bluuebunny/crossref_metadata_2025 huggingface dataset:
Frozen vein wrapping for chronic nerve constriction injury reduces sciatic nerve allodynia in a rat model
Authors: Mukai Michiaki , Uchida Kentaro , Hirosawa Naoya , Murakami Kenichi , Inoue Gen , Miyagi Masayuki , Shiga Yasuhiro , Sekiguchi Hiroyuki , Inage Kazuhide , Orita Sumihisa , Suzuki Takane , Matsuura Yusuke , Takaso Masashi , Ohtori Seiji
Published: June 2022

Background

Autologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury.

Results

The rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. Gene expression of HO-1 was evaluated by quantitative polymerase chain reaction (qPCR). The response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group.

Conclusions

FVW increased the withdrawal threshold similar to VW in a rat CCI model for short periods. Frozen vein wrapping using vein allograft without donor site morbidity may be an alternative therapeutic option.
Chemokine (C–C motif) receptor 2 is associated with the pathological grade and inflammatory response in IgAN children
Authors: Shen Yanjie , Zhu Zhiqing , Wang Rui , Yan Lili , Sun Shuaichen , Lu Ling , Ren Zhenhua , Zhang Qin
Published: June 2022

Background

Chemokine (C–C motif) receptor 2 (CCR2) is involved in important physiological and pathological processes, such as inflammation and autoimmune diseases. Abnormal immune and inflammatory responses play a critical role in the development and progression of IgA nephritis (IgAN). However, the role of CCR2 in IgAN is unknown.

Methods

Fifteen IgAN children who were diagnosed by kidney biopsy provided kidney biopsy tissue, blood and urine samples, and age-matched healthy control subjects (blood donatorsn = 12; tissue donatorsn = 8) were included. Immunohistochemical analysis was used to detect the expression of CCR2, MCP-1, IL-6, IL-17, and TNF-α in the kidney tissues. Relative optical density (OD) was calculated by Image J software, and the correlation between CCR2 expression and pathological grade in IgAN children was analyzed.

Results

The expression of CCR2 significantly increased in mesangial cells of children with IgAN compared to that in control group (P < 0.001), especially in IgAN patients with Lee’s grade III to IV (P < 0.001). Interestingly, CCR2 expression was positively correlated with Lee’s grade (r = 0.9152,P = 0.0001) in IgAN children. The expression levels of inflammatory factors were markedly increased in IgAN children, and importantly CCR2 expression was positively correlated with it’s expression level.

Conclusions

The results suggest that CCR2 signaling might be involved in pathological process and inflammatory responses of children IgAN, and could potentially be an intervention target in children IgAN.
The feasibility of proteomics sequencing based immune-related prognostic signature for predicting clinical outcomes of bladder cancer patients
Authors: Jiang Liren , Chen Siteng , Pan Qi , Zheng Jun , He Jin , Sun Juanjuan , Han Yaqin , Yang Jiji , Zhang Ning , Fu Guohui , Gao Feng
Published: June 2022

Background

Bladder cancer (BCa) shows its potential immunogenity in current immune-checkpoint inhibitor related immunotherapies. However, its therapeutic effects are improvable and could be affected by tumor immune microenvironment. Hence it is interesting to find some more prognostic indicators for BCa patients concerning immunotherapies.

Methods

In the present study, we retrospect 129 muscle-invasive BCa (MIBC) patients with radical cystectomy in Shanghai General Hospital during 2007 to 2018. Based on the results of proteomics sequencing from 9 pairs of MIBC tissue from Shanghai General Hospital, we focused on 13 immune-related differential expression proteins and their related genes. An immune-related prognostic signature (IRPS) was constructed according to Cancer Genome Atlas (TCGA) dataset. The IRPS was verified in ArrayExpress (E-MTAB-4321) cohort and Shanghai General Hospital (General) cohort, separately. A total of 1010 BCa patients were involved in the study, including 405 BCa patients in TCGA cohort, 476 BCa patients in E-MTAB-4321 cohort and 129 MIBC patients in General cohort.

Result

It can be indicated that high IRPS score was related to poor 5-year overall survival and disease-free survival. The IRPS score was also evaluated its immune infiltration. We found that the IRPS score was adversely associated with GZMB, IFN-γ, PD-1, PD-L1. Additionally, higher IRPS score was significantly associated with more M2 macrophage and resting mast cell infiltration.

Conclusion

The study revealed a novel BCa prognostic signature based on IRPS score, which may be useful for BCa immunotherapies.
Breastfeeding has no protective effects on the development of coronary artery lesions in Kawasaki disease: a retrospective cohort study
Authors: Wang Hongli , Tang Yunjia , Yan Wenhua , Xu Qiuqin , Li Xuan , Qian Weiguo
Published: June 2022

Background

Kawasaki disease (KD) is a self-limiting vasculitis with an unknown etiology. It has been reported that breastfeeding has a potential protective effect on KD development. However, whether breastfeeding has an effect on the development of coronary artery lesions (CALs) remains unclear.

Methods

We retrospectively reviewed the medical records of patients with the main diagnosis of KD hospitalized in our hospital from May 2017 to November 2018. Standardized telephone interviews were carried out to obtain feeding practices before KD was onset.

Results

Two hundred and ninety-three (51.6%) were exclusively breastfed, 223 (39.3%) were partially breastfed and 52 (9.2%) were formula fed. There were no significant differences in the characteristics regarding age, gender, incomplete KD, intravenous immunoglobulin (IVIG) resistance, and the laboratory variables among the three groups. With formula feeding as a reference, patients exclusively breastfed and partially breastfed seemed to have a higher incidence of CALs, even after adjusting confounders, but were not statistically significant. After grouping patients who were older than six months into formula feeding, partial breastfeeding for < 2 months, partial breastfeeding for ≥ 2 and < 4 months, partial breastfeeding for ≥ 4 and < 6 months and exclusively breastfeeding based on the length of breastfeeding, the results remained the same (P > 0.05).

Conclusions

Breastfeeding has no protective effect on the development of CALs in KD.
Adolescents’ self-efficacy and digital health literacy: a cross-sectional mixed methods study
Authors: Taba Melody , Allen Tiffany B. , Caldwell Patrina H.Y. , Skinner S. Rachel , Kang Melissa , McCaffery Kirsten , Scott Karen M.
Published: June 2022

Background

The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires critical health literacy to discriminate between sources, critically analyse meaning and relevance, and use information for personal health. Adolescents with poor digital health literacy risk using misinformation, with potential negative health outcomes. We aimed to understand adolescents’ contemporary digital health literacy and compared self-efficacy with capability.

Methods

Adolescents (12–17 years) completed an eHEALS self-report digital health literacy measure, a practical search task using a think-aloud protocol and an interview to capture perceived and actual digital health literacy. eHEALS scores were generated using descriptive statistics, search tasks were analysed using an observation checklist and interviews were thematically analysed based on Social Cognitive Theory, focussing on self-efficacy.

Results

Twenty-one participants generally had high self-efficacy using online health information but perceived their digital health literacy to be higher than demonstrated. They accessed online health information unintentionally on social media and intentionally via search engines. They appraised information medium, source and content using general internet searching heuristics taught at school. Information on social media was considered less trustworthy than websites, but participants used similar appraisal strategies for both; some search/appraisal heuristics were insufficiently nuanced for digital health information, sometimes resulting in misplaced trust or diminished self-efficacy. Participants felt anxious or relieved after finding online health information, depending on content, understanding and satisfaction. They did not act on information without parental and/or health professional advice. They rarely discussed findings with health professionals but would welcome discussions and learning how to find and appraise online health information.

Conclusions

Whilst adolescents possess many important digital health literacy skills and generally feel self-efficacious in using them, their critical health literacy needs improving. Adolescents desire increased digital health literacy so they can confidently appraise health information they find online and on social media. Co-designed educational interventions with adolescents and health providers are required.
Perceptions of COVID-19 self-testing and recommendations for implementation and scale-up among Black/African Americans: implications for the COVID-19 STEP project
Authors: Nwaozuru Ucheoma , Obiezu-Umeh Chisom , Diallo Hassim , Graham Danielle , Whembolua Guy-Lucien , Bourgeau Marie Janeeca , Ritchwood Tiarney D. , Nelson LaRon E. , Shato Thembekile , Mathews Allison , Moise Rhoda , Ward Maranda C. , Raude Jocelyn , Ahonkhai Aima A. , Young Diane J. , Conserve Donaldson F.
Published: June 2022

Background

COVID-19 self-testing (ST) is an innovative strategy with the potential to increase the access and uptake of testing and ultimately to limit the spread of the virus. To maximize the uptake and reach of this promising strategy and inform intervention development and scale up, research is needed to understand the acceptability of and willingness to use this tool. This is vital to ensure that Black/African Americans are reached by the Biden-Harris Administration’s free national COVID-19 ST program. This study aimed to explore the acceptability and recommendations to promote and scale-up the uptake of COVID-19 ST among Black/African Americans.

Methods

We conducted a cross-sectional qualitative study using a semi-structured questionnaire to assess barriers and facilitators to the uptake of COVID-19 ST among a convenience sample of 28 self-identified Black/African Americans from schools, community centers, and faith-based institutions in Ohio and Maryland. Inductive content analysis was conducted to identify categories and subcategories related to acceptability and recommendations for implementing and scaling up COVID-19 ST in communities.

Results

Participants perceived COVID-19 self-testing as an acceptable tool that is beneficial to prevent transmission and address some of the barriers associated with health facility testing, such as transportation cost and human contact at the health facility. However, concerns were raised regarding the accurate use of the kits and costs. Recommendations for implementing and scaling up COVID-19 ST included engagement of community stakeholders to disseminate information about COVID-19 self-testing and creating culturally appropriate education tools to promote knowledge of and clear instructions about how to properly use COVID-19 ST kits. Based on these recommendations, the COVID-19 STEP (Self-Testing Education and Promotion) Project is being developed and will involve engaging community partners such as barbers, church leaders, and other community-based organizations to increase the uptake and use of free COVID-19 ST kits among Black/African Americans.

Conclusion

Findings showed that most participants considered COVID-19 ST valuable for encouraging COVID-19 testing. However, cost and accuracy concerns may pose barriers. Future work should consider implementing interventions that leverage the benefits of COVID-19 ST and further assess the extent to which these identified facilitators and barriers may influence COVID-19 ST uptake.
Valuing the impact of self-rated health and instrumental support on life satisfaction among the chinese population
Authors: Chan Chee Hon , Wong Anna
Published: June 2022

Background

Research has highlighted that satisfaction in health, and instrumental support (IS) are key areas of life affecting an individual’s wellbeing. Many social and public health initiatives use these two intervention mechanisms to improve individual’s wellbeing. For the purpose of cost-benefit assessment, there has been growing interest in expressing these intervention effects in economic terms. However, only a handful of studies have ever estimated these effects in economic terms, none of which examined them in a Chinese context. The aim of this study is to extend this line of valuation work to the Chinese population, estimating the implicit willingness-to-pays on the effects of improving individuals’ self-rated health (SRH) status and IS on their life satisfaction (LS).

Methods

Using data from a two-wave representative panel survey in Hong Kong (n = 1,109), this study conducted a cross-lagged analysis with a structural equation modelling technique to examine the causal effects of SRH and IS on LS. The use of this cross-lagged approach was an effort to minimise the endogeneity problem. Then, substituting the respective estimates to the formulae of compensating surplus, the marginal rate of substitution of SRH and IS with respect to individual’s equivalised monthly household income (HI) were estimated and were then expressed as the implicit willingness-to-pays on the effect of improving individuals’ SRH and IS on their LS.

Results

The cross-lagged analysis ascertained the causal effects of SRH (β = 0.074, 95% Confidence Interval: 0.021, 0.127) and IS (β = 0.107, 95% Confidence Interval: 0.042, 0.171) on individuals’ satisfaction with life. Translating into the concept of compensating surplus, the implicit monetary values of improving the sample’s SRH from “poor health” to “excellent health” and their perceived IS from “little support” to “a lot of support” are equivalent to an increase in their equivalised monthly HI by US$1,536 and US$1,523 respectively.

Conclusions

This study is the first to derive the implicit monetary values of SRH and IS on individual’s LS in a predominantly Chinese society, and it has implications for the cost-benefit assessment in wellbeing initiatives within the population.
Systematic review of effectiveness and quality assessment of patient education materials and decision aids for breathlessness
Authors: Sunjaya Anthony Paulo , Bao Lexia , Martin Allison , DiTanna Gian Luca , Jenkins Christine R.
Published: June 2022

Background

Around 10% of adults suffer from clinically significant breathlessness. High quality and actionable patient education materials (PEMs) and patient decision aids (PDAs) have an important role for shared decision making and patient self-management.

Objective

To systematically assess the effectiveness of patient education materials (PEMs) and patient decision aids (PDAs) on clinical outcomes. Secondly, to assess the quality of PEMs and PDAs for breathlessness that are accessible online.

Methods

A systematic review of PEM or PDA intervention for breathlessness published between 1 January 2010 and November 2020 was conducted. An environmental scan and quality assessment of publicly available PEMs and PDAs was also conducted.

Results

Out of 2985 records, five studies were eligible for inclusion in this systematic review. Results of two randomised controlled trials suggest potential effectiveness of PEMs to improve patient reported outcomes and reduce healthcare utilization. In the environmental scan, 88 materials were included. Minimum reading age for most was high (Grade 10) and PEMs scored an average of 87% for understandability and 67% for actionability. Based on the DISCERN tool only 10 were classified as high quality.

Conclusion

There is a paucity of evidence on the effectiveness of PEMs and PDAs for improvement in breathlessness. There is a need to develop higher quality PEMs for breathlessness.
Clinical and prognosis value of the number of metastatic lymph nodes in patients with papillary thyroid carcinoma
Authors: Zhan Ling , Feng Hong-fang , Yu Xi-zi , Li Ling-rui , Song Jun-long , Tu Yi , Yuan Jing-ping , Chen Chuang , Sun Sheng-rong
Published: June 2022

Objective

It has been reported that papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) are largely associated with adverse outcomes. The present study aimed to assess the correlation between the number of metastatic lymph nodes (NMLNs) and clinical prognosis in patients with PTC.

Methods

We retrospectively reviewed the medical records of patients with PTC who underwent initial thyroid cancer surgery in Renmin Hospital of Wuhan University between 2017 and 2019. A total of 694 patients with PTC and cervical lymph node dissection as well as a total checked number of lymph nodes ≥ 5 were involved in this study. The clinicopathological characteristics of patients were compared according to NMLNs, the number of central cervical lymph nodes (CLNs) and the number of lateral lymph nodes (LLNs).

Results

NMLNs > 5, CLNs > 5 and LLNs > 5 were 222 (32.0%), 159 (24.3%) and 70 (10.1%) seen in the analyzed samples, respectively. Young patients, patients with larger tumor diameter, bilaterality, multifocality and gross extrathyroidal extension (ETE) were more inclined to NMLNs > 5, CLNs > 5 and LLNs > 5 (P < 0.05). It was found that the recurrence-free survival among pN1 patients was significantly discrepant between different groups (NMLNs ≤ 5/5: P = 0.001; LLNs ≤ 5/5: P < 0.001). In multivariate logistic regression analysis, patients aged < 55 years (OR = 1.917), primary tumor size > 10 mm (OR = 2.131), bilaterality (OR = 1.889) and tumor gross ETE (OR = 2.759) were independent predictors for high prevalence of total NMLNs > 5 (P < 0.05). Specially, patients aged < 55 years (OR = 2.864), primary tumor size > 10 mm (OR = 2.006), and tumor gross ETE (OR = 2.520) were independent predictors for high prevalence of CLNs > 5 (P < 0.01); Bilaterality (OR = 2.119), CLNs > 5 (OR = 6.733) and tumor gross ETE (OR = 4.737) were independent predictors for high prevalence of LLNs > 5 (P < 0.05).

Conclusions

In conclusion, it is evident that NMLNs is related to the invasive clinicopathological features and adverse outcome of patients with PTC which should be correctly evaluated to provide an appropriate guidance for reasonable treatment and careful follow-up.
Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermal matrix
Authors: Hong Hyun Ki , Kim Yun Hyun , Lee Joon seok , Lee Jeeyeon , Park Ho Yong , Yang Jung Dug
Published: June 2022

Background

Several studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermal matrix (ADM) prosthesis to achieve full coverage. However, methods for anterior coverage have rarely been reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and determine its functional and cosmetic outcomes as well as compare them with those of existing subpectoral DTI techniques.

Methods

This prospective comparative study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control group) and anterior coverage prepectoral implant insertion (anterior coverage group), respectively. Postoperative complications were noted, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) scale was used to assess the patient’s subjective satisfaction with the reconstruction and postoperative quality of life.

Results

No remarkable differences in terms of complications (seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection) were noted in both groups. Compared with controls, considerably better results were observed among those in the anterior coverage group in terms of the mean drain removal period. Furthermore, those in the anterior coverage group showed greater symmetry on three-dimensional scans than the controls; however, this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different between both groups.

Conclusions

Considering its stability, faster recovery time, and cosmetic benefit, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good choice to perform breast reconstruction with implant insertion in patients who have undergone mastectomy.

Level of evidence: II.
A technique for laparoscopic extraperitoneal colostomy with an intact posterior sheath of rectus
Authors: Li Zeyu , Tian Lifei , Liu Ruiting , Zheng Bobo , Wang Ben , Zhao Xu , Quan Pan , Qiu Jian
Published: June 2022

Regardless of the advances in surgical techniques, parastomal hernia is still an inevitable complication for many patients with low rectal cancer undergoing abdominal perineal resection (APR). Extraperitoneal colostomy (EPC) seems to be a effective method to reduce the risk of parastomal hernia. We propose a new approach to simplify and standardize laparoscopic EPC to make this operation easy to perform. We used the technique of laparoscopic TEP groin hernia repair to produce an extraperitoneal tunnel, which can not only facilitate precise visualization of the extraperitoneal tunnel but also utilize the intact posterior rectus abdominis sheath as biologic materials to maintain soft-tissue augmentation, with a satisfactory result. With laparoscopy, we can create adequate space without insufficient dissection of the extraperitoneal tunnel while avoiding damage to the retrorectus sheath. At the time of writing, we had performed this method in four patients, without any complications. This technique is effective at preventing parastomal hernia without extra costs.
Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study
Authors: Van Gorp Gertrude , Lambrechts Marjan , Jacobs Reinhilde , Declerck Dominique
Published: June 2022

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.
Verification of the folkloric and anecdotal antidiabetic effects of Hypoxis hemerocallidea (Fisch., C.A. Mey. & Avé-Lall) and isolated, β-sitosterol using early-stage type II spontaneous diabetic mutant BKS-Leprdb mice
Authors: Mkolo N. M. , Olaokun O. O. , King P. H. , Janse van Rensburg I. , Eloff J. N. , Naidoo V.
Published: June 2022

Background

Previous studies in our laboratory in ex vivo assays have demonstratedH. hemerocallideaextract as potential antidiabetic agent through increased insulin release from pancreatic beta cells. Thus, for this study the early stage type II spontaneous diabetic mutant mice model was used to evaluate and determine the degree of the antidiabetic efficacy ofH.hemerocallidea.

Methods

Eight-weeks-old type II spontaneous pre-diabetic mutant BKS-Leprdb mice were fed with feed supplemented with eitherH.hemerocallideaextract, isolated compound (β-sitosterol) or chlorpropamide (positive control) for 4 weeks. The haematological parameters, clinical chemistry, glucose tolerance, feed intake, faecal output and body weights were measured.

Results

The blood glucose concentrations of all the animals treated with plant extract, β-sitosterol compound and non-treated pre-diabetic animals did not return to baseline levels. Only the β-sitosterol treatment and positive control groups resulted in a respective small decrease of 5.8 and 5.2% in the mouse weights over the study period, with no significant changes (p > 0.05) in food intake. However, there was a general trend for decrease in faecal output for all the groups. Albumin, triglycerides, and total cholesterol levels in β-sitosterol and chlorpropamide-treated animals were lower, relative to untreated-animals. Animals fed with plant extract showed large amounts of internal fat. There were no significant changes (p > 0.05) in total serum protein, globulin, alanine aminotransferase, alkaline phosphatase, urea nitrogen and creatinine attributed to administration of treatments. In all groups, some animals showed lesions associated with cardiac puncture. Few animals except animals treated with plant extract, showed presence of a left-ventricular hypertrophic cardiomyopathy. The liver and kidneys for all groups appeared macroscopically normal and the thymuses were small (±2 mg). There were pathological signs in some of the animals particularly in myocardial fibres, renal tubular, glomerular, hepatocyte granularity and pancreas islets. However, there was no significance trend between the groups.

Conclusion

Based on the results, none of the treatments could be considered highly effective for the management of type II pre-diabetes as sole therapeutic intervention.
AEDNav: indoor navigation for locating automated external defibrillator
Authors: Rao Gaurav , Mago Vijay , Lingras Pawan , Savage David W.
Published: June 2022

Background

In a sudden cardiac arrest, starting CPR and applying an AED immediately are the two highest resuscitation priorities. Many existing mobile applications have been developed to assist users in locating a nearby AED. However, these applications do not provide indoor navigation to the AED location. The time required to locate an AED inside a building due to a lack of indoor navigation systems will reduce the patient’s chance of survival. The existing indoor navigation solutions either require special hardware, a large dataset or a significant amount of initial work. These requirements make these systems not viable for implementation on a large-scale.

Methods

The proposed system collects Wi-Fi information from the existing devices and the path’s magnetic information using a smartphone to guide the user from a starting point to an AED. The information collected is processed using four techniques: turn detection method, Magnetic data pattern matching method, Wi-Fi fingerprinting method and Closest Wi-Fi location method to estimate user location. The user location estimations from all four techniques are further processed to determine the user’s location on the path, which is then used to guide the user to the AED location.

Results

The four techniques used in the proposed systemTurn detection,Magnetic data pattern matching,Closest Wi-Fi locationandWi-Fi fingerprintingcan individually achieve the accuracy of 80% with the error distance ± 9.4 m, ± 2.4 m, ± 4.6 m, and ± 4.6 m respectively. These four techniques, applied individually, may not always provide stable results. Combining these techniques results in a robust system with an overall accuracy of 80% with an error distance of ± 2.74 m. In comparison, the proposed system’s accuracy is higher than the existing systems that use Wi-Fi and magnetic data.

Conclusion

This research proposes a novel approach that requires no special hardware, large scale data or significant initial work to provide indoor navigation. The proposed systemAEDNavcan achieve an accuracy similar to the existing indoor navigation systems. Implementing this indoor navigation system could reduce the time to locate an AED and ultimately increase patient survival during sudden cardiac arrest.
Snap out stigma photovoice project in the U.S. South
Authors: Pichon Latrice C. , Stubbs Andrea Williams , Teti Michelle
Published: June 2022

Background

The purpose of SNAP Out Stigma (SOS) was to design and implement a community-based intervention to reduce HIV-related stigma for people living with HIV (PLWH) in the Deep South. This region is a subset of 9 states including Memphis, Tennessee (project site) driving the epidemic in the United States. The purpose of this paper is to explain how PLWH in the U.S. South used Photovoice to communicate stigmatizing lived experiences and contextualize their intersection with multi-level sources of support.

Methods

PLWH attended one-on-one and/or group sessions with other PLWH. In Session 1, PLWH received a project overview, met other participants, received a camera and camera training, completed a standardized internalized stigma scale, discussed experiences of internalized stigma, and were instructed to take 3–10 pictures that captured stigma. In Session 2, PLWH discussed the pictures and their meaning. In Session 3, PLWH expanded on what they shared in previous sessions in a one-on-one interview. Thematic analysis captured key patterns of how PLWH experienced stigma.

Results

Forty-seven PLWH attended Session 1 and were issued a camera. Of those, 35 completed sessions 2 and 3. Participants self-identified as cis man who has sex with men (n = 18), ciswoman (n = 5), transwoman (n = 10), and non-binary (n = 2). Four emergent themes intersecting with internalizations of stigma were identified including: medical, social support, church, and self.

Conclusions

The SOS intervention created a safe space for PLWH to share lived experiences of stigmatization. Photovoice facilitated discussion topics ranging from healing and recovery to overcoming factors of social determinants of HIV. We identified trauma-informed growth as an area of future programs for PLWH.
Impact of integrated medication management program on medication errors in a medical center: an interrupted time series study
Authors: Chen Kuan-Lin , Hunag Chih-Fen , Sheng Wang-Huei , Chen Yu-Kuei , Wang Chi-Chuan , Shen Li-Jiuan
Published: June 2022

Background

Medication errors (MEs) are harmful to patients during hospitalization, especially elderly patients. To reduce MEs, an integrated medication management (IMM) model was developed in a 2500-bed medical center, allowing a clinical pharmacist to participate in the daily ward round and perform medication reconciliation and medication reviews. This study aimed to evaluate the impact of the IMM model on MEs and medication utilization using a quasi-experimental design.

Methods

We conducted an interrupted time-series study using the aggregated data of monthly admissions from two wards of a medical center, where one ward served as the intervention and the other served as the external control. The pre- and post-intervention phases comprised of 40 and 12 monthly observational units, respectively. The primary outcome was the mean number of ME reports, which were further investigated for different ME types. The mean number of daily inpatient prescriptions, mean number of daily self-prepared medications, and median daily medication costs were measured. All outcomes were measured per admission episode. Segmented regression was used to evaluate the level and slope changes in the outcomes after IMM model implementation, and subgroup analyses were performed to examine the effects on different groups.

Results

After IMM model implementation, the mean number of ME reports increased (level change: 1.02, 95% confidence interval [CI]: 0.68 to 1.35, P < 0.001). The number of reports has shown a dramatic increase in omissions or medication discrepancies, inappropriate drug choices, and inappropriate routes or formulations. Furthermore, the mean number of daily inpatient prescriptions was reduced for patients aged ≥75 years (level change: −1.78, 95% CI: −3.06 to −0.50, P = 0.009). No significant level or slope change was observed in the control ward during the post-intervention phase.

Conclusions

The IMM model improved patient safety and optimized medication utilization by increasing the reporting of MEs and decreasing the number of medications used.
The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review
Authors: Kakemam Edris , Arab-Zozani Morteza , Raeissi Pouran , Albelbeisi Ahmed Hassan
Published: June 2022

Background

Defensive Medicine (DM) concept refers to all medical care provided by physicians without increasing the benefits to the patient, the primary purpose of which is to prevent the risk of litigation. Although several studies have been published investigating the occurrence of DM around the world, no review conducted on DM among physicians. Therefore, this study aims to summarize and map the available evidence on occurrence, types of behaviors, and reasons for practicing of DM among physicians and possible solutions and strategies to reduce DM in the literature.

Methods

This is a scoping review in which we searched Web of Science, Scopus, and PubMed in December 2021. Our target was original studies of any type that included data on DM among physicians between 2000 and 2021. We followed the JBI guideline for conducting a scoping review and for increasing the rigor of the study. First, the percentage was used to summarize the occurrence of DM, and then, findings related to types of behaviors and reasons for practicing DM and mitigation strategies were analyzed inductively in NVivo 10 in three stages.

Results

Twenty-seven studies were included in the review. The overall occurrence of DM practice ranged from 6.7 to 99.8%. Two types of DM behaviors including assurance and avoidance behaviors have been identified. The common reasons for practicing DM were categorized into four themes, patient-related reasons, physician-related reasons, organization-related reasons, and society-related reasons. The main strategies to prevent or reduce DM are structured training and education, restoring physician-patient relationships, reform of the health system, and reform of the liability system.

Conclusions

The vast majority of research studies were conducted in high-income countries, and studies are needed to measure this phenomenon and its consequences in depth in low- and middle-income countries. Various solutions and strategies are needed to reduce defensive behaviors such as structured training and education, restoring physician-patient relationships, reforming the health system, and reforming the liability system.

Keywords

Defensive medicine, Defensive practice, Medical malpractice, Physicians, Scoping review
Person-centred care to prevent hospitalisations – a focus group study addressing the views of healthcare providers
Authors: Lyhne Cecilie Nørby , Bjerrum Merete , Jørgensen Marianne Johansson
Published: June 2022

Background

The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and ultimately reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. To improve the quality and responsiveness of primary healthcare and to develop initiatives to support the interdisciplinary collaboration in preventive services, there is a need to investigate the views of primary healthcare providers. The aim of this study was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care.

Methods

Five focus group interviews were conducted with 27 healthcare providers, including general practitioners, social and healthcare assistants, occupational therapists, physiotherapists, home care nurses, specialist nurses and acute care nurses. Interviews were transcribed, and analysed with qualitative content analysis.

Results

Three categories emerged from the analysis: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions. These describe that the healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation, entailing a focus on person-centred care. Nevertheless, in the preventive services, interdisciplinary collaboration focusses primarily on handling acute physical conditions, which constitutes a barrier for interdisciplinary collaboration.

Conclusions

By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some hospitalisations. Stakeholders at all levels should be informed about the relevance of considering mental, social and physical conditions to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration.
Clinical benefit of systolic blood pressure within the target range among patients with or without diabetes mellitus: a propensity score-matched analysis of two randomized clinical trials
Authors: Li Chao , Chen Kangyu , Shi Guoshuai , Shi Rui , Wu Zhenqiang , Yuan Xiaodan , Watson Vicky , Jiang Zhixin , Mai Hui , Yang Tian , Wang Duolao , Chen Tao
Published: June 2022

Background

Recent guidelines recommended a systolic blood pressure (SBP) target of < 130 mmHg for patients with or without diabetes but without providing a lower bound. Our study aimed to explore whether additional clinical benefits remain at achieved blood pressure (BP) levels below the recommended target.

Methods

We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) among the non-diabetic population and the Action to Control Cardiovascular Risk in Diabetes BP (ACCORD-BP) trial among diabetic subjects. We used the propensity score method to match patients from the intensive BP group to those from the standard group in each trial. Individuals with different achieved BP levels from the intensive BP group were used as “reference.” For each stratum, the trial-specific primary outcome (i.e., composite outcome of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure (HF), or cardiovascular death for SPRINT; non-fatal MI, non-fatal stroke, or cardiovascular death for ACCORD-BP) was compared by Cox regression.

Results

A non-linear association was observed between the mean achieved BP and incidence of composite cardiovascular events, regardless of treatment allocation. The significant treatment benefit for primary outcome remained at SBP 110–120 mmHg (hazard ratio, 0.59 [95% CI, 0.46, 0.76] for SPRINT; 0.67 [0.52, 0.88] for ACCORD-BP) and SBP 120–130 mmHg for SPRINT (0.47 [0.34, 0.63]) but not for ACCORD-BP (0.93 [0.70, 1.23]). The results were similar for the secondary outcomes including all-cause mortality, cardiovascular mortality, MI, stroke, and HF. Intensive BP treatment benefits existed among patients maintaining a diastolic BP of 60–70 mmHg but were less distinct.

Conclusions

The treatment benefit persists at as low as SBP 110–120 mmHg irrespective of diabetes status. Achieved very low BP levels appeared to increase cardiovascular events and all-cause mortality.
Optimizing the downstream MVA pathway using a combination optimization strategy to increase lycopene yield in Escherichia coli
Authors: Cheng Tao , Wang Lili , Sun Chao , Xie Congxia
Published: June 2022

Background

Lycopene is increasing in demand due to its widespread use in the pharmaceutical and food industries. Metabolic engineering and synthetic biology technologies have been widely used to overexpress the heterologous mevalonate pathway and lycopene pathway in Escherichia coli to produce lycopene. However, due to the tedious metabolic pathways and complicated metabolic background, optimizing the lycopene synthetic pathway using reasonable design approaches becomes difficult.

Results

In this study, the heterologous lycopene metabolic pathway was introduced into E. coli and divided into three modules, with mevalonate and DMAPP serving as connecting nodes. The module containing the genes (MVK, PMK, MVD, IDI) of downstream MVA pathway was adjusted by altering the expression strength of the four genes using the ribosome binding sites (RBSs) library with specified strength to improve the inter-module balance. Three RBS libraries containing variably regulated MVK, PMK, MVD, and IDI were constructed based on different plasmid backbones with the variable promoter and replication origin. The RBS library was then transformed into engineered E. coli BL21(DE3) containing pCLES and pTrc-lyc to obtain a lycopene producer library and employed high-throughput screening based on lycopene color to obtain the required metabolic pathway. The shake flask culture of the selected high-yield strain resulted in a lycopene yield of 219.7 mg/g DCW, which was 4.6 times that of the reference strain.

Conclusion

A strain capable of producing 219.7 mg/g DCW with high lycopene metabolic flux was obtained by fine-tuning the expression of the four MVA pathway enzymes and visual selection. These results show that the strategy of optimizing the downstream MVA pathway through RBS library design can be effective, which can improve the metabolic flux and provide a reference for the synthesis of other terpenoids.
Need for optimized dosages in the design of comparative clinical trials of anti-malarial drugs
Authors: Krishna Sanjeev , Kremsner Peter G.
Published: June 2022

We read with interest the publication on malaria treatment by Obonyo et al. (Malaria J 21:30, 2022). This commentary questions the methodology, especially the chosen time points of treatment outcome measures.
Malaria-associated risk factors among adolescents living in areas with persistent transmission in Senegal: a case–control study
Authors: Tairou Fassiatou , Diallo Abdoulaye , Sy Ousmane , Kone Aminatou , Manga Isaac Akhenaton , Sylla Khadim , Lelo Souleye , Fall Cheikh Binetou , Sow Doudou , Ndiaye Magatte , Faye Babacar , Tine Roger C. K.
Published: June 2022

Background

In Senegal, malaria morbidity has sharply decreased over these past years. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal.

Methods

A case–control study was conducted from November to December 2020 in four health posts located in the Saraya district. Cases were defined as adolescents (10–19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Factors associated with clinical malaria were assessed using stepwise logistic regression analysis.

Results

In total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65; 95% CI 1.58–4.45), non-use of other preventive measures (aOR = 2.51; 95% CI 1.53–4.11) and indoor sleeping (aOR = 3.22; 95% CI 1.66–6.23). Protective factors included 15–19 years of age (aOR = 0.38; 95% CI 0.23–0.62), absence of stagnant water around the house (aOR = 0.27; 95% CI 0.16–0.44), having a female as head of household (aOR = 0.47; 95% CI 0.25–0.90), occupation such as apprentice (OR = 0.24; 95% CI 0.11–0.52).

Conclusions

The study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups.