bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of stent rupture after endovascular treatment of superior mesenteric aneurysm with open surgery
Authors: He Yiwei , Zhang Jun , Li Gangzhi , Zhou Haining
Published: February 2023

Background

The progress of visceral artery aneurysms (VAAs) after the endovascular repair of artery aneurysms is often accompanies by the potential risks of stent fracture. The clinical reported cases of VAAs stent fractures with stent displacement were extremely rare but severe complication, particularly for the superior mesenteric artery aneurysm (SMAA).

Method

We here reported a 62-year-old female patient with recurrent symptoms of SMAA 2 years after the successful endovascular repair using coil embolization and two partial overlapping stent-grafts in SMAA. The open surgery was performed instead of secondary endovascular intervention.

Result and conclusion

The patient experienced a good recovery. As one of the complications after endovascular repair, stent fracture maybe more dangerous than SMAA itself, the stent fracture after endovascular repair treated by open surgery with satisfactory results is alternative and feasible.
Patient and provider perspectives on barriers and facilitators to reproductive healthcare access for women experiencing homelessness with substance use disorders in San Francisco
Authors: Schmidt Christina N , Wingo Erin E , Newmann Sara J , Borne Deborah E , Shapiro Brad J , Seidman Dominika L
Published: February 2023

Background:

Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals.

Objective:

This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them.

Design:

This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers.

Methods:

We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed.

Results:

Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9/28) reported desiring pregnancy in the next year; over half (16/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14/28). Twenty-six healthcare providers participated in interviews (n = 15) and focus groups (n = 2). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect.

Conclusion:

Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.
A career handbook for professional soccer players
Authors: Ács Balázs , Kovács Roland , Toka László
Published: February 2023

The success of a soccer player is not entirely pre-destined by their physical ability, talent, and motivation. There are certain decisions along the way that greatly affect the arc of their career: which skills to develop, and which club to sign a contract with. In this paper, we identify the optimal strategic choices toward multiple potential aims a soccer player can have and we seek the knowledge of what made the greatest soccer players in terms of those decisions. Our two main data sources are Transfermarkt and Sofifa from which we collect data for the period between 2007 and 2021 with 29,231 players. We perform time series analysis on skill features of soccer players, and network analysis of the players’ acquaintance graph, i.e., a graph that indicates whether two given players have ever been teammates before. Finally, we create key performance indicators to check the differences in certain features, i.e., individual player skills and connectivity attributes, between top-tier and the rest of the players, and use dynamic time warping for validation. The outcome of this work is a recommendation tool that helps players to find what needs to be improved in order to achieve their desired goals. The source code and the career advisor tool for soccer players that we have implemented are available online.
Healthcare use and medical cost before and after diagnosis of nontuberculous mycobacterial infection in Korea: the National Health Insurance Service-National Sample Cohort Study
Authors: Lee Seung Won , Chang Shihwan , Park Youngmok , Kim Sol , Sohn Hojoon , Kang Young Ae
Published: February 2023

Background and objective:

The global prevalence and incidence of nontuberculous mycobacterial (NTM) infections are increasing; however, population-level data on healthcare use and medical costs for people with NTM infections are limited. Thus, we investigated the rates of healthcare use and medical costs of people with NTM infections in South Korea using the National Health Insurance Service-National Sample Cohort from 2002 to 2015.

Methods:

In this cohort study, people with and without NTM infection aged 20–89 years were matched 1 to 4 by sex, age, Charlson comorbidity index, and year of diagnosis. The overall and annual average healthcare use and medical costs were calculated. In addition, trends in healthcare use and medical costs for each of the 3 years before and after NTM diagnosis were investigated for people diagnosed with NTM infection.

Results:

A total of 798 individuals (336 men and 462 women) diagnosed with NTM infection and 3192 controls were included in the study. NTM-infected patients had significantly higher rates of healthcare use and medical costs than those in the control group ( p < 0.05). NTM-infected patients showed 1.5 times the medical cost and 4.5 times the respiratory disease cost of the control group. People diagnosed with NTM infection incurred the highest medical costs in the 6 months before diagnosis.

Conclusion:

NTM infection increases the economic burden on Korean adults. Appropriate diagnostic tests and treatment plans for NTM infections are needed to reduce the burden of the disease caused by such infection.
How Can Point-of-Care Technologies Support In-Hospital Diabetes Care?
Authors: Misra Shivani , Avari Parizad , Lumb Alistair , Flanagan Daniel , Choudhary Pratik , Rayman Gerry , Dhatariya Ketan
Published: February 2023

People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quality framework are critical to ensuring accuracy and veracity of results and preventing erroneous clinical decision making. POC results can be used for self-management of glucose levels in those well-enough and/or by healthcare professionals to identify unsafe levels. Connectivity of POC results to electronic health records further offers the possibility of utilising these results proactively to identify patients ‘at risk’ in real-time and for audit purposes. In this article, the key considerations when implementing POC tests for diabetes in-patient management are reviewed and potential to drive improvements using networked glucose and ketone measurements are discussed. In summary, new advances in POC technology should allow people with diabetes and the teams looking after them whilst in hospital to integrate to provide safe and effective care.
Treadmill Exercise Suppresses Histological Progression of Disuse Atrophy in Articular Cartilage in Rat Knee Joints during Hindlimb Suspension
Authors: Takahashi Ikufumi , Matsuzaki Taro , Kuroki Hiroshi , Hoso Masahiro
Published: February 2023

Objective

The purpose of this study was to determine the preventive effects of treadmill exercise or physiological loading on disuse atrophy in the rat knee joint cartilage and bone during hindlimb suspension.

Design

Twenty male rats were divided into 4 experimental groups, including the control, hindlimb suspension, physiological loading, and treadmill walking groups. Histological changes in the articular cartilage and bone of the tibia were histomorphometrically and immunohistochemically evaluated 4 weeks after the intervention.

Results

Compared with the control group, the hindlimb suspension group showed thinning of cartilage thickness, decreased matrix staining, and decreased proportion of noncalcified layers. Cartilage thinning, decreased matrix staining, and decreased noncalcified layers were suppressed in the treadmill walking group. The physiological loading group exhibited no significant suppression of cartilage thinning or decreased noncalcified layers, but the decreased matrix staining was significantly suppressed. No significant prevention of bone mass loss or changes in subchondral bone thickness were detected after physiological loading or treadmill walking.

Conclusion

Disuse atrophy of the articular cartilage caused by unloading conditions could be prevented by treadmill walking in rat knee joints.
Autogestion and ecological politics in the work of Henri Lefebvre
Authors: Butler Chris
Published: February 2023

In this commentary, I discuss how Napoletano, Urquijo, Clark and Foster engage with the work of Henri Lefebvre through three interlinked themes: the dialectical method, the nature–society problematic, and the concept of autogestion. I outline each of these themes and consider the importance of Lefebvre's interpretation of autogestion for an ecological politics which can reconcile human emancipation with resistance to the socio-ecological crises of capitalism and its destructive effects on the non-human environment.
Observational Analysis of a Generalized, Health Plan-led Community Health Worker Intervention in Medicaid
Authors: Gordon Aliza S. , Oakes Allison H. , Allender Rebeca , Vang Lucida , Hennemann Beau , Chi Winnie C.
Published: February 2023

Introduction/Objectives:

In 2018, a Medicaid managed care plan launched a new community health worker (CHW) initiative in several counties within a state, designed to improve the health and quality of life of members who could benefit from additional services. The CHW program involved telephonic and face-to-face visits from CHWs who provided support, empowerment, and education to members, while identifying and addressing health and social issues. The primary objective of this study was to evaluate the impact of a generalized (not disease-specific), health plan-led CHW program on overall healthcare use and spending.

Methods:

This retrospective cohort study used data from adult members who received the CHW intervention (N = 538 participants) compared to those who were identified for participation but were unable to be reached (N = 435 nonparticipants). Outcomes measures included healthcare utilization, including scheduled and emergency inpatient admissions, emergency department (ED) visits, and outpatient visits; and healthcare spending. The follow-up period for all outcome measures was 6 months. Using generalized linear models, 6-month change scores were regressed on baseline characteristics to adjust for between-group differences (eg, age, sex, comorbidities) and an indicator for group.

Results:

Program participants experienced a greater increase in outpatient evaluation and management visits (0.09 per member per month [PMPM]) than the comparison group during the first 6 months of the program. This greater increase was observed across in-person (0.07 PMPM), telehealth (0.03 PMPM), and primary care (0.06 PMPM) visits. There was no observed difference in inpatient admissions, ED utilization or allowed medical spending and pharmacy spending.

Conclusions:

A health plan-led CHW program successfully increased multiple forms of outpatient utilization in a historically disadvantaged population of patients. Health plans may be particularly well positioned to finance, sustain, and scale programs that address social drivers of health.
Vertical Integration Strategies and Environmental Uncertainty: China’s Film Industry
Authors: Yang Yubin , Choo Seungyoup , Limb Seong-Joon
Published: February 2023

This study analyses the effectiveness of vertical integration for motion pictures’ box office revenues and the moderating effects of environmental uncertainty on China’s film industry, where a market economy was introduced in 2002. We analyzed a sample of 1,824 films released between 2005 and 2016 using a PROCESS model. We found strong evidence that vertical integration positively influenced box office revenues, which were higher under greater environmental uncertainty post reforms than under relative stability. We also found films that (1) had major producers or distributors, (2) were based on intellectual property, (3) belonged to the action or fantasy genre, or (4) featured superstars performed better. This study demonstrates the current operating level of the market economy in China’s film industry and offers a unique, fresh dataset comprising almost all films released in Mainland China and produced by enterprises in Greater China.
Longitudinal Stability of Disordered-Eating Symptoms From Age 12 to 40 in Black and White Women
Authors: Parker Jordan E. , Levinson Jordan A. , Hunger Jeffrey M. , Enders Craig K. , Laraia Barbara A. , Epel Elissa S. , Tomiyama A. Janet
Published: February 2023

The purpose of the current study was to test the longitudinal association between disordered-eating symptoms (body dissatisfaction, drive for thinness, and bulimia) in adolescence (ages 12, 14, 16, 18, 19) and adulthood (age 40) in a sample of 883 white and Black women. We also investigated moderation by race. Adolescent symptoms at each time point significantly predicted adulthood symptoms for the Body Dissatisfaction and Drive for Thinness subscales for both Black and white women. Bulimia symptoms in adolescence predicted symptoms in adulthood; however, the effect was largely driven by white women. Although moderation was nonsignificant, among white women, bulimia symptoms at all adolescent time points predicted adulthood bulimia, but among Black women, only symptoms at ages 18 and 19 were predictive of adulthood bulimia. Results suggest that both Black and white women are susceptible to disordered eating and that symptoms emerging in adolescence can potentially follow women into midlife.
Decentering From Emotions in Daily Life: Dynamic Associations With Affect, Symptoms, and Well-Being
Authors: Naragon-Gainey Kristin , DeMarree Kenneth G. , Kyron Michael J. , McMahon Tierney P. , Park Juhyun , Biehler Kaitlyn M.
Published: February 2023

Decentering is thought to be protective against a range of psychological symptoms, but little is known about the outcomes of decentering as a momentary state in daily life. We used ecological momentary assessment (42 reports across 1 week) to examine the temporal ordering of the associations of decentering with affect, dysphoria, participant-specific idiographic symptoms, and well-being. We also hypothesized that greater decentering predicts less inertia (persistence) of each variable and weakens the association of affect with dysphoria, idiographic symptoms, and well-being. Results in 345 community participants indicated that decentering and these variables were mutually reinforcing over time and that greater decentering was associated with less inertia of negative affect and dysphoria. Decentering generally predicted reduced impact of positive and negative affect on dysphoria symptoms, but results were mixed when predicting idiographic symptoms or well-being. Clinical implications and refinements for theory on decentering are discussed.
Transnational Technical Communication: English as a Business Lingua Franca in Engineering Workplaces
Authors: Hodges Amy , Seawright Leslie
Published: February 2023

Recent scholarship argues for increased attention to students’ linguistic diversity and intercultural communication competence. Our study examined the experiences of 10 working engineers who had graduated from an English-medium international branch campus in the Arabian Gulf. An analysis of their interviews reveals the complex role of English as a business lingua franca (BELF) in workplace communication. Interviewees’ reflections about their university experience indicate that they had not previously understood the full rhetorical and communicative nature of BELF. We provide implications for instructors who wish to provide methods that center intercultural professional communication and decenter English as a standardized, static language.
Examining Social Presence, Team Cohesion, and Collaborative Writing in Online Teams
Authors: McCool Lynn B.
Published: February 2023

In a case study involving three asynchronous online professional writing courses, this research investigates students’ abilities to establish a social presence and build team cohesion via collaborative, team-based writing projects. Using the Community of Inquiry (COI) framework, this study is situated in the understanding that teaching and learning in higher education are not about the mere transmission of knowledge but that “teaching and learning are inherently interactive” as the terms of “community” and “inquiry” used in the framework suggest. Prior researchers have also established a clear connection between one element of the COI framework— social presence and student satisfaction in online courses. Findings from this study indicate participation in collaborative team assignments contributes to team cohesion and positively affects students’ ability to establish their social presence within online environments as well as transfer their knowledge to other contexts.
SMEs filing for bankruptcy in Spain: The best of luck!
Authors: Sánchez-Vidal F Javier , García Marí José Horacio , Madrid-Guijarro Antonia
Published: February 2023

The aim of this work is to analyze the factors that help companies avoid liquidation following the spirit of the Spanish insolvency law. This work focuses on the phase starting when companies file for bankruptcy and ending with the completion of the common phase. We apply the agency theory to explain how insolvency administrators and court characteristics influence the outcome of the bankruptcy process (liquidation or reorganization). We analyze unique accounting data from 2,627 companies that filed for bankruptcy during the period 2008–2014. The findings reveal the significant roles played by the liquidation trustee, Big 4 administrators, and higher remunerations, along with the type of court in charge. Processes are more likely to result in reorganization if they are handled by specialized courts, managed by the Big 4, and if the insolvency administrator has longer experience in bankruptcy filing and receives a higher remuneration. These findings have important implications for all the agents involved. It is necessary to rationalize the filing process, foment better training for insolvency administrators, provide courts with more funds, and create more specialized courts. The principal contribution of this article is to examine the role played by insolvency administrators and the courts, and their influence on the outcome of the insolvency process.

JEL CLASSIFICATION C35; D21; D22; G33; G38
Income Inequality in U.S. Voting: A Visualization
Authors: Laurison Daniel , Rastogi Ankit
Published: February 2023

Although it is clear that the 2020 election broke turnout records, we do not know how levels of voting changed across income groups. Journalistic accounts emphasized increases in turnout across demographic groups but relied on self-reported voter data. The authors use validated voting data from both the Common Election Study and the Pew Research Center to examine the relationship between income and voting across the two elections (along with education and race in supplemental analyses ). The authors show that levels of inequality in political participation were the same or higher in 2020 compared with previous years and that there are substantial differences in coefficients for income between the two data sets, raising questions about the accuracy of validated voter data.
Corruption and Public Procurement in Health Sector: The Challenges of Pandemic Era in Greece
Authors: Stamouli Eirini , Gasparinatou Margarita , Kouroutzas Christos
Published: February 2023

The health sector in Greece is considered as one of the most vulnerable sectors with high levels of corruption and appears to be particularly problematic in the provision of health services and in medical supplies procurement processes carried out by public hospitals. Viewed from a systemic-structural perspective, corruption is examined as a phenomenon emerging from the interactions and interconnections between the organized structures of venture capital and the state apparatus. This paper argues that the COVID-19 crisis has produced a breeding ground for potential corruption practices and seem to intensify the unlawful practices especially in procurement processes. The state of exception and the implementation of emergency measures manufacture the conditions that permit the lack of transparency in the transactions between the health care system and the pharmaceutical industry. Applying an integrated theoretical model of state-corporate crime and critical health criminology and drawing on empirical qualitative research, this paper highlights the procurement corruption risks in the health sector during the pandemic era.
Diagnostic workup of childhood interstitial lung disease
Authors: Nathan Nadia , Griese Matthias , Michel Katarzyna , Carlens Julia , Gilbert Carlee , Emiralioglu Nagehan , Torrent-Vernetta Alba , Marczak Honorata , Willemse Brigitte , Delestrain Céline , Epaud Ralph
Published: February 2023

Childhood interstitial lung diseases (chILDs) are rare and heterogeneous diseases with significant morbidity and mortality. An accurate and quick aetiological diagnosis may contribute to better management and personalised treatment. On behalf of the European Respiratory Society Clinical Research Collaboration for chILD (ERS CRC chILD-EU), this review summarises the roles of the general paediatrician, paediatric pulmonologists and expert centres in the complex diagnostic workup. Each patient's aetiological chILD diagnosis must be reached without prolonged delays in a stepwise approach from medical history, signs, symptoms, clinical tests and imaging, to advanced genetic analysis and specialised procedures including bronchoalveolar lavage and biopsy, if necessary. Finally, as medical progress is fast, the need to revisit a diagnosis of “undefined chILD” is stressed.
Conservatively transmitted alleles of key agronomic genes provide insights into the genetic basis of founder parents in bread wheat (Triticum aestivum L.)
Authors: Li Chang , Zhuang Lei , Li Tian , Hou Jian , Liu Hongxia , Jian Chao , Li Huifang , Zhao Jing , Liu Yunchuan , Xi Wei , Hao Pingan , Liu Shujuan , Si Xuemei , Wang Xiaolu , Zhang Xueyong , Hao Chenyang
Published: February 2023

Background

Founder parents play extremely important roles in wheat breeding. Studies into the genetic basis of founder parents and the transmission rules of favorable alleles are of great significance in improving agronomically important traits in wheat.

Results

Here, a total of 366 founder parents, widely grown cultivars, and derivatives of four representative founder parents were genotyped based on efficient kompetitive allele-specific PCR (KASP) markers in 87 agronomically important genes controlling yield, quality, adaptability, and stress resistance. Genetic composition analysis of founder parents and widely grown cultivars showed a consistently high frequency of favorable alleles for yield-related genes. This analysis further showed that other alleles favorable for resistance, strong gluten, dwarf size, and early heading date were also subject to selective pressure over time. By comparing the transmission of alleles from four representative founder parents to their derivatives during different breeding periods, it was found that the genetic composition of the representative founder parents was optimized as breeding progressed over time, with the number and types of favorable alleles carried gradually increasing and becoming enriched. There are still a large number of favorable alleles in wheat founder parents that have not been fully utilized in breeding selection. Eighty-seven agronomically important genes were used to construct an enrichment map that shows favorable alleles of four founder parents, providing an important theoretical foundation for future identification of candidate wheat founder parents.

Conclusions

These results reveal the genetic basis of founder parents and allele transmission for 87 agronomically important genes and shed light on breeding strategies for the next generation of elite founder parents in wheat.
The Integrated Electronic Health System in Iranian health centers: benefits and challenges
Authors: Kalkhajeh Sasan Ghorbani , Aghajari Azam , Dindamal Behnaz , Shahvali-Kuhshuri Zohreh , Faraji-Khiavi Farzad
Published: February 2023

Background

Electronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran.

Methods

This was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis.

Results

Overall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research.

Conclusions

In the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems.
A comprehensive computational analysis to explore the importance of SIGLECs in HCC biology
Authors: Yao Senbang , Chen Wenjun , Chen Tingting , Zuo He , Bi Ziran , Zhang Xiuqing , Pang Lulian , Jing Yanyan , Yin Xiangxiang , Cheng Huaidong
Published: February 2023

Background

Hepatocellular carcinoma (HCC) is an aggressive, malignant cancer with a complex pathogenesis. However, effective therapeutic targets and prognostic biomarkers are limited. Sorafenib provides delaying cancer progression and survival improvement in advanced HCC. But despite 10 years of research on the clinical application of sorafenib, predictive markers for its therapeutic effect are lacking.

Methods

The clinical significance and molecular functions of SIGLEC family members were assessed by a comprehensive bioinformatic analysis. The datasets included in this study (ICGC-LIRI-JP, GSE22058 and GSE14520) are mainly based on patients with HBV infections or HBV-related liver cirrhosis. The TCGA, GEO, and HCCDB databases were used to explore the expression of SIGLEC family genes in HCC. The Kaplan–Meier Plotter database was used to evaluate relationships between the expression levels of SIGLEC family genes and prognosis. Associations between differentially expressed genes in the SIGLEC family and tumour-associated immune cells were evaluated using TIMER.

Results

The mRNA levels of most SIGLEC family genes were significantly lower in HCC than in normal tissues. Low protein and mRNA expression levels of SIGLECs were strongly correlated with tumour grade and clinical cancer stage in patients with HCC. Tumour-related SIGLEC family genes were associated with tumour immune infiltrating cells. High SIGLEC expression was significantly related to a better prognosis in patients with advanced HCC treated with sorafenib.

Conclusions

SIGLEC family genes have potential prognostic value in HCC and may contribute to the regulation of cancer progression and immune cell infiltration. More importantly, our results revealed that SIGLEC family gene expression may be used as a prognostic marker for HCC patients treated with sorafenib.
Induced abortions of women living with HIV in Finland 1987–2019: a national register study
Authors: Mutru Mikaela , Kivelä Pia , Ollgren Jukka , Liitsola Kirsi , Gissler Mika , Aho Inka
Published: February 2023

Background

Recent data on the rate and risk factors of induced abortion among women living with HIV (WLWH) are limited. Our aim was to use Finnish national health register data to 1) determine the nationwide rate of induced abortions of WLWH in Finland during 1987–2019, 2) compare the rates of induced abortions before and after HIV diagnosis over different time periods, 3) determine the factors associated with terminating a pregnancy after HIV diagnosis, and 4) estimate the prevalence of undiagnosed HIV at induced abortions to see whether routine testing should be implemented.

Methods

A retrospective nationwide register study of all WLWH in Finland 1987–2019 (n = 1017). Data from several registers were combined to identify all induced abortions and deliveries of WLWH before and after HIV diagnosis. Factors associated with terminating a pregnancy were assessed with predictive multivariable logistic regression models. The prevalence of undiagnosed HIV at induced abortion was estimated by comparing the induced abortions among WLWH before HIV diagnosis to the number of induced abortions in Finland.

Results

Rate of induced abortions among WLWH decreased from 42.8 to 14.7 abortions/1000 follow-up years from 1987–1997 to 2009–2019, more prominently in abortions after HIV diagnosis. After 1997 being diagnosed with HIV was not associated with an increased risk of terminating a pregnancy. Factors associated with induced abortion in pregnancies that began after HIV diagnosis 1998–2019 were being foreign-born (OR 3.09, 95% CI 1.55–6.19), younger age (OR 0.95 per year, 95% CI 0.90–1.00), previous induced abortions (OR 3.36, 95% CI 1.80–6.28), and previous deliveries (OR 2.13, 95% CI 1.08–4.21). Estimated prevalence of undiagnosed HIV at induced abortion was 0.008–0.029%.

Conclusions

Rate of induced abortions among WLWH has decreased. Family planning should be discussed at every follow-up appointment. Routine testing of HIV at all induced abortions is not cost-effective in Finland due to low prevalence.
Comparison of anaphylaxis epidemiology between urban and suburban pediatric emergency departments
Authors: Gurkha Dhritiman , Podolsky Robert , Sethuraman Usha , Levasseur Kelly
Published: February 2023

Background

Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. To date, there are no published data on epidemiology of pediatric anaphylaxis in Michigan. Our objective was to describe and compare the time trends in incidence of anaphylaxis in urban and suburban populations of Metro Detroit.

Methods

We performed a retrospective study of Pediatric Emergency Department (ED) anaphylaxis visits from January 1, 2010, to December 1, 2017. The study was conducted at 1 suburban ED (SED) and 1 urban ED (UED). We identified cases using an International Classification of Diseases (ICD) 9 and 10 query of the electronic medical record. Patients were included if they aged 0–17 years and met the 2006 National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network diagnostic criteria for anaphylaxis. The anaphylaxis rate was calculated as the number of detected cases divided by the total number of pediatric emergency room visits for that month. Anaphylaxis rates were compared between the two EDs using Poisson regression.

Results

A total of 8,627 patient encounters had ICD codes for anaphylaxis, of which 703 visits fulfilled the inclusion criteria and were used in subsequent analyses. Overall, the incidence of anaphylaxis was more common in males and in children < 4 years of age in both centers. Although the total number of anaphylaxis related visits was higher at UED over the eight-year time frame for this study, the anaphylaxis rate (cases per 100,000 ED visits) throughout the study was higher at the SED. While the observed anaphylaxis rate at UED was 10.47 – 162.05 cases per 100,000 ED visits, the observed anaphylaxis rate at SED was 0 – 556.24 cases per 100,000 ED visits.

Conclusion

Pediatric anaphylaxis rates differ significantly between urban and suburban populations in metro Detroit EDs. The rate of anaphylaxis related visits to the ED has significantly increased over the past 8 years in the metro Detroit area, with significantly higher rise in suburban compared to urban ED. More studies are needed to explore the reasons for this observed difference in increase rates.
Pain inhibition—the unintended benefit of electrically elicited muscle strengthening contractions
Authors: Rudolph Katherine S. , Cloutier Matthew , Stackhouse Scott
Published: February 2023

Background

Neuromuscular electrical stimulation (NMES) is effective in muscle strengthening after orthopedic injury particularly when muscle activation failure is present, but the associated pain can be a barrier. Pain itself can produce a pain inhibitory response called Conditioned Pain Modulation (CPM). CPM is often used in research studies to assess the state of the pain processing system. However, the inhibitory response of CPM could make NMES more tolerable to patients and could improve functional outcomes in people with pain. This study compares the pain-inhibitory effect of NMES compared to volitional contractions and noxious electrical stimulation (NxES).

Methods

Healthy participants, 18–30 years of age experienced 3 conditions: 10 NMES contractions, 10 bursts of NxES on the patella, and 10 volitional contractions on the right knee. Pressure pain thresholds (PPT) were measured before and after each condition in both knees and the middle finger. Pain was reported on an 11-point VAS. Repeated measures ANOVAs with 2 factors: site and time were performed for each condition followed by post-hoc paired t-tests, with Bonferroni correction.

Results

Pain ratings were higher in the NxES condition compared to NMES (p = .000). No differences in PPTs prior to each condition were observed but PPTs were significantly higher in the right and left knees after the NMES contractions (p = .000, p = .013, respectively) and after the NxES (p = .006, P-.006, respectively). Pain during NMES and NxES did not correlate with pain inhibition (p > .05). Self-reported pain sensitivity correlated with pain during NxES.

Conclusion

NxES and NMES produced higher PPTs in both knees but not in the finger, suggesting that the mechanisms responsible for the reduction in pain are located in the spinal cord and local tissues. Pain reduction was elicited during the NxES and NMES conditions regardless of the self-reported pain ratings. When NMES is used for muscle strengthening significant pain reduction can also occur, which is an unintended benefit of the intervention that could improve functional outcomes in patients.
Does the intraoperative 3D-flat panel control of the planned implant position lead to an optimization and increased in safety in the anatomically demanding region C1/2?
Authors: Jarvers J.-S. , Spiegl U. A. J. , Pieroh P. , von der Höh N. , Völker A. , Pfeifle C. , Glasmacher S. , Heyde C. E.
Published: February 2023

Background

The aim of this study was to evaluate the applicability and advantages of intraoperative imaging using a 3D flat panel in the treatment of C1/2 instabilities.

Materials

Prospective single-centered study including surgeries at the upper cervical spine between 06/2016 and 12/2018. Intraoperatively thin K-wires were placed under 2D fluoroscopic control. Then an intraoperative 3D-scan was carried out. The image quality was assessed based on a numeric analogue scale (NAS) from 0 to 10 (0 = worst quality, 10 = perfect quality) and the time for the 3D-scan was measured. Additionally, the wire positions were evaluated regarding malpositions.

Results

A total of 58 patients were included (33f, 25 m, average age 75.2 years, r.:18–95) with pathologies of C2: 45 type II fractures according to Anderson/D'Alonzo with or without arthrosis of C1/2, 2 Unhappy triad of C1/2 (Odontoid fracture Type II, anterior or posterior C1 arch-fracture, Arthrosis C1/2) 4 pathological fractures, 3 pseudarthroses, 3 instabilities of C1/2 because of rheumatoid arthritis, 1 C2 arch fracture). 36 patients were treated from anterior [29 AOTAF (combined anterior odontoid and transarticular C1/2 screw fixation), 6 lag screws, 1 cement augmented lag screw] and 22 patients from posterior (regarding to Goel/Harms). The median image quality was 8.2 (r.: 6–10). In 41 patients (70.7%) the image quality was 8 or higher and in none of the patients below 6. All of those 17 patients the image quality below 8 (NAS 7 = 16; 27.6%, NAS 6 = 1, 1.7%), had dental implants. A total of 148 wires were analyzed. 133 (89.9%) showed a correct positioning. In the other 15 (10.1%) cases a repositioning had to be done (n = 8; 5.4%) or it had to be drawn back (n = 7; 4.7%). A repositioning was possible in all cases. The implementation of an intraoperative 3D-Scan took an average of 267 s (r.: 232-310 s). No technical problems occurred.

Conclusion

Intraoperative 3D imaging in the upper cervical spine is fast and easy to perform with sufficient image quality in all patients. Potential malposition of the primary screw canal can be detected by initial wire positioning before the Scan. The intraoperative correction was possible in all patients.

Trial registration German Trials Register (Registered 10 August 2021, DRKS00026644—Trial registration: German Trials Register (Registered 10 August 2021, DRKS00026644—https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026644)
The effect of a roving nurse mentor on household coverage and quality of care provided by community health worker teams in South Africa: a longitudinal study with a before, after and 6 months post design
Authors: Goudge Jane , Babalola Olukemi , Malatji Hlologelo , Levin Jonathan , Thorogood Margaret , Griffiths Frances
Published: February 2023

Objective

Community health workers (CHW) are undertaking more complex tasks as part of the move towards universal health coverage in many low- and middle-income settings. They are expected to provide promotive and preventative care, make referrals to the local clinic, and follow up on non-attendees for a range of health conditions. CHW programmes can improve access to care for vulnerable communities, but many such programmes struggle due to inadequate supervision, low levels of CHW literacy, and the marginalized status of CHW in the health system. In this paper, we assess the effect of a roving nurse mentor on the coverage and quality of care of the CHW service in two vulnerable communities in South Africa.

Participants

CHW, their supervisors, household members.

Intervention

Roving professional nurse mentor to build skills of supervisors and CHW teams.

Methods

Three household surveys to assess household coverage of the CHW service (baseline, end of the intervention, and 6 months after end of intervention); structured observations of CHW working in households to assess quality of care.

Results

The intervention led to a sustained 50% increase in the number of households visited by a CHW in the last year. While the proportion of appropriate health messages given to household members by CHW remained constant at approximately 50%, CHW performed a greater range of more complex tasks. They were more likely to visit new households to assess health needs and register the household in the programme, to provide care to pregnant women, children and people who had withdrawn from care. CHW were more likely to discuss with clients the barriers they were facing in accessing care and take notes during a visit.

Conclusion

A nurse mentor can have a significant effect both on the quantity and quality of CHW work, allowing them to achieve their potential despite their marginalised status in the health system and their limited prior educational achievement. Supportive supervision is important in enabling the benefit of having a health cadre embedded in marginalised communities to be realised.
Socioeconomic inequality in modern contraceptive utilization among reproductive-age women in sub-Saharan African countries: a decomposition analysis
Authors: Fentie Elsa Awoke , Asmamaw Desale Bihonegn , Shewarega Ever Siyoum , Negash Wubshet Debebe , Teklu Rediet Eristu , Alemu Tewodros Getaneh , Eshetu Habitu Birhan , Belay Daniel Gashaneh , Aragaw Fantu Mamo , Fetene Samrawit Mihret
Published: February 2023

Introduction

Family planning services allow individuals to achieve desired birth spacing, family size, and contribute to improved health outcomes for infants, children, women, and families, and prevent unintended pregnancy. Births resulting from unintended pregnancies can have negative consequences Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood. Even though many international organizations work to ensure universal access to sexual and reproductive health services, reproductive health service utilization is concentrated among individuals with rich socioeconomic status. Therefore, this study aimed to assess the presence of socioeconomic inequality in modern contraceptive utilization and its contributors in sub-Saharan African countries.

Methods

A total of 466,282 weighted reproductive-aged women samples from DHS data SSA countries were included in the study. Erreygers normalized concentration index and its concentration curve were used to assess socioeconomic-related inequality in modern contraceptive utilization. Decomposition analysis was performed to identify factors contributing to socioeconomic-related inequality.

Results

The weighted Erreygers normalized concentration index for modern contraceptive utilization was 0.079 with Standard error = 0.0013 (P value< 0.0001); indicating that There is small amount but statistically significant pro rich distribution of wealth related in equalities of modern contraceptive utilization among reproductive age women. The decomposition analysis revealed that mass media exposure, wealth index., place of residency, and distance of health facility were the major contributors to the pro-rich socioeconomic inequalities in modern contraceptive utilization.

Conclusion and recommendation

In this study, there is a small amount but statistically significant pro rich distribution of modern contraceptive utilization. Therefore, give priority to modifiable factors such as promoting the accessibility of health facilities, media exposure of the household, and improving their country’s economy to a higher economic level to improve the wealth status of the population.
Inhaled prostacyclin therapy in the acute respiratory distress syndrome: a randomized controlled multicenter trial
Authors: Haeberle Helene A. , Calov Stefanie , Martus Peter , Serna-Higuita Lina Maria , Koeppen Michael , Goll Almuth , Bernard Alice , Zarbock Alexander , Meersch Melanie , Weiss Raphael , Mehrländer Martin , Marx Gernot , Putensen Christian , Bakchoul Tamam , Magunia Harry , Nieswandt Bernhard , Mirakaj Valbona , Rosenberger Peter
Published: February 2023

Background

Acute respiratory distress syndrome (ARDS) results in significant hypoxia, and ARDS is the central pathology of COVID-19. Inhaled prostacyclin has been proposed as a therapy for ARDS, but data regarding its role in this syndrome are unavailable. Therefore, we investigated whether inhaled prostacyclin would affect the oxygenation and survival of patients suffering from ARDS.

Methods

We performed a prospective randomized controlled single-blind multicenter trial across Germany. The trial was conducted from March 2019 with final follow-up on 12th of August 2021. Patients with moderate to severe ARDS were included and randomized to receive either inhaled prostacyclin (3 times/day for 5 days) or sodium chloride (Placebo). The primary outcome was the oxygenation index in the intervention and control groups on Day 5 of therapy. Secondary outcomes were mortality, secondary organ failure, disease severity and adverse events.

Results

Of 707 patients approached 150 patients were randomized to receive inhaled prostacyclin (n = 73) or sodium chloride (n = 77). Data from 144 patients were analyzed. The baseline PaO2/FiO2 ratio did not differ between groups. The primary analysis of the study was negative, and prostacyclin improved oxygenation by 20 mmHg more than Placebo (p = 0.17). Secondary analysis showed that the oxygenation was significantly improved in patients with ARDS who were COVID-19-positive (34 mmHg, p = 0.04). Mortality did not differ between groups. Secondary organ failure and adverse events were similar in the intervention and control groups.

Conclusions

The primary result of our study was negative. Our data suggest that inhaled prostacyclin might be beneficial treatment in patients with COVID-19 induced ARDS.

Trial registration: The study was approved by the Institutional Review Board of the Research Ethics Committee of the University of Tübingen (899/2018AMG1) and the corresponding ethical review boards of all participating centers. The trial was also approved by the Federal Institute for Drugs and Medical Devices (BfArM, EudraCT No. 2016003168-37) and registered at clinicaltrials.gov (NCT03111212) on April 6th 2017.