bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased workload without clinical benefit: Results following implementation of the ACR‐TIRADS system for thyroid nodules
Authors: Bolland Mark J. , Grey Andrew
Published: January 2023

Objective

The ACR‐TIRADS system for stratifying thyroid nodule malignancy risk has been widely promoted and implemented. We audited its introduction at a large public hospital in Auckland, New Zealand.

Design

Audit of outcomes following thyroid nodule fine needle aspiration (FNA) before/after ACR‐TIRADS.

Patients

Individuals undergoing thyroid FNA 2017−2019.

Measurements

From medical records, we obtained details from the pre‐FNA ultrasound (nodule size, TIRADS points/levels, radiologist recommendation for FNA), Bethesda (B) cytology classification, histology and post‐FNA follow‐up.

Results

Four hundred and twenty‐two individuals had 564 FNAs, 163 had surgery and 54 (13%) had cancer in the primary nodule. 37/54 (69%) cancers were papillary thyroid carcinoma (median size 25 mm, 87% ≥10 mm, 61% ≥20 mm). Following ACR‐TIRADS introduction, FNA recommendations increased greater than twofold, FNAs performed by 71%−83%, and the monthly rate of FNAs and operations by 60% and 40%, respectively. However, the proportion of cancers/FNA remained similar (9.9% post‐TIRADS vs. 8.7% pre‐TIRADS). The proportions of FNA results remained stable for B2−B4 categories, but doubled (11% vs. 5%) for B5−B6: 15 FNAs were needed to identify an additional B5/B6 lesion. TIRADS‐5 nodules had a higher proportion of B5/B6 (20%) and a lower proportion of B2 (30%) than TIRADS‐3 (2%, 57%, respectively) and TIRADS‐4 (9%, 56%) nodules. About 5 additional cancers/year were diagnosed, but they were more often small (49% vs. 8% <2 cm, 17% vs. 0% <1 cm).

Conclusion

ACR‐TIRADS introduction increased workload (FNAs and operations), without increasing the proportion of cancers/FNA. It led to a few more cancers being diagnosed, but many were small and of uncertain clinical significance.
Current landscape of kidney allocation: Organ procurement organization perspectives
Authors: Concepcion Beatrice P. , Harhay Meera , Ruterbories Jay , Finn Jan , Wiseman Alex , Cooper Matthew , Mohan Sumit , Doshi Mona D.
Published: January 2023

Organ procurement organizations (OPOs) play a central role in the recovery, preservation, and distribution of deceased donor kidneys for transplantation in the United States. We conducted a national survey to gather information on OPO practices and perceived barriers to efficient organ placement in the face of the new circle‐based allocation and asked for suggestions to overcome them. Of the 57 OPOs, 44 responded (77%). The majority of OPOs (61%) reported barriers to obtaining a kidney biopsy, including lack of an available pathologist. Most OPOs (55%) indicated barriers to pumping owing to a lack of available staff and transportation. Respondents agreed or strongly agreed that the new allocation system has worsened transportation challenges (85%), increased provisional acceptances of kidneys (66%), increased communication challenges with transplant centers (68%), and worsened the efficiency of organ allocation (83%). OPO‐suggested solutions include making transplant centers more accountable for inefficient selection practices, developing reliable transportation options, and removing the requirement for national sharing. These findings underscore the need to examine closely the trade‐offs of the new allocation system with respect to costs, organ ischemia, and discard. These findings may help inform practice and policy for overcoming transportation barriers and improving the efficiency of organ placement.
Monitoring of mitral‐ and tricuspid valve interventions with CardioMEMS: Insights beyond imaging
Authors: Dannenberg Varius , Koschutnik Matthias , Donà Carolina , Nitsche Christian , Spinka Georg , Heitzinger Gregor , Mascherbauer Katharina , Kammerlander Andreas , Schneider‐Reigbert Matthias , Winter Max‐Paul , Bartko Philipp , Goliasch Georg , Hengstenberg Christian , Mascherbauer Julia , Gwechenberger Marianne
Published: January 2023

Background

Mitral‐ and tricuspid regurgitation are associated with significant morbidity and mortality and are increasingly treated interventionally. CardioMEMS is a transcutaneously implanted pressure sensor placed in the pulmonary artery that allows invasive measurement of pulmonary artery pressure and cardiac output.

Methods

This proof‐of‐concept study aimed to observe hemodynamic changes as determined by CardioMEMS after transcatheter atrioventricular valve interventions, assess the additional value of CardioMEMS on top of echocardiography, and investigate a potential effect of CardioMEMS on outcome. Patients treated with transcatheter mitral‐ or tricuspid valve interventions (mitral: TMVR, tricuspid: TTVR) or bicaval valve implantation (bi‐CAVI) were recruited. All patients were followed for 12 months.

Results

Thirty‐six patients were included (4 with CardioMEMS, 32 controls). Patients with CardioMEMS were monitored prior to intervention and 3–12 months thereafter (one received TMVR, one bi‐CAVI, one both TMVR and TTVR, and one isolated TTVR). CardioMEMS group: In both patients with TMVR and in the patient with bi‐CAVI, mean pulmonary artery pressures decreased (all p < .001) and cardiac output increased significantly (both TMVR p < .001 and bi‐CAVI p = .006) while functional parameters, echocardiography, and NT‐proBNP were difficult to interpret, unreliable, or both. Changes after TTVR remained inconclusive.

Conclusion

Invasive monitoring using CardioMEMS provides important information after mitral‐ and tricuspid valve interventions. Such data pave the way for a deeper understanding of the prerequisites for optimal patient selection and management for catheter‐based interventions.
Effect of magnifying loupes on tooth preparation of complete coverage crown: A quantitative assessment using a digital approach
Authors: Murbay Sukhdeep , Neelakantan Prasanna , Li Kar Yan , Pow Edmond Ho Nang
Published: January 2023

Objective

The purpose of this study was to evaluate the use of magnifying loupes (×2.5) on the quality of tooth preparation for complete coverage crowns; performed by predoctoral students using an objective and quantitative digital method.

Materials and Methods

Forty‐two predoctoral students were randomly assigned into 2 groups to perform tooth preparation for a complete coverage crown on a mandibular first molar in a manikin, with and without the use of magnifying loupes. All preparations were digitally evaluated by PrepCheck 3.0 (Dentsply Sirona). Parameters including tooth reduction, total occlusal convergence (TOC), undercut, margin quality and surface quality were assessed. Continuous data were analysed using Paired t‐tests or Wilcoxon Signed Ranks tests. Ordinal data were analysed by McNemer's tests. To further detect the majority pattern ( > 50%) in each group (with and without loupes), one‐sample t‐test or one‐sample Wilcoxon Signed Rank test was performed. The level of significance was set at p = .001 after Bonferroni adjustments for multiple testing.

Results

No significant differences in the measured outcomes were found between the groups with or without the use of magnifying loupes (p > .002). The majority (>50%) of both groups had no undercuts (99.3% and 99.4% both p < .001) and the preparation type was within tolerance (81.6% and 85.3%, both p < .001) with acceptable margin (86.4% and 86.3%, both p < .001) and acceptable surface quality (99.0% and 99.1%, both p < .001). However, the majority of both groups underprepared occlusally (96.0% and 95.4%, both p < .001) and axially (65.3% and 67%, both p < .001). Only 30.0%–42.1% of the participants achieved the TOC within 0–20°.

Conclusions

Within the limitations of this study, the use of magnification loupes does not appear to significantly improve the quality of tooth preparation for complete coverage crown. The TOC was also found to be overprepared and occlusally underprepared.
Role of reflectance confocal microscopy for in vivo investigation of oral disorders: White, red and pigmented lesions
Authors: Franceschini Chiara , Mandel Victor Desmond , Peterson Gary , Manciocco Valentina , Guitera Pascale , Rajadhyaksha Milind , Ardigò Marco
Published: January 2023

In vivo reflectance confocal microscopy (RCM) is poorly investigated in oral pathology due to the peculiar anatomical and topographical oral mucosa features. A dedicated handheld confocal microscope with an intra‐oral probe was developed for oral mucosa imaging. The main objective was to describe the healthy oral mucosa and the cytoarchitectural findings detectable in different oral disorders by means of the newly designed handheld confocal microscope. Secondary aim was to identify the main RCM criteria that differentiate oral lesions in order to provide algorithm for a rapid non‐invasive evaluation. This observational retrospective study included all consecutive patients with oral disorders and volunteers with healthy oral mucosa who underwent RCM examination in our outpatient clinic from September 2018 to December 2021. Three different investigators examined together the RCM images to detect the key features and secondary criteria for each type of oral lesion collected. The study population included 110 patients affected by oral lesions and seven volunteers with healthy oral mucosae. A total of 15 oral disorders were imaged and divided in three main groups: white, red and pigmented lesions. Key features and secondary criteria were identified for every single type of oral disease. RCM permits a cytoarchitectural evaluation of the oral mucosae affected by inflammatory, dysplastic and neoplastic diseases, thus orienting the clinicians towards non‐invasive diagnosis and enhancing the diagnostic management. The “tree diagrams” proposed allow a schematic and simplified view of confocal features for each type of oral disease, thus drastically reducing the diagnostic timing.
The Stable Low‐Conflict Index: A policy‐relevant outcome in government‐funded relationship education efforts
Authors: Stanley Scott M. , Barton Allen W. , Ritchie Lane L. , Allen Maggie O. T. , Rhoades Galena K.
Published: January 2023

Objective

We posit that evaluators of relationship education interventions can explore a policy relevant outcome by assessing relationship stability and conflict in a single index that is based on the literature on the effects of divorce and marital distress on children. We provide an empirical example from a randomized trial.

Background

The U.S. Administration for Children and Families funds community‐based projects using relationship education with a foundational goal of fostering stable and healthy relationships. Assessing this outcome requires an approach different from separately analyzing stability and relationship quality.

Method

We used data (N = 1,156 couples) from a randomized trial of Family Expectations to test the Stable Low‐Conflict Index, comparing couples assigned to the intervention to couples assigned to an untreated control group at a follow‐up 8 to 9 months postintervention.

Results

Intervention couples were more likely to be in a stable, low‐conflict relationship at the follow up than control couples (b = .36, SE = .15, odds ratio = 1.44, p = .014).

Conclusion

An index based on empirical precedence showed evidence of an intervention impact in a community‐based program.

Implications

Evaluators of family policy linked interventions may advance the field by exploring outcomes that encapsulate aspects of both relationship stability and quality.
Effects of Soil Type and Thermal Boundary on Predicting Temperature Profiles and Groundwater Fluxes
Authors: Chang Chia‐Hao , Lin Ying‐Fan , Shiau Yo‐Jin , Tsai Yi‐Zhih , Tsai Jui‐Pin
Published: January 2023

In the last few years, several articles have studied heat as a groundwater tracer and developed analytical geothermal solutions to predict the subsurface temperature and groundwater fluxes. These solutions can be sorted into steady‐state and transient solutions. The steady‐state solutions cannot describe the time‐varying subsurface temperature, while the transient solutions ignore subsurface thermal boundary effects. Moreover, soil type may be another crucial factor significantly affecting the prediction results. This study compares six existing classical analytical solutions to examine the effects of soil types and subsurface thermal boundaries on simulating temperature‐depth profiles and estimating groundwater fluxes. Several synthetic cases are built by considering the common soil types, sand and clay, to demonstrate their effects on predicting the profiles. A field case is used to show the effect of subsurface thermal boundaries on the groundwater flux estimated by an inverse approach. The study results indicate that the soil types have significant influences on simulating the profiles, and the influences grow with time. Some existing solutions may give inaccurate estimations of the field groundwater flux since they merely consider the heat source from the temperature variations on the ground surface but ignore possible thermal boundary effects in the subsurface. These findings will be valuable to those applying heat as a tracer to investigate infiltration.
Sodium hyaluronates applied in the face affects the diversity of skin microbiota in healthy people
Authors: He Chen , Yue YingXue , Li Ruilong , Huang Yiping , Shu Luan , Lv Huixia , Wang Jing , Zhang Zhenhai
Published: January 2023

Objective

A healthy and stable microbiome has many beneficial effects on the host, while an unbalanced or disordered microbiome can lead to various skin diseases. Hyaluronic acid is widely used in the cosmetics and pharmaceutical industries; however, specific reports on its effect on the skin microflora of healthy people have not been published. This study aimed to determine the effect of sodium hyaluronate on the facial microflora of healthy individuals.

Methods

Face of 20 healthy female volunteers between 18 and 24 years was smeared with sodium hyaluronate solution once per day. Cotton swabs were used to retrieve samples on days 0, 14, and 28, and high‐throughput sequencing of 16 S rRNA was used to determine the changes in bacterial community composition.

Results

Facial application of HA can reduce the abundance of pathogenic bacteria, such as Cutibacterium and S. aureus, and increase the colonization of beneficial bacteria.

Conclusion

This is the first intuitive report to demonstrate the effect of hyaluronic acid on facial microflora in healthy people. Accordingly, sodium hyaluronate was found to have a positive effect on facial skin health.
Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles
Authors: Gulabivala Kishor , Ng Yuan Ling
Published: January 2023

This paper undertakes a broad and comprehensive synthesis of relevant clinical, biological, biomechanical, technical and healthcare services data to understand the factors affecting outcomes of periapical healing after root canal (re)treatment. The medical and dental evidence‐based era (1980–present) is contextualized with the earlier evidence drive in endodontics (1911–1940) triggered by the focal infection era. The current evidence‐based approach has a sharper focus on evidence quality and derivation of practice guidelines. Contrary views question whether guideline‐driven, or expertise‐development‐driven endeavours would best serve outcome improvement in society. The endodontic discipline functions in a broad healthcare framework and sustains industrial, economic and trend pressures that may be deemed to influence outcomes. The nature of root canal treatment and the challenges in determining the factors that affect its outcomes is discussed. The factors potentially affecting periapical healing after root canal treatment are classified into pre‐operative, intra‐operative and postoperative groups. These categories subsume multiple elements with interactive influences, creating a complex picture, further confounded by some apparently surprising, counter‐intuitive and contradictory findings. The technical versus biological conundrum in root canal treatment continues to cause cognitive dissonance. However, due reflection and cross‐discipline‐synthesis resolve the apparent data conflicts into a very simple, consistent and plausible picture of how root canal treatment works and the key factors that affect periapical healing. Root canal retreatment is considered mainly in the context of its differences from primary treatment as the majority of factors influencing outcomes are common to both. The exceptional difference is that retreatments have a proportionately reduced probability of healing by virtue of compromised apical root canal ramification access or modified host/infection interactions. Root canal (re)treatment outcomes are dominantly influenced by the nature of prior dynamic host/infection interaction (pre‐operative patient factors) and how the direction of this dynamic is influenced by two factors: (1) the active efficacy of the operators' root canal treatment protocol to sustain a microbial ecological shift (intra‐operative treatment factors) and dampen periapical inflammation; and (2) the passive ability of the functional tooth (and its restoration margin) to maintain its integrity to resist infection reversal (postoperative restorative factors).
YSZ/Ni double‐shell powder via surface electroless deposition tuned by an active kinetic model
Authors: Yan Kang , Meijun Liu , Lin Chen , Guanjun Yang
Published: January 2023

Yttria‐stabilized zirconia (YSZ) powder with surface Ni plating has promising application in many fields due to its large surface area, low density and excellent high temperature performance. In this study, YSZ/Ni double‐shell powder was fabricated via electroless deposition method, and an active surface kinetic model was developed to tune the surface area and nuclei loading quantitatively. A novel concept, active surface ratio (ASR, the ratio of active deposition surface area to projected area of ceramic powder), is proposed to intrinsically correlate deposition rate with nuclei topology on ceramic surface. The intrinsic relationship between microstructure of metallized ceramic surface and deposition duration was clarified. The active surface kinetic model reveals the correlation between the ASR and instantaneous deposition rate and provides necessary theoretical basis for effective control of ceramic surface modification process by electroless deposition.
Dimensions of emigration policy: An indexing exercise for polities across three regions
Authors: Pedroza Luicy , Palop‐García Pau
Published: January 2023

Specialized indices of immigration, immigrant integration policies, and citizenship policies are expanding the confines of our knowledge in the field of comparative migration policies. Emigration policies, however, have garnered less attention. We address this gap in the literature, by using a new data set to create an index that measures contemporary emigration regulations of 32 polities across three regions in the world (Asia, Europe and Latin America and the Caribbean). Based on this exploratory exercise, we examine the assumptions about emigration controls and policies being a matter of the past or belonging to non‐democratic regimes. We find that emigration policies go beyond the mere regulation of the right to exit. Different components across a continuum from restriction to encouragement of emigration suggest different rationales and purposes of states, even if the hardest forms of emigration control, such as exit bans are absent in the studied sample.
Clinical and economic burden of benign and malignant skin lesions in renal transplant recipients
Authors: Thet Zaw , Lam Alfred K. , Pham Tony , Ng Shu‐Kay , Steel Jason C. , Sawhney Sirena , Arellano Carolina T. , Aung Soe Yu , Han Thin , Ranganathan Dwarakanathan , John George , Pepito Christina , Rautenberg Tamlyn , Khoo Tien K.
Published: January 2023

Background

Studies evaluating the economic burden of dermatological care in the transplant setting are currently not available in Australia.

Aims

To evaluate the clinical and economic burden of benign and malignant skin lesions in renal transplant recipients in Central Queensland.

Methods

A bottom‐up approach was used to determine the clinical burden and direct costs from patient‐level Medicare data obtained from Service Australia for skin lesions.

Results

Seventy‐six percent of the renal transplant population in Central Queensland participated in this study. The median age was 57.0 years (standard deviation ± 13.6) and the majority (61.8%) of participants were men. The mean duration after transplant surgery was 99.9 months (interquartile range, 73.2–126.6 months). During a 2‐year follow‐up, 22 (40%) patients were diagnosed with benign skin lesions, 21 (38%) with nonmelanoma skin carcinoma (NMSC) and one (2%) with melanoma. There was a total of 231 visits to clinicians for diagnostic and therapeutic skin procedures and the direct costs to Medicare was $48 806 Australian Dollars (AUD) or $30 427 US Dollars (USD). Approximately 86% of the total direct costs was spent for nonNMSC and mean direct costs for NMSC was $763 AUD (or $476 USD).

Conclusion

This Medicare data‐based study provides further insight into the burgeoning clinical and economic burden of the care for benign and malignant skin lesions in the renal transplantation setting in Australia.
Emotion regulation, e‐learning readiness, technology usage status, in‐class smartphone cyberloafing, and smartphone addiction in the time of COVID‐19 pandemic
Authors: Gökçearslan Şahin , Yildiz Durak Hatice , Esiyok Elif
Published: January 2023

Background

The COVID‐19 pandemic has spread quickly, e‐learning became compulsory and disseminated throughout the world. During the pandemic, smartphones are frequently used to access e‐learning content, but connecting to technological tools increased the risk of cyberloafing during e‐courses. Currently, there are a limited number of studies on how e‐learning will evolve under compulsory conditions.

Objectives

This study aimed to investigate the relationship between emotion regulation, e‐learning readiness, technology usage status (TUS), in‐class smartphone cyberloafing, and smartphone addiction (SA) of the students during the pandemic.

Methods

In total 1294 students participated in this study. A research model was tested by structural equation modelling.

Results and Conclusion

The findings of this study indicated that there is a relationship between TUS and SA. Emotion regulation was related to SA. E‐learning readiness levels can help to explain cyberloafing. This study presents a conceptual model of the variables that affect cyberloafing in the context of the e‐learning environment.
Empagliflozin is associated with lower risk of cardiovascular events and all‐cause mortality in routine care in East Asia: Results from the EMPRISE study
Authors: Kim Dae Jung , Sheu Wayne H‐H , Chung Wook‐Jin , Yabe Daisuke , Ha Kyoung Hwa , Nangaku Masaomi , Tan Elise Chia‐Hui , Node Koichi , Yasui Atsutaka , Lei Weiyu , Lee Sunwoo , Saarelainen Laura , Deruaz‐Luyet Anouk , Kyaw Moe H , Seino Yutaka ,   EMPRISE East Asia Study Group
Published: January 2023

Aims/Introduction

The EMPA‐REG OUTCOME® trial demonstrated benefits of empagliflozin, a sodium‐glucose cotransporter‐2 inhibitor (SGLT2i), on cardiovascular, renal outcomes and all‐cause mortality in patients with type 2 diabetes and established cardiovascular disease. The EMPRISE study program evaluates how these effects translate in a broad population of patients with type 2 diabetes in routine clinical care across countries.

Materials and Methods

The study included patients ≥18 years with type 2 diabetes initiating empagliflozin or any dipeptidyl peptidase‐4 inhibitors (DPP‐4i) from large administrative databases in Japan, South Korea, and Taiwan. Propensity score‐matched (1:1) ‘as‐treated’ analyses comparing the risk of cardiovascular outcomes and all‐cause mortality between empagliflozin and DPP‐4i use were performed in each country. Pooled hazard ratios (pHR) with 95% confidence intervals (CI) were computed using random effects meta‐analysis models comparing both empagliflozin and SGLT2i with DPP‐4i use, respectively. Intention‐to‐treat and subgroup analyses in patients with/without cardiovascular disease and in patients receiving 10 mg empagliflozin were performed.

Results

The study included 28,712 and 70,233 matched patient pairs for empagliflozin/DPP‐4i and SGLT2i/DPP‐4i analyses, respectively. The risk of composite outcomes including (i) hospitalization for heart failure (HHF) and all‐cause mortality was lower with empagliflozin (pHR 0.76, 95% CI 0.67–0.86) and SGLT2i (0.71, 0.65–0.77); (ii) combined myocardial infarction, stroke, and all‐cause mortality was also lower with empagliflozin (0.74, 0.61–0.88) and SGLT2i (0.69, 0.60–0.78) compared to DPP‐4i. The intention‐to‐treat and three subgroup analyses were consistent with results of the main analyses.

Conclusions

The results suggest that both empagliflozin and SGLT2i compared with DPP‐4i are associated with a lower risk of cardiovascular events and all‐cause mortality in routine clinical care in East Asia.
Comparison of the long‐term outcomes between proximal and distal IgG4‐related sclerosing cholangitis: A multicenter cohort study
Authors: Cho Sung Hyun , Song Tae Jun , Park Jin‐Seok , Yoon Jai Hoon , Yang Min Jae , Yoon Seung Bae , Lee Jae Min , Lee Yun Nah , Kim Seong‐Hun , Choi Eun Kwang , Park Se Woo , Oh Dongwook , Park Do Hyun , Lee Sang Soo , Seo Dong‐Wan , Lee Sung Koo , Kim Myung‐Hwan
Published: January 2023

Background and Aims

Immunoglobulin G4‐related sclerosing cholangitis (IgG4‐SC) is considered a biliary manifestation of IgG4‐related diseases. However, there has been a controversy on the clinical outcomes according to the location of the involved bile duct. We therefore compared the clinical outcomes and long‐term prognosis of IgG4‐SC with proximal bile duct involvement (proximal IgG4‐SC) and IgG4‐SC with distal bile duct involvement (distal IgG4‐SC).

Methods

We reviewed the data of patients with IgG4‐SC that were prospectively collected at 10 tertiary centers between March 2002 and October 2020. Clinical manifestations, outcomes, association with autoimmune pancreatitis (AIP), steroid‐responsiveness, and relapse of IgG4‐SC were evaluated.

Results

A total of 148 patients (proximal IgG4‐SC, n = 59; distal IgG4‐SC, n = 89) were analyzed. The median age was 65 years (IQR, 56.25–71), and 86% were male. The two groups were similar in terms of jaundice at initial presentation (51% vs 65%; P = 0.082) and presence of elevated serum IgG4 (66% vs 70%; P = 0.649). The two groups showed significant differences in terms of steroid‐responsiveness (91% vs 100%; P = 0.008), association with AIP (75% vs 99%; P = 0.001), and occurrence of liver cirrhosis (9% vs 1%; P = 0.034). During a median follow‐up of 64 months (IQR, 21.9–84.7), the cumulative relapse‐free survival was significantly different between the two groups (67% vs 79% at 5 years; P = 0.035).

Conclusions

Relapse of IgG4‐SC frequently occurred during follow‐up. Proximal IgG4‐SC and distal IgG4‐SC had different long‐term outcomes in terms of steroid‐responsiveness, occurrence of liver cirrhosis, and recurrence. It may be advantageous to determine the therapeutic and follow‐up strategies according to the location of bile duct involvement.
Financial literacy in the digital age—A research agenda
Authors: Koskelainen Tiina , Kalmi Panu , Scornavacca Eusebio , Vartiainen Tero
Published: January 2023

Digital innovations are transforming financial services and resulting changes in consumer behavior and personal money management. Diffusion of pervasive digital technologies offers individuals quick and easy access to various digital services bringing opportunities and challenges into their personal money management. The study aimed to explore how digitalization affects individuals' financial literacy and financial capability. As a result, we identified three main themes in the intersection of finance and digitalization: Fintech, Financial behavior in digital environments, and Behavioral interventions. We propose directions for measuring digital financial literacy, updates to the financial literacy curriculum, and developments of digital learning tools. Further, we highlight collaboration between the public and private sectors to create a fairer and more inclusive economic landscape. Our study contributes to existing research by proposing a framework for digital financial literacy and financial capability and a research agenda for future studies.
Transforming acute pain management in children: A concept analysis to develop a new model of nurse, child and parent partnership
Authors: Eull Donna , Looman Wendy , O'Conner‐Von Susan
Published: January 2023

Objectives

To identify the core components of acute pain management in children, re‐conceptualise the process and update the existing model to inform nursing research and clinical practice.

Background

Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient‐centred approach and a conceptual model which includes the role of parents and partnership.

Design

Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children.

Methods

A scoping review of peer‐reviewed literature from 1990 through 2020 was conducted using the terms “pain management,” “pain control,” “pain treatment,” “multi modal,” and “concept*”. Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used.

Results

A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision‐making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process.

Conclusion

The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient‐centred. The new collaborative model will promote shared decision‐making for individualised pain assessments, interventions and evaluations.

Relevance to clinical practice

Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science.

No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works.
Objective biomarkers of depression: A study of Granger causality and wavelet coherence in resting‐state fMRI
Authors: Cîrstian Ramona , Pilmeyer Jesper , Bernas Antoine , Jansen Jacobus F. A. , Breeuwer Marcel , Aldenkamp Albert P. , Zinger Svitlana
Published: January 2023

Background and Purpose

The lack of a robust diagnostic biomarker makes understanding depression from a neurobiological standpoint an important goal, especially in the context of brain imaging.

Methods

In this study, we aim to create novel image‐based features for objective diagnosis of depression. Resting‐state network time series are used to investigate neurodynamics with the help of wavelet coherence and Granger causality (G‐causality). Three new features are introduced: total wavelet coherence, wavelet lead coherence, and wavelet coherence blob analysis. The fourth feature, pair‐wise conditional G‐causality, is used to establish the causality between resting‐state networks. We use the proposed features to classify depression in adult subjects.

Results

We obtained an accuracy of 86% in the wavelet lead coherence, 80% in Granger causality, and 86% in wavelet coherence blob analysis. Subjects with depression showed hyperconnectivity between the dorsal attention network and the auditory network as well as between the posterior default mode network and the dorsal attention network. Hypoconnectivity was found between the anterior default mode network and the auditory network as well as the right frontoparietal network and the lateral visual network. An abnormal co‐activation pattern was found between cerebellum and the lateral motor network according to the wavelet coherence blob analysis.

Conclusion

Based on abnormal functional dynamics between brain networks, we were able to identify subjects with depression with high accuracy. The findings of this study contribute to the understanding of the impaired emotional and attention processing associated with depression, as well as decreased motor activity.
Atopy and allergy following solid organ transplantation: A 15‐year experience
Authors: Roberts Amin J , Lim Alicia , Bishop Jonathan R , Gane Ed , Rakhmanova Elizaveta , Wong William , Evans Helen M
Published: January 2023

Aim

There are increasing reports of atopy/allergy following solid organ transplantation, especially paediatric liver transplantation (LT) with minimal New Zealand (NZ) data. We describe the prevalence of transplant‐acquired atopy and allergy (TAA) in NZ paediatric liver transplant recipients, compared to paediatric kidney and adult liver transplants.

Methods

TAA focussed health questionnaires were sent to patients selected from the NZ transplant registry (transplanted between January 2003 and December 2017). Demographic and clinical data were also obtained from electronic health records and follow‐up phone calls.

Results

A total of 232 patients (62% male) participated (111 adult liver, 82 paediatric liver, 39 paediatric kidney transplant recipients). Tacrolimus was primary immunosuppression for all LT patients; with combined tacrolimus, mycophenolate and corticosteroids for kidney transplants. The number of patients who developed TAA was significantly higher (P < 0.001) in the paediatric LT group (36/82, 44%) compared to adult liver (12/111, 11%) and paediatric kidney transplants (4/39, 10%). Eczema was most common (73%), then IgE‐mediated food allergy (FA, 33%), allergic rhinitis (19%) and asthma (17%). Six paediatric LT recipients developed eosinophilic oesophagitis (EoE). Egg was the most common allergen in the IgE‐mediated FA group. TAAs were severe enough to warrant a switch from tacrolimus to another agent in seven paediatric LT patients. For paediatric LT patients, female gender and younger age at transplant were risk factors for developing TAA.

Conclusions

TAA is common in paediatric liver transplant recipients, with female gender and younger age at transplant being risk factors identified. This highlights the need for detailed atopic and allergy history to be incorporated in all pre‐transplant assessments.
Patents and other conditions of access to vaccines
Authors: Arup Christopher , Plahe Jagjit
Published: January 2023

This paper reviews the experience with access to vaccines during the pandemic. Its inquiry is the extent to which pharmaceutical patents have hindered or enhanced access when compared to other factors or conditions like health spending, manufacturing capacity, and regulatory competence. To conduct the review, the paper queries the regulatory governance perspective when it suggests a decentralised field of legal pluralism will maximise access. It recalls the pre‐COVID‐19 experience with antiretrovirals to provide pointers to the present situation. It then examines the experience with COVID vaccines under the headings of invention, production, procurement, and distribution. The review finds while patents may hinder access to vaccines, other, essential conditions for access, like independent manufacturing capacity and commitment to procurement, are not established. Regulatory governance must now adopt a much more concerted, coordinated approach, mobilising both patent regulation and other key conditions to further access. The review is an opportunity to gather some of the copious commentary on this issue.
Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study
Authors: Lu Yi , Yang Jun , Li Peng , Teng Fei , Guo Shubin
Published: January 2023

Objective

This study aims to investigate the changes in microcirculation and internal environment before sepsis in patients with infectious diseases.

Methods

In this single‐center prospective observational study, all patients did not meet the diagnostic criteria of sepsis 3.0 at admission. Blood samples and sublingual microcirculation were collected at admission, 24 and 48 h after admission.

Results

A total of 101 patients completed this study. In total, 46 patients met the diagnostic criteria of sepsis 3.0 within 5 days after admission, while the remaining 55 patients did not. The platelet (PLT) was significantly lower in the sepsis patients (195.17 ± 63.89 vs. 242.02 ± 68.59, p = .01), Microvascular Flow Index (MFI) (2.45 ± 0.33 vs. 2.70 ± 0.18, p = .00) and Proportion of Perfused Vessels (PPV) (92.44 ± 4.45 vs. 95.88 ± 3.20, p = .00) were significantly lower, while Flow Heterogeneity Index (FHI) (0.32 ± 0.13 vs. 0.22 ± 0.10, p = .00) was significantly higher in the in the sepsis patients at admission. Decreased levels of MFI (p = .00, OR 0.02, 95% CI: 0.00, 0.15) and PLT (p = .00, OR 0.99, 95% CI: 0.98, 1.00) were independent risk factors for sepsis. Additionally, the 24 h PLT change rate (AUC 0.85, Cutoff −0.17, sensitivity 0.70, specificity 0.93, and Youden index 0.63) suggested a potential early warning effect for sepsis.

Conclusion

Changes in microcirculation disturbance and the internal environment occurred before sepsis. The MFI and PLT are independent risk factors for sepsis. Sublingual microcirculation and PLT deterioration can be used as early warning indicators before sepsis.
Regional redistribution of CB1 cannabinoid receptors in human foetal brains with Down's syndrome and their functional modifications in Ts65Dn+/+ mice
Authors: Patthy Ágoston , Hanics János , Zachar Gergely , Kovács Gábor G. , Harkany Tibor , Alpár Alán
Published: January 2023

Aims

The endocannabinoid system with its type 1 cannabinoid receptor (CB1R) expressed in postmitotic neuroblasts is a critical chemotropic guidance module with its actions cascading across neurogenic commitment, neuronal polarisation and synaptogenesis in vertebrates. Here, we present the systematic analysis of regional CB1R expression in the developing human brain from gestational week 14 until birth. In parallel, we diagrammed differences in CB1R development in Down syndrome foetuses and identified altered CB1R signalling.

Methods

Foetal brains with normal development or with Down's syndrome were analysed using standard immunohistochemistry, digitalised light microscopy and image analysis (NanoZoomer). CB1R function was investigated by in vitro neuropharmacology from neonatal Ts65Dn transgenic mice brains carrying an additional copy of ~90 conserved protein‐coding gene orthologues of the human chromosome 21.

Results

We detected a meshwork of fine‐calibre, often varicose processes between the subventricular and intermediate zones of the cortical plate in the late first trimester, when telencephalic fibre tracts develop. The density of CB1Rs gradually decreased during the second and third trimesters in the neocortex. In contrast, CB1R density was maintained, or even increased, in the hippocampus. We found the onset of CB1R expression being delayed by ≥1 month in age‐matched foetal brains with Down's syndrome. In vitro, CB1R excitation induced excess microtubule stabilisation and, consequently, reduced neurite outgrowth.

Conclusions

We suggest that neuroarchitectural impairments in Down's syndrome brains involve the delayed development and errant functions of the endocannabinoid system, with a particular impact on endocannabinoids modulating axonal wiring.
Haemodialysis vascular catheter‐related blood stream infection: Organism types and clinical outcomes
Authors: Phillips Jessica , Chan Doris T. , Chakera Aron , Swaminathan Ramyasuda , Patankar Khalil , Boudville Neil , Lim Wai H.
Published: January 2023

Catheter‐related bloodstream infection (CRBI) is an important complication of catheter use for haemodialysis, but it remains unclear whether clinical outcomes following CRBI are influenced by organism type. This study aims to compare clinical outcomes following CRBI from Gram‐positive and non‐Gram‐positive organisms. This was a retrospective cohort study of patients with kidney failure receiving haemodialysis (HD) via vascular catheters who had a documented episode of CRBI in Western Australia between 2005 and 2018. The associations between organism type, likelihood of hospitalization, catheter removal and death from CRBI were examined using adjusted logistic regression models. There were 111 episodes of CRBI in 99 patients (6.1 episodes per 1000‐catheter‐days at risk). Of the study cohort, 53 (48%) were male and 38 (34%) identified as Aboriginal or Torres Strait Islander. Gram‐positive organisms were identified in 73 (66%) CRBI episodes, most commonly Staphylococcus aureus. Of those with non‐Gram‐positive CRBI, 9 (24%) were attributed to Pseudomonas aeruginosa. One‐hundred and two (92%) episodes of CRBI required hospitalization and 15 (13%) patients died from CRBI. Compared with non‐Gram‐positive CRBI, Gram‐positive CRBI was associated with an increased risk of hospitalization and catheter removal, with adjusted odds ratio of 9.34 (95% CI 1.28–68.03) and 3.47 (95% CI 1.25–9.67), respectively. There was no association between organism type and death from CRBI. Staphylococcus aureus remains the most common organism causing CRBI in HD patients. CRBI is associated with substantial morbidity, particularly CRBI attributed to Gram‐positive organisms.

image
Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus
Authors: Wang Yeming , Li Jian , Men Yutao , Wei Wanfu
Published: January 2023

Objective

Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column.

Methods

A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20–39 years), group B (40–59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one‐way ANOVA.

Results

The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C.

Conclusion

Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.
All you fear is love: The roles of rejection by intimate others
Authors: Aracı‐İyiaydın Ayşegül , Toplu‐Demirtaş Ezgi , Akçabozan‐Kayabol Nazlı Büşra , Rohner Ronald P.
Published: January 2023

Interpersonal acceptance‐rejection theory (IPARTheory) asserts that recollections of parental rejection in childhood tend to result in psychological maladjustment and intimacy problems in later romantic relationships. Informed by IPARTheory, we investigated the association between maternal & paternal rejection, and fear of intimacy by the mediating role of psychological maladjustment in a Turkish sample with 462 mostly young adults. We further explored the moderator role of gender in Model 1 and the moderating roles of both gender and intimate partner rejection in Model 2. Model 1 revealed that adults who had experienced maternal and paternal rejection in childhood tended to be psychologically maladjusted. Consequently, they also tended to have a fear of intimacy, regardless of gender. Model 2 revealed that women who recall having been rejected in childhood by their mothers tended to be psychologically maladjusted and to have a significant fear of intimacy when they also experienced moderate or more than moderate intimate‐partner rejection. However, both women and men who experienced paternal rejection in childhood tended to be psychologically maladjusted and to experience a greater fear of intimacy when they perceived any degree of intimate partner rejection. Implications of the results for theory, research, and practice are discussed.
Disparities in vaccination rates in solid organ transplant patients
Authors: Felzer Jamie R. , Finney Rutten Lila J. , Wi Chung‐Il , LeMahieu Allison M. , Beam Elena , Juhn Young J. , Jacobson Robert M. , Kennedy Cassie C.
Published: January 2023

Introduction

Vaccinations against preventable respiratory infections such as Streptococcus pneumoniae and influenza are important in immunosuppressed solid organ transplant (SOT) recipients. Little is known about the role of age, race, ethnicity, sex, and sociodemographic factors including rurality, or socioeconomic status (SES) associated with vaccine uptake in this population.

Methods

We conducted a population‐based study using the Rochester Epidemiology Project, a medical records linkage system, to assess socioeconomic and demographic factors associated with influenza and pneumococcal vaccination rates among adult recipients of solid organ transplantation (aged 19–64 years) living in four counties in southeastern Minnesota. Vaccination data were obtained from the Minnesota Immunization Information Connection from June 1, 2010 to June 30, 2020. Vaccination rate was assessed with Poisson and logistic regression models.

Results

A total of 468 SOT recipients were identified with an overall vaccination rate of 57%–63% for influenza and 56% for pneumococcal vaccines. As expected, vaccination for pneumococcal vaccine positively correlated with influenza vaccination. Rural patients had decreased vaccination in both compared to urban patients, even after adjusting for age, sex, race, ethnicity, and SES. Although the population was mostly White and non‐Hispanic, neither vaccination differed by race or ethnicity, but influenza vaccination did by SES. Among organ transplant groups, liver and lung recipients were least vaccinated for influenza, and heart recipients were least up‐to‐date on pneumococcal vaccines.

Conclusions

Rates of vaccination were below national goals. Rurality was associated with undervaccination. Further investigation is needed to understand and address barriers to vaccination among transplant recipients.

image