bluuebunny/crossref_metadata_2025 huggingface dataset:
Decoding the association between urban streetscape skeletons and urban activities: Experiments in Beijing using Dazhong Dianping data
Authors: Zhang Enjia , Xie Hanting , Long Ying
Published: December 2022

The essential role of urban streetscape skeletons in fostering vibrant streets has been repeatedly emphasized. However, most research focused on the macro-scale or mesoscale urban form or measuring streetscape skeletons using quantitative methods, failing to systematically examine the relationship between the street-level urban form with urban activities. This study took street segments as the analytic unit to analyze the relationship between streetscape skeletons and urban activities represented by the density of online reviews on the Dazhong Dianping by controlling other built environments. Using models like Multiple Linear Regression, Spatial Lag Model, and Random Forest Regression, the result suggested that when conducting activities, people preferred the strengths of the street but ignored its weaknesses. The findings demonstrated some skeleton indicators associated with urban activities, such as the width and enclosure of the street and the higher and more continuous buildings on the side of the streets. Moreover, the result also suggested that some streetscape skeletons, such as cross-section and length, have differentiated performances for online reviews at different distances to the street centerlines. These findings could help urban designers to rethink the interaction between urban activities and street-level urban form.
Use of Lung Sonography in the Assessment and Confirmation of Pulmonary Complications in the Pediatric Patient
Authors: Shonk Andrew , Sergakis Georgianna , Varekojis Sarah M.
Published: December 2022

Objective:

To determine if lung sonography is accurate in assessing and confirming pulmonary compromise and thereby reduce the risk of x-ray exposure, for pediatric patients.

Materials and Methods:

This study was a systematic review of individual published studies. PubMed was the only database used for the article search. A review by a committee of contributors determined whether studies met the specific inclusion criteria. Studies reviewed had participants between the ages 0 and 18 years, with lung compromise of varying pathophysiological diagnoses. Each intervention was coded by levels of evidence; grading of recommendations, assessment, development, and evaluation (GRADE); the evidence alert traffic light grading system; and risk of bias in nonrandomized studies of interventions. Each article was evaluated using the Cochrane assessment of bias and GRADE evidence tables.

Results:

Thirty-seven articles were retrieved. Of those, 21 articles were removed following title and abstract screening. With 16 articles remaining, only one duplicate was removed. Based on the 15 articles extracted, in full-text versions, only two articles were noted to be irrelevant, and one article was not provided in English. Only 12 articles met the eligibility criteria, but two articles had to be removed because they were systematic reviews and not individual studies. The final analysis was based on 10 articles that met the inclusion criteria.

Conclusion:

Once reviewed, all 10 articles indicated that lung sonography had high accuracy and confirmation of lung compromise, which spanned multiple pulmonary diagnoses, in pediatric patients. When used by a trained clinician, lung sonography was as highly effective in comparison to other diagnostic tools, such as a chest radiograph and computed tomography.
The global progress on the non-point source pollution research from 2012 to 2021: a bibliometric analysis
Authors: Xie Zi-jian , Ye Chun , Li Chun-hua , Shi Xiao-gang , Shao Ying , Qi Wei
Published: December 2022

Background

With effective control of point source pollution, non-point source (NPS) pollution has been widely concerned as the primary reason for the improvement of global water environmental quality. Some bibliometric analysis related to NPS pollution has been carried out before the mid-2010s. Analyzing the research status and hot issues of NPS pollution in the past decade is important for guiding the control and management of NPS pollution in the future.

Results

A bibliometric analysis was conducted based on 3407 publications retrieved from the Web of Science during 2012–2021. China, USA and UK were the most productive countries. Sci. Total Environ, Environ. Sci. Pollut. Res, and Water were the most productive journals. The NPS pollutant, pollution types, driving forces, technology and the research object were retrieved from the keywords analysis. The common NPS pollutants of nitrogen, phosphorus, and heavy metals grabbed the highest attention, while the emerging contaminants have attracted increased attention. The migration and transformation of agricultural NPS pollution and urban NPS pollution driven by climate change and land use change were hot issues related to NPS pollution studies. Technologies related to the combination of 3S technology (RS, GIS, and GPS) and NPS pollution models, the sustainable control technologies, the technology of accurate traceability and automatic monitoring, and the comprehensive management plan were the important research areas related to NPS pollution. Although the research locations were mostly concentrated in the surface water and groundwater, the ocean and drinking water have great potential for future research.

Conclusions

This study illustrates the global focuses related to NPS pollution during 2012–2021 according to analyzing the publication outputs, source journals, source country, author, institution and the high-frequency keywords. Results demonstrated that the migration and transformation mechanism and ecological risk assessment for heavy metals and emerging pollutants, accurate traceability techniques, sustainable ecological restoration control techniques, and marine pollution have attracted rising attention. Additionally, developing countries will have a higher interest in NPS pollution in the future, because developed countries have already made great progress in controlling NPS pollution.
Review and future trends of soil microplastics research: visual analysis based on Citespace
Authors: Ya-di Zhu , Tian-jie Shao , Yan-hua Wang , Rui-yuan Wang
Published: December 2022

Compared with the research results of water microplastics, soil microplastics have been of concern for a shorter time, and the research started later. As a whole, they are still in the initial stage of development, and the problems of arable land and food security caused by them have attracted close attention from scholars around the world, but have not been effectively solved. To reveal the research status, development and change process and future trend, this paper is based on the data in the Web of Science (WOS) databases from 2016 to November 2021, with the help of Citespace software. The number of articles published, source countries and degree of cooperation, research institutions and teams, keyword clustering and change trend are sorted out. The results showed that: (1) the research results of soil microplastics has experienced a slow-rapid growth stage. In terms of the number of articles published, China occupies the first place in the world, with 55 articles. In terms of the number of publications, Free Univ Berlin ranks first, followed by the Chinese Academy of Sciences, Berlin Brandenburg Inst Adv Biodivers Res, and Wageningen Univ&Res. (2) In terms of content, environmental pollution and exposure, the function and health of soil-associated media, the common shape characteristics of microplastics and their influencing factors, and the combined pollution caused by microplastics are all covered, and can be divided into eight main categories: soil, ingestion, heavy meals, fiber, marine environment, microplastic, metals, and plants. (3) The migration behavior and ecotoxicological effects of microplastics in soil media are still the focus of attention at present. (4) In the future, “regression process and mechanism", “detection method and evaluation standard”, “risk assessment model”, “removal technology and control means” are undoubtedly worthy of attention.
Alfaxalone anaesthesia increases brain derived neurotrophic factor levels and preserves postoperative cognition by activating pregnane-X receptors: an in vitro study and a double blind randomised controlled trial
Authors: Serrao Juliet M. , Goodchild Colin S.
Published: December 2022

Background

Alfaxalone is a fast acting intravenous anaesthetic with high therapeutic index. It is an analogue of the naturally-occurring neurosteroid allopregnanolone responsible for maintenance of cognition and neuroprotection by activation of brain pregnane X receptors and consequent increased production of mature brain-derived neurotrophic factor (m-BDNF). Two studies are reported here: an in vitro study investigated whether alfaxalone activates human pregnane X receptors (h-PXR) as effectively as allopregnanolone; and a clinical study that measured postoperative changes in serum m-BDNF and cognition in patients after alfaxalone anaesthesia compared with propofol and sevoflurane.

Methods

In vitro Activation of h-PXR by allopregnanolone and alfaxalone solutions (206 - 50,000 nM) was measured using human embryonic kidney cells expressing h-PXR hybridised and linked to the firefly luciferase gene. Light emission by luciferase stimulated by each ligand binding with h-PXR was measured.

Clinical A double blind prospective randomised study of patients undergoing hip arthroplasty anaesthetised with alfaxalone TIVA (n = 8) or propofol TIVA (n = 3) or propofol plus sevoflurane inhalational anaesthesia (n = 4). The doses of anaesthetics were titrated to the same depth of anaesthesia (BIS 40-60). Subjects’ cognitive performance was assessed using the Grooved Pegboard Test, Digit Symbol Substitution Test (DSST) and Mini Mental State examination (MMSE) for 7 days postoperatively. Serum m-BDNF concentrations were measured for 7 postoperative days.

Results

In vitro Allopregnanolone and alfaxalone both activated h-PXR, alfaxalone being more efficacious than allopregnanolone: 50,000 nM, p = 0.0019; 16,700 nM, p = 0.0472; 5600 nM, p = 0.0031.

Clinical Alfaxalone treated subjects scored better than propofol and sevoflurane anaesthetised patients in the cognition tests: (MMSE p = 0.0251; Grooved Pegboard test dominant hand pre v post anaesthesia scores p = 0.8438 for alfaxalone and p = 0.0156 for propofol and propofol/sevoflurane combined). The higher cognition scores were accompanied by higher serum m-BDNF levels in the alfaxalone anaesthetised patients (p < 0.0001).

Conclusions

These results suggest that sedation and anaesthesia induced by the synthetic neuroactive steroid alfaxalone may be accompanied by effects normally caused by physiological actions of allopregnanolone at PXR, namely, increased secretion of m-BDNF and consequent neuroprotection and preservation of cognition.

Trial registration

The clinical trial was registered on 17/01/2018 with the Australian New Zealand Clinical Trials Registry: registration number ACTRN12618000064202 [Universal Trial Number U1111-1198-0412].
Emergency department crowding negatively influences outcomes for adults presenting with asthma: a population-based retrospective cohort study
Authors: Huang Yifu , Ortiz Silvia S. , Rowe Brian H. , Rosychuk Rhonda J.
Published: December 2022

Background

Access to emergency department (ED) services is important for patients with acute asthma; however, ED crowding may impact the quality of care and compromise outcomes. We examine the association between ED crowding metrics and individual patient outcomes for adults presenting with asthma.

Methods

This population-based retrospective cohort study extracted all ED presentations made by patients aged 18 to 55 years to 18 high-volume EDs in Alberta from April 2014 to March 2019. Physician initial assessment (PIA) time and ED length of stay (LOS) for discharged and admitted patients were calculated. Other metrics and patient outcomes were also obtained. Linear and generalized linear models were fit for continuous and categorical outcomes. Cox proportional hazards models were used for time-to-event outcomes.

Results

There were 17,724 ED presentations by 12,569 adults. The median age was 33 years, and females (58.7%) made more presentations. ED crowding affected the PIA time for all triage groups. For the high acuity group (Canadian Triage and Acuity Scale [CTAS] 1/2), 1 h increase in median facility-specific PIA was associated with 26 min (95%CI: 24,28) increase; for the moderate acuity (CTAS 3) and low acuity (CTAS 4/5) groups, the individual-level PIA increased by 54 min (95%CI: 53,55) and 61 min (95%CI: 59,63), respectively adjusted by other predictors. Increases in facility PIA resulted in increase in odds of admissions for the high acuity group and increase odds of left without completion of care for the moderate and low acuity groups.

Conclusion

The care provided for patients from all triage groups was impacted when EDs experienced crowding. Effective interventions are needed to mitigate ED crowding and improve care and outcomes for this important patient group.
Automated lung ultrasound image assessment using artificial intelligence to identify fluid overload in dialysis patients
Authors: Tan Grace Feng Ling , Du Tiehua , Liu Justin Shuang , Chai Chung Cheen , Nyein Chan Maung , Liu Allen Yan Lun
Published: December 2022

Background

Fluid assessment is challenging, and fluid overload poses a significant problem among dialysis patients, with pulmonary oedema being the most serious consequence. Our study aims to develop a simple objective fluid assessment strategy using lung ultrasound (LUS) and artificial intelligence (AI) to assess the fluid status of dialysis patients.

Methods

This was a single-centre study of 76 hemodialysis and peritoneal dialysis patients carried out between July 2020 to May 2022. The fluid status of dialysis patients was assessed via a simplified 8-point LUS method using a portable handheld ultrasound device (HHUSD), clinical examination and bioimpedance analysis (BIA).

The primary outcome was the performance of 8-point LUS using a portable HHUSD in diagnosing fluid overload compared to physical examination and BIA. The secondary outcome was to develop and validate a novel AI software program to quantify B-line count and assess the fluid status of dialysis patients.

Results

Our study showed a moderate correlation between LUS B-line count and fluid overload assessed by clinical examination (r = 0.475, p < 0.001) and BIA (r = 0.356. p < 0.001). The use of AI to detect B-lines on LUS in our study for dialysis patients was shown to have good agreement with LUS B lines observed by physicians; (r = 0.825, p < 0.001) for the training dataset and (r = 0.844, p < 0.001) for the validation dataset.

Conclusion

Our study confirms that 8-point LUS using HHUSD, with AI-based detection of B lines, can provide clinically useful information on the assessment of hydration status and diagnosis of fluid overload for dialysis patients in a user-friendly and time-efficient way.
Smoking cessation in pregnant women using financial incentives: a feasibility study
Authors: Kroder T. A. , Peters L. L. , Roggeveld A. L. , Holtrop M. , Harshagen L. , Klein L. M. , Erwich J. J. H. M.
Published: December 2022

Background

The high prevalence of smoking pregnant women in Dutch areas with lower socioeconomic status and the consecutively harmful exposure to tobacco to both mother and child, depicted a high need for a novel intervention. According to other studies, the utilisation of financial incentives appeared to be a promising method for smoking cessation in pregnant women. Therefore, the aim of this study was to investigate the feasibility of implementing contingent financial incentives as smoking cessation support for pregnant women in the Netherlands.

Methods

Feasibility study consisting of four developmental phases: (1) acceptability of Dutch population regarding financial-incentive-intervention by conducting an online questionnaire, (2) composing a pilot study utilising the financial-incentive-intervention in clinical practice, (3) execution of the composed pilot study and (4) evaluation of the executed pilot study utilising a mixed-methods approach.

A financial-incentive-intervention, given in a contingent financial scheme (during five consequential appointments, respectively €25/€50/€100/€150/€250), if smoking abstinence was proven by the amount of cotinine in the urine of the pregnant women measured utilising a urine dipstick test.

The public acceptability for the financial-incentive-intervention was assessed using 5-Likert scales. The number of pregnant women able to abstain from smoking during the pilot study and utilising the financial-incentive-intervention in clinical practice were used to assess the prosperity and practicality of the pilot study respectively. The pilot study was evaluated using a mixed-methods approach.

Results

In total, 55.1% of the Dutch population sample (n = 328) found a financial incentive inappropriate for smoking cessation in pregnant women, while the healthcare professionals and pilot study participants thought the financial-incentive-intervention to be a helpful approach. Eleven vouchers were given during the pilot study, and one woman completed all test points and tested negative for cotinine at the end of the pilot study.

Conclusion

Although the financial-incentive-intervention appeared to be a promising approach for smoking cessation in pregnant women, the acceptability of the Dutch population and the number of pregnant women able to abstain smoking during this pilot study was low. Despite the limited study population, this study proved the concept of this financial-incentive-intervention to be feasible for implementation in the Netherlands.

Trial registration

Not applicable since this is a feasibility study prior to a trial.
New AMH cutoff values for warning of decreased ovarian response based on MCL characteristics in young women: a retrospective study using a propensity score-matching analysis
Authors: Lv Jia-Bei , Han Ying , Wang Xin-Yan , Yuan Li-Na , Diao Jun-Rong , Fan Ya-Zhen , Luo Hai-Ning
Published: December 2022

Background

Menstrual cycle length (MCL) and ovarian response varies widely among women of childbearing age. They are provided with anti-Mu¨llerian hormone (AMH) cutoffs for “normal” and “weakened” ovarian responses, which give an early warning of the onset of decreased ovarian response.

Methods

This was a retrospective study in women aged 21 to 35 years with MCLs of 21–35 days receiving in vitro fertilization (IVF) treatment at Center for Reproductive Medicine from October 2018 to October 2021. Intergroup variables were balanced using propensity score matching based on age and BMI, and each case patient (patients with MCLs of 21–25 days) was matched with three control patients (patients with MCLs of 26–35 days). A receiver operating characteristic curve was used to calculate the AMH cutoff values.

Results

We included 135 patients with MCLs of 21–25 days and 405 matched control patients with MCLs of 26–35 days who received IVF treatment. The case group had significantly fewer retrieved oocytes, lower AMH values and higher initial and total Gonadotropin (Gn) levels during controlled ovarian hyperstimulation than the control group. The ovarian response began to decrease when AMH was < 3.5 ng/ml in the case group and < 2.7 ng/ml in the control group.

Conclusion

In young women with MCLs of 21–35 days, short MCL was negatively correlated with AMH values and the number of oocytes retrieved. In patients with MCLs of 21–25 days and 26–35 days, the AMH cutoff values corresponding to the onset of decreased ovarian response were 3.5 ng/ml and 2.7 ng/ml, respectively.
The effectiveness of a “EspaiJove.net”- a school-based intervention programme in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population: a cluster randomised controlled trial
Authors: Casañas Rocío , Castellvi Pere , Gil Juan-José , Torres-Torres María , Barón Jesica , Teixidó Mercè , Sampietro Hernán María , Díez Marta , Fernández Raúl , Sorli Raquel , Siñol Patricia , Jurado Francisca , Carreras-Salvador Regina , Vazquez Davinia , Gonzalez Sandra , Martín Maria Isabel Fernandez-San , Raya-Tena Antonia , Alvarez Rosa , Amado-Rodriguez Isaac , López Luis Miguel Martín- , Alonso Jordi , Lalucat-Jo Lluís
Published: December 2022

Background

The aim of this study is to evaluate the short- and long-term effects of the universal mental health literacy intervention “EspaiJove.net” in increasing mental health knowledge, help seeking and reducing stigma attitudes in the adolescent population. We also examine whether these effects depend on the intervention intensity. 

Methods

A clustered school-based randomised controlled trial (cRCT) design. Subjects: 1,298 secondary pupils aged 13 and 14 were recruited from 18 schools in Barcelona (Spain) between September 2016 and January 2018. Intervention: Three programmes were assessed: 1) Sensitivity Programme (SP; 1 h); 2) Mental Health Literacy (MHL; 6 h); 3) MHL plus a first-person Stigma Reduction Programme (MHL + SR; 7 h); 4) Control group (CG): waiting list. Outcome measures: 1) MHL: EspaiJove.net EMHL Test (First part and Second Part); 2) Stigma: RIBS and CAMI; 3) Help-seeking and use of treatment: GHSQ. Analysis: The data was collected at baseline, post-intervention and 6 and 12 months later. An intention-to-treat analysis and imputation method was used to analyse the missing data. Intervention effects were analysed using multilevel modelling.

Results

One thousand thirty-two students were included (SP = 225; MHL = 261; MHL + SR = 295 and CG = 251). The MHL and MHL + SR interventions showed short- and long-term an increase in knowledge compared to SP and CG, but no significant change post-intervention or over time (First part p = 0.52 and Second part p = 0.62) between intervention groups and CG. No significant changes were found in stigma scores post-intervention or over time (CAMI p = 0.61 and RIBS p = 0.98) or in help-seeking scores (parent p = 0.69; teacher p = 0.23 and healthcare professional p = 0.75). The MHL + SR intervention was the best valued and recommended (p < 0.005).

Conclusions

The three interventions of the EspaiJove.net programme (SP, MHL and MHL + SR) seem not to be effective in terms MHL, Stigma and help-seeking behaviours. The contact with a person who has experimented mental illness first-hand did not reduce stigma attitudes. Further research should deal with the heterogeneity of MHL interventions (concept, duration and measures) and identify which components of stigma interventions are effective.

Trial registration

ClinicalTrials.gov identifier: NCT03215654 (registration date 12 July 2017).
The role of platelet-related parameters for the prediction of NAFLD in OSAHS patients
Authors: Chen Menglan , Wang Biying , Huang Jiefeng , Zhao Jianming , Chen Jia , Chen Gongping
Published: December 2022

Purpose

As the detection of non-alcoholic fatty liver disease (NAFLD) is imperative for the prevention of its complications, we aimed to explore the predictive value of platelet to lymphocyte count ratio (PLR) and white blood cell count to mean platelet volume ratio (WBC/MPV) in relation to the occurrence of NAFLD among patients with obstructive sleep apnea–hypopnea syndrome (OSAHS).

Methods

This was a cross-sectional study consisting of 351 patients with OSAHS (279 with and 72 without NAFLD). The logistic regression analysis was performed to estimate associations between PLR, WBC/MPV, and NAFLD. Finally, the receiver operating characteristic curve (ROC curve) was used to analyze the efficacy of PLR and WBC/MPV in NAFLD prediction.

Results

Compared to the OSAHS-only group, there was a rising trend in AHI and TS90% in the OSAHS + NAFLD group. And the logistic regression analysis identified average oxygen saturation (MaSO2), WBC/MPV and PLR as predicted factors (odds ratio [OR] = 1.134, P = 0.031; OR = 7.559, P = 0.018, OR = 0.980, P < 0.001, respectively) for NAFLD in OSAHS patients. Moreover, compared with WBC/MPV, PLR, FLI, and APRI, a combination of WBC/MPV and PLR presented the largest AUC for the detection of NAFLD in BMI < 28 kg/m2 (0.753, 95% CI 0.684–0.822), and in age ≥ 60 years subgroup (0.786, 95% CI 0.692–0.880) in ROC analysis. Meanwhile, a combination of WBC/MPV and PLR presented the second largest AUC for the detection of NAFLD in all subjects (0.743, 95% CI 0.708–0.831), as well as in the age < 60 years subgroup (0.729, 95% CI 0.652–0.806), only ranked after FLI, suggesting the combination of WBC/MPV and PLR has a good predictive value for NAFLD in OSAHS patients.

Conclusion

We confirmed that the levels of WBC/MPV, PLR, and MaSO2 were closely related to the occurrence of NAFLD among OSAHS patients. Furthermore, our results highlighted the clinical combination of WBC/MPV and PLR levels could act as a simple and effective biomarker for screening NAFLD in patients with OSAHS.
Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial
Authors: Li Hong , Luo Tong-Feng , Zhang Nan-Rong , Zhang Li-Zhen , Huang Xia , Jin San-Qing
Published: December 2022

Background

The postoperative length of hospital stay (PLOS) is an important indicator of surgical quality. We identified perioperative factors that affect prolonged PLOS (PPLOS) after laparoscopic colorectal cancer resection, which is the preferred surgical approach for colorectal cancer, the third most common cancer.

Methods

This study was a secondary analysis of a randomized trial (clinicaltrials.gov ID: NCT03160144) that included 280 patients who underwent laparoscopic colorectal cancer resection. The primary outcome was a PPLOS, defined as a PLOS that was longer than the median PLOS. Baseline, anesthetic, surgical, and postoperative management factors were included in the univariate and multivariate analyses to identify factors influencing PPLOS.

Results

The median PLOS was 10 days, and 117 patients had a PPLOS. We identified six influencing factors for PPLOS: preoperative pulse oxygen saturation < 96% (odds ratio [OR], 3.09 [95% confidence interval (CI) 1.38–6.92]; P = 0.006), distant tumor metastasis (OR, 0.34 [95% CI 0.13–0.91]; P = 0.031), the Miles procedure or left hemicolectomy (OR, 4.51 [95% CI 1.67–12.18]; P = 0.003), perioperative surgical events (OR, 2.44 [95% CI 1.25–4.76]; P = 0.009), postoperative albumin infusion (OR, 2.19 [95% CI 1.14–4.19]; P = 0.018), and postoperative early ambulation (OR, 0.35 [95% CI 0.18–0.68]; P = 0.002). Further stratified analysis showed that postoperative albumin infusion might be a risk factor for PPLOS, even in patients with a preoperative albumin level < 40 g/L (OR, 2.29 [95% CI 0.98–5.34]; P = 0.056) or duration of surgery ≥ 3 h (OR, 2.52 [95% CI 1.08–5.87]; P = 0.032).

Conclusions

A low preoperative pulse oximetry reading, complex surgical procedures, perioperative surgical events, and postoperative albumin infusion may be risk factors for PPLOS after laparoscopic colorectal cancer resection, whereas distant tumor metastasis and postoperative early ambulation might be protective factors. The association between postoperative albumin infusion, a modifiable factor, and PLOS or clinical outcomes warrants further investigation.
Oral health perceptions and practices of caregivers at children’s religious schools and foster care centers: a qualitative exploratory study in Lahore, Pakistan
Authors: Saleem Javeria , Ishaq Muhammad , Butt Muhammad Salman , Zakar Rubeena , Malik Ushna , Iqbal Maida , Fischer Florian
Published: December 2022

Background

Oral diseases are one of the major public health problems worldwide and affect the population of all age groups. This qualitative study aimed to explore the perceptions and practices of caregivers at care centres and boarding religious schools responsible for managing children’s oral health.

Methods

A qualitative ethnomethodological approach was used to collect data from the caregivers at the children’s religious schools and foster care centres. A purposive sampling technique was used to conduct focus group discussions comprising 4–7 caregivers from five foster care centres and religious schools located in Lahore, Pakistan.

An interview guide was developed based on results from previous studies. An inductive approach was used to analyse data on broader oral health concepts to generate themes in this qualitative research. A three-step thematic analysis was applied to develop codes that were merged to generate categories and to conclude into themes from the transcribed data. Five focus group discussions were conducted at two foster care centres (FG1 & FG2) and three religious schools (FG3, FG4 & FG5). Foster care centres had children of both gender within the same premises; however, religious schools had segregated settings.

Results

The following four themes emerged from the thematic analysis: development of the desired living environment and responsibilities of the caregivers, preexisting traditional personal knowledge of the caregivers determine children’s oral health, use of religio-cultural driven and convenience-based oral hygiene practices, and ethnomedicine, spiritual healing, and self-medication. Development and the existing living environment of the foster care centres and religious schools appeared important to manage the matters of the boarding children.

Conclusions

This qualitative study concludes that the oral health of the children at foster care centres and at religious schools depends upon the personal reasoning and pre-existing religio-cultural knowledge of the caregivers rather than on specialized oral health-oriented approaches. The foster care centres are more involved in supervising the children to maintain oral hygiene and oral health compared to religious schools.
Experience of obstetricians and gynecologists in the management of medicolegal cases in Egypt
Authors: Sobh Zahraa Khalifa , Oraby Esraa Hassan Ahmed , Abdelaziz Saffa Abdelaziz Mohamed
Published: December 2022

Background

Obstetrics and gynecology (OB/GYN) is concerned with both fetal and maternal wellbeing with doubled professional responsibilities. Also, OB/GYN specialists are engaged in management of medicolegal cases (MLC). This study had an in-depth look at handling of MLC by obstetricians and gynecologists in Egypt. Also, influence of religious and cultural norms on OB/GYN practice was investigated.

Methods

A questionnaire was formulated in compliance with literature and modulated according to religious and cultural background.

Results

Responses were received from practitioners in 19 governorates. 28% of respondents were accused of malpractice. 87.3% of participants denoted increasing rate of litigations over last years. The commonest mentioned error is intra-operative problems (60%), whereas the commonest harm is neonatal deaths (46.7%). The mean participants' awareness score regarding elements of malpractice was 1.49 ± 0.76 (maximum possible score is 4). 18.7% of respondents managed cases of sexual assaults and premarital sexual relations. Hymen repair is not justified by 53.3% of participants. Termination of pregnancy before 16 weeks without medical indication is unaccepted by 96.7% of participants. The mean participants' awareness score regarding precautions of therapeutic abortion was 3.34 ± 1.63 (maximum possible score is 5).

Conclusions

OB/GYN specialists are at high risk of accusation with inadequate measures to guard against malpractice claims in Egypt. High controversy among respondents regarding management of cases with premarital sexual acts and termination of pregnancy was elucidated.
Inequalities in reported use of cervical screening in Estonia: results from cross-sectional studies in 2004–2020
Authors: Suurna Maria , Orumaa Madleen , Ringmets Inge , Pärna Kersti
Published: December 2022

Background

Despite the national cervical cancer (CC) screening program established in 2006, the CC incidence in Estonia in 2020 was still one of the highest in Europe. To better understand the possible barriers among women, the aim of this study was to describe the inequalities in the Pap smear uptake trend in 2004–2020 and to analyse the associations between different factors in Estonia.

Methods

Weighted data of 25–64-year-old women (N = 6685) from population-based cross-sectional studies of Health Behaviour among Estonian Adult Population in 2004–2020 was used. Linear trends in uptake of Pap smear over time were tested using the Cochrane-Armitage test. Binary logistic regression with interactions was performed to analyse associations between the uptake of Pap smear and sociodemographic, socioeconomic, health-related and lifestyle factors. Crude and adjusted odds ratios with 95% confidence intervals were calculated.

Results

Prevalence of lifetime uptake of Pap smear increased in 2004–2020 from 50.6 to 86.7% (P < 0.001). From 2004 to 2020, uptake of Pap smear increased significantly among women aged 25–34, 35–44, 45–54 and 55–64, in both ethnicity groups and among women with basic, secondary and higher education (P < 0.001). The gap in Pap smear uptake increased between Estonians and non-Estonians but decreased between education levels over time. Lower lifetime uptake of Pap smear was associated from sociodemographic factors with younger age, being non-Estonian and single, from socioeconomic factors with lower educational level and unemployment, from health indicators with higher body mass index indicating overweight and obesity, presence of chronic disease and depressiveness, and from lifestyle factors with non-smoking.

Conclusions

Although Pap smear uptake among 25–64 year old women increased significantly in Estonia in 2004–2020, inequalities were found indicating an opportunity for development of targeted CC prevention strategies.
Association between weight loss and mortality in idiopathic pulmonary fibrosis
Authors: Kalininskiy Aleksandr , Rackow Ashley Rose , Nagel David , Croft Daniel , McGrane-Minton Heather , Kottmann Robert Matthew
Published: December 2022

Rationale

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease that has no cure. Many current research efforts center on diagnostic and therapeutic modalities for IPF while other risk factors affecting disease pathogenesis receive less attention. Emerging data support the clinical importance of weight loss in patients with IPF. However, factors associated with weight loss and the impact of weight loss on mortality remain incompletely explored.

Objectives

Explore the association between weight loss and transplant-free survival in patients with IPF and identify clinical variables associated with weight loss in this population.

Methods

Kaplan–Meier and Cox proportional hazard regression analyses were generated and stratified by weight loss or use of antifibrotic medications. Conditional logistic regression was used to evaluate for factors associated with weight loss.

Results

There was a significant increase in mortality in patients who lost ≥ 5% of their body weight loss (HR 2.21, [1.29, 4.43] p = .021). The use of supplemental oxygen (adjusted OR 13.16), and ≥ 200 mL loss of FVC over 1 year (adjusted OR 5.44) were both associated with a ≥ 5% weight loss in the year following a diagnosis of IPF. The use of antifibrotic medication did not significantly change median transplant-free survival in patients who lost more than ≥ 5% of their body mass.

Conclusions

Weight loss over the first year following a diagnosis of IPF is strongly associated with decreased transplant-free survival. More research is needed to determine the mechanisms surrounding weight loss in patients with IPF.
Meeting the challenges of NTM-PD from the perspective of the organism and the disease process: innovations in drug development and delivery
Authors: van der Laan Roald , Snabilié Andy , Obradovic Marko
Published: December 2022

Non-tuberculous mycobacterial pulmonary disease (NTM-PD) poses a substantial patient, healthcare, and economic burden. Managing NTM-PD remains challenging, and factors contributing to this include morphological, species, and patient characteristics as well as the treatment itself. This narrative review focusses on the challenges of NTM-PD from the perspective of the organism and the disease process. Morphological characteristics of non-tuberculous mycobacteria (NTM), antimicrobial resistance mechanisms, and an ability to evade host defences reduce NTM susceptibility to many antibiotics. Resistance to antibiotics, particularly macrolides, is of concern, and is associated with high mortality rates in patients with NTM-PD. New therapies are desperately needed to overcome these hurdles and improve treatment outcomes in NTM-PD. Amikacin liposome inhalation suspension (ALIS) is the first therapy specifically developed to treat refractory NTM-PD caused by Mycobacterium avium complex (MAC) and is approved in the US, EU and Japan. It provides targeted delivery to the lung and effective penetration of macrophages and biofilms and has demonstrated efficacy in treating refractory MAC pulmonary disease (MAC-PD) in the Phase III CONVERT study. Several other therapies are currently being developed including vaccination, bacteriophage therapy, and optimising host defences. Newly developed antibiotics have shown potential activity against NTM-PD and include benzimidazole, delamanid, and pretomanid. Antibiotics commonly used to treat other infections have also been repurposed for NTM-PD, including clofazimine and bedaquiline. Data from larger-scale studies are needed to determine the potential of many of these therapies for treating NTM-PD.
Metabolic engineering of Rhodotorula toruloides for resveratrol production
Authors: Zhang Mengyao , Gao Qidou , Liu Yijuan , Fang Zhumei , Gong Zhiwei , Zhao Zongbao K. , Yang Xiaobing
Published: December 2022

Background

Resveratrol is a plant-derived phenylpropanoid with diverse biological activities and pharmacological applications. Plant-based extraction could not satisfy ever-increasing market demand, while chemical synthesis is impeded by the existence of toxic impurities. Microbial production of resveratrol offers a promising alternative to plant- and chemical-based processes. The non-conventional oleaginous yeast Rhodotorula toruloides is a potential workhorse for the production of resveratrol that endowed with an efficient and intrinsic bifunctional phenylalanine/tyrosine ammonia-lyase (RtPAL) and malonyl-CoA pool, which may facilitate the resveratrol synthesis when properly rewired.

Results

Resveratrol showed substantial stability and would not affect the R. toruloides growth during the yeast cultivation in flasks. The heterologus resveratrol biosynthesis pathway was established by introducing the 4-coumaroyl-CoA ligase (At4CL), and the stilbene synthase (VlSTS) from Arabidopsis thaliana and Vitis labrusca, respectively. Next, The resveratrol production was increased by 634% through employing the cinnamate-4-hydroxylase from A. thaliana (AtC4H), the fused protein At4CL::VlSTS, the cytochrome P450 reductase 2 from A. thaliana (AtATR2) and the endogenous cytochrome B5 of R. toruloides (RtCYB5). Then, the related endogenous pathways were optimized to affect a further 60% increase. Finally, the engineered strain produced a maximum titer of 125.2 mg/L resveratrol in YPD medium.

Conclusion

The non-conventional oleaginous yeast R. toruloides was engineered for the first time to produce resveratrol. Protein fusion, co-factor channeling, and ARO4 and ARO7 overexpression were efficient for improving resveratrol production. The results demonstrated the potential of R. toruloides for resveratrol and other phenylpropanoids production.
Molecular surveillance of anti-malarial drug resistance genes in Plasmodium falciparum isolates in Odisha, India
Authors: Rana Ramakanta , Khan Nikhat , Sandeepta Sonali , Pati Sanghamitra , Das Aparup , Bal Madhusmita , Ranjit Manoranjan
Published: December 2022

Background

Despite significant progress in eliminating malaria from the state of Odisha, India, the disease is still considered endemic. Artesunate plus sulfadoxine-pyrimethamine (AS + SP) has been introduced since 2010 as first-line treatment for uncomplicated Plasmodium falciparum malaria. This study aimed to investigate the prevalence of mutations associated with resistance to chloroquine (CQ), sulfadoxine-pyrimethamine (SP), and artesunate (ART) in P. falciparum parasites circulating in the state.

Methods

A total of 239 isolates of P. falciparum mono infection were collected during July 2018-November 2020 from the four different geographical regions of the state. Genomic DNA was extracted from 200 µL of venous blood and amplified using nested polymerase chain reaction. Mutations on gene associated with CQ (Pfcrt and Pfmdr1) were assessed by PCR amplification and restriction fragment length polymorphism, artemisinin (Pfk13) gene by DNA sequencing and SP (Pfdhfr and Pfdhps) genes by allele-specific polymerase chain reaction (AsPCR).

Results

The point mutation in Pfcrt (K76T) was detected 2.1%, in Pfmdr1 (N86Y) 3.4%, and no mutations were found in Pfkelch13 propeller domain. Prevalence of Pfdhfr, Pfdhps and Pfhdfr-Pfdhps (two locus) gene mutations were 50.43%, 47.05% and 49.79% respectively. The single, double, triple and quadruple point mutations in Pfdhfr gene was 11.2%, 8.2%, 17.2% and 3.4% while, in Pfdhps gene was 10.9%,19.5%, 9.5% and 2.7% respectively. Of the total 13 haplotypes found in Pfdhfr, 8 were detected for the first time in the state and of the total 26 haplotypes found in Pfdhps, 7 were detected for the fisrt time in the state. The linked quintuple mutation Pfdhfr (N51I-C59R-S108N)-Pfdhps (A437G-K540E) responsible for clinical failure (RIII level of resistance) of SP resistance and A16V-S108T mutation in Pfdhfr responsible for cycloguanil was absent.

Conclusion

The study has demonstrated a low prevalence of CQ resistance alleles in the study area. Despite the absence of the Pfkelch13 mutations, high prevalence of Pfdhfr and Pfdhps point mutations undermine the efficacy of SP partner drug, thereby threatening the P. falciparum malaria treatment policy. Therefore, continuous molecular and in vivo monitoring of ACT efficacy is warranted in Odisha.
Avoidable mortality due to long-term exposure to PM2.5 in Colombia 2014–2019
Authors: Rodriguez-Villamizar Laura A. , Belalcazar-Ceron Luis Carlos , Castillo María Paula , Sanchez Edwin Ricardo , Herrera Víctor , Agudelo-Castañeda Dayana Milena
Published: December 2022

Objective

To compare estimates of spatiotemporal variations of surface PM2.5 concentrations in Colombia from 2014 to 2019 derived from two global air quality models, as well as to quantify the avoidable deaths attributable to the long-term exposure to concentrations above the current and projected Colombian standard for PM2.5 annual mean at municipality level.

Methods

We retrieved PM2.5 concentrations at the surface level from the ACAG and CAMSRA global air quality models for all 1,122 municipalities, and compare 28 of them with available concentrations from monitor stations. Annual mortality data 2014–2019 by municipality of residence and pooled effect measures for total, natural and specific causes of mortality were used to calculate the number of annual avoidable deaths and years of potential life lost (YPLL) related to the excess of PM2.5 concentration over the current mean annual national standard of 25 µg/m3 and projected standard of 15 µg/m3.

Results

Compared to surface data from 28 municipalities with monitoring stations in 2019, ACAG and CAMSRA models under or overestimated annual mean PM2.5 concentrations. Estimations from ACAG model had a mean bias 1,7 µg/m3 compared to a mean bias of 4,7 µg/m3 from CAMSRA model. Using ACAG model, estimations of total nationally attributable deaths to PM2.5 exposure over 25 and 15 µg/m3 were 142 and 34,341, respectively. Cardiopulmonary diseases accounted for most of the attributable deaths due to PM2.5 excess of exposure (38%). Estimates of YPLL due to all-cause mortality for exceeding the national standard of 25 µg/m3 were 2,381 years.

Conclusion

Comparison of two global air quality models for estimating surface PM2.5 concentrations during 2014–2019 at municipality scale in Colombia showed important differences. Avoidable deaths estimations represent the total number of deaths that could be avoided if the current and projected national standard for PM2.5 annual mean have been met, and show the health-benefit of the implementation of more restrictive air quality standards.
Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study
Authors: Prajapati Nirmala , Soler-Michel Patricia , Vieira Verónica M. , Padilla Cindy M.
Published: December 2022

Background

The detection of cancer in its early latent stages can improve patients’ chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates.

Methods

Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50–74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion.

Results

The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization.

Conclusions

This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.