT Hybrid Plants Accounting for Long-Term Degradation Effects Via Pseudo-Steady-State Model Simulations
Authors: Lai Haoxiang , Adams Thomas A.
Published: June 2023

In this study, four solid oxide fuel cell (SOFC) power plants, with natural gas (NG) as the fuel source, that account for long-term degradation were designed and simulated. The four candidate SOFC plants included a standalone SOFC plant, a standalone SOFC plant with a steam bottoming cycle, an SOFC/ (gas turbine) GT hybrid plant, and an SOFC/GT hybrid plant with a steam bottoming cycle. To capture dynamic behaviors caused by long-term SOFC degradation, this study employed a pseudo-stead-state approach that integrated real-time dynamic 1D SOFC models (degradation calculation embedded) with steady-state balance-of-plant models. Model simulations and eco-techno-economic analyses were performed over a 30-year plant lifetime using matlab simulink R2017a, aspen plus V12.1, and python 3.7.4. The results revealed that, while the standalone SOFC plant with a steam bottoming cycle provided the highest overall plant efficiency (65.0% LHV), it also had high SOFC replacement costs due to fast degradation. Instead, the SOFC/GT hybrid plant with a steam bottoming cycle was determined to be the best option, as it had the lowest levelized cost of electricity ($US 35.1/MWh) and the lowest cost of CO2 avoided (−$US100/ton CO2e).
Vibration Analysis Approach to Model Incremental Wear and Associated Sound in Multi-Contact Sliding Friction Mechanisms
Authors: Basit Kanza , Shams Hamza , Khan Muhammad Ali , Mansoor Asif
Published: June 2023

This paper proposes a simplistic approach toward estimating incremental wear in a multi-contact scenario using a vibrational analysis approach and in turn goes a step forward to model its associated sound. Predicted wear depth and frictional sound are compared to the experimental values obtained using a standardized pin-on-disc tribometer setup affixed with a free-field microphone to capture air-borne noise. The results show good conformity between the proposed analytical model values and the standardized experiments, hence ensuing that within certain limitations, the proposed model and the intended approach can effectively be used as a good estimator of wear and its sound in a multi-contact scenario.
Hardmask engineering by mask encapsulation for enabling next generation reactive ion etch scaling
Authors: Tirukkonda Roshan J. , Kraman Mark D. , Sharangpani Rahul , Sondhi Kartik , Fancher Aaron N. , Ross Stephen R. , Nag Joyeeta , Bogdanov Alexei L. , Makala Raghuveer S. , Kanakamedala Senaka K.
Published: June 2023

Miniaturization and scaling of semiconductor devices require development of innovative techniques to sustain advancements. A promising trend is the migration from 2D to 3D device architectures that necessitate fabrication of high-aspect-ratio narrow features through layers of different materials. Reactive ion etching can achieve this but poses unique challenges due to the requirement of etch chemistries capable of etching dissimilar materials with varying etch rates while maintaining high productivity. The choice of hardmask is also crucial, as it plays a critical role in determining efficacy of the etch process and the final shape of the feature being etched. To address these challenges, we introduce a new concept of hardmask engineering that involves a bilayer hardmask scheme consisting of a patterned conventional hardmask encapsulated with a thin layer of etch-resistant ruthenium (Ru) layer. Experimental results for etching multilayer stacks consisting of alternating pairs of SiO2 and Mo show that this engineered hardmask results in improved hardmask remaining and etch profile with smaller critical dimensions (CDs). Technology computer-aided design simulations with the Ru encapsulation layer on conventional carbon hardmask demonstrate increased poly-Si etch depth with reduced bow CD. This concept can be extended to any semiconductor nanofabrication step involving high-aspect-ratio etching where precise control of CDs is essential in the vertical direction.
No Associations Between Physical Activity and Immunogenicity in SARS-CoV-2 Seropositive Patients With Autoimmune Rheumatic Diseases Prior to and After Vaccination
Authors: Smaira Fabiana Infante , Mazzolani Bruna Caruso , Lemes Ítalo Ribeiro , da Silva Rafael Pires , Pinto Ana J. , Sieczkowska Sofia M. , Aikawa Nadia E. , Pasoto Sandra G. , Medeiros-Ribeiro Ana C. , Saad Carla G.S. , Yuk Emily F.N. , Silva Clovis A. , Swinton Paul , Kupa Leonard de Vinci Kanda , Hallal Pedro C. , Roschel Hamilton , Gualano Bruno , Bonfa Eloisa
Published: June 2023

Aim: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or ≥60 y), sex, body mass index (<25, 25–30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. Results: A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. Conclusions: This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.
Let there be dark
Authors: Service Robert F.
Published: June 2023

Crops grown without sunlight could help feed astronauts bound for Mars, and someday supplement dinner plates on Earth
Genome Sequence of Lichtheimia ornata, an Emerging Opportunistic Mucorales Pathogen
Authors: Shea Terrance , Mohabir Jason T. , Kurbessoian Tania , Berdy Brittany , Fontaine James , Gnirke Andreas , Livny Jonathan , Stajich Jason E. , Cuomo Christina A.
Published: June 2023

Lichtheimia ornata
is an emerging opportunistic Mucorales pathogen that is associated with fatal infections in immunocompromised individuals. While these environmentally acquired infections have rarely been reported to date, cases were noted in a recent analysis of coronavirus disease 2019 (COVID-19)-associated mucormycosis in India. Here, we report the annotated genome sequence of the environmental isolate CBS 291.66.
Supplemental Material: High-temperature altered oceanic crust recycling into oceanic-island basalt–like mantle produces alkaline continental crust driven by mélange diapirs: Insights from isotopic tracing and numerical modeling
Authors: Liu Huichuan , Huangfu Pengpeng , al. et
Published: June 2023

Supplemental Texts S1–S9: Analytical methods. Supplemental Tables S1–S7: Analytical results. Supplemental Figures S1–S5: Supporting figures.
Emotional work of getting help: a qualitative analysis of caregiver-perceived barriers to responding to childhood adversity
Authors: Loveday Sarah , Balgovind Manisha , Hall Tess , Goldfeld Sharon , Sanci Lena , Hiscock Harriet
Published: June 2023

Objective

To explore caregivers’ experiences and challenges of accessing help for adversity across both health and social care sectors.

Design

Qualitative study design using semistructured interviews to explore how caregivers accessed services across health and social care. Interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis.

Setting

Families living in the city of Wyndham, Victoria, Australia.

Participants

17 caregivers of children aged 0–8 years.

Results

Five main themes emerged. (1) Emotional work of getting help. Caregivers described that getting help for life challenges was both emotionally taxing and effortful. (2) Trusting relationships are key. Engagement was related to the degree of relational practice and whether they felt judged or demeaned. (3) Wanting to manage on your own. There was a strong desire by caregivers to be independent and to only seek help when it was absolutely necessary. (4) Importance of knowing help was available and how to access it. (5) Overcoming service access barriers including long waiting times, restricted service criteria, transport issues and out-of-pocket expenses.

Conclusions

Caregivers highlighted a multitude of barriers to getting help for life challenges. Addressing these barriers will require services to become more flexible and codesign best approaches with families in ongoing partnership. Improving community knowledge of available services and building trusting relationships is the first step to overcoming these barriers.
Myopic maculopathy among Chinese children with high myopia and its association with choroidal and retinal changes: the SCALE-HM study
Authors: Deng Junjie , Xu Xian , Pan Chen-Wei , Wang Jingjing , He Mingguang , Zhang Bo , Yang Jinliuxing , Hou Xiao-Wen , Zhu Zhuoting , Borchert Grace , Chen Jun , Cheng Tianyu , Yu Suqing , Fan Ying , Liu Kun , Zou Haidong , Xu Xun , He Xiangui
Published: June 2023

Aims

To investigate myopic maculopathy in Chinese children with high myopia and its association with choroidal and retinal changes.

Methods

This cross-sectional study included Chinese children aged 4–18 years with high myopia. Myopic maculopathy was classified by fundus photography and retinal thickness (RT) and choroidal thickness (ChT) in the posterior pole were measured by swept-source optical coherence tomography. A receiver operation curve was used to determine the efficacy of fundus factors in classifying myopic maculopathy.

Results

In total, 579 children aged 12.8±3.2 years with a mean spherical equivalent of −8.44±2.20 D were included. The proportions of tessellated fundus and diffuse chorioretinal atrophy were 43.52% (N=252) and 8.64% (N=50), respectively. Tessellated fundus was associated with a thinner macular ChT (OR=0.968, 95% CI: 0.961 to 0.975, p<0.001) and RT (OR=0.977, 95% CI: 0.959 to 0.996, p=0.016), longer axial length (OR=1.545, 95% CI: 1.198 to 1.991, p=0.001) and older age (OR=1.134, 95% CI: 1.047 to 1.228, p=0.002) and less associated with male children (OR=0.564, 95% CI: 0.348 to 0.914, p=0.020). Only a thinner macular ChT (OR=0.942, 95% CI: 0.926 to 0.959, p<0.001) was independently associated with diffuse chorioretinal atrophy. When using nasal macular ChT for classifying myopic maculopathy, the optimal cut-off value was 129.00 µm (area under the curve (AUC)=0.801) and 83.85 µm (AUC=0.910) for tessellated fundus and diffuse chorioretinal atrophy, respectively.

Conclusion

A large proportion of highly myopic Chinese children suffer from myopic maculopathy. Nasal macular ChT may serve as a useful index for classifying and assessing paediatric myopic maculopathy.

Trial registration number

NCT03666052.
Trends and symptoms of SARS-CoV-2 infection: a longitudinal study on an Alpine population representative sample
Authors: Barbieri Giulia , Pizzato Massimo , Gögele Martin , Giardiello Daniele , Weichenberger Christian X , Foco Luisa , Bottigliengo Daniele , Bertelli Cinzia , Barin Laura , Lundin Rebecca , Pramstaller Peter P , Pattaro Cristian , Melotti Roberto
Published: June 2023

Objectives

The continuous monitoring of SARS-CoV-2 infection waves and the emergence of novel pathogens pose a challenge for effective public health surveillance strategies based on diagnostics. Longitudinal population representative studies on incident events and symptoms of SARS-CoV-2 infection are scarce. We aimed at describing the evolution of the COVID-19 pandemic during 2020 and 2021 through regular monitoring of self-reported symptoms in an Alpine community sample.

Design

To this purpose, we designed a longitudinal population representative study, the Cooperative Health Research in South Tyrol COVID-19 study.

Participants and outcome measures

A sample of 845 participants was retrospectively investigated for active and past infections with swab and blood tests, by August 2020, allowing adjusted cumulative incidence estimation. Of them, 700 participants without previous infection or vaccination were followed up monthly until July 2021 for first-time infection and symptom self-reporting: COVID-19 anamnesis, social contacts, lifestyle and sociodemographic data were assessed remotely through digital questionnaires. Temporal symptom trajectories and infection rates were modelled through longitudinal clustering and dynamic correlation analysis. Negative binomial regression and random forest analysis assessed the relative importance of symptoms.

Results

At baseline, the cumulative incidence of SARS-CoV-2 infection was 1.10% (95% CI 0.51%, 2.10%). Symptom trajectories mimicked both self-reported and confirmed cases of incident infections. Cluster analysis identified two groups of high-frequency and low-frequency symptoms. Symptoms like fever and loss of smell fell in the low-frequency cluster. Symptoms most discriminative of test positivity (loss of smell, fatigue and joint-muscle aches) confirmed prior evidence.

Conclusions

Regular symptom tracking from population representative samples is an effective screening tool auxiliary to laboratory diagnostics for novel pathogens at critical times, as manifested in this study of COVID-19 patterns. Integrated surveillance systems might benefit from more direct involvement of citizens’ active symptom tracking.
Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial
Authors: Appelboam Andrew , Osborne Ria , Ukoumunne Obioha , Black Sarah , Boot Suzanne , Richards Nicholas , Scotney Natalie , Rhodes Shelley , Cranston Tim , Hawker Ruth , Gillett Annette , Jones Ben , Hawton Annie , Dayer Mark , Creanor Siobhan
Published: June 2023

Introduction

Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital.

Methods and analysis

This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months.

Ethics and dissemination

The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity.

Trial registration number

ISRCTN16145266.
Impact of personal protective equipment on the clarity of vision among trachoma survey graders and trichiasis surgeons in the context of COVID-19
Authors: Ul Hassan Ehtisham , Apadinuwe Sue-Chen , Bisanzio Donal , Dejene Michael , Downs Philip , Harding-Esch Emma M , Jimenez Cristina , Kabona George , Kebede Biruck Negash , Kelly Michaela , Kivumbi Peter , Millar Tom , Mosher Aryc W , Mpyet Caleb , Mkocha Harran , Ngondi Jeremiah M , Olobio Nicholas , Palmer Stephanie , Teyil Wamyil-Mshelia , Courtright Paul
Published: June 2023

Background/aims

The COVID-19 pandemic necessitated the use of personal protective equipment for those involved in trachoma survey grading and trichiasis surgery. We sought to determine which configuration of a face shield would be less likely to impact grading accuracy and ability to conduct trichiasis surgery. The research also included assessment of comfort, ease of cleaning and robustness.

Methods

There were three research phases. In phase 1, assessment of four potential face shield configurations was undertaken with principal trachoma graders and trichiasis surgeon trainers to decide which two options should undergo further testing. In phase 2, clarity of vision and comfort (in a classroom environment) of the two configurations were assessed compared with no face shield (control), while grading trachomatous inflammation—follicular (TF). The second phase also included the assessment of impact of the configurations while performing trichiasis surgery using a training model. In phase 3, face shield ease of use was evaluated during routine surgical programmes.

Results

In phase 2, 124 trachoma graders and 28 trichiasis surgeons evaluated the 2 face shield configurations selected in phase 1. TF agreement was high (kappa=0.83 and 0.82) for both configurations compared with not wearing a face shield. Comfort was reported as good by 51% and 32% of graders using the two configurations. Trichiasis skill scores were similar for both configurations.

Conclusion

The face shield configuration that includes a cut-out for mounting the 2.5× magnifying loupes does not appear to impact the ability or comfort of trachoma graders or trichiasis surgeons to carry out their work.
Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study
Authors: Mathura Pamela , Marini Sandra , Hagtvedt Reidar , Spalding Karen , Duhn Lenora , Kassam Narmin , Medves Jennifer
Published: June 2023

Background

A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study’s purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering.

Methods

Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display.

Results

Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900–CAN$7285). Physicians had similar perceptions of the coalition’s characteristics enabling their QI involvement and the factors influencing BUN test reduction.

Conclusions

To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician—who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes—were factors influencing appropriate BUN test ordering.
Body mass index and survival in people with heart failure
Authors: Jones Nicholas R , Ordóñez-Mena José M , Roalfe Andrea K , Taylor Kathryn S , Goyder Clare R , Hobbs FD Richard , Taylor Clare J
Published: June 2023

Aims

In people with heart failure (HF), a high body mass index (BMI) has been linked with better outcomes (‘obesity paradox’), but there is limited evidence in community populations across long-term follow-up. We aimed to examine the association between BMI and long-term survival in patients with HF in a large primary care cohort.

Methods

We included patients with incident HF aged ≥45 years from the Clinical Practice Research Datalink (2000–2017). We used Kaplan-Meier curves, Cox regression and penalised spline methods to assess the association of pre-diagnostic BMI, based on WHO classification, with all-cause mortality.

Results

There were 47 531 participants with HF (median age 78.0 years (IQR 70–84), 45.8% female, 79.0% white ethnicity, median BMI 27.1 (IQR 23.9–31.0)) and 25 013 (52.6%) died during follow-up. Compared with healthy weight, people with overweight (HR 0.78, 95% CI 0.75 to 0.81, risk difference (RD) −4.1%), obesity class I (HR 0.76, 95% CI 0.73 to 0.80, RD −4.5%) and class II (HR 0.76, 95% CI 0.71 to 0.81, RD −4.5%) were at decreased risk of death, whereas people with underweight were at increased risk (HR 1.59, 95% CI 1.45 to 1.75, RD 11.2%). In those underweight, this risk was greater among men than women (p value for interaction=0.02). Class III obesity was associated with increased risk of all-cause mortality compared with overweight (HR 1.23, 95% CI 1.17 to 1.29).

Conclusion

The U-shaped relationship between BMI and long-term all-cause mortality suggests a personalised approach to identifying optimal weight may be needed for patients with HF in primary care. Underweight people have the poorest prognosis and should be recognised as high-risk.
Autopsy findings from patients diagnosed with COVID-19 demonstrate unique morphological patterns in bone marrow and lymph node
Authors: AlJabban Ali , Evans Mark G , Fell Geoffrey G , Guccione Jack P , Edwards Robert A , Pinkus Geraldine S , Padera Robert F , Pozdnyakova Olga , Kim Annette S
Published: June 2023

Aims

The identification of haemophagocytosis in bone marrow (BM) is recurrently identified in patients with severe COVID-19. These initial COVID-19 autopsy studies have afforded valuable insight into the pathophysiology of this disease; however, only a limited number of case series have focused on lymphoid or haematopoietic tissues.

Methods

BM and lymph node (LN) specimens were obtained from adult autopsies performed between 1 April 2020 and 1 June 2020, for which the decedent had tested positive for SARS-CoV-2. Tissue sections (H&E, CD3, CD20, CD21, CD138, CD163, MUM1, kappa/lambda light chains in situ hybridisation) were examined by two haematopathologists, who recorded morphological features in a blinded fashion. Haemophagocytic lymphohistiocytosis (HLH) was assessed based on HLH 2004 criteria.

Results

The BM demonstrated a haemophagocytic pattern in 9 out of 25 patients (36%). The HLH pattern was associated with longer hospitalisation, BM plasmacytosis, LN follicular hyperplasia and lower aspartate aminotransferase (AST), as well as ferritin at demise. LN examination showed increased plasmacytoid cells in 20 of 25 patients (80%). This pattern was associated with a low absolute monocyte count at diagnosis, lower white cell count and lower absolute neutrophil count at demise, and lower ferritin and AST at demise.

Conclusions

Autopsy results demonstrate distinct morphological patterns in BM, with or without haemophagocytic macrophages, and in LN, with or without increased plasmacytoid cells. Since only a minority of patients met diagnostic criteria for HLH, the observed BM haemophagocytic macrophages may be more indicative of an overall inflammatory state.
Intralesional administration of VAX014 facilitates in situ immunization and potentiates immune checkpoint blockade in immunologically cold tumors
Authors: Reil Katherine A , Tsuji Shingo , Molina Elsa , Nelson Kinsey L , McGuire Kathleen L , Giacalone Matthew J
Published: June 2023

Background

Immunologically cold tumors with an ‘immune desert’ phenotype lack tumor-infiltrating lymphocytes (TILs) and are typically impervious to systemic immune checkpoint blockade (ICB). Intratumoral treatment of tumors with immunomodulatory agents can promote local tumor inflammation leading to improved T cell responses in injected tumors. Addition of systemic ICB increases response frequency and immune-mediated clearance of injected and distal non-injected lesions, and this promising approach is being widely investigated clinically. In this work, we evaluate and characterize the local and systemic antitumor immunotherapeutic activity of VAX014, a novel non-viral targeted oncolytic agent based on recombinant bacterial minicells, following intratumoral administration and in combination with systemic ICB.

Methods

The immunotherapeutic activity of VAX014 following weekly intratumoral administration was investigated in multiple preclinical tumor models with B16F10 murine melanoma serving as the primary model for evaluation of immune desert tumors. Mice bearing a single intradermal tumor were used to evaluate tumor response and overall survival (OS), assess changes in immune cell populations, and explore global changes to immunotranscriptomes of injected tumors. Mice bearing bilateral intradermal tumors were then used to evaluate non-injected tumors for changes in TIL populations and phenotypes, compare immunotranscriptomes across treatment groups, and assess distal non-injected tumor response in the context of monotherapy or in combination with ICB.

Results

VAX014 demonstrated strong immune-mediated tumor clearance of injected tumors coinciding with significantly elevated CD8+TILs and upregulation of multiple immune pathways essential for antitumor immune responses. Modest activity against distal non-injected immune desert tumors was observed despite elevated levels of systemic antitumor lymphocytes. Combination with systemic CTLA-4 blockade improved survival and elevated TILs but did not improve clearance rates of non-injected tumors. Immunotranscriptomes of non-injected tumors from this treatment combination group exhibited upregulation of multiple immune pathways but also identified upregulation of PD-1. Further addition of systemic PD-1 blockade led to rapid clearance of non-injected tumors, enhanced OS, and provided durable protective immunological memory.

Conclusions

Intratumoral administration of VAX014 stimulates local immune activation and robust systemic antitumor lymphocytic responses. Combination with systemic ICB deepens systemic antitumor responses to mediate clearance of injected and distal non-injected tumors.