bluuebunny/crossref_metadata_2025 huggingface dataset:
Visible/Near-Infrared Spectroscopy Devices and Wet-Chem Analyses for Grapes (Vitis vinifera L.) Quality Assessment: An Environmental Performance Comparison
Authors: Zambelli M. , Casson A. , Giovenzana V. , Pampuri A. , Tugnolo A. , Pozzoli C. , Brancadoro L. , Beghi R. , Guidetti R.
Published: November 2022

Background and Aims. The composition of grapes (Vitis vinifera L.) at harvest is a key factor that determines the future quality of wine. The work aimed to evaluate and compare the environmental impact of the most evaluated technological parameters using three approaches: the wet-chem method, the optical method using benchtop devices, and the optical method using a prototype smart and cost-effective device (Technology Readiness Level: 5). Methods and Results. The life cycle assessment (LCA) methodology was used to identify the most environmentally sustainable solution in a “from-cradle-to-grave” approach. The functional unit was identified by the execution of the analyses necessary to measure the three technological parameters: TSS, pH, and TA. The findings show that the optical analysis carried out with the prototype is the most suitable and green solution (i.e., with the lowest environmental impact in all the impact categories analysed); in fact, the same technology has proved to be 3.2 times more sustainable than the wet-chem method for the best average environmental performance. Conclusions. The research demonstrated the environmental impact advantages of the optical analyses for assessment of grape composition. Significance of the Study. Innovations in agriculture and the development of smart solutions represent advantages for managing and monitoring the composition of agri-food products that are a green solution for the industry.
Fibrinogen-to-Albumin Ratio Predicts Postcontrast Acute Kidney Injury in Patients with Non-ST Elevation Acute Coronary Syndrome after Implantation of Drug-Eluting Stents
Authors: Qiao Yong , Li Mingkang , Li Linqing , Tang Chengchun
Published: November 2022

Background. Postcontrast acute kidney injury (PC-AKI) is an adverse reaction to iodinated contrast agents. In this study, we investigated the use of fibrinogen-to-albumin ratio (FAR) as a novel inflammatory marker to track the development and progression of PC-AKI in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) after the implantation of drug-eluting stents (DESs). Methods. A total of 872 patients with NSTE-ACS were enrolled in this study. PC-AKI was identified when serum creatinine (SCr) levels increased >26.5 mol/L (0.3 mg/dL) or was 1.5 times the baseline level within 48–72 h of exposure to an iodinated contrast agent. The effects of different variables on PC-AKI were evaluated using univariate regression analysis. Multivariate logistic regression analysis was used to determine the independent predictors of PC-AKI. The predictive value of FAR was assessed by estimating the area under the receiver operating characteristic (ROC) curve. Results. In total, 114 (13.1%) patients developed PC-AKI. The patients with PC-AKI had lower albumin levels ([Formula: see text] vs. [Formula: see text], [Formula: see text]), higher fibrinogen levels ([Formula: see text] vs. [Formula: see text], [Formula: see text]), and higher FAR levels ([Formula: see text] vs. [Formula: see text], [Formula: see text]) than those with non-PC-AKI. There were no significant differences in the preoperative SCr levels between the two groups. After adjusting for confounding factors, FAR was found to be an independent predictor of PC-AKI ([Formula: see text], 95% [Formula: see text], [Formula: see text]). ROC analysis revealed that for PC-AKI prediction, the area under the curve for FAR was 0.702. The optimum cut-off value of FAR was 10.0, with a sensitivity of 64.9% and a specificity of 69.8%. Moreover, FAR had a higher predictive value for PC-AKI than the Mehran score (0.702 vs. 0.645). Conclusion. Our study showed that elevated preoperative FAR was closely associated with the development of PC-AKI in patients with NSTE-ACS after implantation of DESs. Therefore, it may be worth monitoring FAR as a guide for using preventive measures to avoid the development of PC-AKI.
CLIPA7 Exhibits Pleiotropic Roles in the Anopheles gambiae Immune Response
Authors: Zakhia Renée , Osta Mike A.
Published: November 2022

Clip domain serine proteases and clip domain serine protease homologs (cSPHs) are key components of serine protease cascades that drive the melanization response. Despite lacking catalytic activity, cSPHs play essential roles in regulating melanization, but the spectrum of functions they catalyze within and outside these cascades is not fully understood. Aside from their classical role as cofactors for PPO activation, we have previously revealed an unprecedented complexity in the function and molecular organization of these cSPHs in the immune response of the malaria vector Anopheles gambiae. Here, we add yet another dimension to the complex roles underpinning the contributions of cSPHs to mosquito immunity by showing that CLIPA7, a member of the expanded cSPH family, defines a novel branch within the cSPH network that is essential for the melanization of Escherichia coli but not Plasmodium ookinetes or Gram-positive bacteria. Despite its dispensability for the melanization of Gram-positive bacteria, we show that CLIPA7 is required for the clearance of systemic infections with Staphylococcus aureus. CLIPA7 is produced by hemocytes and associates with the surfaces of live E. coli and S. aureus cells in vivo as well as with those of melanized cells. Based on its RNAi phenotypes and its unique domain architecture among A. gambiae cSPHs including the presence of an RGD motif, we propose that CLIPA7 exhibits pleiotropic roles in mosquito immunity that extend beyond the regulation of melanization to microbial clearance.
Taxonomic review of the elampine cuckoo wasps from northeastern Brazil (Hymenoptera: Chrysididae), with the description of three new species
Authors: LUCENA DAERCIO A. A. , SANTOS-NETO PEDRO E. , ZANELLA FERNANDO C. V. , ALMEIDA EDUARDO A. B.
Published: November 2022

The diversity of the Elampini cuckoo wasps in northeastern Brazil is reviewed. Three new species are described: Hedychrum oxente Lucena & Zanella sp. nov., Holopyga lunae Lucena sp. nov., and Muesebeckidium clemensi Lucena & Zanella sp. nov. A lectotype is designated for Holopyga piliventris Ducke, 1907 and herein illustrated. Elampus aequinoctialis Ducke, 1901 is restored as a valid species (previously synonymized with Elampus gayi Spinola, 1851) and diagnosed. Holophris huberi (Ducke, 1901) and Muesebeckidium clemensi sp. nov. represent the first records of both genera to northeastern Brazil. New records along with up-to-date distributional maps are discussed, and an identification key to the species of Holopyga from northeastern Brazil is provided. The total diversity of Elampini recorded for northeastern Brazil is now represented by the following eight species: Elampus aequinoctialis Ducke, 1901, Exallopyga guatemalensis (Cameron, 1888), Hedychrum oxente Lucena & Zanella sp. nov., Holophris huberi (Ducke, 1901), Holopyga iheringi du Buysson, 1901, H. lunae Lucena sp. nov., H. piliventris Ducke, 1907, and Muesebeckidium clemensi Lucena & Zanella sp. nov.
Co-Doped LaFeO3 Gas Sensor for Fast Low-Power Acetone Detection
Authors: Jing Zhao-Jun , Zhong Zhi-Cheng , Zhang Chun-Ming , Gao Qi-Chen
Published: November 2022

Co-doped LaFe1−xCoxO3 (x = 0, 0.1, 0.2, 0.4, 0.6, 0.9) nanomaterial films were prepared via a citric acidassisted sol–gel method and characterized by various techniques. Compared with pure LaFeO3, the optimum
operating temperature of the LaFe0.9Co0.1O3 gas sensor dropped to 110 °C from 140 °C. The response value to 100 ppm acetone was 35.89, with a fast response–recovery time of 14/9 s. The enhanced gas sensitivity may be attributed to the higher number
of surface oxygen vacancies and larger specific surface area of LaFe0.9Co0.1O3. Doping with Co ions improved the moisture resistance of the LaFeO3 sensor at 18%–54% relative humidity. Appropriate doping of Co3+ into LaFeO3
nanofibers is a promising method for designing and fabricating an acetone sensor with high gas-sensing performance.
First Order Plus Dead Time Model Approximation and Proportional-Integral-Derivative Controllers Tuning for Multi-Volume Process
Authors: Wang Jin , Wu Xiancong , Li Qiang , Zhao Jian
Published: November 2022

Analysis and controller design for the FOPDT model is widely used because of its simpleness and convenience. In this paper, the problem of the multi-volume process (MVP) being approximated to first order plus dead time (FOPDT) model, as well as its proportional-integral-derivative (PID)
controller arguments tuning is studied. These have been heavily studied in recent years and the methods developed for its optimal design rely on the idea of including several robust performance specifications in the objective function the method presents fast convergence and consists of mentioning
a desired closed-loop transfer function. Particle swarm optimization (PSO) algorithm and performance index of the integral of the time-weighted absolute error (ITAE) minimum is presented to determine the approximate FOPDT model coefficients of MVP processes, where the order is from two to
fifteen. In addition, the approximate FOPDT model is used to design the PID controller, which is used to control MVP. A large number of tuning methods are provided to analyze and compare the closed-loop control performances. At the end of the paper, two simulation examples illustrate the superiority
and effectiveness of the PID controller design based on the proposed model reduction method. The simulation results show that the reduced-order controller can control a high-order system well, but the process of order reduction is complicated and it needs a long computation time. The FOPID
is a generalization of the conventional PID controller. This is based on an extension calculus. A new method for approximating MVP to the FOPDT model is presented in this paper with more effectiveness.
On the Structure and Variability of the Migrating Diurnal Temperature Tide Observed by SABER
Authors: Garcia Rolando R.
Published: November 2022

Temperature observations made by the SABER infrared radiometer from January 2002 through December 2021 are used to study the structure and variability of the migrating diurnal temperature tide in the middle atmosphere (∼17–105 km). In the lower stratosphere, and in the mesosphere and lower thermosphere (MLT), tidal structure is dominated by the gravest latitudinally symmetric mode, with a smaller contribution from the first antisymmetric mode; in the middle and upper stratosphere, vertically nonpropagating modes are prominent. Consistent with previous work, low-frequency variability is mainly semiannual, with maxima at the equinoxes. Quasi-biennial variability is also present and evident in low-passed time series. There are robust relationships between the semiannual and quasi-biennial variability of the tide and the semiannual and quasi-biennial tropical zonal wind oscillations, respectively, which persist throughout the 20-yr dataset. While the physical mechanisms responsible for these relationships cannot be ascertained from the observations, the present results should be useful for hypothesis testing with numerical models. It is also found that the diurnal tide breaks due to convective instability in the MLT. This is reflected in its mean vertical structure, which grows as expected for a nondissipating wave below ∼85 km, but ceases to grow at higher altitudes. Direct confirmation that dissipation is due to breaking is obtained from the potential temperature field, which shows frequent instances of reversed vertical gradient, particularly at the equinoxes. Breaking of the diurnal tide has a major impact on the zonal-mean temperature and zonal wind structure of the MLT at the equinoxes.
Exploring Treatment Response Predictors of a Parent-Led Therapist-Assisted Treatment for Childhood Trauma
Authors: Salloum Alison , Lu Yuanyuan , Ali Omar , Chen Henian , Salomon Kristen , Cohen Judith A. , Scheeringa Michael S. , Quast Troy , Storch Eric A.
Published: November 2022

Purpose: While stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT) is an effective service delivery model, understanding predictors of Step One, a parent-led therapist-assisted treatment, will help inform how to best match children at baseline to treatments. Method : Potential predictor variables were explored from 63 parent–child Step One participants with 43 responders and 20 non-responders. Baseline tailoring variables explored were anticipated critical life events, demographics, trauma-related variables, and child and parent outcomes. Results: Predictors of Step One non-response were parental depression, child anger outbursts and Hispanic/Latino parents even after controlling for child demographics, child post-traumatic stress, severity, and impairment. Conclusions: Parents with depression and children with high anger outbursts should consider starting with Step Two, therapist-led TF-CBT. Step One may benefit from including TF-CBT culturally modified strategies for Hispanic/Latino parents. If preference is to start with Step One, these parents and children should be closely monitored for treatment progress.
The Influence of Psychosocial Factors on Hospital Length of Stay Among Aging Canadians
Authors: Renwick Kelly Ann , Sanmartin Claudia , Dasgupta Kaberi , Berrang-Ford Lea , Ross Nancy
Published: November 2022

Background: Hospital stays that are prolonged due to non-clinical factors are costly to health care systems and are likely suboptimal for patient well-being. We assessed the influence of psychosocial factors on hospital length of stay (LOS) for older Canadians in a retrospective cohort study. Data and Methods: Data from the Canadian Community Health Survey were linked with the Discharge Abstract Database. Analyses were stratified by age, 55–64 ( n = 1,060) and 65 and older ( n = 2,718). Main predictor variables of interest included four measures of social support, sense of belonging, and living alone. Multivariate models of LOS adjusted for age, sex, income, smoking, and frailty. Results: Among the younger respondents, low positive social interactions, low emotional/informational support, and living alone were associated with a longer LOS. Among respondents 65 and older, low affection, low positive social interactions, low emotional/informational support, and a weak sense of belonging were associated with a longer LOS. Discussion: Having low social support is associated with longer hospital stays in this Canadian cohort. Social support may influence LOS as risk factors for poor health and precarious care in the community. Mitigating these risk factors could reduce the economic burden that is played out through longer hospital stays.
Respiratory Monitoring Smart Vest Based on Flexible Pressure Sensor
Authors: Xiao Shuang , He Yin
Published: November 2022

A smart vest that can monitor the respiratory rate of the human body has been developed based on flexible sensing technology. Using carbon nanotubes/polyurethane conductive film/yarn electrode flexible pressure sensors, different sizes of smart underwear for men and women have been developed. These smart vest have the characteristics of being detachable and capable of real-time monitoring of human breathing frequency signals. The characteristics of the smart underwear are characterized by the resistivity change curve of the flexible sensor, and the influences of the style, size, and working position of the sensor on the performance of the smart underwear are studied. The most reasonable sensor configuration of the smart vest of each size is obtained. For the female S size it is on the chest. For the female M size it is on the abdominal muscles. For the male XL size it is on the midriff. For the male XXL size it is on the abdominal muscles. The smart vest is comfortable, fits the body and satisfies the daily needs of washing. It will have good application prospects in sports health and medical care, providing new design ideas for the research and development of smart vests.
Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial
Authors: Gu Hongbin , Miao Liyan , Bai Jie , Lu Guolin , Lei Qian , Yang Lijun , Wang Denggui
Published: November 2022

Background

To evaluate the safety and effectiveness of different dosages of intranasal Dexmedetomidine (DEX) in combination with oral midazolam for sedation of young children during brain MRI examination.

Methods

Included in this prospective single-blind randomized controlled trial were 156 children aged from 3 months to 6 years and weighing from 4 to 20 Kg with ASA I-II who underwent brain MRI examination between March 2021 and February 2022. Using the random number table method, they were divided into group A (using 3 ug/kg intranasal DEX plus 0.2 mg/Kg oral midazolam) and group B (using 2 ug/kg intranasal DEX plus 0.2 mg/Kg oral Midazolam). The one-time success rate of sedation, sedation onset time, recovery time, overall sedation time, and occurrence of adverse reactions during MRI examination were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP), and percutaneous SpO2before and after drug administration were observed in both groups. Differences in sedation scores between the two groups were compared before intranasal drug administration (T0), 10 min after drug administration (T1), at the time of falling asleep (T2), at the end of examination (T3), and at the time of recovery (T4).

Results

The one-time success rate of sedation in group A and B was 88.31% and 79.75% respectively, showing no significant difference between the two groups (P>0.05). The sedation onset time in group A was 24.97±16.94 min versus 27.92±15.83 min in group B, and the recovery time was 61.88±22.18 min versus 61.16±28.16 min, both showing no significance difference between the two groups (P>0.05). Children in both groups exhibited good drug tolerance without presenting nausea and vomiting, hypoxia, or bradycardia and hypotension that needed clinical interventions. There was no significant difference in the occurrence of abnormal HR, MAP or other adverse reactions between the two groups (P>0.05).

Conclusion

3 ug/kg or 2 ug/kg intranasal DEX in combination with 0.2 mg/kg oral Midazolam both are safe and effective for sedation of children undergoing MRI examination with the advantages of fast-acting and easy application.

Trial registration

It was registered at the Chinese Clinical Trial Registry (
ChiCTR1800015038) on 02/03/2018.
HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial
Authors: Wohlfeiler Michael B. , Weber Rachel Palmieri , Brunet Laurence , Fusco Jennifer S. , Uranaka Christine , Cochran Quateka , Palma Monica , Evans Tammeka , Millner Carl , Fusco Gregory P.
Published: November 2022

Background

Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States.

Methods

In this cluster randomized controlled trial, 20 AIDS Healthcare Foundation Healthcare Centers (HCCs) were randomized to the intervention (n = 10) or control (n = 10) arm; all maintained existing retention efforts. The intervention included daily automated flags in CHORUS™, a mobile app and web-based reporting solution utilizing electronic health record data, that identified PWH at-risk of falling out of care to clinic staff. Among flagged PWH, the association between the intervention and visits after a flag was assessed using logistic regression models fit with generalized estimating equations (independent correlation structure) to account for clustering. To adjust for differences between HCCs, models included geographic region, number of PWH at HCC, and proportions of PWH who self-identified as Hispanic or had the Ryan White Program as a payer.

Results

Of 15,875 PWH in care, 56% were flagged; 76% (intervention) and 75% (control) resulted in a visit, of which 76% were within 2 months of the flag. In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. Among at-risk PWH with viral loads at baseline and study end, the proportion with < 50 copies/mL increased in both study arms, but more so at intervention (65% to 74%) than control (62% to 67%) HCCs.

Conclusion

Despite challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time, PWH flagged as at-risk of falling out of care were marginally more likely to return for care at intervention than control HCCs and a greater proportion achieved undetectability. Sustained use of the retention module in CHORUS™ has the potential to streamline retention efforts, retain more PWH in care, and ultimately decrease transmission of HIV.

Trial Registration

The study was first registered at Clinical Trials.gov (NCT04147832, https://clinicaltrials.gov/show/NCT04147832) on 01/11/2019.
Quantitative assessment of the microstructure of the mesorectum with different prognostic statuses by intravoxel incoherent motion diffusion-weighed magnetic resonance imaging
Authors: Lu Bao-Lan , Chen Yan , Wen Zi-Qiang , Liu Yi-Yan , Ma Yu-Ru , Que Yu-Tao , Zhang Zhi-Wen , Wu Xue-Han , Yu Shen-Ping
Published: November 2022

Background

The mesorectum surrounding the rectum provides an ideal substrate for tumour spread. However, preoperative risk assessment is still an issue. This study aimed to investigate the microstructural features of mesorectum with different prognostic statuses by intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI).

Methods

Patients with pathologically proven rectal adenocarcinoma underwent routine high-resolution rectal magnetic resonance imaging (MRI) and IVIM DWI sequences were acquired. The MRI-detected circumferential resection margin (mrCRM) and extramural vascular invasion (mrEMVI) were evaluated. IVIM parameters of the mesorectum adjacent to (MAT) and distant from (MDT) the tumour were measured and compared between and within the prognostic factor groups.

Results

The positive mrCRM (pMAT < 0.001; pMDT = 0.013) and mrEMVI (pMAT = 0.001; pMDT < 0.001) groups demonstrated higher D values in the MAT and MDT than the corresponding negative groups. Conversely, the positive mrCRM (p = 0.001) and mrEMVI (p < 0.001) groups both demonstrated lower f values in the MAT. Similarly, in the self-comparison between the MAT and MDT in the above subgroups, D showed a significant difference in all subgroups (p < 0.001 for all), and f showed a significant difference in the positive mrCRM (p = 0.001) and mrEMVI (p = 0.002) groups. Moreover, the MAT displayed a higher D* in the positive mrCRM (p = 0.014), negative mrCRM (p = 0.009) and negative mrEMVI groups (p < 0.001).

Conclusion

The microstructure of the mesorectum in patients with rectal cancer with poor prognostic status shows changes based on IVIM parameters. IVIM parameters might be promising imaging biomarkers for risk assessment of tumour spread in mesorectum preoperatively.
Temporal and spatial characteristics of tumor evolution in a mouse model of oral squamous cell carcinoma
Authors: Cao Yong , Dong Hao , Li Guangyu , Wei Huiping , Xie Cheng , Tuo Yangjuan , Chen Nian , Yu Dahai
Published: November 2022

Objectives

We aimed to elucidate the temporal and spatial characteristics of tumor evolution in an oral squamous cell carcinoma (OSCC) mouse model with higher burden of lymphatic metastasis through high-throughput sequencing.

Methods

The OSCC model was established in 9 mice. DNA was extracted from the tumors of primary tongue lesions and disseminated tumor cells (DTCs) of submandibular gland lymph nodes and bone marrow, and then whole genome sequencing was performed. After bioinformatics analysis, somatic single-nucleotide variants (SSNVs) and copy number variations (CNVs) data were obtained. Based on SSNVs, clonal architecture and ancestor-descendant relationships among tumor cell subclones were elucidated.

Results

A total of 238 tumor-related SSNVs with 120 high-frequency mutated genes were obtained from 36 samples of 9 mice by whole-genome sequencing. The number of unique SSNVs in the primary lesion, submandibular lymph node and bone marrow was greater than the number of shared SSNVs. Furthermore, the primary lesion-originated subclones, which were identified by SSNVs, were also detected in submandibular lymph nodes in the early stage of oral carcinogenesis. Moreover, at different histopathological stages, unique subclones were also identified in DTCs isolated from lymph nodes.

Conclusion

Tumor heterogeneity is significant in primary tumor cells and disseminated tumor cells. OSCC cells probably disseminate to lymph nodes in the early stage of oral carcinogenesis. OSCC is characterized by polyclonal dissemination, and the evolutionary trajectory of DTCs is potentially dominated by the tumor microenvironment.
The contribution of peer research in evaluating complex public health interventions: examples from two UK community empowerment projects
Authors: Southby Kris , Coan Susan , Rushworth Sara , South Jane , Bagnall Anne-Marie , Lam Tiffany , Woodward Jenny , Button Danial
Published: November 2022

Background

Peer-research is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of peer-research in two complex public health intervention evaluations in the UK.

Methods

Reports from 18 peer research projects, completed by residents from 12 communities in the UK taking part in two community empowerment interventions, were analysed using cross-case analysis.

Results

Undertaking peer research helped to build the evaluation and research skills within individual projects as well as providing data on other outcomes related to the programmes Theory of Change. Some peer researchers, however, felt unprepared for the activity despite support from the academic team and were unsatisfied with project outcomes. While peer research projects provided more opportunities for local residents to engage with the overall evaluations, there was an overreliance on people closely connected to the programmes to be peer researchers. The peer research projects explored topics that were broader than the aims and objectives of the overall programme evaluations. All provided insight into the context in which projects occurred, while some also informed understanding of programme change mechanisms.

Conclusions

Including peer research as part of complex public health intervention evaluations can help uncover important contextual and ecological details beyond the reach of more traditional evaluation data collection. Peer research can also empower and build research/evaluation capacity within communities, which is particularly pertinent for community empowerment interventions.
Just and inclusive end-of-life decision-making for long-term care home residents with dementia: a qualitative study protocol
Authors: Sutherland N. , St. Amant O. , Dupuis S. , Kontos P. , Wiersma E. , Brennan M.
Published: November 2022

Background

Many people living with dementia eventually require care services and spend the remainder of their lives in long-term care (LTC) homes. Yet, many residents with dementia do not receive coordinated, quality palliative care. The stigma associated with dementia leads to an assumption that people living in the advanced stages of dementia are unable to express their end-of-life needs. As a result, people with dementia have fewer choices and limited access to palliative care. The purpose of this paper is to describe the protocol for a qualitative study that explores end-of-life decision-making processes for LTC home residents with dementia.

Methods/design

This study is informed by two theoretical concepts. First, it draws on a relational model of citizenship. The model recognizes the pre-reflective dimensions of agency as fundamental to being human (irrespective of cognitive impairment) and thereby necessitates that we cultivate an environment that supports these dimensions. This study also draws from Smith’s critical feminist lens to foreground the influence of gender relations in decision-making processes towards palliative care goals for people with dementia and reveal the discursive mediums of power that legitimize and sanction social relations.

This study employs a critical ethnographic methodology. Through data collection strategies of interview, observation, and document review, this study examines decision-making for LTC home residents with dementia and their paid (LTC home workers) and unpaid (family members) care partners.

Discussion

This research will expose the embedded structures and organizational factors that shape relationships and interactions in decision-making. This study may reveal new ways to promote equitable decision-making towards palliative care goals for LTC home residents with dementia and their care partners and help to improve their access to palliative care.
Low rates of structured advance care planning documentation in electronic health records: results of a single-center observational study
Authors: Wu Adela , Huang Robert J. , Colón Gabriela Ruiz , Zembrzuski Chris , Patel Chirag B.
Published: November 2022

Background

Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.

Methods

We performed a retrospective cohort study at a single, large university medical center in California to analyze rates of S-ACP documentation. S-ACP was defined as ACP documentation contained in standardized locations, auditable, and not in free-text format. The analytic cohort composed of all patients 65 and older with at least one ambulatory encounter at Stanford Health Care between 2012 and 2020, and without concurrent hospice care. We then analyzed clinic-level, provider-level, insurance, and temporal factors associated with S-ACP documentation rate.

Results

Of 187,316 unique outpatient encounters between 2012 and 2020, only 7,902 (4.2%) contained S-ACP documentation in the EHR. The most common methods of S-ACP documentation were through problem list diagnoses (3,802; 40.3%) and scanned documents (3,791; 40.0%). At the clinic level, marked variability in S-ACP documentation was observed, with Senior Care (46.6%) and Palliative Care (25.0%) demonstrating highest rates. There was a temporal trend toward increased S-ACP documentation rate (p < 0.001).

Conclusion

This retrospective, single-center study reveals a low rate of S-ACP documentation irrespective of clinic and specialty. While S-ACP documentation rate should not be construed as a proxy for ACP documentation rate, it nonetheless serves as an important quality metric which may be reported to payers. This study highlights the need to both centralize and standardize reporting of ACP documentation in complex EHR systems.
Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway
Authors: Alkhaled Tariq , Rohde Gudrun , Lie Birgit , Johannessen Berit
Published: November 2022

Background

Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses’ experiences in caring for patients with an ethnic minority background.

Methods

Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews.

Results

The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding.

Conclusions

Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.
Delirium in the intensive care unit: identifying difficulties in applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
Authors: dos Santos Fernanda Cecília Monroe , Rêgo Adriana Sousa , Montenegro Widlani Sousa , de Carvalho Sarah Tarcisia Rabelo Ferreira , Cutrim Rodrigo Costa , Júnior Abraão Albino Mendes , Pereira Fábio Henrique Ferreira , Dibai-Filho Almir Vieira , Bassi-Dibai Daniela
Published: November 2022

Background

Delirium is an underdiagnosed condition and this may be related, among other causes, to the incorrect use of assessment tools due to lack of knowledge about cognitive assessment and lack of training of the care team. The aim of this study was to investigate the difficulties encountered by the nursing team in the application of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in patients on mechanical ventilation.

Methods

This is descriptive study with a qualitative approach in a private tertiary hospital located in northeast Brazil. Data collection took place from July 2018 to January 2019. We included 32 nurses and used face-to-face semi-structured interviews. The recorded data were analysed using content analysis. This study followed the recommendations of the Standards for Reporting Qualitative Research (SRQR).

Results

We identified three major categories: lack of knowledge of professionals, subdivided into deficit in academic formation, difficulty in the differential diagnosis of delirium and delusion, and lack of knowledge about the steps of the CAM-ICU; difficulty in patient cooperation; and lack of adequate training to apply the CAM-ICU.

Conclusion

Nurses have a deficit in academic formation on delirium and need adequate training for the correct and frequent use of the CAM-ICU.
An examination of health care utilization during the COVID-19 pandemic among women with early-stage hormone receptor-positive breast cancer
Authors: Paladino Andrew J. , Pebley Kinsey , Kocak Mehmet , Krukowski Rebecca A. , Waters Teresa M. , Vidal Gregory , Schwartzberg Lee S. , Curry Andrea N. , Graetz Ilana
Published: November 2022

Background

Women undergoing treatment for breast cancer require frequent clinic visits for maintenance of therapy. With COVID-19 causing health care disruptions, it is important to learn about how this population’s access to health care has changed. This study compares self-reported health care utilization and changes in factors related to health care access among women treated at a cancer center in the mid-South US before and during the pandemic.

Methods

Participants (N = 306) part of a longitudinal study to improve adjuvant endocrine therapy (AET) adherence completed pre-intervention baseline surveys about their health care utilization prior to AET initiation. Questions about the impact of COVID-19 were added after the pandemic started assessing financial loss and factors related to care. Participants were categorized into three time periods based on the survey completion date: (1) pre-COVID (December 2018 to March 2020), (2) early COVID (April 2020 – December 2020), and later COVID (January 2021 to June 2021). Negative binomial regression analyses used to compare health care utilization at different phases of the pandemic controlling for patient characteristics.

Results

Adjusted analyses indicated office visits declined from pre-COVID, with an adjusted average of 17.7 visits, to 12.1 visits during the early COVID period (p = 0.01) and 9.9 visits during the later COVID period (p < 0.01). Hospitalizations declined from an adjusted average 0.45 admissions during early COVID to 0.21 during later COVID, after vaccines became available (p = 0.05). Among COVID period participants, the proportion reporting changes/gaps in health insurance coverage increased from 9.5% participants during early-COVID to 14.8% in the later-COVID period (p = 0.05). The proportion reporting financial loss due to the pandemic was similar during both COVID periods (34.3% early- and 37.7% later-COVID, p = 0.72). The proportion of participants reporting delaying care or refilling prescriptions decreased from 15.2% in early-COVID to 4.9% in the later-COVID period (p = 0.04).

Conclusion

COVID-19 caused disruptions to routine health care for women with breast cancer. Patients reported having fewer office visits at the start of the pandemic that continued to decrease even after vaccines were available. Fewer patients reported delaying in-person care as the pandemic progressed.
Knowledge, attitude and application towards fast track surgery among operating room paramedics: a cross-sectional study
Authors: Huang Ting , Wang Jingming , Chen Yuanyao , Ye Zhen , Fang Yiwei , Xia Yuze
Published: November 2022

Background

Fast track surgery has shown its effectiveness to accelerate recovery and gained acceptance in many operations. However, data for paramedics using fast track surgery are limited in China. The aims of our study are to evaluate the knowledge, attitude and application status of fast track surgery in paramedics and to provide suggestions for the better application of fast track surgery.

Methods

Two Hundred Ninety-one operating room paramedics were investigated by simple random sampling from October 20 to December 20, 2019 time. A self-reported questionnaire was used to collect data with five dimensions: demographic data, cognitive level, knowledge, attitude and application of fast track surgery. Data were analyzed using qualitative and quantitative methods.

Results

19.93% of participants never heard fast track surgery and only 3.32% of participants were very familiar with it. Gender (0.702, 95% CI 0.109–1.294), technical title (0.342, 95% CI 0.126–0.558) and awareness of the concept of fast track surgery (0.471, 95% CI 0.165–0.776) had a correlation with the knowledge level of paramedics towards fast track surgery. In terms of attitude towards fast track surgery, gender (− 1.944, 95% CI -3.830- -0.058), age (0.303, 95% CI 0.021–0.585) and knowledge score of fast track surgery (0.426, 95% CI 0.014–0.838) are related. Half of the paramedics believe the most difficult problem in the application of fast track surgery was the lack of multi-team communication and cooperation.

Conclusion

The knowledge of fast track surgery among paramedics in Wuhan is poor, and some paramedics have a negative attitude towards it. As the attitude is positively correlated with the knowledge, it is necessary to improve the knowledge level of fast track surgery among paramedics in Wuhan.
Application of decision analytical models to diabetes in low- and middle-income countries: a systematic review
Authors: Twumwaa Tagoe Eunice , Justice Nonvignon , Robert van Der Meer , Itamar Megiddo
Published: November 2022

Background

Decision analytical models (DAMs) are used to develop an evidence base for impact and health economic evaluations, including evaluating interventions to improve diabetes care and health services—an increasingly important area in low- and middle-income countries (LMICs), where the disease burden is high, health systems are weak, and resources are constrained. This study examines how DAMs–in particular, Markov, system dynamic, agent-based, discrete event simulation, and hybrid models–have been applied to investigate non-pharmacological population-based (NP) interventions and how to advance their adoption in diabetes research in LMICs.

Methods

We systematically searched peer-reviewed articles published in English from inception to 8th August 2022 in PubMed, Cochrane, and the reference list of reviewed articles. Articles were summarised and appraised based on publication details, model design and processes, modelled interventions, and model limitations using the Health Economic Evaluation Reporting Standards (CHEERs) checklist.

Results

Twenty-three articles were fully screened, and 17 met the inclusion criteria of this qualitative review. The majority of the included studies were Markov cohort (7, 41%) and microsimulation models (7, 41%) simulating non-pharmacological population-based diabetes interventions among Asian sub-populations (9, 53%). Eleven (65%) of the reviewed studies evaluated the cost-effectiveness of interventions, reporting the evaluation perspective and the time horizon used to track cost and effect. Few studies (6,35%) reported how they validated models against local data.

Conclusions

Although DAMs have been increasingly applied in LMICs to evaluate interventions to control diabetes, there is a need to advance the use of DAMs to evaluate NP diabetes policy interventions in LMICs, particularly DAMs that use local research data. Moreover, the reporting of input data, calibration and validation that underlies DAMs of diabetes in LMICs needs to be more transparent and credible.
The extrachromosomal circular DNAs of the rice blast pathogen Magnaporthe oryzae contain a wide variety of LTR retrotransposons, genes, and effectors
Authors: Joubert Pierre M. , Krasileva Ksenia V.
Published: November 2022

Background

One of the ways genomes respond to stress is by producing extrachromosomal circular DNAs (eccDNAs). EccDNAs can contain genes and dramatically increase their copy number. They can also reinsert into the genome, generating structural variation. They have been shown to provide a source of phenotypic and genotypic plasticity in several species. However, whole circularome studies have so far been limited to a few model organisms. Fungal plant pathogens are a serious threat to global food security in part because of their rapid adaptation to disease prevention strategies. Understanding the mechanisms fungal pathogens use to escape disease control is paramount to curbing their threat.

Results

We present a whole circularome sequencing study of the rice blast pathogen, Magnaporthe oryzae. We find that M. oryzae has a highly diverse circularome that contains many genes and shows evidence of large LTR retrotransposon activity. We find that genes enriched on eccDNAs in M. oryzae occur in genomic regions prone to presence-absence variation and that disease-associated genes are frequently on eccDNAs. Finally, we find that a subset of genes is never present on eccDNAs in our data, which indicates that the presence of these genes on eccDNAs is selected against.

Conclusions

Our study paves the way to understanding how eccDNAs contribute to adaptation in M. oryzae. Our analysis also reveals how M. oryzae eccDNAs differ from those of other species and highlights the need for further comparative characterization of eccDNAs across species to gain a better understanding of these molecules.
Folate regulates RNA m5C modification and translation in neural stem cells
Authors: Xu Xiguang , Johnson Zachary , Wang Amanda , Padget Rachel L. , Smyth James W. , Xie Hehuang
Published: November 2022

Background

Folate is an essential B-group vitamin and a key methyl donor with important biological functions including DNA methylation regulation. Normal neurodevelopment and physiology are sensitive to the cellular folate levels. Either deficiency or excess of folate may lead to neurological disorders. Recently, folate has been linked to tRNA cytosine-5 methylation (m5C) and translation in mammalian mitochondria. However, the influence of folate intake on neuronal mRNA m5C modification and translation remains largely unknown. Here, we provide transcriptome-wide landscapes of m5C modification in poly(A)-enriched RNAs together with mRNA transcription and translation profiles for mouse neural stem cells (NSCs) cultured in three different concentrations of folate.

Results

NSCs cultured in three different concentrations of folate showed distinct mRNA methylation profiles. Despite uncovering only a few differentially expressed genes, hundreds of differentially translated genes were identified in NSCs with folate deficiency or supplementation. The differentially translated genes induced by low folate are associated with cytoplasmic translation and mitochondrial function, while the differentially translated genes induced by high folate are associated with increased neural stem cell proliferation. Interestingly, compared to total mRNAs, polysome mRNAs contained high levels of m5C. Furthermore, an integrative analysis indicated a transcript-specific relationship between RNA m5C methylation and mRNA translation efficiency.

Conclusions

Altogether, our study reports a transcriptome-wide influence of folate on mRNA m5C methylation and translation in NSCs and reveals a potential link between mRNA m5C methylation and mRNA translation.
Health effects of milk consumption: phenome-wide Mendelian randomization study
Authors: Yuan Shuai , Sun Jing , Lu Ying , Xu Fengzhe , Li Doudou , Jiang Fangyuan , Wan Zhongxiao , Li Xue , Qin Li-Qiang , Larsson Susanna C.
Published: November 2022

Background

We performed phenome-wide Mendelian randomization analysis (MR-PheWAS), two-sample MR analysis, and systemic review to comprehensively explore the health effects of milk consumption in the European population.

Methods

Rs4988235 located upstream of theLCTgene was used as the instrumental variable for milk consumption. MR-PheWAS analysis was conducted to map the association of genetically predicted milk consumption with 1081 phenotypes in the UK Biobank study (n=339,197). The associations identified in MR-PheWAS were examined by two-sample MR analysis using data from the FinnGen study (n=260,405) and international consortia. A systematic review of MR studies on milk consumption was further performed.

Results

PheWAS and two-sample MR analyses found robust evidence in support of inverse associations of genetically predicted milk consumption with risk of cataract (odds ratio (OR) per 50 g/day increase in milk consumption, 0.89, 95% confidence interval (CI), 0.84–0.94;p=3.81×10−5), hypercholesterolemia (OR, 0.91, 95% CI 0.86–0.96;p=2.97×10−4), and anal and rectal polyps (OR, 0.85, 95% CI, 0.77–0.94;p=0.001). An inverse association for type 2 diabetes risk (OR, 0.92, 95% CI, 0.86–0.97;p=0.003) was observed in MR analysis based on genetic data with body mass index adjustment but not in the corresponding data without body mass index adjustment. The systematic review additionally found evidence that genetically predicted milk consumption was inversely associated with asthma, hay fever, multiple sclerosis, colorectal cancer, and Alzheimer’s disease, and positively associated with Parkinson’s disease, renal cell carcinoma, metabolic syndrome, overweight, and obesity.

Conclusions

This study suggests several health effects of milk consumption in the European population.