bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study
Authors: Naito Hiromichi , Yumoto Tetsuya , Yorifuji Takashi , Nojima Tsuyoshi , Yamamoto Hirotsugu , Yamada Taihei , Tsukahara Kohei , Inaba Mototaka , Nishimura Takeshi , Uehara Takenori , Nakao Atsunori
Published: September 2021

Background

Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA.

Methods

A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival.

Results

Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%.

Conclusion

The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.
Use of intravenous N-acetylcysteine in acute severe hepatitis due to severe dengue infection: a case series
Authors: Dissanayake D. M. D. I. B. , Gunaratne W. M. S. N. , Kumarihamy K. W. M. P. P. , Kularatne S. A. M. , Kumarasiri P. V. R.
Published: September 2021

Background

Dengue fever is a common mosquito borne viral infection. Severe dengue fever associated severe hepatitis carries high mortality. Based on the beneficial effect of N-acetylcysteine (NAC) in paracetamol poisoning and non-acetaminophen induced liver failure, it is used in dengue fever associated hepatitis in clinical practice. We aim to study the reversal of liver enzymes with NAC in the setting of severe hepatitis due to severe dengue infection.

Methods

A retrospective analysis was conducted on hospitalized 30 adults with severe dengue fever with severe hepatitis. These 30 patients had aspartate transaminase (AST) and alanine transaminases (ALT) more than 500 U/L and/or PT INR (prothrombin time and international normalized ratio) more than 1.5. They were treated with NAC infusion of 100 mg/h for 3 to 5 days.

Results

The mean age of the group was 49.9 ± 11.46 years and 18 (60%) patients were males. Nineteen patients (63%) developed dengue shock. Of them 12 patients (40%) developed hepatic encephalopathy. Median AST on the day of administration of NAC was 1125 U/L interquartile range (IQR) 1653.25 while median ALT was 752 (IQR 459.25). There was a statistically significant reduction of both ALT (p = 0.034) and AST (p = 0.049) from day 1 to 4 after NAC infusion. Rise of platelet count between day 1 and day 4 also showed statistically significant difference (p = 0.011) but the reduction of prothrombin time and international normalized ratio (PT/INR) from 1 to day 4 did not show statistical significance difference. Mean duration of treatment with NAC was 3.61 ± 0.75 days while mean length of hospital stay was 6.2 ± 1.27 days. Only one patient died (3.3%). None of the patients reported adverse drug reaction due to NAC.

Conclusion

Majority of patients demonstrated marked clinical and biochemical improvements and they recovered fully. We observed faster and significant recovery of liver enzymes following administration of NAC. Based on the above findings, this study provides preliminary evidence for the beneficial effect of NAC in severe hepatitis in dengue infection with greater survival benefits.
Disposal practice and factors associated with unused medicines in Malaysia: a cross-sectional study
Authors: Wang Leong Seng , Aziz Zoriah , Chik Zamri
Published: September 2021

Background

The improper disposal of unused medicines is a worldwide concern because of its impact on the environment, economy, and health. This study aims to describe the disposal practice of unused medicine and identify factors associated with unused medicines in Malaysia.

Methods

This was a cross-sectional, face to face interview-based survey using a structured questionnaire. We used a convenience sampling method to recruit participants from Kuala Lumpur and Selangor in Malaysia.

Results

We interviewed 1184 participants, and the response rate was 96%. Out of the total respondents, 995 (84%) reported having unused medicines. About a quarter of respondents kept unused medicines in the cabinet, and another quarter disposed of them into the trash or toilet. Only half of the respondent who used medicines for chronic illnesses had unused medicines compared to about 90% of respondents who used medicines for acute illnesses. The main reason for having unused medicines among those who used medicines for chronic illness was non-adherence (69%, p <  0.05). Only 27% of these respondents returned unused medicines under the “Medicine Return Programme (MRP)”. The other group who used medicines for acute illnesses had unused medicines because their health conditions improved. Thus, most of the unused medicines will eventually end up in household waste. A multivariate logistic regression analysis identified respondents who used medicines for acute illnesses as the strongest predictor of having unused medicines (Odds Ratio (OR) = 29.8; p <  0.001), followed by those who pay for their medicines (OR = 6.0; p < 0.001) and those who were willing to participate the Medicine Return Programme (OR = 2.5; p = 0.009).

Conclusion

The prevalence of unused medicines and their improper disposal were high in Malaysia. Unused medicines are associated with people who use medicines for acute illnesses, pay for their medication, and are willing to participate in an MRP. Rationale prescription and optimal dispensing practice, together with a broader MRP facilities coverage, could reduce unused medicine possession.
The analysis of the geographical distribution of emergency departments’ frequent users: a tool to prioritize public health policies?
Authors: Hellmann Romain , Feral-Pierssens Anne-Laure , Michault Alain , Casalino Enrique , Ricard-Hibon Agnès , Adnet Frederic , Brun-Ney Dominique , Bouzid Donia , Menu Axelle , Wargon Mathias
Published: September 2021

Background

The individual factors associated to Frequent Users (FUs) in Emergency Departments are well known. However, the characteristics of their geographical distribution and how territorial specificities are associated and intertwined with ED use are limited. Investigating healthcare use and territorial factors would help targeting local health policies. We aim at describing the geographical distribution of ED’s FUs within the Paris region.

Methods

We performed a retrospective analysis of all ED visits in the Paris region in 2015. Data were collected from the universal health insurance’s claims database. Frequent Users (FUs) were defined as having visited ≥3 times any ED of the region over the period. We assessed the FUs rate in each geographical unit (GU) and assessed correlations between FUs rate and socio-demographics and economic characteristics of GUs. We also performed a multidimensional analysis and a principal component analysis to identify a typology of territories to describe and target the FUs phenomenon.

Results

FUs accounted for 278,687 (11.7%) of the 2,382,802 patients who visited the ED, living in 232 GUs. In the region, median FUs rate in each GU was 11.0% [interquartile range: 9.5–12.5]. High FUs rate was correlated to the territorial markers of social deprivation. Three different categories of GU were identified with different profiles of healthcare providers densities.

Conclusion

FUs rate varies between territories and is correlated to territorial markers of social deprivation. Targeted public policies should focus on disadvantaged territories.
Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study
Authors: Dehghani Maryam , Davoodi Zahra , Bidari Farahnaz , Moghaddam Amin Momeni , Khalili Davood , Bahrami-Motlagh Hooman , Jamali Elena , Alamdari Shahram , Hosseinpanah Farhad , Hedayati Mehdi , Valizadeh Majid
Published: September 2021

Background

Regarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients.

Methods

A retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models.

Results

Among 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67;p = 0.015) and 64% (95% CI: 0.19–0.69;p < 0.001), respectively. Responses to the medications were not significantly different among three groups.

Conclusion

Various pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.
Privacy-preserving dataset combination and Lasso regression for healthcare predictions
Authors: van Egmond Marie Beth , Spini Gabriele , van der Galien Onno , IJpma Arne , Veugen Thijs , Kraaij Wessel , Sangers Alex , Rooijakkers Thomas , Langenkamp Peter , Kamphorst Bart , van de L’Isle Natasja , Kooij-Janic Milena
Published: September 2021

Background

Recent developments in machine learning have shown its potential impact for clinical use such as risk prediction, prognosis, and treatment selection. However, relevant data are often scattered across different stakeholders and their use is regulated, e.g. by GDPR or HIPAA.

As a concrete use-case, hospital Erasmus MC and health insurance company Achmea have data on individuals in the city of Rotterdam, which would in theory enable them to train a regression model in order to identify high-impact lifestyle factors for heart failure. However, privacy and confidentiality concerns make it unfeasible to exchange these data.

Methods

This article describes a solution where vertically-partitioned synthetic data of Achmea and of Erasmus MC are combined using Secure Multi-Party Computation. First, a secure inner join protocol takes place to securely determine the identifiers of the patients that are represented in both datasets. Then, a secure Lasso Regression model is trained on the securely combined data. The involved parties thus obtain the prediction model but no further information on the input data of the other parties.

Results

We implement our secure solution and describe its performance and scalability: we can train a prediction model on two datasets with 5000 records each and a total of 30 features in less than one hour, with a minimal difference from the results of standard (non-secure) methods.

Conclusions

This article shows that it is possible to combine datasets and train a Lasso regression model on this combination in a secure way. Such a solution thus further expands the potential of privacy-preserving data analysis in the medical domain.
Waardenburg syndrome type 2A in a large Iranian family with a novel MITF gene mutation
Authors: Zardadi Safoura , Rayat Sima , Hassani Doabsari Maryam , Keramatipour Mohammad , Morovvati Saeid
Published: September 2021

Background

The characteristics of Waardenburg syndrome (WS) as a scarce heritable disorder are sensorineural hearing loss and deficits of pigmentation in the skin, hair, and eye. Here, clinical features and detection of the mutation in theMITFgene of WS2 patients are reported in a sizable Iranian family.

Methods

A man aged 28-years represented with symptoms of mild unilateral hearing loss (right ear), complete heterochromia iridis, premature graying prior to 30 years of age, and synophrys. In this research, there was a sizable family in Iran comprising three generations with seven WS patients and two healthy members. Whole exome sequencing was applied for proband for the identification of the candidate genetic mutations associated with the disease. The detected mutation in proband and investigated family members was validated by PCR-Sanger sequencing.

Results

A novel heterozygous mutation, NM_198159.3:c.1026dup p.(Asn343Glufs*27), in exon 9 of theMITFgene co-segregated with WS2 in the affected family members. The variant was forecasted as a disease-causing variant by the Mutation Taster. According to the UniProt database, this variant has been located in basic helix-loop-helix (bHLH) domain of the protein with critical role in DNA binding.

Conclusions

A frameshift was caused by a nucleotide insertion, c.1026dup, in exon 9 of theMITFgene. This mutation is able to induce an early termination, resulting in forming a truncated protein capable of affecting the normal function of the MITF protein. Helpful information is provided through an exactly described mutations involved in WS to clarify the molecular cause of clinical characteristics of WS and have a contribution to better genetic counseling of WS patients.
Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic?
Authors: Llop-Gironés Alba , Vračar Ana , Llop-Gironés Gisela , Benach Joan , Angeli-Silva Livia , Jaimez Lucero , Thapa Pramila , Bhatta Ramesh , Mahindrakar Santosh , Bontempo Scavo Sara , Nar Devi Sonia , Barria Susana , Marcos Alonso Susana , Julià Mireia
Published: September 2021

Background

Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses’ globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom.

Main body

Nurses’ health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses’ workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses’ employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health.

Conclusion

The protection of nurses’ health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work–life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses’ health and monitor the progress towards nurses’ health equity.
Identifying effective intervention strategies to reduce children’s screen time: a systematic review and meta-analysis
Authors: Jones Alexis , Armstrong Bridget , Weaver R. Glenn , Parker Hannah , von Klinggraeff Lauren , Beets M. W.
Published: September 2021

Background

Excessive screen time ($$\ge$$
≥
2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children’s (0–18 years) screen time.

Methods

A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children’s (0–18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics.

Results

The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased.

Conclusions

Both intervention content and context are important to consider when designing interventions to reduce children’s screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children’s screen time.
Neuromyelitis optica spectrum disorders: from pathophysiology to therapeutic strategies
Authors: Carnero Contentti Edgar , Correale Jorge
Published: September 2021

Neuromyelitis optica (NMO) is a chronic inflammatory autoimmune disease of the central nervous system (CNS) characterized by acute optic neuritis (ON) and transverse myelitis (TM). NMO is caused by a pathogenic serum IgG antibody against the water channel aquoporin 4 (AQP4) in the majority of patients. AQP4-antibody (AQP4-ab) presence is highly specific, and differentiates NMO from multiple sclerosis. It binds to AQP4 channels on astrocytes, triggering activation of the classical complement cascade, causing granulocyte, eosinophil, and lymphocyte infiltration, culminating in injury first to astrocyte, then oligodendrocytes followed by demyelination and neuronal loss. NMO spectrum disorder (NMOSD) has recently been defined and stratified based on AQP4-ab serology status. Most NMOSD patients experience severe relapses leading to permanent neurologic disability, making suppression of relapse frequency and severity, the primary objective in disease management. The most common treatments used for relapses are steroids and plasma exchange.

Currently, long-term NMOSD relapse prevention includes off-label use of immunosuppressants, particularly rituximab. In the last 2 years however, three pivotal clinical trials have expanded the spectrum of drugs available for NMOSD patients. Phase III studies have shown significant relapse reduction compared to placebo in AQP4-ab-positive patients treated with satralizumab, an interleukin-6 receptor (IL-6R) inhibitor, inebilizumab, an antibody against CD19+B cells; and eculizumab, an antibody blocking the C5 component of complement. In light of the new evidence on NMOSD pathophysiology and of preliminary results from ongoing trials with new drugs, we present this descriptive review, highlighting promising treatment modalities as well as auspicious preclinical and clinical studies.
Identification of tissue-specific and common methylation quantitative trait loci in healthy individuals using MAGAR
Authors: Scherer Michael , Gasparoni Gilles , Rahmouni Souad , Shashkova Tatiana , Arnoux Marion , Louis Edouard , Nostaeva Arina , Avalos Diana , Dermitzakis Emmanouil T. , Aulchenko Yurii S. , Lengauer Thomas , Lyons Paul A. , Georges Michel , Walter Jörn
Published: September 2021

Background

Understanding the influence of genetic variants on DNA methylation is fundamental for the interpretation of epigenomic data in the context of disease. There is a need for systematic approaches not only for determining methylation quantitative trait loci (methQTL), but also for discriminating general from cell type-specific effects.

Results

Here, we present a two-step computational framework MAGAR (https://bioconductor.org/packages/MAGAR), which fully supports the identification of methQTLs from matched genotyping and DNA methylation data, and additionally allows for illuminating cell type-specific methQTL effects. In a pilot analysis, we apply MAGAR on data in four tissues (ileum, rectum, T cells, B cells) from healthy individuals and demonstrate the discrimination of common from cell type-specific methQTLs. We experimentally validate both types of methQTLs in an independent data set comprising additional cell types and tissues. Finally, we validate selected methQTLs located in the PON1, ZNF155, and NRG2 genes by ultra-deep local sequencing. In line with previous reports, we find cell type-specific methQTLs to be preferentially located in enhancer elements.

Conclusions

Our analysis demonstrates that a systematic analysis of methQTLs provides important new insights on the influences of genetic variants to cell type-specific epigenomic variation.
Genomic characterization of nine Clostridioides difficile strains isolated from Korean patients with Clostridioides difficile infection
Authors: Ahn Seung Woo , Lee Se Hee , Kim Uh Jin , Jang Hee-Chang , Choi Hak-Jong , Choy Hyon E. , Kang Seung Ji , Roh Seong Woon
Published: September 2021

Background

Clostridioides difficile infection (CDI) is an infectious nosocomial disease caused by Clostridioides difficile, an opportunistic pathogen that occurs in the intestine after extensive antibiotic regimens.

Results

Nine C. difficile strains (CBA7201–CBA7209) were isolated from nine patients diagnosed with CDI at the national university hospital in Korea, and the whole genomes of these strains were sequenced to identify their genomic characteristics. Comparative genomic analysis was performed using 51 reference strains and the nine isolated herein. Phylogenetic analysis based on 16S rRNA gene sequences confirmed that all 60 C. difficile strains belong to the genus Clostridioides, while core-genome tree indicated that they were divided into five groups, which was consistent with the results of MLST clade analysis. All strains were confirmed to have a clindamycin antibiotic resistance gene, but the other antibiotic resistance genes differ depending on the MLST clade. Interestingly, the six strains belonging to the sequence type 17 among the nine C. difficile strains isolated here exhibited unique genomic characteristics for PaLoc and CdtLoc, the two toxin gene loci identified in this study, and harbored similar antibiotic resistance genes.

Conclusion

In this study, we identified the specific genomic characteristics of Korean C. difficile strains, which could serve as basic information for CDI prevention and treatment in Korea.
Ultrasound in active surveillance for low-risk papillary thyroid cancer: imaging considerations in case selection and disease surveillance
Authors: Ghai Sangeet , O’Brien Ciara , Goldstein David P. , Sawka Anna M. ,   the Canadian Thyroid Cancer Active Surveillance Study Group, Rotstein Lorne , Brown Dale , de Almeida John , Gullane Patrick , Gilbert Ralph , Chepeha Douglas , Irish Jonathan , Pasternak Jesse , Ezzat Shereen , Brierley James P. , Tsang Richard W. , Monteiro Eric , Zahedi Afshan , James Jacqueline , Witterick Ian , Hernandez Karen Gomez , Eskander Antoine , Enepekides Danny , Higgins Kevin , Halperin Ilana J. , Zahedi Afshan , Devon Karen , Gooden Everton , Shah Manish , Korman Mark , Chung Janet , Nazarali Kareem , Arruda Eric , Gevorgyan Artur , Chang Michael , Anand Sumeet , Fernandes Vinay , Lin Denny , Banerjee Avik , Bindlish Vinita , Bharadwaj Vinod , Hafidh Maky , Seaburg Raewyn , Whiteacre Laura
Published: September 2021

Active surveillance (AS) of small, low-risk papillary thyroid cancers (PTCs) is increasingly studied in prospective observational studies. Ultrasound is the primary imaging modality for case selection. While researchers have put forward selection criteria for PTCs based on size, absence of suspicious lymph nodes and tumor location, there are limited reported data highlighting inherent ultrasound limitations and guidelines for case selection and follow-up. We report our experience including imaging limitations encountered in the ongoing AS prospective observational study for PTCs measuring < 2 cm at our institute. We define disease progression as an increase in size of > 3 mm in the largest dimension of nodule or evidence of metastatic disease or extrathyroidal extension. Accurate, consistent and reproducible measurements of PTCs are essential in risk stratifying patients for the option of AS or disease progression. Interobserver discrepancy, shadowing from coarse calcification and background parenchyma heterogeneity or thyroiditis can limit accurate PTC size assessment and therefore hinder patient eligibility evaluation or AS follow-up. Following the ACR Thyroid Imaging, Reporting and Data System (TI-RADS) protocol of three-axes technique to measure a thyroid nodule enables reproducibility of measurements. In patients with multi-nodular goiter, accurate identification and labeling of the PTC is important to avoid mistaking with adjacent benign nodules at follow-up. Ultrasound assessment for extrathyroid extension of PTC, and relationship of PTC to trachea and the anatomic course of the recurrent laryngeal nerve are important considerations in evaluation for AS eligibility.
Optimizing integrated imaging service delivery by tier in low-resource health systems
Authors: DeStigter Kristen , Pool Kara-Lee , Leslie Abimbola , Hussain Sarwat , Tan Bien Soo , Donoso-Bach Lluis , Andronikou Savvas
Published: September 2021

Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.
Assessing direct healthcare costs when restricted to self-reported data: a scoping review
Authors: Jabakhanji Samira B. , Sorensen Jan , Valentelyte Gintare , Burke Lee Ann , McElroy Brendan , Murphy Aileen
Published: September 2021

Background

In the absence of electronic health records, analysis of direct healthcare costs often relies on resource utilisation data collected from patient-reported surveys. This scoping review explored the availability, use and methodological details of self-reported healthcare service utilisation and cost data to assess healthcare costs in Ireland.

Methods

Population health surveys were identified from Irish data repositories and details were collated in an inventory to inform the literature search. Irish cost studies published in peer-reviewed and grey sources from 2009 to 2019 were included if they used self-reported data on healthcare utilisation or cost. Two independent researchers extracted studies’ details and the PRISMA-ScR guidelines were used for reporting.

Results

In total, 27 surveys were identified containing varying details of healthcare utilisation/cost, health status, demographic characteristics and health-related risk and behaviour. Of those surveys, 21 were general population surveys and six were study-specific ad-hoc surveys. Furthermore, 14 cost studies were identified which used retrospective self-reported data on healthcare utilisation or cost from ten of the identified surveys. Nine of these cost studies used ad-hoc surveys and five used data from pre-existing population surveys. Compared to population surveys, ad-hoc surveys contained more detailed information on resource use, albeit with smaller sample sizes. Recall periods ranged from 1 week for frequently used services to 1 year for rarer service use, or longer for once-off costs. A range of perspectives (societal, healthcare and public sector) and costing approaches (bottom-up costing and a mix of top-down and bottom-up) were used. The majority of studies (n = 11) determined unit prices using multiple sources, including national healthcare tariffs, literature and expert views. Moreover, most studies (n = 13) reported limitations concerning data availability, risk of bias and generalisability. Various sampling, data collection and analysis strategies were employed to minimise these.

Conclusion

Population surveys can aid cost assessments in jurisdictions that lack electronic health records, unique patient identifiers and data interoperability. To increase utilisation, researchers wanting to conduct cost analyses need to be aware of and have access to existing data sources. Future population surveys should be designed to address reported limitations and capture comprehensive health-related, demographic and resource use data.
Understanding the effectiveness and underlying mechanisms of lifestyle modification interventions in adults with learning disabilities: protocol for a mixed-methods systematic review
Authors: Rana Dikshyanta , Westrop Sophie , Germeni Evi , McGarty Arlene , Ells Louisa , Lally Phillippa , McEwan Michael , Melville Craig , Harris Leanne , Wu Olivia
Published: September 2021

Background

Adults with learning disabilities have an increased disposition to unhealthy lifestyle behaviours which often occur simultaneously. Existing studies focus on complex interventions targeting unhealthy diet, physical inactivity, sedentary behaviour, smoking, and alcohol use to reduce health risks experienced. It is essential to understand how well these interventions work, what works, for whom, in what context and why. This study aims to investigate the effectiveness and underlying mechanisms of lifestyle modification interventions for adults with learning disabilities.

Methods

This is a mixed-methods systematic review consisting of a network meta-analysis (NMA) and realist synthesis. Electronic databases (ASSIA, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched from inception to 14 January 2021 with no language restriction. Additionally, trial registries, grey literature databases and references lists will be searched. Studies related to lifestyle modification interventions on the adult population (>18 years) with learning disabilities will be eligible for inclusion. Two independent researchers will screen studies, extract data and assess its quality and risk of bias using the Cochrane Collaboration’s Risk of Bias Assessment Tool (RoB Version 2) and ROBINS-I. The strength of the body of evidence will be assessed based on the GRADE approach. The NMA will incorporate results from RCTs and quasi-experimental studies to estimate the effectiveness of various lifestyle interventions. Where appropriate, a component NMA (CNMA) will be used to estimate effectiveness. The realist synthesis will complement and explain the findings of NMA and CNMA by including additional qualitative and mixed-methods studies. Studies will be included based on their relevance to the programme theory and the rigour of their methods, as determined by quality appraisal tools appropriate to the study design. Results from both syntheses will be incorporated into a logic model.

Discussion

The paucity of population-specific lifestyle interventions contributes to the challenges of behaviour change in adults with learning disabilities. This study will provide an evidence-base from which various stakeholders can develop effective interventions for adults with learning disabilities. The evidence will also help prioritise and inform research recommendations for future primary research so that people with learning disabilities live happier, healthier and longer lives.

Trial registration

PROSPERO CRD 42020223290
Selection, optimization and compensation strategies and their relationship with well-being and impulsivity in early, middle and late adulthood in a Polish sample
Authors: Zając-Lamparska Ludmiła
Published: September 2021

Background

The model of selection, optimization, and compensation (SOC model) characterises the life management strategies that contribute to successful development. Although the SOC model is an important developmental theory, until now there has been no Polish version of a measurement tool for SOC strategies. The studies conducted so far have consistently indicated a relationship between the use of these strategies and well-being. In contrast, the relationship between SOC strategies and impulsivity has not yet been empirically examined, although there are theoretical premises to assume its existence. The aim of the study was to compare the use of SOC strategies in early, middle and late adulthood, and to investigate the relationship between the use of SOC strategies and well-being and impulsivity, using a newly developed Polish version of the SOC Questionnaire (SOC48-PL).

Methods

The study applied a quantitative approach. The sample comprised 589 Poles from three age groups: early adulthood (n = 186, 20–35 years), middle adulthood (n = 165, 40–55 years) and late adulthood (n = 238, 60–85 years). In the study, in addition to the SOC48-PL questionnaire, the Short Depression-Happiness Scale (SDHS) and the Short UPPS-P Impulsive Behavior Scale (S UPPS-P) were used.

Results

Developmental differences in the use of SOC strategies are rather slight, with considerable individual differences within age groups. The study revealed some indications of a ‘developmental peak’ of SOC strategies in middle adulthood. The use SOC strategies is positively related to well-being. In turn, the relationship between the use of SOC strategies and impulsivity is negative, especially for two dimensions of impulsivity: lack of premeditation and lack of perseverance.

Conclusions

The results only slightly confirm the assumed age-related differences in the use of SOC strategies and point to a large role of individual differences. The revealed positive relationships of SOC strategy use with well-being and negative with impulsivity are consistent with expectations. With the present study, the SOC48-PL questionnaire may find application in further studies on the SOC model involving the Polish population, as well as in the measurement of SOC strategies in psychological practice. Furthermore, the identified associations of SOC strategies with well-being and impulsivity can be taken as initial indications for the development of interventions based on teaching the use of SOC strategies. Cross-cultural comparisons, long-term longitudinal studies on changes in the use of SOC strategies over the life course, and combining quantitative and qualitative approaches in the analysis of the use of SOC strategies in practice are worth mentioning as directions for further research.
Spontaneous emission in micro- or nanophotonic structures
Authors: Qian Zhiyuan , Shan Lingxiao , Zhang Xinchen , Liu Qi , Ma Yun , Gong Qihuang , Gu Ying
Published: September 2021

Single-photon source in micro- or nanoscale is the basic building block of on-chip quantum information and scalable quantum network. Enhanced spontaneous emission based on cavity quantum electrodynamics (CQED) is one of the key principles of realizing single-photon sources fabricated by micro- or nanophotonic cavities. Here we mainly review the spontaneous emission of single emitters in micro- or nanostructures, such as whispering gallery microcavities, photonic crystals, plasmon nanostructures, metamaterials, and their hybrids. The researches have enriched light-matter interaction as well as made great influence in single-photon source, photonic circuit, and on-chip quantum information.
Implementation of a Molecular Tumor Registry to Support the Adoption of Precision Oncology Within an Academic Medical Center: The Duke University Experience
Authors: Green Michelle F. , Bell Jonathan L. , Hubbard Christopher B. , McCall Shannon J. , McKinney Matthew S. , Riedel Jinny E. , Menendez Carolyn S. , Abbruzzese James L. , Strickler John H. , Datto Michael B.
Published: September 2021

PURPOSE

Comprehensive genomic profiling to inform targeted therapy selection is a central part of oncology care. However, the volume and complexity of alterations uncovered through genomic profiling make it difficult for oncologists to choose the most appropriate therapy for their patients. Here, we present a solution to this problem, The Molecular Registry of Tumors (MRT) and our Molecular Tumor Board (MTB).

PATIENTS AND METHODS

MRT is an internally developed system that aggregates and normalizes genomic profiling results from multiple sources. MRT serves as the foundation for our MTB, a team that reviews genomic results for all Duke University Health System cancer patients, provides notifications for targeted therapies, matches patients to biomarker-driven trials, and monitors the molecular landscape of tumors at our institution.

RESULTS

Among 215 patients reviewed by our MTB over a 6-month period, we identified 176 alterations associated with therapeutic sensitivity, 15 resistance alterations, and 51 alterations with potential germline implications. Of reviewed patients, 17% were subsequently treated with a targeted therapy. For 12 molecular therapies approved during the course of this work, we identified between two and 71 patients who could qualify for treatment based on retrospective MRT data. An analysis of 14 biomarker-driven clinical trials found that MRT successfully identified 42% of patients who ultimately enrolled. Finally, an analysis of 4,130 comprehensive genomic profiles from 3,771 patients revealed that the frequency of clinically significant therapeutic alterations varied from approximately 20% to 70% depending on the tumor type and sequencing test used.

CONCLUSION

With robust informatics tools, such as MRT, and the right MTB structure, a precision cancer medicine program can be developed, which provides great benefit to providers and patients with cancer.
Metastatic Castration-Resistant Prostate Cancer Remains Dependent on Oncogenic Drivers Found in Primary Tumors
Authors: Einstein David J. , Arai Seiji , Calagua Carla , Xie Fang , Voznesensky Olga , Capaldo Brian J. , Luffman Christina , Hecht Jonathan L. , Balk Steven P. , Sowalsky Adam G. , Russo Joshua W.
Published: September 2021

PURPOSE

Metastatic prostate cancer is initially sensitive to androgen receptor inhibition, but eventually becomes castration-resistant prostate cancer (mCRPC). Early use of more intensive therapies targeting androgen receptor and other oncogenic drivers in treatment-naïve primary prostate cancer (PC) may be more effective than that in advanced mCRPC. However, analysis of primary tumors may not reveal targetable metastatic drivers that are subclonal in the primary tumor or acquired at metastatic sites.

METHODS

PC samples spanning one patient's clinical course: diagnostic biopsies, pre- or post-enzalutamide metastatic biopsies, and rapid autopsy samples including a patient-derived xenograft (PDX) were analyzed by targeted exome sequencing followed by phylogenetic analysis.

RESULTS

Left- and right-lobe primary PC tumors appeared to diverge, with the right acquiring additional shared mutations and striking differences in copy number alterations that later appeared in metastatic samples during the treatment course and at autopsy, whereas the left base tumor maintained a quiet copy number alteration landscape and partitioned into a dead-end node. RB1 loss, a common finding in advanced castration-resistant disease, was identified throughout mCRPC samples, but not in the primary tumor. Significantly, a truncal EGFR-activating mutation (R108K) was identified in the primary tumor and was also found to be maintained in the mCRPC samples and in a PDX model. Furthermore, the PDX model remained sensitive to the EGFR inhibitor erlotinib, despite the presence of both RB1 and BRCA2 losses.

CONCLUSION

These findings indicate that truncal alterations identified in primary PC can drive advanced mCRPC, even in the presence of additional strong oncogenic drivers (ie, RB1 and BRCA2 loss), and suggest that earlier detection and targeting of these truncal alterations may be effective at halting disease progression.
4-Arylethynyl-5-fluorobenzoyl-1-methylimidazole Exhibiting Self-Recovering Mechanofluorochromism and Forming Fluorescence Molecular Glass
Authors: Miura Youhei , Murai Kazuki , Yamada Kazufumi , Yoshioka Naoki
Published: September 2021

4-Arylethynyl-5-fluorobenzoyl-1-methyl-1H-imidazoles exhibited self-recovering mechanofluorochromism and formed a glass state. Although the solid sample of the anisyl-substituted 1a and dimethoxyphenyl-substituted 1b exhibited no and blue fluorescence, respectively, they exhibited bluish-green fluorescence after grinding. These compounds recovered the color of their fluorescence after approximately 20 s and after 20 h, respectively. Both compounds exhibited non-crystalline samples after melting and rapid cooling to room temperature. Based on thermal analysis, it was found 1a and 1b were supercooling liquid and glass, respectively, at room temperature. Both non-crystalline samples exhibited fluorescence at a wavelength longer than that of the solid state. DFT calculations indicated that the bluish-green fluorescence of the ground and non-crystalline samples was derived from the twisted intramolecular charge transfer excitation state.
Polythiophene-Based Chemical Sensors: Toward On-Site Supramolecular Analytical Devices
Authors: Sasaki Yui , Lyu Xiaojun , Tang Wei , Wu Hao , Minami Tsuyoshi
Published: September 2021

Polythiophene (PT) derivatives are in the spotlight as functional materials with their conductivity and optical properties, which depend on the distortion of coplanarity of the flexible backbone. The PT derivatives can be applied to chemical sensors owing to their tunable chemical and physical properties, while on-site sensing in aqueous media using PT-based solid-state devices is still challenging. In this Account, we describe a strategy for on-site supramolecular analytical devices. To maximize the applicability of PTs, we designed two types of PT-based chemical sensors. In the optical sensors, microarrays made of a hydrogel containing PTs on portable glass chips can simultaneously analyze multi-analytes combined with pattern recognition techniques. The various optical responses by adding analytes on the microarray chips can be recorded by easy-to-handle methods such as a digital camera, achieving on-site and high-throughput analysis without large spectrophotometers. Next, water-gated polythiophene transistors can offer highly sensitive detection due to a synergy effect of field-effect doping and interfacial charge modulation. Moreover, the electrical device with a microfluidic chamber allows real-time monitoring. We believe that our approaches would be a guideline to pave the way for the realization of supramolecular analytical devices.
Advances in Organic Ionic Materials Based on Ionic Liquids and Polymers
Authors: Watanabe Masayoshi
Published: September 2021

Ionics has emerged as an important scientific area for realizing the key materials necessary for the development of advanced electrochemical devices that would support a sustainable society. In this paper, new organic ion-conducting materials such as ionic liquids and polymer electrolytes are the research focus, as conventional aqueous and organic electrolyte solutions have several disadvantages that prove to be a bottleneck for making a breakthrough in electrochemical materials and devices. A detailed investigation of the ion dynamics in these materials and their interfaces with electrodes was performed, and significant contribution was made to establish the field of organic ionics. Furthermore, stimuli-responsive smart materials based on ionic liquids and polymers have been proposed, and new materials distinguished by advantageous features have been realized. The relevant studies are reviewed in this paper.