bluuebunny/crossref_metadata_2025 huggingface dataset:
Episode-Based Bundled Payments in Hand Surgery: An Affordable Solution to Overwhelming Health Care Costs
Authors: Cheng Ryan , Wang Calvin , Sain Jared , Frias Giulia C. , Melendez Justin X. , Badalyan Nicole V. , Carayannopoulos Nicolas L. , Katt Brian M.
Published: December 2024

The purpose of this review is to examine the literature regarding episode-based bundled payment models for hand surgery. Health care and productivity costs associated with the surgical management of hand and wrist pathologies represent a substantial burden on the United States health care system. Traditional fee-for-service models fail to incentivize interdisciplinary collaboration and optimization of resources. More recently, the concept of episode-based bundled payments has evolved as a potential solution to rising health care costs by encouraging care coordination, streamlining billing processes, and linking reimbursement to quality metrics and patient outcomes as opposed to the volume of services rendered. Although episode-based bundled payments have demonstrated the potential to reduce health care costs in various medical specialties, their feasibility in hand surgery remains relatively unexplored. The transition to episode-based bundled payments in hand surgery hinges on the ability to incentivize physicians to work cohesively with other members of the care team to reduce low-value preoperative testing, optimize patients preoperatively, and establish treatment guidelines, especially for patients undergoing high-volume, low-complexity procedures. By fostering collaboration among stakeholders, leveraging data-driven insights, and prioritizing patient-centered care, episode-based bundled payments have the potential to enhance the value and efficiency of hand surgery services while improving patient outcomes. The current literature regarding episode-based bundled payments in hand surgery highlights various avenues for cost savings, including alternative sites of service, surgical approaches, use of anesthesia, and the elimination of low-value tests, and demonstrates that there is sufficient evidence to proceed to a trial phase for episode-based bundled payments in hand surgery.
Cooking and Crafting in a Digital Economy: The Effects of Online Commodification on Leisure Activities
Authors: Jourdain Anne , Naulin Sidonie
Published: December 2024

Growing numbers of people are commodifying their leisure activities on the internet. This article’s mixed-method study of French food bloggers and Etsy handicrafters focuses on the overflow of digital market work into amateurs’ domestic lives. Building on the sociology of ‘serious leisure’, the study examines the novelty of such social phenomena. We show that traditional serious leisure activities have already revealed comparable forms of overflow and similar motives for consent to such spillover effects. However, the study also brings to light three specific effects of online commodification on leisure activities: the new forms of extra work in which amateurs are involved, the transformation of the leisure activity, and the shortening of amateurs’ careers.
A new diagnosis of primary biliary cholangitis in pregnancy treated with a combination of ursodeoxycholic acid and bezafibrate
Authors: Harrington Laura , Ovadia Caroline , Heneghan Michael , Williamson Catherine
Published: December 2024

This primigravid pregnant woman had a new diagnosis of primary biliary cholangitis (PBC) that was treated with a combination of ursodeoxycholic acid (UDCA) and bezafibrate. Pregnancy may unmask underlying chronic hepatic disorders in susceptible women and, in some cases, the associated abnormalities of liver function or increased serum bile acids (hypercholanaemia) can result in significant fetal and maternal risk. Maternal pruritus, with associated sleep deprivation, may cause considerable distress. To our knowledge, this is the first reported case of a new diagnosis of PBC in pregnancy treated with a combination of both UDCA and a fibrate. The case demonstrates the importance of accurate and efficient diagnosis alongside effective multidisciplinary team working to initiate appropriate, timely treatment to minimise the risk to fetus and mother. Early assessment, risk stratification and cautious surveillance is paramount in managing evolving or coexisting pathology plus individualised delivery planning, aiming to optimise fetal and maternal outcomes.
Enhancing parent-child interaction through the gamification of parenting: An exploration of digital interventions
Authors: Indrajaya Mixzy , Chao Wen-Hung , Semwaiko Godfrey Steven , Pusparani Yori , Yang Ching-Yu
Published: December 2024

The increasing use of digital technology by children has created both opportunities and challenges for their parents. This study analyze how digital device usage impacts children’s behaviors and academic achievement, focusing on the critical role of parental involvement. A detailed review of studies released between 2010 and 2023 was carried out using databases such as PubMed, ProQuest, and Scopus to show how parenting gamification affects parent-child relationships, interaction, and child development. While digital games have positive effects on education, such as improving academic performance and cognitive abilities, concerns were raised about negative consequences like aggression and emotional problems caused by excessive use and violent material. This suggests that both educational content and careful monitoring of game types could help parents develop strategies to improve positive interactions and manage negative effects. This systematic review highlights the importance of balanced and mindful digital device use guided by informed parental strategies.
Neighborhood Context, Divine Struggles, and Psychological Distress
Authors: Hill Terrence D. , Cheung Pui Yin , Curtis David S. , Wei Yehua D. , Upenieks Laura , Wen Ming
Published: December 2024

Although researchers have consistently linked structural neighborhood disadvantage with poorer mental health, they continue to search for underlying mechanisms. In this article, we test whether the association between structural neighborhood disadvantage and psychological distress is mediated by perceived neighborhood disorder and divine struggles. Using longitudinal national survey data from the Midlife in the United States (MIDUS 2 and 3) study ( n = 2,083), we employed structural equation modeling and marginal models with unstructured covariances. Our mediation analysis confirmed the indirect effect of neighborhood structural disadvantage (concentrated socioeconomic disadvantage) on psychological distress (depression and anxiety) through perceived neighborhood disorder (perceptions of neighborhood safety and the built environment) and divine struggles (strained relations with God). Our analyses build on previous work by demonstrating that divine struggles may play a role in explaining why living in a neighborhood that is characterized by structural disadvantage and disorder is often associated with poorer mental health.
Which is the Superior Thoracolumbar Injury Classification Tool? TLICS Versus AOSpine 2013: A Systematic Review
Authors: Pidd Kristina T. , Sadauskas David , Tomatis Vanesa , Knight Ema J.
Published: December 2024

Study Design

Systematic Literature Review.

Objectives

To address whether TLICS or AOSpine is best used in clinical practice through assessment of interobserver and intraobserver reliability, agreement, and imaging modality performance.

Methods

This systematic literature review was reported in accordance with PRISMA 2020 guidelines. Articles were included based on meeting eligibility criteria: studies evaluating TLICS, AOSpine, and/or TL AOSIS through reliability, agreement, or imaging modality performance with adult patients (≥18) suffering from traumatic thoracolumbar fractures. Articles were acquired in April 2023 from Medline, CINAHL, and Scopus. Risk of bias was assessed through a modified COSMIN checklist. Tabulated results were separated by classification tool (TLICS or AOSpine/TL AOSIS) and reliability, agreement, or imaging modality results.

Results

Twenty-one studies were included in the final review. Interobserver and intraobserver AOSpine morphology reliability was on average superior to TLICS. Increased familiarity with the tool positively influenced both AOSpine and TLICS performance. For surgical treatment recommendation, AOSpine differentiated between stable and unstable burst fractures and guided clinician’s more accurately than TLICS. Regarding conservative treatment, both TLICS and AOSpine reported similar clinical accuracy. TLICS performed significantly better when MRI was incorporated compared to CT alone. CT was sufficient as an imaging modality for AOSpine/TL AOSIS performance.

Conclusions

AOSpine outperformed TLICS in surgical reliability, agreement and did not require additional MRI imaging to improve accuracy. Limitations of evidence include low quality of available studies and significant heterogeneity in patient and observer number. Future prospective multicentre research is recommended. This study was not funded and not registered on PROSPERO.
An Intersectional Approach to Testing Explanations of the Black-White Mental Health Paradox
Authors: LaMotte Megan E. , Elliott Marta , Mouzon Dawne M.
Published: December 2024

Researchers have sought to explain Black Americans’ lower rates of common mental illnesses than White Americans, despite greater stress exposure, yet few explanations of this paradox are supported empirically. We examined the extent to which the paradox is owing to: Black Americans’ racial identity and religiosity resources offsetting the ill-effects of stressors, limited empirical attention to externalizing mental health outcomes, and the homogenization of both racial groups by disregarding within-group gender differences. Data came from the 25,454 Black and White men and women of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions. We used structural equation modeling to test for indirect effects of race on mental health via stressors, racial identity, and religiosity, and tested multigroup models by gender. Results indicated that the paradox could reflect the failure to account for Black Americans’ increased risk of substance-use disorders and greater symptoms of poor mental health. Racial identity did not explain variations in mental disorder by race overall, but it protected against all mental disorders for Black women. Findings also indicated complex effects of Black Americans’ greater religiosity. Greater religious importance exacerbated some mental health problems, whereas religious service attendance had protective effects, especially among women. Future research on explanations of the paradox should continue to incorporate multiple mental health outcomes and investigate intersectional identities.
Participation in the Supplemental Nutrition Assistance Program (SNAP) 2019–2024: A Systematic Review of Barriers and Enablers
Authors: Figueroa Roger , Owoputi Ibukun , Liu Ruyu , Chiong Reah , Salas Julio , Saltzman Jaclyn , Baker Katherine
Published: December 2024

The Supplemental Nutrition Assistance Program (SNAP), the largest U.S. food safety net program, serves over 42 million people. This study synthesizes evidence of barriers and enablers to participation in SNAP among income-eligible individuals and relevant stakeholders. Peer-reviewed studies based in the United States and published between 2019 and 2024 were included in this review. Data were extracted and synthesized across five (5) databases, and through forward and backward reference searches. Screening and data extraction were conducted using Covidence. The Mixed Methods Appraisal Tool was used for quality assessment. A total of 17 articles were included; 50 factors were identified as barriers or enablers to SNAP participation. Relevant stakeholders identified a similar number of barriers and enablers, while income-eligible individuals identified more barriers compared to enablers to SNAP participation. Findings from this evidence synthesis highlight the need to strengthen SNAP-related policies to preserve adjustments sustained during COVID-19, to maximize participation and health promotion, and to build capacity for future public emergencies.
Prospects of e-Coaching as a Platform for Empowering Families of Person With Mental Disorder: A Qualitative Study
Authors: Arifin Mokhamad , Sekarwana Nanan , Mediawati Ati Surya , Susilaningsih F Sri
Published: December 2024

Introduction

In all countries, the burden of mental disorders (MDs) spans the entire life course. Smartphones are currently widely used by families with a history of MD looking for the required mental health information. The use of digital media is an alternative to improving the ability of families to care for person with MD at home.

Objectives

This study aimed to explore the opportunity and the benefits of e-coaching as a method and media for empowering families of MD person.

Methods

This study was a qualitative study that recruited 21 participants. The mean age was 45.7 years old, male 42.9%, and female 47.1%. They were divided into four groups: families who have a family member with MD, nurses who provide mental health services, mental health cadres, and government elements in Pekalongan, Central Java, Indonesia. An in-depth interview was applied to collect data. Further, the data were analyzed using thematic content analysis using Colaizzi's frame.

Results

There were four themes related to the possibility of using e-coaching to empower families with a family member with MD: menus, needs, supporting factors, and hindering factors. The use of information technology can be used to improve the ability to take care of families, especially in treating MDs at home with the e-coaching application.

Conclusions

The findings show that developing e-coaching as a method and media is beneficial for person, families, and healthcare providers. In an effort to increase families’ capacity to treat MD at home, the findings of this study might be used to create an easy-to-use smartphone e-coaching application.

Recommendation

It is essential to establish e-coaching through a smartphone-based application in the Indonesian context. Additionally, to better treat MD person, nurses who provide mental health care should consider utilizing the mobile application.
Foot and Ankle Soft Tissue Sarcomas – Treatment and Oncologic Outcomes: A Systematic Review of the Literature
Authors: Fanfan Dino , Alvarez Juan , Shae Jillian , Gonzalez Marcos , Larios Felipe , Pretell-Mazzini Juan
Published: December 2024

Category:

Ankle; Other

Introduction/Purpose:

Foot and ankle soft tissue sarcomas (STS) are rare neoplasms associated with a high risk of local recurrence and metastasis. Although amputation is often performed, its impact on prognosis remains unknown. The aims of our systematic review were identifying risk factors for (1) disease-specific death, (2) local recurrence, (3) metastasis, and assessing (4) whether the type of surgery (amputation or limb-salvage) affected disease-specific survival.

Methods:

This systematic review was conducted following PRISMA guidelines. The PubMed, Embase and Scopus databases were searched. Our study was registered in PROSPERO (ID: 415624). Quality appraisal was done using STROBE guidelines.

Results:

A total of 7 studies and 123 patients were included. Metastasis was the only risk factor for disease-specific death (OR=107.85, p< 0.001). Previous unplanned excision (OR=22.29, p=0.009) and positive margins (OR=64.48, p=0.011) were associated with higher risk local of recurrence. Patients with high-grade tumors (OR=13.22, p=0.023) and tumors ≥ 6 cm (OR=7.40, p=0.022) were more likely to develop metastases. After adjusting for confounders (age, sex, and presence of metastasis), amputation was not associated with poorer disease-specific survival.

Conclusion:

Metastasis was the single most important risk factor for death with foot and ankle soft tissue sarcoma. Positive margins and history of previous unplanned excision are risk factors for local recurrence. The most important risk factors for metastasis are tumor grade and size ≥ 6 cm. Amputation was not associated with poorer disease-specific survival.
Occupational Noise Exposure in Foot and Ankle Surgery and the Risk of Noise Induced Hearing Loss
Authors: Kohring Adam , McCahon Joseph A.S , Bridges Tiffany N. , Kwan Stephanie , Parekh Selene G. , Daniel Joseph N.
Published: December 2024

Category:

Other; Basic Sciences/Biologics

Introduction/Purpose:

Occupational exposure to high levels of noise increases the risk of noise induced hearing loss (NIHL), resulting in significant long term quality of life implications. Hearing protection is recommended if occupational noise exposure routinely exceeds 85 dB. The purpose of this study was to determine if foot and ankle surgeons are exposed to excessive levels of noise, thus putting them at an increased risk for NIHL.

Methods:

A prospective review was conducted of intraoperative recordings during a variety of foot and ankle procedures. Recordings were categorized into three sub-groups: trauma, deformity correction and degenerative conditions, and soft tissue procedures. Noise levels were reported as maximum dB level (MDL), defined as the highest sound pressure level during the measurement period, and time-weighted average (TWA), defined as the average dB level projected over an 8-hour period. Dose was reported as the percentage of allowable daily noise, with projected dose reported as the measured dose projected over an 8-hours period.

Results:

193 recordings consisting of 45.5% deformity correction and degenerative conditions, 27.2% soft tissue procedures, and 29.2% trauma cases. Maximal and average noise exposures were similar for all procedures (p=0.077 and p=0.090, respectively), with an average MDL of 98.9 dB and TWA of 60.5 dB. Procedures also did not significantly differ in dose (p=0.273), even when projected over an 8-hour period (p=0.362). The average MDL of TAA and arthrodesis procedures was 102.0 dB, with 52% of all deformity correction and degenerative procedures having an MDL over 100dB.

Conclusion:

Foot and ankle surgeons are typically not exposed to dangerous levels of occupational noise; however, specific procedures such as arthrodesis and TAA routinely achieve dangerous noise levels. Implementing protective measures is crucial for those who regularly perform these types of procedures due to the increased risk of developing NIHL.
Outcomes Following Conversion of Ankle Fusion to Transfibular Total Ankle Arthroplasty in Complex Patients
Authors: Wood Thomas , Arthur Mark , Schon Lew C. , Motsay Morgan , Zhang Zijun
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Ankle fusion takedown with conversion to total ankle arthroplasty (TAA) shows promising results with regards to patient satisfaction and functional outcomes. The objective of this study is to present the results of tibiotalar fusion takedown via a lateral approach with conversion to TAA in complex patients with prior lateral approaches or compromised anterior tissues.

Methods:

A retrospective review was completed using the senior author’s total ankle replacement database. 16 patients underwent an ankle fusion takedown (TD) with conversion to transfibular TAA. 9/16 patients had prior tiobiotalar fusions; 7/16 patients had either a pantalar or tibiotalar calcaneal fusion. A matched cohort of patients who underwent primary transfibular TAA (TF TAA) was compared. Patient demographics, complication profiles, subjective pain questionnaires, and radiographic parameters were collected. Patient reported outcome measures (PROMs) were analyzed with Short Form-12 (SF-12), Visual Analog Scale (VAS), and the Ankle Osteoarthritis Scale (AOS). Radiographic parameters included plantarflexion and dorsiflexion range of motion (PF,DF) measured by tibiopedal excursion on standing flexion-extension radiographs. Radiographic indicators of implant subsidence (alpha, beta, and gamma angles) were measured.

Results:

Average age was 56.81 ± 13.11 years with 3.23 ± 1.46 years of follow-up. ASA was 2 or 3 in 15/16 TD and 16/16 TF TAA. Operative time was longer in TD due to additional procedures (6:04 ± 0.4 vs 4:55 ± 1.0, p=0.004). 6/16 per group underwent reoperation(s), most commonly fibular hardware removal (p=1). Radiographic parameters of TD revealed a 2°change in the beta angle (p=0.02) and increased plantarflexion 7.89 (5.65) to 13.51 (9.09) degrees (p=0.02). Compared to TD, TF TAA had greater PF 17.61 ± 6.52 vs 7.89 ± 5.65 (p = 0.002) and DF 18.95 ± 6.70 vs 12.48 ± 5.61 (p=0.011). Postoperative PROMs showed no significant difference between groups. There was no significant difference in cyst formation or lucency between groups.

Conclusion:

Tibiotalar fusion conversion to a lateral total ankle replacement in complex patients with prior lateral approaches or compromised anterior tissues appear to be a safe and effective surgery. When compared to primary lateral ankle replacements, ankle fusion takedown with conversion to total ankle arthroplasty yields similar patient reported outcomes, radiographic results, and complication rates at 3.2 years follow-up. Although technically challenging, transfibular total ankle replacement following ankle fusion takedown is a reasonable treatment option for symptomatic ankle, pantalar, or tibiotalar calcaneal fusion.
Initial pesticide residue concentrations in nectar and pollen after spray application on flowering plants for assessing impacts on pollination
Authors: Trapp Stefan , Rein Arno , Fantke Peter
Published: December 2024

Background

Pesticide application is one of the factors reported to contribute to the decline of pollinators, such as honey bees and bumble bees, and guidelines for risk assessment have been established recently. We collected a total of 1720 data sets of pesticide residue levels in pollen and nectar from EFSA documents and from the scientific literature, covering 71 different chemicals and 20 different crops. Out of this data set, 164 events for nectar with 27 different chemicals and 161 events for pollen with 32 different chemicals were chosen that describe the initial (t = 0–1 day) residue per unit dose (RUD) after spray application. Median RUD values were calculated to describe the typical realistic initial applied dose.

Results

Overall, we can confirm earlier findings found in the frame of risk assessment of plant protection products on bees. RUD pollen is higher than RUD nectar, and there is a wide variability of results. Polar pesticides had higher median RUD values, in particular in nectar, but the explained variability of substance properties is generally small (≤10%). There are clear indications that the setup and the conditions during the experiment override substance-specific differences. Factors contributing to the observed differences in RUD were identified: spray direction (up/sideward > downward), sampling method of nectar and pollen (from flower > by traps > from bees), experimental setting (greenhouse > field or tunnel) and geometry of flowers (Fabaceae had highest RUD nectar).

Conclusions

A goal of the study was to find a prediction method for initial pesticide residues in nectar and pollen after spray application to flowers and plants. Thus, median RUD values for the different conditions were provided. However, nothing can be said about how combinations of the mentioned factors affect RUD values.
Accounting for qualification in mismatch unemployment
Authors: Bauer Anja
Published: December 2024

The paper shows how important it is to consider the requirement level when measuring mismatch unemployment. While the mismatch between occupations decreases over time, the imbalances in the distribution of unemployed workers and vacant jobs across requirement levels increased, which, in sum, led to a stagnation of mismatch on the combined occupation-requirement level. Furthermore the paper shows that mismatch unemployment emerges especially at the level of un- and semi-skilled activities, as there is excess supply regardless of the occupations. And, more importantly, the excess supply is rising recently.
Role of irradiated and un-irradiated alginate as edible coating in physicochemical and nutritional quality of cherry tomato
Authors: Aly Amina A. , Maraei Rabab W.
Published: December 2024

Background

Fresh vegetables are commodities that have a high tendency to deteriorate after harvest, causing significant losses in economic and environmental costs associated with plant food loss. Therefore, this study was carried out to evaluate the effects of both un-irradiated (UISA) and irradiated sodium alginate (ISA) as an edible coating for preserving cherry tomato fruits under storage conditions. The FTIR, XRD, TGA, SEM, and TEM were used to characterize the UISA and ISA (25, 50, 75, and 100 kGy), which demonstrated that the alginate polymer was degraded and low molecular-weight polysaccharides were formed as a result of irradiation, particularly with the 100 kGy dose level. Sodium alginate irradiated at 100 kGy was used for the coating process, and the physico-chemical and nutritional quality of cherry tomatoes were analyzed.

Results

The results demonstrated that UISA and ISA treatments delayed changes in most of the ripening characteristics; weight and acidity losses, decay, and softening. The weight loss of the control was observed to be greater at the two keeping temperatures (4 and 25 °C) comparison with tomatoes coated with UISA. The ISA coatings gave the least weight loss at the two keeping temperatures (4 and 25 °C) (5.46 and 14.72%), respectively compared to the control (8.77 and 18.93%), respectively at the end of the storage period. In terms of antioxidant properties, significant results were obtained with the use of the alginate coating, specially irradiated sodium alginate. Over time, the majority of water-soluble vitamins in cherry tomatoes decreased, especially vitamin C, and the alginate-coated tomatoes showed the least decrease in vitamin C content, especially ISA.

Conclusions

The current findings suggest that ISA treatment efficiently extends the storage period of tomato fruits and maintains their quality through preservation and offers promising potential for successful commercialization of this eco-friendly eatable coating for fruit and vegetable growers and industries.
Comparative analysis of the LEA gene family in seven Ipomoea species, focuses on sweet potato (Ipomoea batatas L.)
Authors: Hu Mengqin , Li Zhenqin , Lin Xiongjian , Tang Binquan , Xing Meng , Zhu Hongbo
Published: December 2024

Late Embryogenesis Abundant (LEA) proteins are extensively distributed among higher plants and are crucial for regulating growth, development, and abiotic stress resistance. However, comprehensive data regarding the LEA gene family in Ipomoea species remains limited. In this study, we conducted a genome-wide comparative analysis across seven Ipomoea species, including sweet potato (I. batatas), I. trifida, I. triloba, I. nil, I. purpurea, I. cairica, and I. aquatica, identifying 73, 64, 77, 62, 70, 70, and 74 LEA genes, respectively. The LEA genes were divided into eight subgroups: LEA_1, LEA_2, LEA_3, LEA_4, LEA_5, LEA_6, SMP, and Dehydrin according to the classification of the LEA family in Arabidopsis. Gene structure and protein motif analyses revealed that genes within the same phylogenetic group exhibited comparable exon/intron structures and motif patterns. The distribution of LEA genes across chromosomes varied among the different Ipomoea species. Duplication analysis indicated that segmental and tandem duplications significantly contributed to the expansion of the LEA gene family, with segmental duplications being the predominant mechanism. The analysis of the non-synonymous (Ka) to synonymous (Ks) ratio (Ka/Ks) indicated that the duplicated Ipomoea LEA genes predominantly underwent purifying selection. Extensive cis-regulatory elements associated with stress responses were identified in the promoters of LEA genes. Expression analysis revealed that the LEA gene exhibited widespread expression across diverse tissues and showed responsive modulation to various abiotic stressors. Furthermore, we selected 15 LEA genes from sweet potatoes for RT-qPCR analysis, demonstrating that five genes responded to salt stress in roots, while three genes were responsive to drought stress in leaves. Additionally, expression changes of seven genes varied at different stages of sweet potato tuber development. These findings enhanced our understanding of the evolutionary dynamics of LEA genes within the Ipomoea genome and may inform future molecular breeding strategies for sweet potatoes.
Differences in the palliative care phase between patients with nonmalignant pulmonary disease and lung cancer: a retrospective study
Authors: Pihlaja Hanna , Rantala Heidi A. , Soikkeli Silja , Arminen Milja , Aho Sonja , Leivo-Korpela Sirpa , Lehto Juho T. , Piili Reetta P.
Published: December 2024

Background

Patients with chronic nonmalignant pulmonary disease and lung cancer both need palliative care, but palliative care services may be better adjusted to serve cancer patients. We compared the timing and clinical practice of palliative care and acute hospital usage during the last year of life in patients with nonmalignant pulmonary disease or lung cancer.

Methods

This was a retrospective study of all patients in a palliative care phase (palliative goal of care) with nonmalignant pulmonary disease or lung cancer who were treated at Tampere University Hospital, Finland, during the years 2018–2020. The data were collected from the hospital’s medical records. Comparisons between the groups were performed by using the Pearson chi-square test, Fisher’s exact test, or Mann‒Whitney U test when appropriate. Survival was estimated by using the Kaplan‒Meier method.

Results

The study population consisted of 107 patients with nonmalignant pulmonary disease and 429 patients with lung cancer. Patients with nonmalignant pulmonary disease survived longer in the palliative care phase than patients with lung cancer (115 vs. 59 days, p < 0.001). Compared to lung cancer patients, patients with nonmalignant disease received a palliative care specialist consultation more often during hospitalization (66% vs. 45%, p < 0.001) than during a preplanned outpatient visit (6% vs. 52%, p < 0.001), were less likely to be referred to palliative care pathway (79% vs. 87%, p = 0.033), and spent more days in an acute care hospital during the last year of life (median of 10 vs. 6 days, p = 0.023). Contrary to lung cancer patients, referral to the palliative care pathway was not significantly associated with decreased acute hospital resource usage during the last month of life among patients with nonmalignant pulmonary disease.

Conclusions

Compared to lung cancer patients, patients with nonmalignant pulmonary disease had longer palliative care phases but fewer visits to the palliative care outpatient clinic and fewer referrals to the palliative care pathways. Palliative care arrangements seemed to have more influence on the end-of-life care of lung cancer patients. There is a need for long-term palliative care services with better abilities to meet the special needs of patients with nonmalignant pulmonary disease.
“I have never felt so alone and vulnerable” – A qualitative study of bereaved people’s experiences of end-of-life cancer care during the Covid-19 pandemic
Authors: Burton Lara , Goss Silvia , Sivell Stephanie , Selman Lucy E. , Harrop Emily
Published: December 2024

Background

COVID-19 drastically affected healthcare services world-wide. In the UK, many cancer services were overwhelmed as oncology staff were reassigned, and cancer diagnoses and treatments were delayed. The impact of these pressures on end-of-life care for patients with advanced cancer and their relatives is not well understood.

Methods

Secondary thematic analysis of qualitative survey and interview data, collected from family members and close friends bereaved by cancer, as part of a national COVID-19 bereavement study (Survey N = 156; Interview N = 10).

Results

Four key themes were identified: The impact of COVID-19 on contact with patients towards the end of life; Mixed experiences of support for family members; Variable communication quality from health and social care professionals; Prioritisation of COVID-19 and its impact on patient care. Hospital care was perceived more negatively than community care in almost all areas, while support from cancer charities and district nurses was appreciated the most. Almost all participants felt that COVID-19 was detrimentally prioritised over care for their relative/friend.

Conclusions

People bereaved by cancer were uniquely affected by pandemic-restrictions and disruptions to services. As services re-build post-pandemic, improvements in palliative care in hospitals, investment into community care, and ensuring compassionate communication with patients and families must be prioritised, alongside preparedness for future pandemics or similar events.
Psychotherapy with somatosensory stimulation as a complementary treatment for women with endometriosis-associated pain – a qualitative study
Authors: Limmer Anna , Weber Annemarie , Olliges Elisabeth , Kraft Jana , Beissner Florian , Preibisch Christine , Meissner Karin
Published: December 2024

Objective

This qualitative study aimed to explore patients’ experiences with a novel treatment approach for endometriosis-associated pain, termed ‘sinosomatics’. Specifically, it sought to understand women’s experiences of the treatment and its components, the effects of the treatment on biological, psychological, and social levels, and how the women interpreted the changes they experienced.

Methods

We conducted ten semi-structured interviews with patients, who had undergone the complementary treatment for endometriosis-associated pain. These interview sessions were audio-recorded, transcribed, and analyzed using Mayring’s content analysis method with the aid of MAXQDA software.

Results

Three key categories emerged: ‘treatment experience,’ ‘treatment effects,’ and ‘explanation for effects’. The treatment was described as a “turning point” in patients’ lives, offering new insights into the involvement of psychosocial factors in endometriosis-associated pain and paving the way for overcoming adverse life events. The therapy strengthened women’s empowerment, inspired hope, fostered coping strategies, and promoted personal growth. Both the holistic view of body and mind and the psychological approach to treatment led to a change in the way how women perceived the disease.

Conclusions

Patients recognized the innovative combination of psychotherapy and acupuncture point stimulation as a significant advancement in managing their disease. The treatment has helped them to acquire a more holistic understanding of their bodily complaints and to cope more effectively with their symptoms. The findings highlight the importance of a patient-centered and empathetic treatment approach that empowers women to take an active role in managing their condition.
Is perioperative use of a combination of pregabalin and naproxen superior to naproxen only in reducing pain in ankle fractures? A prospective, randomized, multicenter study
Authors: Choi Gi Won , Park Kwang Hwan , Yoon Yeo Kwon , Lee Jin Woo , Shim Dong Woo
Published: December 2024

Purpose

To compare the analgesic efficacy, adverse effects, and long-term functional outcomes of perioperative naproxen alone versus naproxen with pregabalin for treating pain in ankle fractures.

Methods

This study included 70 patients who underwent operative fixation of rotatory ankle fractures. Group A received naproxen 500 mg only, and Group B received naproxen 500 mg with pregabalin 75 mg 2-hour before surgery and 12 hourly for 14 days thereafter. The minimal clinically important difference of the visual analog scale (VAS) for pain was set at 1.8 out of 10. VAS for pain, opioid consumption, and any adverse effects were recorded for 3 days postoperatively. VAS for pain was checked at 2- and 6-weeks and 3- and 6-months, and functional outcomes were measured at 3- and 6-months postoperatively.

Results

Sixty-three patients (33 and 30 in groups A and B, respectively) completed the 6-month follow-up. Demographic data were similar between groups. VAS for pain did not significantly differ between the groups at any timepoint up to 6 months (P ≥ 0.520), with 95% confidence intervals consistently within 1.8. No significant differences were observed between groups in opioid consumption and functional outcomes (P ≥ 0.211). In group B, dizziness at 48-hour and somnolence at 72-hour were significantly predominant (P ≤ 0.05).

Conclusion

Our study demonstrated comparable pain reduction between two groups following operative fixation of rotatory ankle fractures. However, side effects, including dizziness and somnolence, were predominant in Group B between 48 and 72 h.
Effect of individualized versus conventional perioperative blood pressure management on postoperative major complications in high-risk patients undergoing noncardiac surgery: study protocol for the SPROUT-4 multicenter randomized controlled trial
Authors: Chung Jaeyeon , Koo Chang-Hoon , Park Jungchan , Kim Hye-Bin , Bae Jinyoung , Ju Jae-Woo , Lee Soowon , Oh Ah Ran , Kim Hyo Sung , Park Soo Jung , Jeon Yunseok , Nam Karam ,   for the Seoul PeRioperative OUTcome research-4 (SPROUT-4) Investigators
Published: December 2024

Background

Intraoperative hypotension is very common during surgery and is linked to major organ dysfunction and mortality. Current perioperative blood pressure management is largely based on universal blood pressure thresholds ranging from a mean arterial pressure of 60–70 mmHg. However, the effectiveness of this conventional management remains unproven in prospective randomized trials. Therefore, we will conduct this study to test if individualized perioperative blood pressure management decreases the incidence of postoperative major adverse outcomes.

Methods

This multicenter, randomized controlled superiority trial will enroll 1896 high-risk patients undergoing major noncardiac surgery from five tertiary university hospitals in South Korea. In the control group, mean arterial pressure will be maintained at ≥ 65 mmHg and systolic blood pressure ≥ 90 mmHg during surgery. In the intervention group, mean arterial pressure and systolic blood pressure will be maintained at no less than 20% of their baseline values. The baseline values are calculated as the average of all values measured from the day before surgery until the morning of surgery. These targets will be maintained until the patient is discharged from the post-anesthesia care unit or, for those who are transferred to the intensive care unit after surgery, until the end of the surgery. No specific restrictions, except for these blood pressure targets, will be applied to perioperative management. The primary composite outcome consists of all-cause death, stroke, myocardial infarction, new or worsening congestive heart failure, unplanned coronary revascularization, and acute kidney injury within 7 days after noncardiac surgery or until hospital discharge, whichever occurs first.

Discussion

This study will reveal if individualized perioperative blood pressure management decreases the risk of major adverse outcomes in patients at high-risk undergoing noncardiac surgery.

Trial registration

ClinicalTrials.gov NCT06225453. Registered on January 26, 2024.
Cholecystectomy-induced thrombotic microangiopathy (TMA) in a postpartum patient successfully treated with eculizumab: a case report
Authors: Meyer Ashley , Uchida Kathryn , Nguyen Matthew , Vongbunyong Kenny , Ren Dong , Hanna Ramy , Tran Minh-Ha , Darwish Omar
Published: December 2024

Background

Thrombotic microangiopathy (TMA) is a rare, life-threatening disorder characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ damage. Atypical hemolytic uremic syndrome (aHUS) is even less common, comprising less than 10% of hemolytic uremic syndrome (HUS) cases. aHUS in postpartum is associated with poor maternal outcomes, with the majority of cases resulting in end-stage renal disease. aHUS, unlike other types of TMA, is related to complement dysregulation. Thus, the current treatment of choice for aHUS is complement blockade, which limits unregulated activation of complement and complement-mediated end organ damage.

Case presentation

We present a rare case of a previously healthy, postpartum, 20-year-old Hispanic female patient who underwent a laparoscopic cholecystectomy and subsequently developed complement-mediated TMA, successfully treated with eculizumab. Unique to our case was renal failure owing to multiple insults and partial resolution of hematologic TMA findings prior to initiation of eculizumab.

Conclusion

Our case emphasizes the importance of clinicians possessing a high degree of clinical awareness and judgement surrounding complement-mediated TMA, aHUS and its subsets, and surgery as a precipitator, regardless of safety, particularly during the postpartum period.
Atorvastatin inhibits glioma glycolysis and immune escape by modulating the miR-125a-5p/TXLNA axis
Authors: Gao Kang , Zhou Tao , Yin YingChun , Sun XiaoJie , Jiang HePing , Li TangYue
Published: December 2024

Background

Conventional treatments, including surgery, radiotherapy and chemotherapy, have many limitations in the prognosis of glioma patients. Atorvastatin (ATOR) has a significant inhibitory effect on glioma malignancy. Thus, ATOR may play a key role in the search for new drugs for the effective treatment of gliomas.

Methods

U87 cells were treated with different doses of ATOR and transfected. Viability was assessed using MTT, proliferative ability was determined using the colony formation test, Bax and Bcl-2 were identified using Western blot, apoptosis was identified using flow cytometry, and U87 cell migration and invasion were detected using the Transwell assay. Glucose uptake, lactate secretion, and ATP production in U87 cell culture medium were quantified. The positive rates of IFN-γ and TNF-α in CD8T were measured through flow cytometry. Subcutaneous injection of U87 cells was carried out to construct an in vivo mouse model of gliom, followed by HE staining to assess the effects of ATOR and miR-125a-5p on tumor development.

Results

ATOR blocked the viability, proliferation, migration, and invasion of U87 cells through the miR-125a-5p/TXLNA axis, and suppressed glycolysis and immune escape of glioma cells. Furthermore, overexpressing miR-125a-5p enhanced the anti-tumor effect of ATOR in vivo.

Conclusion

ATOR blocks glioma progression by modulating the miR-125a-5p/TXLNA axis, further demonstrating that ATOR provides an effective therapeutic target for the treatment of glioma.
Economic and legal impacts of delayed containers
Authors: Kołacz Marta K. , Storms Katrien , Sys Christa , Verheyen Wouter
Published: December 2024

Usage of containers beyond the predetermined period results in container demurrage and detention (D&D) that is charged by the carriers. The D&D charges are often perceived as a profit-making revenue stream for carriers, which raises the question of whether D&D charges adequately balance the ecosystem actor's interests. D&D charges in the maritime ecosystem have not received wider attention, the focus so far being mainly on some operational aspects of container delays. This paper contributes to the literature by mapping the ecosystem members' interests and proposing how to make these interests more balanced as far as D&D charges are concerned. For that purpose, economic (cost analysis) and legal (doctrinal and comparative) perspectives are employed. The conducted analysis presents the carrier’s opportunity costs and confirms that there might be a notion of the profit-making nature of D&D, which is not sufficiently mitigated under the existing legal framework. The legal framework provides mainly ex-ante mitigation strategies for which a party burdened with a D&D invoice would need to file a court claim. Nevertheless, the correction standards to prevent exaggerated D&D charges are largely missing. The paper suggests contractual and regulatory solutions that could help balance the ecosystem actors’ interests as far as D&D charges are concerned.
Does going against the norm on women’s economic participation increase intimate partner violence risk? A cross-sectional, multi-national study
Authors: Williams Anaise , Heise Lori , Perrin Nancy , Stuart Colleen , Decker Michele R.
Published: December 2024

Background

Women’s economic empowerment (WEE) is believed to reduce the risk of intimate partner violence (IPV), yet the relationship between WEE and IPV has proven to be highly variable. Little attention has been given to how the normative WEE environment may influence this relationship across different settings. This study tests whether IPV is associated with Vanguard WEE, defined as individual economic participation that deviates from community norms.

Methods

This cross-sectional study draws on Demographic and Health Surveys conducted in 44 low- and middle-income countries. The analytic sample was partnered women who participated in the domestic violence module, living in communities with sufficient data to construct WEE norms (n = 186,968). The relationship between Vanguard WEE—measured by the number of WEE activities a woman engaged in that were non-normative in her community—and the incidence of past-year physical IPV, sexual IPV, and partner control was evaluated using a mixed-effects multilevel logistic model. The study also explored interactions between Vanguard WEE and household wealth.

Results

Women who did not deviate from the community norm had an adjusted probability of 0.15 for experiencing physical IPV in the past year. However, this probability increased to 0.17 (marginal effect (ME): 0.014; 95% CI 0.007,0.021), 0.17 (ME: 0.020; 95% CI 0.010,0.030), and 0.19 (ME: 0.037; 95% CI 0.022,0.051) for women with one, two, and three or more vanguard WEE items, respectively. Physical IPV associated with vanguard WEE was higher among poorer women (p = 0.021). Additionally, the probability of past-year sexual IPV and current partner control increased from 0.05 to 0.08 (p < 0.001) and from 0.38 to 0.44 (p < 0.001), respectively, for women with three or more vanguard WEE items.

Conclusions

The study provides evidence of partner backlash in the form of IPV among vanguard women—those whose economic activities contradicted local norms. Programs designed to economically empower women in contexts where such participation is non-normative should include mechanisms to monitor and mitigate potential backlash.