bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving health care facility birth rates in Rorya District, Tanzania: a multiple baseline trial
Authors: Webber Gail , Chirangi Bwire , Magatti Nyamusi , Mallick Ranjeeta , Taljaard Monica
Published: January 2022

Background

Rates of maternal mortality and morbidity in Africa remain unacceptably high, as many women deliver at home, without access to skilled birth attendants and life-saving medications. In rural Tanzania, women face significant barriers accessing health care facilities for their deliveries.

Methods

From January 2017 to February 2019 we conducted a multiple baseline (interrupted time series) trial within the four divisions of Rorya District, Tanzania. We collected baseline data, then sequentially introduced a complex intervention in each of the divisions, in randomized order, over 3 month intervals. We allowed for a 6 month transition period to avoid contamination between the pre- and post-intervention periods. The intervention included using community health workers to educate about safe delivery, distribution of birth kits with misoprostol, and a transport subsidy for women living a distance from the health care facility. The primary outcome was the health facility birth rate, while the secondary outcomes were the rates of antenatal and postpartum care and postpartum hemorrhage. Outcomes were analyzed using fixed effects segmented logistic regression, adjusting for age, marital status, education, and parity. Maternal and baby morbidity/mortality were analyzed descriptively.

Results

We analyzed data from 9565 pregnant women (2634 before and 6913 after the intervention was implemented). Facility births increased from 1892 (71.8%) before to 5895 (85.1%) after implementation of the intervention. After accounting for the secular trend, the intervention was associated with an immediate increase in the odds of facility births (OR = 1.51, 95% CI 1.14 to 2.01, p = 0.0045) as well as a small gradual effect (OR = 1.03 per month, 95% CI 1.00 to 1.07, p = 0.0633). For the secondary outcomes, there were no statistically significant immediate changes associated with the intervention. Rates of maternal and baby morbidity/mortality were low and similar between the pre- and post-implementation periods.

Conclusions

Access to health care facilities can be improved through implementation of education of the population by community health workers about the importance of a health care facility birth, provision of birth kits with misoprostol to women in late pregnancy, and access to a transport subsidy for delivery for women living at a distance from the health facility.

Clinical trials registration

NCT03024905 19/01/2017.
Symptomatology of attention deficit, hyperactivity and defiant behavior as predictors of academic achievement
Authors: Flores Jerome , Caqueo-Urízar Alejandra , López Verónica , Acevedo Daniel
Published: January 2022

Background

It is essential to understand the factors that affect the academic achievement of schoolchildren, both in general and in terms of the major subsectors of each grade. Although symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Negative Defiant Disorder (NDD—which are commonly recognized as externalizing problems in childhood and adolescence—have been associated with lower academic achievement in the international literature, few studies have addressed this problem in Latin America. This study aimed to analyze the possible predictive relationship of attention problems, hyperactivity, and defiant behavior on academic achievement.

Methods

We recruited a sample of 4580 schoolchildren (50.9% female, 1754 belonging to primary school, and 2826 to secondary school, ranging from 9 to 18 years old). This cross-sectional study used the scales pertaining to attention problems, hyperactivity, and challenging behavior from the Child and Adolescent Evaluation System.

Results

The analysis showed that attention problems significantly affected all academic achievement areas, while hyperactivity and challenging behavior affected only some of them. The regression models explained 24% of the variability in overall academic achievement in primary school and 17% in secondary school. Other predictors included sex, age, socioeconomic level, and school attendance.

Conclusions

It is important to consider this symptomatology in the design of educational interventions.
A finite element analysis and cyclic load experiment on an additional transcortical-type hole formed around the proximal femoral nail system’s distal locking screw
Authors: Cho Hong Man , Choi Seung Min , Park Ji Yeon , Lee Young , Bae Jung Hyung
Published: January 2022

Background

A complication associated with the distal locking screw used in the proximal femoral nail (PFN) system is the formation of accidental additional holes. We hypothesized that an increase in stress around additional holes is a relevant factor contributing to fractures. This study aimed to evaluate stress changes in the cortical bone around additional screw holes using finite element analysis.

Methods

Proximal femoral nail antirotation (PFNA)-II (Synthes, Solothurn, Switzerland) was inserted into a femur model. An additional 4.9-mm transcortical hole was made either anteriorly (anterior hole model) or posteriorly (posterior hole model) to the distal locking screw. Finite element analysis was used to calculate compression, tension, and load limits to investigate stress around additional holes with respect to the direction of screw penetration and degree of osteoporosis. The results were then compared with those of mechanical testing. A 31A-21 type intertrochanteric fracture was applied. As a control group, a model without additional holes (no-hole model) was developed. Repeated load-loading tests were performed on 10 model bones per model group.

Results

Tensile stress was significantly greater in the no-hole model when additional screw holes were present, and the anterior hole showed a higher maximum stress value than the posterior hole, suggesting that the anterior hole was more susceptible to fracture. The change in tensile stress first appeared in the hole around the lateral cortical bone and proceeded to the medial side. Biomechanical testing showed that fractures around the distal locking screw occurred in 0 cases of the no-hole, 10 of the anterior hole, and 9 of the posterior hole models.

Conclusions

During PFN surgery for intertrochanteric fracture, holes with distal locking screws fixed and removed at the anterior and posterior of the nail can be a risk factor for fractures in the surrounding area.
Long-term exposure to air pollution and risk of venous thromboembolism in a large administrative cohort
Authors: Renzi Matteo , Stafoggia Massimo , Michelozzi Paola , Davoli Marina , Forastiere Francesco , Solimini Angelo G.
Published: January 2022

Background

Venous thromboembolisms (VTE) are one of the most frequent cause among the cardiovascular diseases. Despite the association between long-term exposure to air pollution and cardiovascular outcomes have been widely explored in epidemiological literature, little is known about the air pollution related effects on VTE. We aimed to evaluate this association in a large administrative cohort in 15 years of follow-up.

Methods

Air pollution exposure (NO2, PM10 and PM2.5) was derived by land use regression models obtained by the ESCAPE framework. Administrative health databases were used to identify VTE cases. To estimate the association between air pollutant exposures and risk of hospitalizations for VTE (in total and divided in deep vein thrombosis (DVT) and pulmonary embolism (PE)), we used Cox regression models, considering individual, environmental (noise and green areas), and contextual characteristics. Finally, we considered potential effect modification for individual covariates and previous comorbidities.

Results

We identified 1,954 prevalent cases at baseline and 20,304 cases during the follow-up period. We found positive associations between PM2.5 exposures and DVT, PE and VTE with hazard ratios (HRs) up to 1.082 (95% confidence intervals: 0.992, 1.181), 1.136 (0.994, 1.298) and 1.074 (0.996, 1.158) respectively for 10 μg/m3 increases. The association was stronger in younger subjects (< 70 years old compared to > 70 years old) and among those who had cancer.

Conclusion

The effect of pollutants on PE and VTE hospitalizations, although marginally non-significant, should be interpreted as suggestive of a health effect that deserves attention in future studies.
Primary intraosseous carcinoma in the pediatric and adolescent mandible
Authors: Oh Hyun Jun , Shin Dong Whan , Yoon Hye-Jung , Myoung Hoon , Kim Soung Min
Published: January 2022

Background

Primary intraosseous carcinoma (PIOC) is a rare malignant odontogenic tumor that predominantly occurs in males older than 50 years. PIOC can be misdiagnosed as odontogenic cyst because it occasionally shows a well-defined border on radiography. In this study, related literatures of pediatric and adolescent PIOC cases were analyzed under strict PRISMA guidelines along with an adolescent case who was provisionally misdiagnosed as an odontogenic cyst.

Methods

All case reports for PIOC published in English from 1966 to 2021 were collected. Cases under the age of 20 were classified as pediatric and adolescent populations in this study. A total of 12 pediatric and adolescent cases including 11 PIOCs from the literature and one new case of a 14-year-old female were analyzed. Clinical and radiographic features, diagnosis and treatment approaches, and prognosis were investigated.

Results

Ages ranged from 4 to 18 years. The female to male ratio was 1.4:1. Seven cases occurred in the mandible. Swelling was observed in 11 patients. The radiologic borders were well-defined in six cases and corticated in four cases. Tooth displacement and root resorption were observed in four and six cases, respectively. The provisional diagnosis for seven patients was odontogenic cyst and enucleation was performed in six cases including the new case. During the follow-up period, local recurrence occurred in three patients. The pediatric and adolescent PIOC cases with local recurrence showed poor prognosis. The locally recurred lesion in the new case did not decrease in size despite concurrent chemo-radiation therapy.

Conclusions

Three-dimensional imaging modalities and incisional biopsy with multiple specimens are necessary to rule out PIOC in the lesions with atypical radiographic findings. PIOC should be diagnosed differentially from odontogenic cyst even in pediatric and adolescent populations to properly manage the disease with poor prognosis.
Polygenic risk and causal inference of psychiatric comorbidity in inflammatory bowel disease among patients with European ancestry
Authors: Li Yao , Bernstein Charles N. , Xu Wei , Hu Pingzhao
Published: January 2022

Background

Approximately 40% of persons with inflammatory bowel disease (IBD) experience psychiatric comorbidities (PC). Previous studies demonstrated the polygenetic effect on both IBD and PC. In this study, we evaluated the contribution of genetic variants to PC among the IBD population. Additionally, we evaluated whether this effect is mediated by the expression level of the RBPMS gene, which was identified in our previous studies as a potential risk factor of PC in persons with IBD.

Materials and methods

The polygenic risk score (PRS) was estimated among persons with IBD of European ancestry (n = 240) from the Manitoba IBD Cohort Study by using external genome-wide association studies (GWAS). The association and prediction performance were examined between the estimated PRS and PC status among persons with IBD. Finally, regression-based models were applied to explore whether the imputed expression level of the RBPMS gene is a mediator between estimated PRS and PC status in IBD.

Results

The estimated PRS had a significantly positive association with PC status (for the highest effect: P-value threshold = 5 × 10–3, odds ratio = 2.0, P-value = 1.5 × 10–5). Around 13% of the causal effect between the PRS and PC status in IBD was mediated by the expression level of the RBPMS gene. The area under the curve of the PRS-based PC prediction model is around 0.7 at the threshold of 5 × 10–4.

Conclusion

PC status in IBD depends on genetic influences among persons with European ancestry. The PRS could potentially be applied to PC risk screening to identify persons with IBD at a high risk of PC. Around 13% of this genetic influence could be explained by the expression level of the RBPMS gene.
Evidence of telomere attrition and a potential role for DNA damage in systemic sclerosis
Authors: Usategui Alicia , Municio Cristina , Arias-Salgado Elena G. , Martín María , Fernández-Varas Beatriz , Del Rey Manuel J. , Carreira Patricia , González Antonio , Criado Gabriel , Perona Rosario , Pablos José L.
Published: January 2022

Background

To investigate the role of cell senescence in systemic sclerosis (SSc), we analyzed telomere shortening (TS) in SSc patients and the effect of targeting DNA damage in the bleomycin model of skin fibrosis.

Results

Telomere length (TL) in blood leukocytes of 174 SSc patients and 68 healthy controls was measured by Southern blot, and we found shorter age-standardized TL in SSc patients compared to healthy controls. TL was shorter in SSc patients with ILD compared to those without ILD and in anti-topoisomerase I positive compared to anti-centromere positive patients. To analyze the potential role of DNA damage in skin fibrosis, we evaluated the effects of the DNA protective GSE4 peptide in the bleomycin mouse model of scleroderma and the fibrotic response of cultured human dermal fibroblasts. Administration of GSE4-nanoparticles attenuated bleomycin-induced skin fibrosis as measured by Masson’s staining of collagen and reduced Acta2 and Ctgf mRNA expression, whereas transduction of dermal fibroblasts with a lentiviral GSE4 expression vector reduced COL1A1, ACTA2 and CTGF gene expression after stimulation with bleomycin or TGF-β, in parallel to a reduction of the phospho-histone H2A.X marker of DNA damage.

Conclusions

SSc is associated with TS, particularly in patients with lung disease or anti-topoisomerase I antibodies. Administration of GSE4 peptide attenuated experimental skin fibrosis and reduced fibroblast expression of profibrotic factors, supporting a role for oxidative DNA damage in scleroderma.
Implementability of healthcare interventions: an overview of reviews and development of a conceptual framework
Authors: Klaic Marlena , Kapp Suzanne , Hudson Peter , Chapman Wendy , Denehy Linda , Story David , Francis Jill J.
Published: January 2022

Background

Implementation research may play an important role in reducing research waste by identifying strategies that support translation of evidence into practice. Implementation of healthcare interventions is influenced by multiple factors including the organisational context, implementation strategies and features of the intervention as perceived by people delivering and receiving the intervention. Recently, concepts relating to perceived features of interventions have been gaining traction in published literature, namely, acceptability, fidelity, feasibility, scalability and sustainability. These concepts may influence uptake of healthcare interventions, yet there seems to be little consensus about their nature and impact. The aim of this paper is to develop a testable conceptual framework of implementability of healthcare interventions that includes these five concepts.

Methods

A multifaceted approach was used to develop and refine a conceptual framework of implementability of healthcare interventions. An overview of reviews identified reviews published between January 2000 and March 2021 that focused on at least one of the five concepts in relation to a healthcare intervention. These findings informed the development of a preliminary framework of implementability of healthcare interventions which was presented to a panel of experts. A nominal group process was used to critique, refine and agree on a final framework.

Results

A total of 252 publications were included in the overview of reviews. Of these, 32% were found to be feasible, 4% reported sustainable changes in practice and 9% were scaled up to other populations and/or settings. The expert panel proposed that scalability and sustainability of a healthcare intervention are dependent on its acceptability, fidelity and feasibility. Furthermore, acceptability, fidelity and feasibility require re-evaluation over time and as the intervention is developed and then implemented in different settings or with different populations. The final agreed framework of implementability provides the basis for a chronological, iterative approach to planning for wide-scale, long-term implementation of healthcare interventions.

Conclusions

We recommend that researchers consider the factors acceptability, fidelity and feasibility (proposed to influence sustainability and scalability) during the preliminary phases of intervention development, evaluation and implementation, and iteratively check these factors in different settings and over time.
Effectiveness of psychosocial school interventions in Finnish schools for refugee and immigrant children, “Refugees Well School” in Finland (RWS-FI): a protocol for a cluster randomized controlled trial
Authors: Kankaanpää Reeta , Aalto Sanni , Vänskä Mervi , Lepistö Riina , Punamäki Raija-Leena , Soye Emma , Watters Charles , Andersen Arnfinn , Hilden Per Kristian , Derluyn Ilse , Verelst An , Peltonen Kirsi
Published: January 2022

Background

Schools are natural environments in which to enhance young people’s social and emotional skills, mental health, and contact between diverse groups, including students from refugee and immigrant backgrounds. A layered or tiered provision of services is recommended as it can be effective to meet the needs of war-affected adolescents who variably show mental health problems (such as posttraumatic stress disorder (PTSD)). The current protocol describes the study design for a multi-layered intervention model. The study will test the effectiveness of two interventions: a teacher-training intervention In-Service Teacher Training (INSETT) combined with targeted cognitive-behavioral treatment-based Teaching Recovery Techniques (TRT) and a classroom-focused preventive intervention Peer Integration and Enhancement Resources (PIER). We analyze, first, whether the interventions are effective in decreasing psychological distress and increasing positive resources, i.e., prosocial behavior and resilience among refugee and immigrant students. Second, we analyze which student-, school-, and parent-related factors mediate the possible beneficial changes. Third, we look at which groups the interventions are most beneficial to.

Methods

A three-arm cluster RCT with parallel assignment, with a 1:1:1 allocation ratio, is applied in 16 schools that agreed to participate in the Refugees Well School interventions and effectiveness study. Schools were randomized to three conditions of two active interventions and a waiting list control condition. Students, their parents, and teachers in intervention and control schools participated in the study at baseline before the interventions, after the interventions, and at 6 to 12 months after the interventions. The primary effectiveness criterion variables are psychological distress (SDQ) symptoms, resilience (CYRM-12), and prosocial behavior (SDQ).

Discussion

The current study presents a recommended universal approach of layered interventions aiming to reduce psychological distress and increase resilience among refugee and immigrant students. A combination of promotive, preventive, and targeted interventions may offer a holistic, ecological intervention package for schools to better address the needs of the whole group.

Trial registration

ISRCTN ISRCTN64245549. Retrospectively registered on 10 June 2020
Association of tobacco retailer count with smoking population versus vaping population in California (2019)
Authors: Purushothaman Vidya , Cuomo Raphael E. , Li Jiawei , Nali Matthew , Mackey Tim K.
Published: January 2022

Background

Access to tobacco products, including vape products, from local brick-and-mortar stores influences the exposure, uptake, and use of these products in local communities.

Methods

Licensed tobacco retailers in California were classified as specialized tobacco/vape stores or non-specialized stores by obtaining categories published on Yelp. California smoking and vaping prevalence data were obtained from the 500 cities project and ESRI community analyst tool respectively. A series of simple linear regression tests were performed, at the zip code level, between the retailer count in each store category and smoking/vaping population. The Getis-Ord Gi* and Anselin Local Moran’s I statistics were used for characterization of tobacco retail density hotspots and cold spots.

Results

The association between CA smoking/vaping population and number of tobacco retailers was statistically significant for all store categories. Variability in smoking population was best explained by variability in non-specialized storefronts(R2=0.84). Spatial variability in tobacco-only storefronts explained the least proportion of variability in the overall smoking population. Similar results were obtained specific to vaping population, although the proportion of population explained by variability in the number of non-specialized storefronts was comparatively lower(R2=0.80).

Conclusions

Localities with greater numbers of non-specialized tobacco retailers had higher rates of smoking/vaping populations, and this association was much stronger for localities with greater numbers of specialized retailers. Non-specialized storefronts may represent convenient access points for nicotine products, while specialized storefronts may represent critical access points for initiation. Hence, regulations that address the entirety of the tobacco/vaping retail environment by limiting widespread access from non-specialized stores and reducing appeal generated by specialized retailers should be incorporated in future tobacco regulatory science and policymaking.
Mental health and satisfaction with partners: a longitudinal analysis in the UK
Authors: Downward Paul , Rasciute Simona , Kumar Harish
Published: January 2022

Background

Current UK health policy stresses treating health as an asset to underpin and promote a more inclusive and productive society. The quality of personal relationships is essential for overall quality of life. The social determinants of health (SDH) literature shows that poor mental health and well-being are linked to weaker personal and social connections for individuals, families, and society. The causal impact that mental health has on satisfaction with partners is less understood but requires investigation.

Methods

The causal relationship between mental health and satisfaction with partners is examined drawing on the United Kingdom’s British Household Panel Survey from 1991 to 2008. A total sample of 9,024 individuals in dyadic couples comprising 42,464 observations was analysed using fixed-effects and instrumental variable fixed-effects panel data estimation.

Results

Lower mental health is associated with a lower satisfaction with partners. However, some causal evidence of lower mental health reducing satisfaction with partners is present for males.

Discussion

For females, relationship satisfaction is more likely to influence mental health. For males there is a potential ‘vicious circle’ between satisfaction with partners and mental health.

Conclusions

Investment in mental health provision can improve satisfaction with partners which in turn will further enhance health and well-being.
Rapid monitoring of health services use following a policy to switch patients from originator to biosimilar etanercept—a cohort study in British Columbia
Authors: Fisher Anat , Kim Jason D. , Carney Greg , Dormuth Colin
Published: January 2022

Background

Drug coverage policies that incentivize switching patients from originator to biosimilar products may result in significant health care savings. Our study aimed to detect early impacts on health services utilization following a mandated switch from originator to biosimilar etanercept in British Columbia (BC), Canada.

Methods

We conducted a prospective, population-based cohort study using linked administrative health data from BC (2010–2020). The policy cohort consisted of patients with inflammatory arthritis who used originator etanercept in 2019, prior to BC’s Biosimilars Initiative switching policy. Three historical cohorts included patients with inflammatory arthritis who used originator etanercept in the years 2016, 2017, and 2018. We compared the daily cumulative incidences of drug refills and outpatient and inpatient services between the policy and historical cohorts. A likelihood ratio sustained (≥ 31 days) at 7.1 or higher compared with the null hypothesis was chosen a priori as a threshold for a potential impact of the policy.

Results

Each cohort contained between 1694 and 1963 patients. We detected several potential impacts: 1) a transient increase in etanercept refills between months three and eight (cumulative incidence difference of + 3.0%); 2) an anticipated increase in visits to physicians of any specialty between months three and eight (+ 2.6%); and 3) an anticipated increase in visits to a rheumatologist from the end of month three onwards (+ 12.8%). The policy had no impact on incidences of switching to a different biologic antirheumatic drug, visits to emergency departments, or admissions to hospitals.

Conclusions

Only transient and/or anticipated increases in drug refills and physician visits were observed during the study period. Additional research on clinical outcomes is recommended to strengthen the evidence that no long-term unintended negative health impacts are associated with BC’s Biosimilars Initiative [switching policy].
Operative secondary prevention of fragility fractures: national clinical standards for fracture liaison service in Egypt—an initiative by the Egyptian Academy of Bone Health
Authors: Gadallah Naglaa , El Miedany Yasser
Published: January 2022

Background

Despite a broad spectrum of effective anti-osteoporosis therapies and a growing number of older adults worldwide, the number of people receiving appropriate secondary fracture prevention is not yet optimum or achieved its expected target, i.e., avoiding refracture.

Main body

To close this gap in the patients’ care, and in concordance with the International Osteoporosis Foundation (IOF) as well as international organizations recommendations, the Egyptian Academy of Bone Health and Metabolic Bone Diseases has launched specialised healthcare system for fracture liaison services (FLSs). FLS is a small team of healthcare professionals who identify, investigate, initiate therapy and arrange for follow-up plan over time, for people aged 50 and above presenting with a fragility fracture. Such comprehensive service requires operative clinical standards which would help to standardise the service across the different centres to become effective and sustainable. An estimated 71.8% of the Egyptian population currently have access to a local FLSs. This article aims at setting up evidence-based standards of post-fracture care and provide the necessary index for efficient implementation of secondary fracture prevention in the different FLS centres in Egypt.

Conclusion

The Egyptian FLS clinical standards agree with the international protocols and are an effective approach to target interventions to the properly identified patients at risk. The Egyptian model has identified 19 key performance indicators to measure the effectiveness of fracture liaison services and guide quality improvement.
Clarifying the importance of microplastic particles as vectors for long-range transport of chemical contaminants: a response to letter to the editor
Authors: Gouin Todd
Published: January 2022

This correspondence article provides a response to comments that have been raised regarding the long-range environmental transport of chemical additives associated with microplastic particles and plastic debris, which includes additional clarification for the continuing need for holistic approaches. Recognizing that not all microplastic particles are equal with respect to environmental fate and toxicological effects, it is strongly encouraged that the research community continue to acquire quantitative understanding regarding which types of microplastic particles are likely to be subject to long-range transport. Comments and responses that engage in constructive dialogue represent positive contributions that can only strengthen our ability to evaluate the role of microplastic and plastic debris as vectors of transport for plastic associated chemicals, and the associated risks, which represents an important component of the scientific process.
Association between previous and future antipsychotic adherence in patients initiating clozapine: real-world observational study
Authors: Brodeur Sébastien , Courteau Josiane , Vanasse Alain , Courteau Mireille , Stip Emmanuel , Fleury Marie-Josée , Lesage Alain , Demers Marie-France , Corbeil Olivier , Béchard Laurent , Roy Marc-André
Published: January 2022

Background

Although recognised as the most effective antipsychotic for treatment-resistant schizophrenia, clozapine remains underused. One reason is the widespread concern about non-adherence to clozapine because of poor adherence before initiating clozapine.

Aims

To determine if prior poor out-patient adherence to treatmentbefore initiating clozapine predisposes to poor out-patient adherence to clozapine or to any antipsychotics (including clozapine) after its initiation.

Method

This cohort study included 3228 patients with schizophrenia living in Quebec (Canada) initiating (with a 2-year clearance period) oral clozapine (index date) between 2009 and 2016. Using pharmacy data, out-patient adherence to treatment was measured by the medication possession ratio (MPR), over a 1-year period preceding and following the index date. Five groups of patients were formed based on their prior MPR level (independent variable). Two dependent variables were defined after clozapine initiation (good out-patient adherence to any antipsychotics and to clozapine only). Along with multiple logistic regressions, state sequence analysis was used as a visual representation of antipsychotic-use trajectories over time, before and after clozapine initiation.

Results

Although prior poor adherence to antipsychotics was associated with poor adherence after clozapine initiation, the absolute risk of subsequent poor adherence remained low, regardless of previous adherence level. Most patients adhered to their treatment after initiating clozapine (>68% to clozapine and >84% to any antipsychotics).

Conclusions

Despite the fact that poor adherence prior to initiating clozapine is widely recognised by clinicians as a barrier for the prescription of clozapine, the current study supports the initiation of clozapine in all eligible patients.
Diagnosis moderates the relationship between anxiety and digital communications in bipolar disorder and borderline personality disorder: A naturalistic remote-monitoring study
Authors: Gillett G. , Mcgowan N. , Palmius N. , Bilderbeck A. , Goodwin G. , Saunders K.
Published: January 2022

Introduction

Differences in the relationship between mood and digital communication metrics have been shown to act as a diagnostic marker in Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Anxiety has been associated with mobile-phone use in non-clinical populations, although a potential association between anxiety and digital communications in BD or BPD populations hasn’t been studied.

Objectives

To explore the association between self-reported anxiety symptoms and objective, naturalistic digital communications metrics in BD and BPD participants.

Methods

BD (n= 17) and BPD (n=17) cohorts were provided with a smartphone application which monitored phone call and SMS frequency and duration, alongside weekly self-reported anxiety (Generalised Anxiety Disorder 7-item scale). Linear mixed-effects regression models assessed the association between digital communications, anxiety state and interaction effects between anxiety and diagnosis.

Results

Self-reported anxiety state was negatively associated with decreased total call frequency (B=-5.150, p=0.002), cumulative total call duration (seconds; B=-1456.779, p<0.001), cumulative outgoing call duration (seconds; B=-1108.23, p<0.001), total SMS frequency (B=-31.412, p<0.001), outgoing SMS frequency (B=-16.443, p<0.001), cumulative total SMS length (characters; B=-1664.78, p=0.001) and cumulative outgoing SMS length (characters; B=-857.770, p=0.005) for BD, but not BPD, participants. Associations remained significant after adjusting for mood.

Conclusions

These results further suggest that BPD individuals, compared to BD individuals, exhibit persistent social interaction during mental distress. Together with previous findings, this effect appears to be common, but independent, for both self-reported anxiety and depression. These findings inform our understanding of the psychopathology of the two conditions, and may contribute to the development of tools to aid their diagnostic differentiation.

Conflict of interest

Prof Goodwin is a NIHR Emeritus Senior Investigator, holds shares in P1vital and P1Vital products and has served as consultant, advisor or CME speaker in the last 3 years for Compass pathways, Evapharm, Janssen, Lundbeck, Medscape, P1Vital, Sage, Servier.
Neoadjuvant Chemoradiotherapy Versus Upfront Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Long-Term Results of the Dutch Randomized PREOPANC Trial
Authors: Versteijne Eva , van Dam Jacob L. , Suker Mustafa , Janssen Quisette P. , Groothuis Karin , Akkermans-Vogelaar Janine M. , Besselink Marc G. , Bonsing Bert A. , Buijsen Jeroen , Busch Olivier R. , Creemers Geert-Jan M. , van Dam Ronald M. , Eskens Ferry A. L. M. , Festen Sebastiaan , de Groot Jan Willem B. , Groot Koerkamp Bas , de Hingh Ignace H. , Homs Marjolein Y. V. , van Hooft Jeanin E. , Kerver Emile D. , Luelmo Saskia A. C. , Neelis Karen J. , Nuyttens Joost , Paardekooper Gabriel M. R. M. , Patijn Gijs A. , van der Sangen Maurice J. C. , de Vos-Geelen Judith , Wilmink Johanna W. , Zwinderman Aeilko H. , Punt Cornelis J. , van Tienhoven Geertjan , van Eijck Casper H. J. ,   for the Dutch Pancreatic Cancer Group
Published: January 2022

PURPOSE

The benefit of neoadjuvant chemoradiotherapy in resectable and borderline resectable pancreatic cancer remains controversial. Initial results of the PREOPANC trial failed to demonstrate a statistically significant overall survival (OS) benefit. The long-term results are reported.

METHODS

In this multicenter, phase III trial, patients with resectable and borderline resectable pancreatic cancer were randomly assigned (1:1) to neoadjuvant chemoradiotherapy or upfront surgery in 16 Dutch centers. Neoadjuvant chemoradiotherapy consisted of three cycles of gemcitabine combined with 36 Gy radiotherapy in 15 fractions during the second cycle. After restaging, patients underwent surgery followed by four cycles of adjuvant gemcitabine. Patients in the upfront surgery group underwent surgery followed by six cycles of adjuvant gemcitabine. The primary outcome was OS by intention-to-treat. No safety data were collected beyond the initial report of the trial.

RESULTS

Between April 24, 2013, and July 25, 2017, 246 eligible patients were randomly assigned to neoadjuvant chemoradiotherapy (n = 119) and upfront surgery (n = 127). At a median follow-up of 59 months, the OS was better in the neoadjuvant chemoradiotherapy group than in the upfront surgery group (hazard ratio, 0.73; 95% CI, 0.56 to 0.96; P = .025). Although the difference in median survival was only 1.4 months (15.7 months v 14.3 months), the 5-year OS rate was 20.5% (95% CI, 14.2 to 29.8) with neoadjuvant chemoradiotherapy and 6.5% (95% CI, 3.1 to 13.7) with upfront surgery. The effect of neoadjuvant chemoradiotherapy was consistent across the prespecified subgroups, including resectable and borderline resectable pancreatic cancer.

CONCLUSION

Neoadjuvant gemcitabine-based chemoradiotherapy followed by surgery and adjuvant gemcitabine improves OS compared with upfront surgery and adjuvant gemcitabine in resectable and borderline resectable pancreatic cancer.
Entanglement concentration protocols for quantum entangled states
Authors: Song Tingting , Zhang Ke-Jia , Jia Hengyue
Published: January 2022

Noise in the channel affects the security of cryptography protocols. The obvious solution for quantum protocols is to estimate the transformation of quantum states caused by the noise. Cluster states are the basic structures of quantum cryptography protocols, which are transmitted through the lossy quantum channel during the procedure of the protocols. The entanglement of the cluster states is extremely fragile and easy to be inflected by inevitable interaction with the environment. To ensure the fidelity of cluster states, the entanglement of the states must be concentrated after the transmission. We propose four protocols to concentrate the entanglement of five-photon linear cluster states by linear optics, in two of which only three parties should perform the local POVM operations. All the protocols reach the maximum of successful probability, and furthermore they are implemented by the linear optics alone. The simulation results depict that lots of five-photon linear cluster states could be concentrated via our protocols, and those protocols are robust against the accuracy of the linear optics. Hence, our protocols are valuable in many fields of quantum information and quantum cryptography.
Risk Factors and Consequences of Acute Kidney Injury After Noncardiac Surgery in Children
Authors: Hawkins Jesse , Mpody Christian , Corridore Marco , Cambier Greg , Tobias Joseph D. , Nafiu Olubukola O.
Published: January 2022

BACKGROUND:

Postoperative acute kidney injury (AKI) is a serious complication that is associated with prolonged hospital stay, high risk of short-term postsurgical mortality, need for dialysis, and possible progression to chronic kidney disease. To date, very little data exist on the risk of postoperative AKI among children undergoing noncardiac surgical procedures. We used data from a large multicenter cohort to determine the factors associated with AKI among children who underwent inpatient noncardiac surgical procedures and its impact on the postoperative course.

METHODS:

We utilized the National Surgical Quality Improvement Program Pediatric participant user files to identify a cohort of children who underwent inpatient surgery between 2012 and 2018 (n = 257,439). We randomly divided the study population into a derivation cohort of 193,082 (75%) and a validation cohort of 64,357 (25%), and constructed a multivariable logistic regression model to identify independent risk factors for AKI. We defined AKI as the occurrence of either acute renal failure or progressive renal insufficiency within the 30 days after surgery.

RESULTS:

The overall rate of postoperative AKI was 0.10% (95% confidence interval [CI], 0.09–0.11). In a multivariable model, operating times longer than 140 minutes, preexisting hematologic disorder, and preoperative sepsis were the strongest independent predictors of AKI. Other independent risk factors for AKI were American Society of Anesthesiologists (ASA) physical status ≥III, preoperative inotropic support, gastrointestinal disease, ventilator dependency, and corticosteroid use. The 30-day mortality rate was 10.1% in children who developed AKI and 0.19% in their counterparts without AKI (P < .001). Children who developed AKI were more likely to require an extended hospital stay (≥75th percentile of the study cohort) relative to their peers without AKI (77.4% vs 21.0%; P < .001).

CONCLUSIONS:

Independent preoperative risk factors for AKI in children undergoing inpatient noncardiac surgery were hematologic disorder, preoperative sepsis, ASA physical status ≥III, inotropic support, gastrointestinal disease, ventilator dependency, and steroid use. Children with AKI were 10 times more likely to die and nearly 3 times more likely to require an extended hospital stay, relative to their peers without AKI.
The Mystery of the Missing AIDS Crisis: A Comparative Reading of Caper in the Castro and Murder on Main Street
Authors: Ruberg Bo
Published: January 2022

This article addresses the seeming absence of the HIV/AIDS pandemic in video games from the 1980s and 1990s, the height of the US AIDS crisis. As Adrienne Shaw and Christopher Persaud have noted, stories about HIV/AIDS were pervasive across American popular media during this period, which also represented a boom in video game development. However, documentation remains of only a handful of early video games that mention HIV/AIDS. This article argues that, far from being absent from video game history, HIV/AIDS and the US AIDS crisis were actually influential in shaping a number of the design elements and narrative genres that have become important to contemporary video games. Scholars like Cait McKinney have demonstrated how people living with HIV/AIDS in America played a crucial part in the evolution of internet technologies that now form the backbone of video games. Through a comparative reading of two games by C. M. Ralph, Caper in the Castro (1989) and Murder on Main Street (1989), this article demonstrates how HIV/AIDS has also manifested in the content and form of video games, even (and perhaps especially) when it seems absent. Derritt Mason has explained how Caper in the Castro, widely celebrated as the first LGBTQ video game, contains clear echoes of the AIDS crisis. Yet, as this article demonstrates, HIV/AIDS remains a powerful presence even in Murder on Main Street, Ralph’s “straight version” of the game. Together, these games offer a microcosm through which to explore larger tensions between HIV/AIDS and video games, with the AIDS crisis representing a key element of what Cody Mejeur has termed the “present absence of queerness in video games.”
Characterization of Excited States in a Multiple-Resonance-Type Thermally Activated Delayed Fluorescence Molecule Using Time-Resolved Infrared Spectroscopy
Authors: Saigo Masaki , Shimoda Yuushi , Ehara Takumi , Ryu Tomohiro , Miyata Kiyoshi , Onda Ken
Published: January 2022

We investigated the correlation between the photophysical properties and detailed excited-state characteristics of a multiple-resonance-type thermally activated delayed fluorescence (TADF) molecule, DABNA-1, using time-resolved infrared vibrational spectroscopy. By comparing the distinctive vibrational spectra in the fingerprint region (1000–1700 cm−1) to the simulated spectra, we found the optimal calculation conditions for density functional theory calculations to retrieve the vibrational spectra. Based on the calculations, the excited-state geometries and molecular orbitals in the lowest excited singlet (S1) and triplet (T1) states, as well as the ground state (S0), were determined. Consequently, we revealed that the similarity between the potential surfaces of T1 and S0 suppressed non-radiative decay and improved the high fluorescence quantum yield via TADF. Furthermore, we calculated the spin-orbit coupling matrix elements (SOCMEs) considering the experimentally confirmed geometries, and revealed that twisting of the main skeleton increases the SOCMEs.
Highly Selective Production of Aromatic Hydrocarbons by CO2 Hydrogenation over Fe-Zn Oxide + H-ZSM-5 Composite Catalyst
Authors: Fujiwara Masahiro
Published: January 2022

Composite catalysts consisting of Fe-Zn oxides and H-ZSM-5 were very effective for the selective production of aromatic hydrocarbons by CO2 hydrogenation. The ratios of aromatic hydrocarbons in all hydrocarbons were beyond 80 C-mol% using these catalysts. When the weight ratio of Fe-Zn oxide and H-ZSM-5 was optimized, the ratio of aromatic hydrocarbons reached more than 90 C-mol%. The Fe-Zn oxides acted as methanol synthesis catalyst in the composite catalyst, forming aromatic hydrocarbons by methanol-to-hydrocarbons reaction over H-ZSM-5. Two aromatic hydrocarbons, p-xylene and 1,2,4-trimethylbenzene, were mainly obtained by the shape selectivity effect of H-ZSM-5. The composite catalyst deactivated by coke formation could be regenerated by air flow treatment.
Artificial intelligence study on left ventricular function among normal individuals, hypertrophic cardiomyopathy and dilated cardiomyopathy patients using 1.5T cardiac cine MR images obtained by SSFP sequence
Authors: Guo Jiajun , Lu HongFei , Chen Yinyin , Zeng Mengsu , Jin Hang
Published: January 2022

Objectives:

To evaluate the performance of a deep learning-based method to automatically quantify left ventricular (LV) function from MR images in different cardiomyopathy.

Methods:

This retrospective study included MRI data sets from 2013 to 2020. Data on left ventricular function from patients with hypertrophic cardiomyopathy (HCM), patients with dilated cardiomyopathy (DCM), and healthy participants were analyzed. MRI data from a total of 388 patients were measured manually and automatically.The performance of Convolutional Neural Networks (CNNs) was evaluated based on the manual notes of two experienced observers: (a) LV segmentation accuracy, and (b) LV functional parameter accuracy. Bland-Altman analysis, Receiver operating Characteristic (ROC) curve analysis and Pearson correlation analysis were used to evaluate the consistency between fully automatic and manual diagnosis of HCM and DCM.

Results:

The deep-learning CNN performed best in HCM in evaluating LV function and worst in DCM. Compared with manual analysis, four parameters of LV function in the HCM group showed high correlation (r at least >0.901), and the correlation of DCM in all parameters was weaker than that of HCM, especially EF (r2 = 0.776) and SV (r2 = 0.645). ROC curve analysis indicated that at the optimal cut-off value, EF from automatic segmentation identified DCM and HCM patients with sensitivity of 92.31 and 78.05%, specificity of 82.96 and 54.07%, respectively.

Conclusion:

Among different heart diseases, the analysis of cardiac function based on deep-learning CNN may have different performances, with DCM performing the worst and HCM the best and thus, special attention should be paid to DCM patients when assessing LV function through artificial intelligence method. LV function parameter obtained by artificial intelligence method may play an important role in the future AI diagnosis of HCM and DCM.

Advances in knowledge:

These data for the first time objectively evaluate the performance of a commercially available deep learning-based method in cardiac function evaluation of different cardiomyopathy and point out its advantages and disadvantages in different cardiomyopathy. This work did not attempt to design the algorithm itself, but rather applied an already existing method to a test dataset of clinical data and evaluated the results for a limited number of cardiomyopathy.