bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuromusculoskeletal model-informed machine learning-based control of a knee exoskeleton with uncertainties quantification
Authors: Zhang Longbin , Zhang Xiaochen , Zhu Xueyu , Wang Ruoli , Gutierrez-Farewik Elena M.
Published: August 2023

Introduction

Research interest in exoskeleton assistance strategies that incorporate the user's torque capacity is growing rapidly. However, the predicted torque capacity from users often includes uncertainty from various sources, which can have a significant impact on the safety of the exoskeleton-user interface.

Methods

To address this challenge, this paper proposes an adaptive control framework for a knee exoskeleton that uses muscle electromyography (EMG) signals and joint kinematics. The framework predicted the user's knee flexion/extension torque with confidence bounds to quantify the uncertainty based on a neuromusculoskeletal (NMS) solver-informed Bayesian Neural Network (NMS-BNN). The predicted torque, with a specified confidence level, controlled the assistive torque provided by the exoskeleton through a TCP/IP stream. The performance of the NMS-BNN model was also compared to that of the Gaussian process (NMS-GP) model.

Results

Our findings showed that both the NMS-BNN and NMS-GP models accurately predicted knee joint torque with low error, surpassing traditional NMS models. High uncertainties were observed at the beginning of each movement, and at terminal stance and terminal swing in self-selected speed walking in both NMS-BNN and NMS-GP models. The knee exoskeleton provided the desired assistive torque with a low error, although lower torque was observed during terminal stance of fast walking compared to self-selected walking speed.

Discussion

The framework developed in this study was able to predict knee flexion/extension torque with quantifiable uncertainty and to provide adaptive assistive torque to the user. This holds significant potential for the development of exoskeletons that provide assistance as needed, with a focus on the safety of the exoskeleton-user interface.
Cell cycle arrest and apoptotic studies of Terminalia chebula against MCF-7 breast cancer cell line: an in vitro and in silico approach
Authors: Reddy Pruthvish , Pradeep Sushma , S. M. Gopinath , Dharmashekar Chandan , G. Disha , M. R. Sai Chakith , Srinivasa Chandrashekar , Shati Ali A. , Alfaifi Mohammad Y. , Elbehairi Serag Eldin I. , Achar Raghu Ram , Silina Ekaterina , Stupin Victor , Manturova Natalia , Shivamallu Chandan , Kollur Shiva Prasad
Published: August 2023

Breast cancer is a leading cause of mortality in women, and alternative therapies with fewer side effects are actively being explored. Breast cancer is a significant global health concern, and conventional treatments like radiotherapy and chemotherapy often have side effects. Medicinal plant extracts offer a promising avenue for the development of effective and safe anticancer therapies. Terminalia chebula, a plant known for its medicinal properties, was selected for investigation in this study. We aimed to assess the antiproliferative effects of TCF extract on breast cancer cells and explore the potential role of saccharopine, a phytochemical found in TCF, as an anticancer agent. MCF7 breast cancer cell lines were exposed to TCF extract, and cell viability and apoptosis assays were performed to evaluate the antiproliferative and apoptogenic effects. Molecular docking studies were conducted to assess the binding affinity of saccharopine with EGFRs. Molecular dynamics simulations and binding energy calculations were employed to analyze the stability of the EGFR-saccharopine complex. The TCF extract exhibited significant antiproliferative effects on MCF7 breast cancer cells and induced apoptosis in a dose-dependent manner. Molecular docking analysis revealed that saccharopine demonstrated a higher binding affinity with EGFR compared to the reference compound (17b-estradiol). The subsequent MDS simulations indicated stable binding patterns and conformation of the EGFR-saccharopine complex, suggesting a potential role in inhibiting EGFR-mediated signaling pathways. The investigation of Terminalia chebula fruit extract and its phytochemical saccharopine has revealed promising antiproliferative effects and a strong binding affinity with EGFR. These findings provide a foundation for future research aimed at isolating saccharopine and conducting in vivo studies to evaluate its potential as a targeted therapy for breast cancer. The development of novel anticancer agents from plant sources holds great promise in advancing the field of oncology and improving treatment outcomes for breast cancer patients.
2023 Chinese guideline for lipid management
Authors: Li Jian-Jun , Zhao Shui-Ping , Zhao Dong , Lu Guo-Ping , Peng Dao-Quan , Liu Jing , Chen Zhen-Yue , Guo Yuan-Lin , Wu Na-Qiong , Yan Sheng-Kai , Wang Zeng-Wu , Gao Run-Lin
Published: August 2023

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of Chinese guideline for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the “Guidelines for the prevention and treatment of dyslipidemia" were adapted into the “Chinese guideline for Lipid Management" (henceforth referred to as the new guidelines) by an Experts’ committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with cardiovascular disease (CVD) risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice.
Effects of drip irrigation on yield, soil fertility and soil enzyme activity of different potato varieties in Northwest China
Authors: Zhang Fan , Chen Mengru , Fu Jintao , Zhang Xiangzhu , Li Yuan , Xing Yingying
Published: August 2023

The effects of different irrigation and fertilization on potato yield, soil fertility and soil enzyme activity of different varieties under drip irrigation fertilization mode were studied, which could provide support for selecting the best varieties in Northwest China. Three factors and three levels orthogonal experimental design method, a total of nine treatments. The three irrigation levels were W1 (100% crop evapotranspiration (ETC)), W2 (80% ETC) and W3 (60% ETC). The three fertilization levels were F1 (N-P2O5-K2O, 240-120-300 kg ha−1), F2 (180-90-225 kg ha−1) and F3 (120-60-150 kg ha−1). The three varieties were V1 (Feiuritar), V2 (Longshu7) and V3 (Qingshu 9). The results showed that different irrigation and fertilization had significant effects on potato yield, soil fertility and soil enzyme activity in root zone. The highest yield of T5 (80%ETC, 180-90-225 kg ha−1, Qingshu 9) was 49,222.3 kg ha−1. With the increase of fertilizer application rate, potato yield and soil enzyme activity in root zone increased first and then decreased, but soil electrical conductivity (SEC), soil nitrate-N content (SNNC), soil alkali-hydrolyzable nitrogen content (SAHC), soil available potassium (AK), soil available phosphorus (AP), soil ammonium-N content (SANC) and soil organic matter (SOM) in root zone increased continuously. The yield, soil catalase activity, soil urease activity and soil sucrase activity at W2 were 2.81% and 22.2%, 1.84% and 7.04%, 8.26% and 9.62%, 5.34% and 13.36% higher than those at W1 and W3, respectively. The overall trend of soil water content, soil nutrient content and enzyme activity in root zone was 0–20 cm >20–40 cm >40–60 cm soil layer. There were many soil factors affecting tuber yield, among which soil enzyme activity, pH value and root zone conductivity were the key factors. The results showed that T5 (80%ETC, 180-90-225 kg ha−1, Qingshu 9) was the best treatment to improve soil enzyme activity and yield.
Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis
Authors: Jeong EunYoung
Published: August 2023

Background

The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years.

Methods

The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio.

Results

Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables—HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin—were higher in institutions with 100% of experienced RNs than those with less than 50%.

Conclusions

In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.
The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers
Authors: Asthana Sheena , Prime Samantha
Published: August 2023

Healthcare systems worldwide are striving for the “quadruple aim” of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.
Towards reuse and recycling of lithium-ion batteries: tele-robotics for disassembly of electric vehicle batteries
Authors: Hathaway Jamie , Shaarawy Abdelaziz , Akdeniz Cansu , Aflakian Ali , Stolkin Rustam , Rastegarpanah Alireza
Published: August 2023

Disassembly of electric vehicle batteries is a critical stage in recovery, recycling and re-use of high-value battery materials, but is complicated by limited standardisation, design complexity, compounded by uncertainty and safety issues from varying end-of-life condition. Telerobotics presents an avenue for semi-autonomous robotic disassembly that addresses these challenges. However, it is suggested that quality and realism of the user’s haptic interactions with the environment is important for precise, contact-rich and safety-critical tasks. To investigate this proposition, we demonstrate the disassembly of a Nissan Leaf 2011 module stack as a basis for a comparative study between a traditional asymmetric haptic-“cobot” master-slave framework and identical master and slave cobots based on task completion time and success rate metrics. We demonstrate across a range of disassembly tasks a time reduction of 22%–57% is achieved using identical cobots, yet this improvement arises chiefly from an expanded workspace and 1:1 positional mapping, and suffers a 10%–30% reduction in first attempt success rate. For unbolting and grasping, the realism of force feedback was comparatively less important than directional information encoded in the interaction, however, 1:1 force mapping strengthened environmental tactile cues for vacuum pick-and-place and contact cutting tasks.
Hyperhomocysteinemia in hypofertile male patients can be alleviated by supplementation with 5MTHF associated with one carbon cycle support
Authors: Clement Arthur , Amar Edouard , Clement Patrice , Sedbon Éric , Brami Charles , Alvarez Silvia , Menezo Yves
Published: August 2023

Introduction

Homocysteine (Hcy) is a cellular poison, side product of the hydrolysis of S-Adenosyl Homocysteine, produced after the universal methylation effector S -Adenosylmethionine liberates a methyl group to recipient targets. It inhibits the methylation processes and its rising is associated with multiple disease states and ultimately is both a cause and a consequence of oxidative stress, affecting male gametogenesis. We have determined hyper homocysteinhemia (HHcy) levels can be reliably reduced in hypofertile patients in order to decrease/avoid associated epigenetic problems and protect the health of future children, in consideration of the fact that treatment with high doses of folic acid is inappropriate.

Methods

Homocysteine levels were screened in male patients consulting for long-standing infertility associated with at least three failed Assisted Reproductive Technology (ART) attempts and/or repeat miscarriages. Seventy-seven patients with Hcy levels > 15 µM were treated for three months with a combination of micronutrients including 5- MethylTetraHydroFolate (5-MTHF), the compound downstream to the MTHFR enzyme, to support the one carbon cycle; re-testing was performed at the end of a 3 months treatment period. Genetic status for Methylenetetrahydrofolate Reductase (MTHFR) Single nucleotide polymorphisms (SNPs) 677CT (c.6777C > T) and 1298AC (c.1298A > C) was determined.

Results

Micronutrients/5-MTHF were highly efficient in decreasing circulating Hcy, from averages 27.4 to 10.7 µM, with a mean observed decrease of 16.7 µM. The MTHFR SNP 677TT (homozygous form) and combined heterozygous 677CT/1298AC status represent 77.9% of the patients with elevated Hcy.

Discussion

Estimation HHcy should not be overlooked in men suffering infertility of long duration. MTHFR SNPs, especially 677TT, are a major cause of high homocysteinhemia (HHcy). In these hypofertile patients, treatment with micronutrients including 5-MTHF reduces Hcy and even allows spontaneous pregnancies post treatment. This type of therapy should be considered in order to ensure these patients' quality of life and avoid future epigenetic problems in their descendants.
Density, planning, and the emergent landscapes of purpose-built student accommodation in England
Authors: Livingstone Nicola , Fiorentino Stefania , Short Michael
Published: August 2023

This mini review explores perspectives on density and discretionary planning policy in relation to the emergent landscapes of purpose-built student accommodation (PBSA) across selected English university cities. It examines the nexus between density in planning policies and transformations in student accommodation, presenting a research gap requiring further investigation. Our research builds upon limited literature on UK PBSA within which there has been inadequate interrogation of policy impacts on the substantial growth of this now mature market sector. By better understanding the relations between national planning policies and their local interpretations regarding PBSA, we can move toward improving understandings for urban futures. The intersectionality between the evolution of the PBSA sector and the planning system are currently underexplored. The paper highlights the proliferation, densification, and concentration patterns of PBSAs and their connections to the surrounding planning system. The emergence of privately developed PBSA in the UK is typically characterized by medium to high rise, and medium to high density development. Higher density PBSA has created a dynamic spectrum of impacts reflecting subjective perceptions of their emergence in university cities. Our mini review illustrates the growth trajectory and direction of the PBSA sector. We conclude with a reflection on the discretionary nature of planning policies for density that often create regulatory loopholes allowing PBSA to thrive as a niche real estate asset class but not necessarily as a local and social collective asset.
A new generation of consumers? A study on the pro-environmental behavior of the Fridays for Future generation based on the social identity approach
Authors: Bauernschmidt Verena , Beitz Beatrice , Schröder Hendrik
Published: August 2023

Especially for the younger generation, climate change is a threat, and therefore, environmental protection and pro-environmental behavior (PEB) are most important. The Fridays for Future movement speaks up for the young generation. Based on the social identity approach, the study is the first to investigate the role of stereotypes related to identification with the movement as a political expression of youth. Using structural equation modeling (n = 543), the study demonstrates that identification is higher when pupils connect the movement with positive stereotypes, aligning with previous research findings for other activists, such as feminists. Whereby environmental concern has an additionally significant but low impact on identification, pro-material value orientation has no effect. Furthermore, the study investigates the relationship between identification with the movement and different types of PEB. The relationship is strongest with public sphere PEB in the form of future participation in a demonstration of the movement. Nevertheless, there is also a positive relationship with private sphere PEB such as nature-compatible actions in everyday life, for example, a meat-free diet and buying an environmentally friendly product. This is partly additionally confirmed through a conjoint analysis also conducted as part of the study. These findings enhance the understanding of the relationship between activism and different types of PEB among pupils and they contribute to closing this research gap. Finally, the implications and limitations of the work are discussed, along with an outlook for future research.
Developing a new technology for demonstrating environmental sustainability in the Australian grassfed beef industry
Authors: Sarwar Salman , Ross Helen , van Bommel Séverine , Polack Sharelle , Waschka Marie , Lubcke Katelyn , Bryceson Kim , Cooper Tarni L. , Butler Don W. , Macintosh Andrew
Published: August 2023

Meeting the increasing consumer and market expectations for sustainably produced beef requires measurement and demonstration of the producers’ sustainability practices. Typically, demonstration of sustainable production relies on time consuming and costly on-ground audits. Online tools using combinations of remotely sensed data and other information sources could offer a cost-effective alternative. However, there are also concerns about the merits and risks of such tools. This paper presents a case of the development process of an online platform for Australian beef producers to demonstrate their sustainable production practices, connected with learning opportunities for continual improvement of their sustainability performance. The project is led by an innovative cross-sectoral collaboration of beef industry, non-government organisation and university partners. Our approach combines producer and market perspectives; focusing on the “value proposition” of the proposed technology for producers, and value chains’ priorities in sustainability markets and in having the ability to demonstrate sustainability in a cost-effective manner. The development process adopted co-design at three levels: (1) the “Consortium” of project partners (2) collaborative co-design through small online groups with producers and value chain representatives; and (3) consultative co-design through producer testing of the platform as it is built by software developers. The design process focused on five themes: tree cover, ground cover, biodiversity stewardship, carbon balance, and drought resilience. We present the main platform design characteristics sought by the co-design groups, and the indicators and measures they considered important for each of the five themes. We then discuss a set of key issues and their implications for technology development, according to a framework expressing interactions between people and their properties, processes and technology. This case shows the importance of taking a “demand-led” rather than a “supply-driven” approach, for the best possible fit of new technology to its users. Since co-design is more often consultative than treating users as equals or leaders in a technology design process, our case highlights the desirability of a fully collaborative approach to co-design.
Quality of Life and Needs in Caregivers: Results From the Prospective Multicentric Open-Label Randomized Study of Informal Caregivers of Elderly Patients
Authors: Pozet Astrid , Darnis Sophie , Bonnet Magalie , Meurisse Aurélia , Dabakuyo-Yonli Tienhan Sandrine , Lejeune Catherine , Fagnoni Philippe , Gaimard Maryse , Manckoundia Patrick , Quibel Clémence , Marchand Mélanie , Anota Amélie , Nerich Virginie
Published: August 2023

Objectives: To assess health-related quality of life (QoL) in caregivers of elderly patients with chronic disabilities receiving, or not receiving, social worker support.

Methods: This multicenter open-label randomized study assigned caregivers to receive an information booklet, exclusively, or with social worker support. Caregivers completed Short Form-36 (SF-36) and Hospital Anxiety Depression Scale quarterly, and Zarit Burden Interview each semester, for 24 months. We reported caregiver QoL mean changes at 12 and 24 months (M12, M24). Longitudinal QoL analysis up to M24 used mixed models for repeated measures (MMRM).

Results: Among the 179 caregivers randomized from 2015 to 2019, the SF-36 physical and mental component summary showed no significant changes at M12 and M24, in terms of neither anxiety nor burden. However, depression significantly increased (M12: 1.4 ± 4.0; M24: 1.7 ± 4.1) with significant adjusted mean increase using MMRM at M24: 3.4 [0.6–2.5] in the control group, exclusively.

Conclusion: These findings call for better recognition of the social support to prevent caregiver QoL deterioration and alleviate their depression early in the course of the disease.

Clinical Trial Registration:ClinicalTrials.gov, identifier NCT02626377.
Healthcare Professionals’ Experiences During the COVID-19 Pandemic in Sudan: A Cross-Sectional Survey Assessing Quality of Life, Mental Health, and Work-Life-Balance
Authors: Mahfouz Mohamed Salih , Osman Sara Amir , Mohamed Badreldin Abdelrhman , Saeed Esra Ali Mahjoub , Ismaeil Mohajer Ibrahim Hassan , Elkhider Rafiaa Ali Abdalla , Orsud Merdi Ahmed
Published: August 2023

Objectives: The main objective of this research was to investigate the Work-life balance (WLB), mental health, and quality of life and their associated factors among Healthcare Professionals (HCPs) in Sudan during the peak of the COVID-19 pandemic during 2021.

Methods: An observational cross-sectional web-based survey was conducted during August-December 2021 among a sample of 430 HCPs working in the hospitals of four Sudanese states. The study used the WHOQoLBREF scale, Work-Life Balance Scale, and General Anxiety Disorder (GAD-7).

Results: HCPs reporting a poor quality of life made up 33.5% (95% CI 29.1–38.0), while those reporting worse WLB made up 52.6% (95% CI 47.8–57.2). HCPs reporting moderate to severe anxiety symptoms accounted for 35.8% (95% CI 31.4–40.5). The Multiple Regression model indicated that an increase in the anxiety scores is associated with a decrease in Health-related Quality of Life (HRQoL) (β= 0.831, p < 0.05). Female HCPs exhibited 4.53-fold lower HRQoL scores than their male colleagues (p < 0.05).

Conclusion: Approximately one-third of the HCPs in Sudan reported low HRQoL and suffered from moderate to severe anxiety, while a large portion of them had an unequal work-life balance during COVID-19. Health policies addressing these factors are needed to improve the quality of health of HCPs.
Distributed Adaptive Path-Following Control for Distance-Based Formation of Fixed-Wing UAVs under Input Saturation
Authors: Wu Junfeng , Wang Huan , Li Shanshan , Liu Shuguang
Published: August 2023

This paper investigates the distance-based formation and cooperative path-following control problems for multiple fixed-wing unmanned aerial vehicles (UAVs). In this study, we design the distance-based formation control structure to achieve the virtual leader and followers pre-defined rigid formation pattern, ensuring simultaneously relative localization. A path-following control strategy based on adaptive dynamic surface and neural network control technology is proposed to approximate the uncertain disturbances of the environment and unmodeled dynamics. And the longitudinal and lateral subsystems’ adaptive fault-tolerant controllers are designed, respectively, to achieve the fault-tolerant control of UAVs’ formation in three-dimensional environments. Furthermore, the adaptive sliding mode controller with an auxiliary controller is designed to realize the UAVs path following with limited input saturation. Finally, simulation examples are given to clarify and verify the effectiveness of the theoretical results.
Phosphoethanolamine Transferases as Drug Discovery Targets for Therapeutic Treatment of Multi-Drug Resistant Pathogenic Gram-Negative Bacteria
Authors: Thai Van C. , Stubbs Keith A. , Sarkar-Tyson Mitali , Kahler Charlene M.
Published: August 2023

Antibiotic resistance caused by multidrug-resistant (MDR) bacteria is a major challenge to global public health. Polymyxins are increasingly being used as last-in-line antibiotics to treat MDR Gram-negative bacterial infections, but resistance development renders them ineffective for empirical therapy. The main mechanism that bacteria use to defend against polymyxins is to modify the lipid A headgroups of the outer membrane by adding phosphoethanolamine (PEA) moieties. In addition to lipid A modifying PEA transferases, Gram-negative bacteria possess PEA transferases that decorate proteins and glycans. This review provides a comprehensive overview of the function, structure, and mechanism of action of PEA transferases identified in pathogenic Gram-negative bacteria. It also summarizes the current drug development progress targeting this enzyme family, which could reverse antibiotic resistance to polymyxins to restore their utility in empiric therapy.
Responding to Urinary Tract Infection Symptoms in England’s Community Pharmacies
Authors: Parekh Sejal , Hand Kieran , Xu Lingqian , Roberts Victoria , Pursey Fionna , Ashiru-Oredope Diane , Lecky Donna M.
Published: August 2023

Most urinary tract infections (UTIs) are self-limiting and frequently present in primary care; it is common for patients to seek symptom relief. The TARGET Treating Your Infection (TYI) leaflet was used to respond to UTI symptoms for women under 65 years presenting in community pharmacies. The widespread use of these leaflets was incentivised as part of NHS England’s Pharmacy Quality Scheme (PQS) 2022–23, between October 2022 and March 2023. The TARGET TYI leaflets are aimed to support appropriate antibiotic use and antimicrobial stewardship (AMS) as well as reducing the opportunity for resistance to develop. A total of 8363 community pharmacies completed the AMS criteria within the PQS and collectively submitted data for 104,142 patients presenting with UTI symptoms. The majority, 77% (75,071), of (non-pregnant) women presented with none or only one of the three strongly predictive symptoms of dysuria, new nocturia, cloudy urine, and/or vaginal discharge and, therefore, were less likely to have a UTI, as outlined in the English UTI diagnostic guidance. Conversely, 23% (22,381) of women presented with two or more symptoms of dysuria, new nocturia, cloudy urine, and with no vaginal discharge and, therefore, they were more likely to have a UTI. The TARGET TYI UTI leaflets support community pharmacy teams to differentiate between symptoms more likely to be associated with UTIs and those that could be managed with self-care. The findings suggest that most women presenting to community pharmacies with urinary symptoms were likely to have self-limiting symptoms, and could be suitably managed with self-care, pain relief, and appropriate safety netting. Approximately one-third of patients were managed by community pharmacy team members without the need for referral to a pharmacist and one in five patients presented with escalation symptoms and were signposted to other healthcare settings. A total of 94% (97,452) of women received self-care advice of which 36% (37,565) were also provided with additional patient information leaflets.
Technical Evaluation of a New Medical Device Based on Rigenase in the Treatment of Chronic Skin Lesions
Authors: Romano Eugenia , Campagnuolo Claudio , Palladino Roberta , Schiavo Giulia , Maglione Barbara , Luceri Cristina , Mennini Natascia
Published: August 2023

Chronic wound is characterized by slow healing time, persistence, and abnormal healing progress. Therefore, serious complications can lead at worst to the tissue removal. In this scenario, there is an urgent need for an ideal dressing capable of high absorbency, moisture retention and antimicrobial properties. Herein we investigate the technical properties of a novel advanced non-woven triple layer gauze imbibed with a cream containing Rigenase, an aqueous extract of Triticum vulgare used for the treatment of skin injuries. To assess the applicability of this system we analyzed the dressing properties by wettability, dehydration, absorbency, Water Vapor Transmission Rate (WVTR), lateral diffusion and microbiological tests. The dressing showed an exudate absorption up to 50%. It created a most environment allowing a proper gaseous exchange as attested by the WVTR and a controlled dehydration rate. The results candidate the new dressing as an ideal medical device for the treatment of the chronic wound repairing process. It acts as a mechanical barrier providing a good management of the bacterial load and proper absorption of abundant wound exudate. Finally, its vertical transmission minimizes horizontal diffusion and side effects on perilesional skin as maceration and bacterial infection.
Factors Governing the Erythropoietic Response to Intravenous Iron Infusion in Patients with Chronic Kidney Disease: A Retrospective Cohort Study
Authors: Chukwu Chukwuma A. , Gilbody Helen , Wickens Olivia , Carroll Craig , Bhandari Sunil , Kalra Philip A.
Published: August 2023

Background: Limited knowledge exists about factors affecting parenteral iron response. A study was conducted to determine the factors influencing the erythropoietic response to parenteral iron in iron-deficient anaemic patients whose kidney function ranged from normal through all stages of chronic kidney disease (CKD) severity. Methods: This retrospective cohort study included parenteral iron recipients who did not receive erythropoiesis-stimulating agents (ESA) between 2017 and 2019. The study cohort was derived from two groups of patients: those managed by the CKD team and patients being optimised for surgery in the pre-operative clinic. Patients were categorized based on their kidney function: Patients with normal kidney function [estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2] were compared to those with CKD stages 3–5 (eGFR < 60 mL/min/1.73 m2). Patients were further stratified by the type of iron deficiency [absolute iron deficiency (AID) versus functional iron deficiency (FID)]. The key outcome was change in hemoglobin (∆Hb) between pre- and post-infusion haemoglobin (Hb) values. Parenteral iron response was assessed using propensity-score matching and multivariate linear regression. The impact of kidney impairment versus the nature of iron deficiency (AID vs. FID) in response was explored. Results: 732 subjects (mean age 66 ± 17 years, 56% females and 87% White) were evaluated. No significant differences were observed in the time to repeat Hb among CKD stages and FID/AID patients. The Hb rise was significantly lower with lower kidney function (non-CKD and CKD1–2; 13 g/L, CKD3–5; 7 g/L; p < 0.001). When groups with different degrees of renal impairment were propensity-score matched according to whether iron deficiency was due to AID or FID, the level of CKD was found not to be relevant to Hb responses [unmatched (∆Hb) 12.1 vs. 8.7 g/L; matched (∆Hb) 12.4 vs. 12.1 g/L in non-CKD and CKD1–2 versus CKD3–5, respectively]. However, a comparison of patients with AID and FID, while controlling for the degree of CKD, indicated that patients with FID exhibited a diminished Hb response regardless of their level of kidney impairment. Conclusion: The nature of iron deficiency rather than the severity of CKD has a stronger impact on Hb response to intravenous iron with an attenuated response seen in functional iron deficiency irrespective of the degree of renal impairment.
Specific Cellular and Humoral Response after the Third Dose of Anti-SARS-CoV-2 RNA Vaccine in Patients with Immune-Mediated Rheumatic Diseases on Immunosuppressive Therapy
Authors: Mohamed Mohamed Kauzar , Álvarez-Hernández María Paula , Jiménez García Carlos , Guevara-Hoyer Kissy , Freites Dalifer , Martínez Prada Cristina , Pérez-Sancristóbal Inés , Fernández Gutiérrez Benjamín , Mato Chaín Gloria , Rodero Maria , Rodríguez de la Peña Antonia , Mulero Teresa , Bravo Cecilia , Toledano Esther , Culebras López Esther , Mediero Valeros Beatriz , Pérez Segura Pedro , Sánchez-Ramón Silvia , Candelas Rodríguez Gloria
Published: August 2023

Objective: Data on cellular and humoral immunogenicity after the third dose of anti-SARS-CoV-2 vaccines in patients with immune-mediated rheumatic diseases (IMRDs) are scarce. Herein, we evaluated the adaptive immune response in IMRD patients treated with different immunosuppressive therapies (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs], biological disease-modifying antirheumatic drugs [bDMARDs], and targeted synthetic disease-modifying antirheumatic drugs [tsDMARDs]) after the booster of the anti-SARS-CoV-2 vaccine to determine whether any drug reduced the vaccine’s response. Methods: A single-center prospective study was conducted, including patients presenting with IMRD and healthy controls (HC). Specific anti-SARS-CoV-2 interferon-gamma (IFN-γ) production was evaluated between 8–12 weeks after the third dose of the SARS-CoV-2 vaccine. In addition, anti-Spike IgG antibody titers were also measured. Results: Samples were obtained from 79 IMRD patients (51 women, 28 men; mean age 57 ± 11.3 years old): 43 rheumatoid arthritis, 10 psoriatic arthritis, 14 ankylosing spondylitis, 10 undifferentiated spondyloarthritis, and 2 inflammatory bowel disease-associated spondyloarthritis (IBD-SpA). In total, 31 HC (mean age 50.9 ± 13.1 years old, 67.7% women) were included in the study. Post-vaccine results displayed positive T-cell immune responses in 68 out of 79 (86.1%) IMRD patients (82.3% of those without prior COVID-19). All HC and IMRDs patients had an antibody response against the SARS-CoV-2 receptor-binding domain; however, the HC response was significantly higher (median of 18,048 AU/mL) than in IMRDs patients (median of 6590.3 AU/mL, p < 0.001). MTX and leflunomide were associated with lower titers of IgG and IFN-γ responses. Among bDMARDs, adalimumab, etanercept, and guselkumab are associated with reduced cellular responses. Conclusion: Our preliminary data show that the majority of our IMRD patients develop cellular and humoral responses after the SARS-CoV-2 booster vaccination, emphasizing the relevance of vaccination in this group. However, the magnitude of specific responses was dependent on the immunosuppressive therapy administered. Specific vaccination protocols and personalized decisions about boosters are essential for these patients.
Diagnostic Performance of Serum MicroRNAs for ST-Segment Elevation Myocardial Infarction in the Emergency Department
Authors: Amezcua-Guerra Brianda , Amezcua-Castillo Luis M. , Guerra-López Jazmín A. , Díaz-Domínguez Kietseé A. , Sánchez-Gloria José L. , Cruz-Melendez Andrés , Hernández-Díazcouder Adrián , Juárez-Vicuña Yaneli , Sánchez-Muñoz Fausto , Huang Fengyang , Tavera-Alonso Claudia , Brianza-Padilla Malinalli , Varela-López Elvira , Sierra-Lara Daniel , Arias-Mendoza Alexandra , Fonseca-Camarillo Gabriela , Márquez-Velasco Ricardo , González-Pacheco Héctor , Springall Rashidi , Amezcua-Guerra Luis M.
Published: August 2023

Prompt diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for initiating timely treatment. MicroRNAs have recently emerged as biomarkers in cardiovascular diseases. This study aimed to evaluate the discriminatory capacity of serum microRNAs in identifying an ischemic origin in patients presenting with chest discomfort to the Emergency Department. The study included 98 participants (78 with STEMI and 20 with nonischemic chest discomfort). Significant differences in the expression levels of miR-133b, miR-126, and miR-155 (but not miR-1, miR-208, and miR-208b) were observed between groups. miR-133b and miR-155 exhibited 97% and 93% sensitivity in identifying STEMI patients, respectively. miR-126 demonstrated a specificity of 90% in identifying STEMI patients. No significant associations were found between microRNAs and occurrence of major adverse cardiovascular events (MACE). However, patients with MACE had higher levels of interleukin (IL)-15, IL-21, IFN-γ-induced protein-10, and N-terminal pro B-type natriuretic peptide compared to non-MACE patients. Overall, there were significant associations among the expression levels of microRNAs. However, microRNAs did not demonstrate associations with either inflammatory markers or cardiovascular risk scores. This study highlights the potential of microRNAs, particularly miR-133b and miR-126, as diagnostic biomarkers for distinguishing patients with STEMI from those presenting with nonischemic chest discomfort to the Emergency Department.
Long-Term Efficacy of Mepolizumab at 3 Years in Patients with Severe Asthma: Comparison with Clinical Trials and Super Responders
Authors: Bagnasco Diego , Nicola Stefania , Testino Elisa , Brussino Luisa , Pini Laura , Caminati Marco , Piccardo Federica , Canevari Rikki Frank , Melissari Laura , Ioppi Alessandro , Guastini Luca , Lombardi Carlo , Milanese Manlio , Losa Francesca , Robbiano Michela , De Ferrari Laura , Riccio Anna Maria , Guida Giuseppe , Bonavia Marco , Fini Donatella , Balbi Francesco , Caruso Cristiano , Paggiaro Pierluigi , Blasi Francesco , Heffler Enrico , Paoletti Giovanni , Canonica Giorgio Walter , Senna Gianenrico , Passalacqua Giovanni ,   on behalf of SANI
Published: August 2023

The efficacy mepolizumab in severe asthmatic patients is proven in the literature. Primarily to study the effect of mepolizumab on exacerbations, steroid dependence, and the continuation of efficacy in the long term. Secondarily to evaluate the effect of the drug on nasal polyps. Analyzing data from SANI (Severe Asthma Network Italy) clinics, we observed severe asthmatic patients treated with mepolizumab 100 mg/4 weeks, for a period of 3 years. 157 patients were observed. Exacerbations were reduced from the first year (−84.6%) and progressively to 90 and 95% in the second and third ones. Steroid-dependent patients decreased from 54% to 21% and subsequently to 11% in the second year and 6% in the third year. Patients with concomitant nasal polyps, assessed by SNOT-22, showed a 49% reduction in value from baseline to the third year. The study demonstrated the long-term efficacy of mepolizumab in a real-life setting.
Peripartum Traumas and Mental Health Outcomes in a Low-Income Sample of NICU Mothers: A Call for Family-Centered, Trauma-Informed Care
Authors: Williams Allison , Parlier-Ahmad Anna Beth , Thompson Erin , Wallace Rachel , Perrin Paul B. , Ward Alyssa , Hendricks-Muñoz Karen D.
Published: August 2023

Postpartum depression (PPD), postpartum anxiety (PPA), and post-traumatic stress disorder (PTSD) among birthing people have increased substantially, contributing to adverse maternal/infant dyad outcomes, with a high prevalence in the neonatal intensive care unit (NICU). Despite calls for trauma-informed care in the NICU and high rates of post-traumatic stress, little research has examined the rates of or the relationships between peripartum mood and adverse child experiences (ACEs) in NICU mothers or evaluated which peripartum traumas are most distressing. This study employed structural equation modeling (SEM) to explore whether peripartum-related traumas and NICU-related stressors mediated the associations between ACEs and mental health outcomes in 119 lower-income, racially diverse mothers in a Level IV NICU. Mental health concerns were prevalent and highly comorbid, including 51.3% PPA, 34.5% PPD, 39.5% post-traumatic stress, and 37% with ≥4 ACEs. The majority (53.8%) of mothers endorsed multiple peripartum traumas; NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). Our SEMs had good fit and demonstrated that ACEs predicted peripartum distress. Trauma-informed care efforts should employ transdiagnostic approaches and recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas.
Does the Mediterranean Dietary Pattern Promote Lower Sodium Urinary Excretion in Children?
Authors: Rodrigues Mónica , Castro Mendes Francisca de , Padrão Patrícia , Delgado Luís , Barros Renata , Rufo João Cavaleiro , Silva Diana , Moreira André , Moreira Pedro
Published: August 2023

An adequate sodium intake is related to various health benefits. Parallelly, the Mediterranean diet (MD) is a dietary pattern known for its many positive impacts on health. Nonetheless, the association between adherence to the MD and sodium urinary excretion is scarce, even more in children. This study aimed to assess the association between MD adherence and the excretion of sodium, as a proxy of intake. This cross-sectional analysis comprised 295 children (46.8% females, aged 7–11 years, mean age: 8.53 ± 0.73 years) from 20 schools within Porto, Portugal. MD adherence was evaluated utilizing the alternate Mediterranean score (aMED). Higher scores denote a healthier dietary pattern (0–8). Sodium excretion was estimated by 24-h urine collection. The association between adherence to MD and Na excretion was estimated by logistic regression, adjusting for confounders. Children in the higher sodium excretion group had a higher intake of legumes, a higher body mass index and parents with lower education levels compared to children in the lower sodium excretion group. In logistic regression analysis, sodium urinary excretion was not associated with higher MD adherence, even after adjustment for confounders. High MD adherence could not be associated with lower sodium excretion in children.
Collaborating to Improve Neonatal Care: ParentAl Participation on the NEonatal Ward—Study Protocol of the neoPARTNER Study
Authors: Hoeben Hannah , Alferink Milène , van Kempen Anne , van Goudoever Johannes , van Veenendaal Nicole , van der Schoor Sophie ,   on behalf of the neoPARTNER Study Group
Published: August 2023

Parents are often appointed a passive role in the care for their hospitalised child. In the family-integrated care (FICare) model, parental involvement in neonatal care is emulated. Parental participation in medical rounds, or family-centred rounds (FCR), forms a key element. A paucity remains of randomised trials assessing the outcomes of FCR (embedded in FICare) in families and neonates, and outcomes on an organisational level are relatively unexplored. Likewise, biological mechanisms through which a potential effect may be exerted are lacking robust evidence. Ten level two Dutch neonatal wards are involved in this stepped-wedge cluster-randomised trial FCR (embedded in FICare) by one common implementation strategy. Parents of infants hospitalised for at least 7 days are eligible for inclusion. The primary outcome is parental stress (PSS:NICU) at discharge. Secondary outcomes include parental, neonatal, healthcare professional and organisational outcomes. Biomarkers of stress will be analysed in parent–infant dyads. With a practical approach and broad outcome set, this study aims to obtain evidence on the possible (mechanistic) effect of FCR (as part of FICare) on parents, infants, healthcare professionals and organisations. The practical approach provides (experiences of) FICare material adjusted to the Dutch setting, available for other hospitals after the study.
Dynamics of Cytokine, SARS-CoV-2-Specific IgG, and Neutralizing Antibody Levels in COVID-19 Patients Treated with Convalescent Plasma
Authors: Pratedrat Pornpitra , Intharasongkroh Duangnapa , Chansaenroj Jira , Vichaiwattana Preeyaporn , Srimuan Donchida , Thatsanatorn Thaksaporn , Klinfueng Sirapa , Nilyanimit Pornjarim , Chirathaworn Chintana , Kupatawintu Pawinee , Chaiwanichsiri Dootchai , Wanlapakorn Nasamon , Poovorawan Yong
Published: August 2023

Coronavirus disease 2019 (COVID-19) is a contagious illness worldwide. While guidelines for the treatment of COVID-19 have been established, the understanding of the relationship among neutralizing antibodies, cytokines, and the combined use of antiviral medications, steroid drugs, and convalescent plasma therapy remains limited. Here, we investigated the connection between the immunological response and the efficacy of convalescent plasma therapy in COVID-19 patients with moderate-to-severe pneumonia. The study included a retrospective analysis of 49 patients aged 35 to 57. We conducted clinical assessments to determine antibody levels, biochemical markers, and cytokine levels. Among the patients, 48 (98%) were discharged, while one died. We observed significantly higher levels of anti-nucleocapsid, anti-spike, and neutralizing antibodies on days 3, 7, and 14 after the transfusion compared to before treatment. Serum CRP and D-dimer levels varied significantly across these four time points. Moreover, convalescent plasma therapy demonstrated an immunoregulatory effect on cytokine parameters, with significant differences in IFN-β, IL-6, IL-10, and IFN-α levels observed at different sampling times. Evaluating the cytokine signature, along with standard clinical and laboratory parameters, may help to identify the onset of a cytokine storm in COVID-19 patients and determine the appropriate indication for anti-cytokine treatment.