bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart rate responses in critical care trainees during airway intubation: a comparison between the simulated and clinical environments
Authors: Ji Jackson , Langley Bridget , Zordan Rachel , van Dijk Julian , Thies Heidi Helene Graham , Brahmbhatt Anjalee , Torcasio Clarissa , Cunningham Neil
Published: June 2023

Objective

This study aimed to compare the heart rate response to stress during airway intubations in clinical practice and a simulated environment.

Methods

Twenty-five critical care registrars participated in the study over a 3-month period. Heart rate data during intubations was recorded by a FitBit® Charge 2 worn by each participant during their clinical practice, and during a single simulated airway management scenario. The heart rate range was calculated by subtracting the baseline working heart rate (BWHR) from the maximum functional heart rate (MFHR). For each airway intubation performed participants recorded an airway diary entry. Data from intubations performed in the clinical environment was compared to data from a simulated environment. Heart rate changes were observed in two ways: percentage rise (median) across the 20-min intubation period and; percentage rise at point of intubation (median).

Results

Eighteen critical care registrars completed the study, mean age 31.8 years (SD = 2.015, 95% CI = 30.85–32.71). Throughout the 20-min peri-intubation recording period there was no significant difference in the median change in heart rates between the clinical (14.72%) and simulation (15.96%) environment (p = 0.149). At the point of intubation there was no significant difference in the median change in heart rate between the clinical (16.03%) and the simulation (25.65%) environment groups (p = 0.054).

Conclusion

In this small population of critical care trainees, a simulation scenario induced a comparable heart rate response to the clinical environment during intubation. This provides evidence that simulation scenarios are able to induce a comparable physiological stress response to the clinical environment and thus facilitates effective teaching of a high-risk procedure in a safe manner.
Powered mobility device use in residential aged care: a retrospective audit of incidents and injuries
Authors: Dickson Natalie C. , Gohil Apeksha R. , Unsworth Carolyn A.
Published: June 2023

Background

Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care.

Methods

Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9–12 months post incident to review and record the outcome for each PMD user.

Results

No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income.

Conclusion

This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.
Moms in the NICU: developing a pilot to engage and empower women who have delivered a prematurely born infant
Authors: Padua Kimber , Robinson Rebecca , Ness Amen , Judy Amy , Lee Grace M , Gould Jeffrey
Published: June 2023

Background

Mothers spend long hours at their preterm infant’s bedside in the Neonatal Intensive Care Unit (NICU), giving clinicians the opportunity to engage mothers in caring for their own health.

Objective

To develop a NICU based intervention to reduce the risk of a future premature birth by engaging and empowering mothers to improve their own health and identify barriers to implementing their improvement.

Design

Development based on a framework of narrative discourse refined by the Quality Improvement Plan Do Study Act Approach.

Setting

Level II Stepdown Neonatal Intensive Care Unit.

Participants

14 mothers of preterm infants, ages 24–39 years.

Methods

A team of Maternal Fetal Medicine Physicians, obstetricians, neonatologists, neonatal nurses, and parents developed guidelines to elicit the mother’s birth story, review the story with a clinical expert to fill in knowledge gaps, identify strategies to improve health to reduce the risk of future preterm birth, and facilitate mother developing an action plan with specific six week goals. A phone interview was designed to assess success and identify barriers to implementing their health plan. The protocol was modified as needed after each intervention to improve the interventions.

Results

“Moms in the NICU” toolkit is effective to guide any clinical facilitator to engage, identify health improvement strategies, and co-develop an individualized health plan and its take home summary reached stability after the 5th mother. Mothers reported experiencing reassurance, understanding, and in some cases, relief. Participants were enthusiastic to inform future quality improvement activities by sharing the six week barriers faced implementing their health plan.

Conclusion

Engaging in the NICU provides an opportunity to improve mothers’ understanding of potential factors that may be linked to preterm birth, and promote personally selected actions to improve their health and reduce the risk of a future preterm birth.
Reducing anastomotic leakage in TaTME by mucosal coverage of staple lines: a pilot study with preliminary results
Authors: Deguchi Katsuya , Hirano Yasumitsu , Okazaki Naoto
Published: June 2023

Purpose

We have performed a single stapled anastomosis with double purse-string sutures as a Trans anal Total Mesorectal Excision (TaTME) reconstruction for low rectal cancer. We report an attempt to control local infection and reduce anastomotic leakage (AL) at this anastomotic site.

Patients and methods

Fifty-one patients who underwent TaTME for low rectal cancer from April 2021 to October 2022 were included. TaTME was performed by two teams, and reconstruction was performed by anastomosis with a single stapling technique (SST). After the anastomosis was thoroughly cleaned, Z sutures were placed parallel to the staple line to suture the mucosa on the oral and anal side of the staple line and to cover the staple line circumferentially. Data on operative time, Distal Margin (DM), recurrence and postoperative complications including AL were prospectively collected.

Results

The mean age of patients was 67 years. There were 36 males and 15 females. The overall mean operative time was 283.1 min, and the mean Distal Margin was 2.2 cm. Postoperative complications were observed in 5.9% of the patients, but no AL was observed, nor any serious complications with Clavien-Dindo ≥ 3 grade. Of the 49 cases excluding Stage 4, postoperative recurrence was observed in 2 cases (4.9%).

Conclusion

In patients with lower rectal cancer who underwent TaTME, additional mucosal coverage of the anastomotic staple line by transanal manipulation after reconstruction may be associated with a reduction in the incidence of postoperative AL. Further studies including late anastomotic complications are needed.
Pre-treatment metastatic growth rate is associated with clinical outcome in patients with metastatic renal cell carcinoma treated with nivolumab
Authors: Matsumura Soichi , Kato Taigo , Kujime Yuma , Kitakaze Hiroaki , Nakano Kosuke , Hongo Sachiko , Yoshioka Iwao , Okumi Masayoshi , Nonomura Norio , Takada Shingo
Published: June 2023

Background

Immune checkpoint inhibitors (ICIs) have been approved for the treatment of metastatic renal cell carcinoma (mRCC). However, the response rate is still limited, and it is urgent to pursue novel and concise markers of responses to ICIs that allow the determination of clinical benefits. Recently, it was reported that the metastatic growth rate (MGR) is an independent factor associated with clinical outcome for anticancer therapy in some types of cancer.

Methods

We investigated pre-treatment MGR before starting nivolumab for mRCC patients between September 2016 to October 2019. In addition, we examined clinicopathological factors including MGR and analyzed the correlation between pre-treatment MGR and clinical efficacy of nivolumab.

Results

Of all patients, the median age was 63 years (range, 42–81), and the median observation period was 13.6 months (range, 1.7–40.3). Twenty-three patients and sixteen patients were classified as the low and the high MGR group, respectively, with the cutoff value of 2.2 mm/month. Progression-free survival (PFS) and overall survival (OS) were significantly better in patients in the low MGR group (p = 0.005 and p = 0.01). Importantly, in multivariate analysis, only the high MGR was significantly associated with a decrease of PFS (Hazard ratio (HR): 2.69, p = 0.03) and OS (HR: 5.27, p = 0.02).

Conclusions

Pre-treatment MGR may serve as the simple and valid indicator obtained from imaging studies, and the prominent surrogate marker associated with OS and PFS in mRCC patients treated with nivolumab.
Disinfection of 3D-printed surgical guides using virgin coconut oil (in vitro study)
Authors: Khalil Rania T. , Alshimy Ahmed , Elsherbini Eglal , Abd-Ellah Mervat E.
Published: June 2023

Background/objective

Disinfection of a 3D-printed surgical guide is of utmost importance as it comes into contact with hard and soft tissue during implant placement so it poses a potential risk of pathogenic transmission. Methods used for disinfection in the surgical field should be reliable, practical, and safe for the instruments and the patients. The objectives of this study were to compare the antimicrobial potential of 100% Virgin Coconut Oil, 2% Glutaraldehyde, and 70% Ethyl Alcohol used to decontaminate 3D-printed surgical guides.

Materials and methods

Thirty identical surgical guides were printed and cut into two halves (N = 60). Both halves were then contaminated with a defined amount of human saliva samples (2 ml). The first half (n = 30) was sub-grouped into three study groups which were immersed in one of the three disinfectants for 20 min as follows; group VCO was immersed in 100% Virgin Coconut Oil, group GA was immersed in 2% Glutaraldehyde, and group EA was immersed in 70% Ethyl Alcohol. The second half (n* = 30) was sub-grouped into three control groups which were immersed in sterile distilled water as follows group VCO*, group GA*, and group EA*. The microbial count was expressed as colony-forming units per plate and the comparison of the antimicrobial potential of the three tested disinfectants between the three study and three control groups was done using the One-Way ANOVA test.

Results

The culture results of three study groups revealed no bacterial growth with the highest % of reduction in the mean microbial count of the oral microorganisms (about100%) and an uncountable bacterial growth was shown between the three control groups (more than 100 CFU/plate) representing the baseline of the oral microorganisms. Therefore; statistically significant differences were found between the three control and three study groups (P < .001).

Conclusion

The antimicrobial potential of Virgin Coconut Oil was comparable and equivalent to Glutaraldehyde and Ethyl Alcohol with a significant inhibitory action against oral pathogens.
Implementing a text message-based intervention to support type 2 diabetes medication adherence in primary care: a qualitative study with general practice staff
Authors: Butler Karen , Bartlett Yvonne Kiera , Newhouse Nikki , Farmer Andrew , French David P. , Kenning Cassandra , Locock Louise , Rea Rustam , Williams Veronika , Mc Sharry Jenny
Published: June 2023

Background

The Support through Mobile Messaging and digital health Technology for Diabetes (SuMMiT-D) project has developed, and is evaluating, a mobile phone-based intervention delivering brief messages targeting identified behaviour change techniques promoting medication use to people with type 2 diabetes in general practice. The present study aimed to inform refinement and future implementation of the SuMMiT-D intervention by investigating general practice staff perceptions of how a text message-based intervention to support medication adherence should be implemented within current and future diabetes care.

Methods

Seven focus groups and five interviews were conducted with 46 general practice staff (including GPs, nurses, healthcare assistants, receptionists and linked pharmacists) with a potential role in the implementation of a text message-based intervention for people with type 2 diabetes. Interviews and focus groups were audio-recorded, transcribed and analysed using an inductive thematic analysis approach.

Results

Five themes were developed. One theme ‘The potential of technology as a patient ally’ described a need for diabetes support and the potential of technology to support medication use. Two themes outlined challenges to implementation, ‘Limited resources and assigning responsibility’ and ‘Treating the patient; more than diabetes medication adherence’. The final two themes described recommendations to support implementation, ‘Selling the intervention: what do general practice staff need to see?’ and ‘Fitting the mould; complementing current service delivery’.

Conclusions

Staff see the potential for a text message-based support intervention to address unmet needs and to enhance care for people with diabetes. Digital interventions, such as SuMMiT-D, need to be compatible with existing systems, demonstrate measurable benefits, be incentivised and be quick and easy for staff to engage with. Interventions also need to be perceived to address general practice priorities, such as taking a holistic approach to care and having multi-cultural reach and relevance. Findings from this study are being combined with parallel work with people with type 2 diabetes to ensure stakeholder views inform further refinement and implementation of the SuMMiT-D intervention.
A graphitic nano-onion/molybdenum disulfide nanosheet composite as a platform for HPV-associated cancer-detecting DNA biosensors
Authors: Kim Youngjun , Kang Eunah
Published: June 2023

An electrochemical DNA sensor that can detect human papillomavirus (HPV)-16 and HPV-18 for the early diagnosis of cervical cancer was developed by using a graphitic nano-onion/molybdenum disulfide (MoS2) nanosheet composite. The electrode surface for probing DNA chemisorption was prepared via chemical conjugation between acyl bonds on the surfaces of functionalized nanoonions and the amine groups on functionalized MoS2 nanosheets. The cyclic voltammetry profile of an 1:1 nanoonion/MoS2 nanosheet composite electrode had an improved rectangular shape compared to that of an MoS2 nanosheet elecrode, thereby indicating the amorphous nature of the nano-onions with sp2 distancing curved carbon layers that provide enhanced electronic conductivity, compared to MoS2 nanosheet only. The nanoonion/MoS2 sensor for the DNA detection of HPV-16 and HPV-18, respectively, was measured at high sensitivity through differential pulse voltammetry (DPV) in the presence of methylene blue (MB) as a redox indicator. The DPV current peak was lowered after probe DNA chemisorption and target DNA hybridization because the hybridized DNA induced less effective MB electrostatic intercalation due to it being double-stranded, resulting in a lower oxidation peak. The nanoonion/MoS2 nanosheet composite electrodes attained higher current peaks than the MoS2 nanosheet electrode, thereby indicating a greater change in the differential peak probably because the nanoonions enhanced conductive electron transfer. Notably, both of the target DNAs produced from HPV-18 and HPV-16 Siha and Hela cancer cell lines were effectively detected with high specificity. The conductivity of MoS2 improved by complexation with nano-onions provides a suitable platform for electrochemical biosensors for the early diagnosis of many ailments in humans.

Graphical Abstract
Organotypic hippocampal culture model reveals differential responses to highly similar Zika virus isolates
Authors: Oliveira Marina da Silva , Cassiano Larissa Marcely Gomes , Pioline Jeanne , de Carvalho Ketyllen Reis Andrade , Salim Anna Christina de Matos , Alves Pedro Augusto , Fernandes Gabriel da Rocha , Machado Alexandre de Magalhães Vieira , Coimbra Roney Santos
Published: June 2023

Introduction

Zika virus (ZIKV) caused an outbreak in Brazil, in 2015, being associated to microcephaly. ZIKV has a strong neurotropism leading to death of infected cells in different brain regions, including the hippocampus, a major site for neurogenesis. The neuronal populations of the brain are affected differently by ZIKV from Asian and African ancestral lineages. However, it remains to be investigated whether subtle variations in the ZIKV genome can impact hippocampus infection dynamics and host response.

Objective

This study evaluated how two Brazilian ZIKV isolates, PE243 and SPH2015, that differ in two specific missense amino acid substitutions, one in the NS1 protein and the other in the NS4A protein, affect the hippocampal phenotype and transcriptome.

Methods

Organotypic hippocampal cultures (OHC) from infant Wistar rats were infected with PE243 or SPH2015 and analyzed in time series using immunofluorescence, confocal microscopy, RNA-Seq and RT-qPCR.

Results

Unique patterns of infection and changes in neuronal density in the OHC were observed for PE243 and SPH2015 between 8 and 48 h post infection (p.i.). Phenotypic analysis of microglia indicated that SPH2015 has a greater capacity for immune evasion. Transcriptome analysis of OHC at 16 h p.i. disclosed 32 and 113 differentially expressed genes (DEGs) in response to infection with PE243 and SPH2015, respectively. Functional enrichment analysis suggested that infection with SPH2015 activates mostly astrocytes rather than microglia. PE243 downregulated biological process of proliferation of brain cells and upregulated those associated with neuron death, while SPH2015 downregulated processes related to neuronal development. Both isolates downregulated cognitive and behavioral development processes. Ten genes were similarly regulated by both isolates. They are putative biomarkers of early hippocampus response to ZIKV infection. At 5, 7, and 10 days p.i., neuronal density of infected OHC remained below controls, and mature neurons of infected OHC showed an increase in the epigenetic mark H3K4me3, which is associated to a transcriptionally active state. This feature is more prominent in response to SPH2015.

Conclusion

Subtle genetic diversity of the ZIKV affects the dynamics of viral dissemination in the hippocampus and host response in the early stages of infection, which may lead to different long-term effects in neuronal population.
Renal disease and diabetes increase the risk of failed outpatient management of cellulitic hand infections: a retrospective cohort study
Authors: Allen Michael , Gluck Joshua , Benson Emily
Published: June 2023

Background

Hand infections are heterogeneous, and some may undergo successful outpatient management. There are no strict guidelines for determining which patients will likely require inpatient admission for successful treatment, and many patients succeed with outpatient therapy. We sought to determine risk factors for failed outpatient management of cellulitic hand infections.

Methods

We performed a retrospective review of patients who presented to the Emergency Department (ED) for hand cellulitic infections over five years, from 2014 to 2019. Vital signs, lab markers, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Measure (ECM), and antibiotic use were investigated. Discharge from the ED without subsequent admission was considered an outpatient success, while admission within 30 days of the prior visit was considered a failure. Continuous variables were compared with Welch's t test, and categorical data with Fisher's exact tests. Multivariable logistic regression was performed on comorbidities. Multiple testing adjustment was performed on p-values to generate q-values.

Results

Outpatient management was attempted for 1,193 patients. 31 (2.6%) infections failed treatment, and 1,162 (97.4%) infections succeeded. Attempted outpatient treatment was 97.4% successful. Multivariable analysis demonstrated higher odds of failure with renal failure according to both CCI (OR 10.2, p < 0.001, q = 0.002) and ECM (OR 12.63, p = 0.003, q = 0.01) and with diabetes with complications according to the CCI (OR 18.29, p = 0.021, q = 0.032).

Conclusions

Outpatient treatment failure was higher in patients with renal failure and complicated diabetes. These patients require a high index of suspicion for outpatient failure. These comorbidities should influence consideration for inpatient therapy though most patients can undergo successful treatment as outpatients.

Level of evidence

Level III.
A systematic review and meta‐analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms
Authors: Exley Victoria , Jones Katherine , O'Carroll Grace , Watson Judith , Backhouse Michael
Published: June 2023

Background

Ingrown toenails are a common nail pathology. When conservative treatments are ineffective, a surgical approach is often utilised. Despite recent narrative reviews, there is a need for an up‐to‐date and rigorous systematic review of surgical methods for treating ingrown toenails.

Methods

Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails with a follow‐up of at least 1 month. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence.

Results

Of 3,928 records identified, 36 (3,756 participants; 62.7% males) surgical interventions were included in the systematic review and 31 studies in the meta‐analysis. There was very low quality evidence that using phenol with nail avulsion vs nail avulsion without phenol reduces the risk of recurrence (risk ratio [RR] 0.13 [95% CI 0.06 to 0.27],p < 0.001). No favourable effect was observed between chemical or surgical vs conservative management (0.55 [0.19 to 1.61],p = 0.280; 0.72 [0.33 to 1.56],p = 0.410), chemical or surgical vs other (e.g., CO2laser, electrocautery) (1.61 [0.88 to 2.95],p = 0.120; 0.58 [0.25 to 1.37],p = 0.220), chemical vs surgical (0.75 [0.46 to 1.21],p = 0.230), surgical vs surgical (0.42 [0.21 to 0.85]), chemical vs chemical (0.19 [0.01 to 3.80],p = 0.280), surgical vs surgical + chemical (3.68 [0.20 to 67.35],p = 0.380), chemical vs surgical + chemical (1.92 [0.06 to 62.30],p = 0.710), local anaesthetic vs local anaesthetic + adrenaline (1.03 [0.22 to 4.86],p = 0.970), chemical timings 30 s vs 60 s (2.00 [0.19 to 21.41]) or antibiotics vs no antibiotics (0.54 [0.12 to 2.52],p = 0.430). Central toenail resection was the only procedure to significantly relieve symptoms (p = 0.001) but data were only available up to 8 weeks post‐surgery.

Conclusion

Despite the high number of publications, the quality of research was poor and the conclusions that can be inferred from existing trials is limited. Phenolisation of the nail matrix appears to reduce the risk of recurrence following nail ablation, and with less certainty 1 min appears to be the optimum time for application. Despite this being a widely performed procedure there remains a lack of good quality evidence to guide practice.
Spatial and risk factor analyses of vector-borne pathogens among shelter dogs in the Eastern United States
Authors: Hazelrig Corinna M. , Gettings Jenna R. , Cleveland Christopher A. , Varela-Stokes Andrea , Majewska Ania A. , Hubbard Kris , Burton K. Wade , Yabsley Michael J.
Published: June 2023

Background

Vector-borne infections pose significant health risks to humans, domestic animals, and wildlife. Domestic dogs (Canis lupus familiaris) in the United States may be infected with and serve as sentinel hosts for several zoonotic vector-borne pathogens. In this study, we analyzed the geographical distribution, risk factors, and co-infections associated with infection withEhrlichiaspp.,Anaplasmaspp.,Borrelia burgdorferi, andDirofilaria immitisin shelter dogs in the Eastern United States.

Methods

From 2016 to 2020, blood samples from 3750 shelter dogs from 19 states were examined with IDEXX SNAP®4Dx®Plus tests to determine the seroprevalence of infection with tick-borne pathogens and infection withD. immitis. We assessed the impact of factors including age, sex, intact status, breed group, and location on infection using logistic regression.

Results

The overall seroprevalence ofD. immitiswas 11.2% (n = 419/3750), the seroprevalence ofAnaplasmaspp. was 2.4% (n = 90/3750), the seroprevalence ofEhrlichiaspp. was 8.0% (n = 299/3750), and the seroprevalence ofB. burgdorferiwas 8.9% (n = 332/3750). Regional variation in seroprevalence was noted:D. immitis(17.4%,n = 355/2036) andEhrlichiaspp. (10.7%,n = 217/2036) were highest in the Southeast while seroprevalence forB. burgdorferi(19.3%,n = 143/740) andAnaplasmaspp. (5.7%,n = 42/740) were highest in the Northeast. Overall, 4.8% (n = 179/3750) of dogs had co-infections, the most common of which wereD. immitis/Ehrlichiaspp. (1.6%,n = 59/3750),B. burgdorferi/Anaplasmaspp. (1.5%,n = 55/3750), andB. burgdorferi/Ehrlichiaspp. (1.2%,n = 46/3750). Risk factors significantly influenced infection across the evaluated pathogens were location and breed group. All evaluated risk factors were significant for the seroprevalence ofD. immitisantigens.

Conclusions

Our results demonstrate a regionally variable risk of infection with vector-borne pathogens in shelter dogs throughout the Eastern United States, likely due to varying distributions of vectors. However, as many vectors are undergoing range expansions or other changes in distribution associated with climate and landscape change, continued vector-borne pathogen surveillance is important for maintaining reliable risk assessment.

Graphical Abstract
The emerging studies on mesenchymal progenitors in the long bone
Authors: Shen Fangyuan , Huang Xiaobin , He Guangxu , Shi Yu
Published: June 2023

Mesenchymal progenitors (MPs) are considered to play vital roles in bone development, growth, bone turnover, and repair. In recent years, benefiting from advanced approaches such as single-cell sequence, lineage tracing, flow cytometry, and transplantation, multiple MPs are identified and characterized in several locations of bone, including perichondrium, growth plate, periosteum, endosteum, trabecular bone, and stromal compartment. However, although great discoveries about skeletal stem cells (SSCs) and progenitors are present, it is still largely obscure how the varied landscape of MPs from different residing sites diversely contribute to the further differentiation of osteoblasts, osteocytes, chondrocytes, and other stromal cells in their respective destiny sites during development and regeneration. Here we discuss recent findings on MPs’ origin, differentiation, and maintenance during long bone development and homeostasis, providing clues and models of how the MPs contribute to bone development and repair.
Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature
Authors: Jakubowski Andrea , Fowler Sabrina , Fox Aaron D.
Published: June 2023

Background

Syringe services programs (SSPs) provide a spectrum of health services to people who use drugs, with many providing referral and linkage to substance use disorder (SUD) treatment, and some offering co-located treatment with medications for opioid use disorder (MOUD). The objective of this study was to review the evidence for SSPs as an entry point for SUD treatment with particular attention to co-located (onsite) MOUD.

Methods

We performed a scoping review of the literature on SUD treatment for SSP participants. Our initial query in PubMed led to title and abstract screening of 3587 articles, followed by full text review of 173, leading to a final total of 51 relevant articles. Most articles fell into four categories: (1) description of SSP participants’ SUD treatment utilization; (2) interventions to link SSP participants to SUD treatment; (3) post-linkage SUD treatment outcomes; (4) onsite MOUD at SSPs.

Results

SSP participation is associated with entering SUD treatment. Barriers to treatment entry for SSP participants include: use of stimulants, lack of health insurance, residing far from treatment programs, lack of available appointments, and work or childcare responsibilities. A small number of clinical trials demonstrate that two interventions (motivational enhancement therapy with financial incentives and strength-based case management) are effective for linking SSP participants to MOUD or any SUD treatment. SSP participants who initiate MOUD reduce their substance use, risk behaviors, and have moderate retention in treatment. An increasing number of SSPs across the United States offer onsite buprenorphine treatment, and a number of single-site studies demonstrate that patients who initiate buprenorphine treatment at SSPs reduce opioid use, risk behaviors, and have similar retention in treatment to patients in office-based treatment programs.

Conclusions

SSPs can successfully refer participants to SUD treatment and deliver onsite buprenorphine treatment. Future studies should explore strategies to optimize the implementation of onsite buprenorphine. Because linkage rates were suboptimal for methadone, offering onsite methadone treatment at SSPs may be an appealing solution, but would require changes in federal regulations. In tandem with continuing to develop onsite treatment capacity, funding should support evidence-based linkage interventions and increasing accessibility, availability, affordability and acceptability of SUD treatment programs.
Ambiguity in utopian XR-games
Authors: Höhl Wolfgang
Published: June 2023

Utopian images in XR-games are often ambiguous. How can ambiguity be consciously designed in virtual worlds? What are the design principles for game designers? Ambiguity arises from discontinuity and decontextualization, from the deliberate omission of facts, and from the skillful superimposition of contradictory codes. An ontology of interactive media explains the elusive visual poetry and image perception. The five basic elements of media are presented. The model shows the key correlations of user, content, and technology in image perception. An overview of utopian representation as a cross-media phenomenon places game design in an interdisciplinary context. Six selected computer-generated illustrations show how the above design criteria can be successfully applied to the design of virtual worlds. The ambiguous utopia of an image exists only in a brief, irretrievable moment of our own perception. But this moment is valuable for designing real visions for a better future.
“It’s a revolving door”: understanding the social determinants of mental health as experienced by formerly incarcerated people
Authors: Nishar Shivani , Brumfield Esteem , Mandal Shromona , Vanjani Rahul , Soske Jon
Published: June 2023

Background

This qualitative study seeks to understand how formerly incarcerated individuals in Rhode Island conceptualize their mental health and perceive obstacles to accessing and utilizing mental health services following recent incarceration.

Methods

We conducted in-depth semi-structured interviews from 2021 to 2022 with 25 people who had been released from incarceration within the past five years. We identified participants using voluntary response and purposive sampling. We analyzed the data using a modified form of grounded theory developed to capitalize on insights drawn from the lived experience of research team members, including a team member with experience of incarceration, and refined initial findings with a community advisory board with lived experience of incarceration and/or mental health issues similar to the study’s sample.

Results

Participants overwhelmingly identified social determinants of health such as housing, employment, transport, and insurance coverage as the main obstacle to both accessing and maintaining engagement with mental health care. They also reported a level of opacity in the mental health system as they attempted to navigate it with limited systems literacy and support. Participants discussed alternative strategies that they employed when they believed formal mental health failed to meet their needs. Importantly, the majority of participants perceived a lack of empathy or understanding from their providers regarding the impact of SDOH on their mental health.

Conclusions

Despite growing efforts to address social determinants among formerly incarcerated people, the majority of participants believed that providers neither understood nor addressed these dimensions of their lives. Participants reported two social determinants of mental health that have not yet been adequately explored in the literature: mental health systems literacy and systems opacity. We offer some strategies for how behavioral health professionals can develop stronger relationships with this population.
Experimental investigation on grout propagation in poured aggregates for controlling water inrush in tunnels with flowing water
Authors: Sui Wanghua , Liu Zongyuan , Zhang Gailing , Mao Deguang , Li Ruijian , Liang Jinxi
Published: June 2023

Background

In recent years, the technology of blocking and grouting of has been widely used in the treatment of groundwater inrush in tunnels in China’s mines. Studies have been carried out on the aggregates pouring under hydrodynamic conditions; however, there is lack of studies of the grout propagation in the pouring aggregate mass, which formed in the earlier stage. This paper presents an experimental investigation of grout propagation in poured aggregates with flowing water, which focused on the second stage, i.e., the grouting stage, after the first stage of aggregates pouring in the salvage of an inundated underground tunnel.

Results

In this work, a visualized tunnel replica with flowing water was adopted to investigate the main effects of sealing efficiency, water pressure variation, propagation mechanism during grouting in the poured aggregates with different grain sizes and flowing water conditions. A series of experiments with orthogonal array design were carried out, and the propagation of cement/sodium silicate and the change characteristics of fluid pressure in the tunnel were obtained. The results show that the main effects on the sealing efficiency of grouting in poured aggregates with flowing water in a descending order is cement/sodium silicate ratio, relative density of aggregates, particle size distribution of aggregates, and final water pressure difference of both ends of aggregates segment. The cementation form of grouted aggregates has four types; T shape, H shape, O shape and shell shape. The main mode of grout propagation includes three types; permeation filling mode, compaction- permeation mode, and compaction-fracturing mode, which reflects the influence of grain size, density of aggregates and grouting pressure. The variation of water pressure can be divided into four categories; overall ascending type, step ascending type, concave type, and convex type. The curve type mainly depends on water pressure, water flowrate, relative density and grain size of aggregates, gel time, propagation mechanism of grout.

Conclusion

The flow rate after grouting has decreased by approximately 60% to 86% compared to that before grouting, bulk hydraulic conductivity decreased by more than 80%, reflecting a great improvement of the sealing efficiency in the grouting stage after the pouring stage. The research on grout propagation in different graded aggregate mass has guiding significance for the design and construction of a rapid disaster treatment after groundwater inrush.
Socioeconomic and attitudinal differences between service users of private and public early childhood education and care in the Finnish context
Authors: Ruutiainen Ville , Räikkönen Eija , Alasuutari Maarit
Published: June 2023

The marketisation and privatisation of welfare services such as early childhood education and care (ECEC) have been a global trend in recent decades. Earlier research suggests that market-based ECEC provision often leads to inequalities and stratification of service users. In Finland, as in other Nordic countries where provision of ECEC has traditionally been a public responsibility, ECEC services have also been undergoing marketisation and privatisation. Until now, especially in Finland, little has been known about service users of public and private ECEC or parental decisions between public and private ECEC. This study addresses that gap by showing that the clientele of private and public ECEC differ in their socioeconomic attitudinal characteristics. It appears that the combination of marketisation and privatisation of ECEC extends processes of educational and social distinction into the early childhood.
Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models
Authors: Rippon Mark , Rogers Alan A , Westgate Samantha , Ousey Karen
Published: June 2023

Objective:

Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions.

Method:

Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified.

Results:

The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered.

Conclusion:

This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.
Clinical investigation of use of an antimicrobial peptide hydrogel wound dressing on intact skin
Authors: Blomstrand Edvin , Atefyekta Saba , Rajasekharan Anand K , Andersson Martin
Published: June 2023

A material with the ability to rapidly eradicate bacteria via a contact-killing mechanism has the benefit of a more localised treatment that is easy to implement when needed to prevent or treat a bacterial infection. Here, we present an antimicrobial material based on covalently attached antimicrobial peptides (AMPs) to a soft amphiphilic hydrogel. This results in a material that exhibits an antimicrobial effect based on contact-killing. In this study, the antimicrobial efficacy of the AMP-hydrogel was investigated by observing the changes in total bioburden on the intact skin of healthy human volunteers when the AMP-hydrogel dressing was placed on the forearm for three hours. The AMP-hydrogel significantly reduced the bioburden on the skin from a mean value of 1200CFU/cm2for the untreated skin to 23CFU/cm2. Biocompatibility evaluations of the AMP-hydrogel showed no sign of cytotoxicity, acute systemic toxicity, irritation or sensitisation, demonstrating the safety of the AMP-hydrogel as a potential wound dressing. Leachability studies confirmed no release of AMPs and that the antimicrobial effect was localised to the surface of the hydrogels, demonstrating a pure contact-killing mode of action.
Diabetic foot ulcers: weekly versus second-weekly conservative sharp wound debridement
Authors: Nube Vanessa L , Alison Jennifer A , Twigg Stephen M
Published: June 2023

Diabetic foot ulcers (DFU) are a serious and costly long-term complication of diabetes, and are one of the most prevalent hard-to-heal (chronic) wound types. Conservative sharp wound debridement (CSWD) is a mainstay of care. It is performed regularly until healing is achieved (when there is adequate blood flow for healing) to support endogenous healing and improve the efficacy of advanced healing therapies. CSWD is supported by evidence-based treatment guidelines, despite a lack of prospective studies. The first prospective randomised study to compare different frequencies of CSWD—the Diabetes Debridement Study (DDS)—showed no difference in healing outcomes at 12 weeks between those ulcers debrided weekly and those debrided every second week. A DFU may require more or less frequent debridement according to individual wound characteristics; however, the new data from DDS can inform clinical decisions and service provision. The implications of weekly versus second-weekly debridement are discussed.
Methanolic extract of Kigelia africana and wound healing: an in vitro study
Authors: Karatay Kadriye Busra , Muftuler Fazilet Zumrut Biber , Law Benedict , Aras Omer
Published: June 2023

Objective:

Kigelia africana (Lam.) Benth. (Bignoniaceae) syn. Kigelia pinnata (Jacq. DC) is a tropical plant that is native to tropical Africa. The aim of this study was to determine if a methanolic extract prepared from Kigelia africana (KAE) can promote wound healing in treated human normal epidermal keratinocyte (HaCaT) cells and human normal foreskin fibroblast cell line (BJ) cells compared with untreated cells.

Method:

Experimental steps included: the methanolic extraction of the leaf and fruit of the Kigelia africana plant; the preparation of HaCaT and BJ cell lines; cell culture with a stable tetrazolium salt-based proliferation assay; and the evaluation of the wound healing effect of KAE (2μg/ml) in BJ and HaCaT cells. The phytochemical contents of KAE were determined using liquid chromatography quadrupole time-of-flight mass spectrometry.

Results:

The following molecules were identified as being present in the KAE, among others: cholesterol sulfate; lignoceric acid; embelin; isostearic acid; linoleic acid; dioctyl phthalate; arg-pro-thr; 15-methyl-15(S)-PGE1; sucrose; benzododecinium (Ajatin); and 9-Octadecenamide (oleamide). KAE effected faster wound healing in treated cells compared with untreated cells for both cell lines. HaCaT cells that had been mechanically injured and treated with KAE healed completely in 48 hours compared with 72 hours for untreated HaCaT cells. Treated BJ cells healed completely in 72 hours compared with 96 hours for untreated BJ cells. Concentrations of KAE up to 300μg/ml had a very low cytotoxic effect on treated BJ and HaCaT cells.

Conclusion:

The experimental data in this study support the potential of KAE-based wound healing treatment to accelerate wound healing.
Statin prescribing practice
Authors: Robertson Deborah
Published: June 2023

Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided
French claims for compensation of property nationalised by Bulgaria 1944-1960. A foreign policy interpretation.
Authors: Deschanel Gabriel
Published: June 2023

This article presents an overview of French demands for compensation of property taken by Bulgaria in the course of its post World War II nationalisations. Approaching this issue from the point of view of foreign policy, it connects claims for compensation with French ambitions of influence in Bulgaria which emerged in the late nineteenth century.This article offers an analysis of Franco-Bulgarian relations funded on an extensive study of French diplomatic archives and expolores the relations and arbitrages bewteen these claims and foreign policy ambitions. To better account for mentalities and worldviews, this article relies on both general statements of policy and diplomatic correspondence. While it is not the puropse of this article to challenge narratives of the Cold War, it provides a complement to their depictions. It also contributes to the understanding of Eastern Europe relations with the West in general and with France in particular.