bluuebunny/crossref_metadata_2025 huggingface dataset:
An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice
Authors: Harrison Dening Karen , Crowther Jaqueline , Adnan Sadaf
Published: February 2021

Addressing palliative care needs of people with dementia appropriately, identifying the end-of-life stage, meeting the needs of family carers as well as supporting the preferences and wishes of the person with the diagnosis can all present challenges to generalist health and social care providers. In partnership with Dementia UK and Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care. This paper describes and discusses this innovative partnership and outcomes from year one evaluation and sets out future plans.
Use of participatory action research approach to develop a self-management resource for persons living with dementia
Authors: Dupuis Sherry , McAiney Carrie , Loiselle Lisa , Hounam Brenda , Mann Jim , Wiersma Elaine C
Published: February 2021

This article describes the use of a participatory action research (PAR) approach to developing a self-management resource for persons living with dementia and care partners. Despite growing evidence that persons with dementia are able to contribute in meaningful ways to decision-making about their care and life preferences, few opportunities exist for them to participate in the design of resources and services meant for them. There is also a need to support the self-management of persons living with dementia with the provision of accurate, high quality, user-friendly information. The Living Well with Dementia resource was developed through a partnership with persons with dementia, family members, Alzheimer Society representatives, primary care providers, and researchers. The methods used in the development of this resource are outlined in six steps employed in this process, from establishment of a PAR team to final resource creation. Informed by a whole systems approach, the resource brings together essential components of self-management into a comprehensive system of care and support for living. It empowers users to be active participants in the application of new knowledge to their lives. Better self-management has important implications for access to health care and quality of life for persons with dementia and care partners.
An in vitro study of pressure increases during contrast injections in diagnostic cerebral angiography
Authors: Marfoglio Samantha , Kovarovic Brandon , Hou Wei , Fiorella David J , Sadasivan Chander
Published: February 2021

Background

During diagnostic cerebral angiography, the contrast bolus injected into a vessel can cause substantial changes in baseline pressures and flows. One potential, and serious complication is the re-rupture of aneurysms due to these injections. The goals of this in vitro study were to evaluate the effect of injection conditions on intraneurysmal pressure changes during angiography.

Methods

A silicone replica of a complete circle of Willis model with ophthalmic, anterior communicating, and basilar tip aneurysms was connected to a physiologically accurate flow pump. Contrast injections were performed under different conditions (carotid or vertebral vessel imaging, catheter diameter, injection rate, injection time, and arterial blood flow rate) and the pressure in each aneurysm was recorded before and during each injection. The effect of injection conditions on percentage increase in aneurysm pressures was statistically assessed. Additionally, the effect of the distance between the aneurysm and the catheter-tip on aneurysmal pressures was assessed.

Results

Mean intraneurysmal pressures during injection (84.5 ± 10.8 mmHg) were significantly higher than pre-injection pressures (80.4 ± 10.6 mmHg, p < 0.0001). Only 3 of the 5 conditions – carotid injections, higher injection rates, and smaller catheter diameters – significantly increased intraneurysmal pressures. The catheter-tip distance showed no correlation to pressure increases.

Conclusions

Increasing contrast injection rates and decreasing catheter diameters are correlated to intraneurysmal pressure increases during angiography irrespective of the distance to the catheter tip. Future in vivo studies are required to confirm these findings and determine whether the amplitude of pressure increases with commonly used injection rates can be clinically detrimental.
Semi-active control of a nonlinear quarter-car model of hyperloop capsule vehicle with Skyhook and Mixed Skyhook-Acceleration Driven Damper controller
Authors: Negash Birhan Abebaw , You Wonhee , Lee Jinho , Lee Changyoung , Lee Kwansup
Published: February 2021

A suspension system is one of the integral parts of a hyperloop capsule train, which is used to isolate the car-body from bogie vibration to provide a safer and comfortable service. A semi-active suspension system is one of the best candidates for its advantageous features. The performance of a semi-active suspension system relies greatly on the control strategy applied. In this article, Skyhook (SH) and mixed Skyhook-Acceleration Driven Damper (SH-ADD) controlling algorithms are adopted for a nonlinear quarter-car model of a capsule with semi-active magnetorheological damper. The nonlinear vertical dynamic response and performance of the proposed control algorithms are evaluated under MATLAB Simulink environment and hardware-in-loop-system (HILS) environment. The SH controlled semi-active suspension system performance is found to be better at the first resonance frequency and worse at the second resonance frequency than the passive MR damper, but the mixed SH-ADD controlled semi-active suspension system performs better than the passive at all frequency domains. Taking the root-mean-square (RMS) value of sprung mass vertical displacement as an evaluation criterion, the response is reduced by 58.49% with mixed SH-ADD controller and by 54.49% with the SH controller compared to the passive MR damper suspension.
Improving Communication Messages by Using Perceptual Mapping: Family Planning Survey in East Java and West Nusa Tenggara, Indonesia
Authors: Handayani Sarah , Damayanti Rita , Ariawan Iwan , Yelda Fitra , Harlan Sarah , Wahyuningrum Yunita , Storey Douglas
Published: February 2021

Objectives:

Contraceptive methods vary in effectiveness, actions required of users, and side effects. This article aims to analyze the perceptions about contraceptive methods among family planning clients of the East Java and West Nusa Tenggara (NTB) provinces in Indonesia.

Methods:

The data were obtained from the operational research of the Improving Contraceptive Method Mix Project in Indonesia, conducted in 2015–2016 in six districts in East Java and West Nusa Tenggara. The total sample size was 12,190 women aged 15–49 years. The perceptual mapping method uses cross-sectional surveys that require the respondent to rate the level to which they associate specific elements with each other, based on similarities and differences of perceived association. The correlation matrices for six contraceptive methods and five attributes were subjected to a multidimensional scaling analysis.

Results:

The results showed injectable to be the most preferred method, which was positioned closest to the attributes ‘easy to use’ and ‘easy to get’, followed by pills. Implants ranked higher than other long-acting and permanent method.

Conclusion:

Injectables and pills were the most preferred because people believe that they were ‘easy to use’ and ‘easy to get’. The least preferred methods were tubectomy and vasectomy because the respondents thought those were not close to any attributes at all. To increase the demand for the long-acting and permanent method choice in the provinces of East Java and West Nusa Tenggara, the attributes ‘easy to use’ and ‘easy to get’ should be emphasized in the long-acting and permanent method Information Education and Communication messages.
Plasticity of Treg and imbalance of Treg/Th17 cells in patients with systemic sclerosis modified by FK506
Authors: Liu Xinjuan , Wu Yu , Li Mengtao , Hao Jianyu , Wang Qian , Zeng Xiaofeng
Published: February 2021

To determine the effects of Tacrolimus (FK506) on Treg cells and subpopulations in SSc patients and assess the ability of FK506 to modify the immune imbalance of Treg/Th17 cells. We analyzed PBMC from five SSc patients and six healthy control by flow cytometry after cultured with 0, 0.1, 1, or 10 ng/ml FK506 in vitro. The number of Treg cells decreased in SSc patients treated with FK506. The number of FrI cells were decreased in SSc following FK506 treatment. The drug did increase the frequency of FrII/Treg cells, but not FrII cells. However, FK506 significantly decreased FrIII in both SSc patients and controls. FK506 clearly decreased the numbers of Th17 cells and FoxP3+IL-17+ cells. The proliferation capacity of cells was also inhibited by FK506, which had a greater effect on FoxP3− cells than FoxP3+ cells. FK506 did inhibit the proliferation of FrIII cells, but not FrI or FrII cells. Our study provides that FK506 reduced the number of FoxP3low CD45RA− T cells (FrIII) by inhibiting its proliferation. Therefore, FK506 modifies Treg cells and the immune imbalance between Tregs and Th17 cells in SSc patients.
Interrater and Intrarater Reliability and Discriminant Validity of a Pediatric Lower Extremity Physical Therapy Clearance Test
Authors: Ellington Matthew D. , Randich Kelly , Garfin Jessica , Archambault Nicole , Roocroft Joanna , Bastrom Tracey P. , Pennock Andrew T. , W. Edmonds Eric
Published: February 2021

Background:

Few studies have validated when an athlete can safely return to sports, and even fewer have identified when he or she no longer requires physical therapy after surgery. Discontinuing physical therapy is often dictated by insurance restrictions, but most studies have suggested that the decision should be multifactorial, stemming from patient-derived subjective outcome questionnaires, clinical examination, and isokinetic and functional testing.

Purpose/Hypothesis:

The purpose of this study was to establish discriminant validity and reliability of an objective physical therapy clearance (PTC) test in a clinical setting. The hypotheses were that the PTC test (1) will demonstrate different scores between normal and postoperative cohorts and (2) will have acceptable inter- and intraobserver reliability.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Four cohorts (27 total participants; age range, 12-18 years) underwent the PTC test: 9 adolescents 6 months after anterior cruciate ligament reconstruction, 4 adolescents 6 weeks after partial meniscectomy, 5 adolescents with nonstructural knee pain, and 9 control/healthy participants without any lower extremity complaint. The PTC test included a dynamic warm-up, objective measures (knee range of motion, thigh girth, and muscle motor tone), functional strength tests (heel raises, single-leg dips, hop tests, tuck jumps), and agility tests (shuffle and sprint T-test). Each testing session was videotaped and scored live by the physical therapist administering the test, and then scored via the video recording by an independent physical therapist and 2 orthopaedic surgeons.

Results:

The PTC test was found to have discriminant validity between the control cohort and both cohorts with previous surgery. The single-leg dip, single-leg hop, and vertical tuck jump were the most discriminatory components. The PTC test had moderate to almost perfect intrarater reliability (κ = 0.57-1), but only fair to moderate interrater reliability among video graders (κ = 0.29-0.58) and slight to substantial reliability between video graders and the live PT rater (κ = 0.19-0.63).

Conclusion:

The PTC test was found to have moderate inter- and intraobserver agreement, with the ability to discriminate between postoperative and control patients.
Adjustable-Loop Devices Promote Graft Revascularization in the Femoral Tunnel After ACL Reconstruction: Comparison With Fixed-Loop Devices Using Magnetic Resonance Angiography
Authors: Kamitani Aguri , Hara Kunio , Arai Yuji , Atsumi Satoru , Takahashi Takeshi , Nakagawa Shuji , Fuji Yuta , Inoue Hiroaki , Takahashi Kenji
Published: February 2021

Background:

Hamstring tendon grafts are usually fixed in anterior cruciate ligament (ACL) reconstruction using either an adjustable-loop device (ALD) or a fixed-loop device (FLD). The contact area between the graft and the tunnel wall is different between the 2 devices.

Purpose:

To determine using magnetic resonance angiography (MRA) whether ALD and FLD result in different blood flow of the graft in the femoral tunnel during the early postoperative period.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Between 2008 and 2018, a total of 42 patients (17 men and 25 women) underwent MRA at 3 months after ACL reconstruction. All surgical procedures were performed using semitendinosus tendon autografts folded into 4 strands. Overall, 23 patients underwent the FLD procedure and 19 patients underwent the ALD procedure. The signal intensity of the superior portion of the graft in the femoral tunnel was evaluated using transverse MRA images perpendicular to the femoral tunnel axis.

Results:

MRA images showed high signal intensity in the superior portion of the graft in the femoral tunnel in 94.7% and 60.9% of the ALD patients and FLD patients, respectively, a statistically significant difference ( P = .03).

Conclusion:

MRA images at 3 months after surgery revealed that blood flow reached the superior end of the tendon graft in the femoral tunnel in more patients who underwent ACL reconstruction with an ALD compared with an FLD.
The role of Hill-Sachs localization on the failure of arthroscopic shoulder stabilization. The results of a prospective cohort study
Authors: Goetti Patrick , Sandman Emilie , Nault Marie-lyne , Davies Jonah Hebert , Rouleau Dominique
Published: February 2021

Objectives:

Recurrent glenohumeral instability is frequently associated with glenoid and humeral bone loss. It is predictive of capsulolabral repair failure. However, the best way to quantify these shortcomings remains controversial. The aim of our study is to determine the best predictor of recurrent instability after arthroscopic shoulder stabilization.

Methods:

Over the past 10 years, all the patients recruited for shoulder stabilization surgery in 4 academic centers have been included in the prospective cohort called "LUXE". The ISIS score is used to stratify patients for surgery (Bankart, Bankart + Remplissage, Latarjet). Only patients with a preoperative CT scan with 3D reconstruction and clinical follow-up ≥1 year were included. Of a total of 262 patients included in the “LUXE” cohort, 103 met the inclusion criteria. The majority of patients were male (79%) with an average age of 28 years. The median number of dislocations before stabilization surgery was six. Bone deficits were measured on the 3D reconstructions using the Glenoid Clock and Ratio, the Humeral Clock and Ratio and the Glenoid Track methods and the angle of engagement of the Hill-Sachs lesion in the axial plane.

Results:

Seventy patients had arthroscopic stabilization and 33 a Latarjet procedure. The ISIS scores for the two groups were 2.7 and 4.8 (p<0.001) respectively. The average glenoid bone loss was 9+/-10% (0-37%), humeral bone loss was 15+/-6% (0-36%) and the angle of engagement of the Hill-Sachs lesion was 71+/-30° in external rotation. Fifty-three patients (51%) had an off-track lesion. Eighteen patients had recurrent instability after arthroscopic stabilization (23%) versus only 2 patients (6%) for Latarjets (OR= 4.6, p=0.034). Preoperative bone loss was not related to failure after a Latarjet procedure. The risk factors identified after arthroscopic stabilization were a lower engaging Hill-Sachs angle in external rotation (65° vs. 72°; p=0.05), less humeral bone loss (humeral clock of 42° vs. 58°; p=0.034) and an extended follow-up time (p=0.006). Glenoid bone loss, or the combined measurement (glenoid track) was not predictive of failure.

Conclusion:

Despite a lower ISIS score, arthroscopic management with Bankart +/- Remplissage is correlated with a significantly higher recurrence rate compared to the Latarjet procedure. Failure was related to humeral bone loss and to the morphology/orientation of the Hill-Sachs lesion rather than the volume of bone loss.
Macroscopic and microscopic analysis of the structures inserted in the posterior segment of the medial meniscus. How is the semimembranosus tendon involved in ramp lesions?
Authors: Cavaignac Etienne , Sylvie Remy , Teulières Maxime , Fernandez Andrea , Sonnery-Cottet Bertrand
Published: February 2021

Objectives:

The anatomical description of the posterior segment of the medial meniscus is debatable. The aim of this study was to describe by macroscopic and microscopic analysis the histological nature of the posterior segment of the medial meniscus and the inserted structures (semimembranosus tendon and menisco-tibial ligament)

Methods:

Fourteen fresh knees were dissected. For each specimen, a stable anatomical piece was taken en bloc, including the medial femoral condyle, the medial tibial condyle, the entire medial meniscus, the cruciate ligaments and the joint capsule, and the distal insertion of the semimembranosus tendon was preserved in its entirety. At this stage, a macroscopic analysis was performed. The blocks were cut along the sagittal plane in order to isolate the distal insertion of the semimembranosus tendon on the posterior joint capsule and the posterior segment of the medial meniscus in the same section. Histological slides were produced from these samples and were microscopically analyzed.

Results:

In all patients, the macroscopic analysis showed direct semimembranosus tendon expansion and tendinous capsular expansion ending behind the posterior segment of the medial meniscus. It projected onto the joint capsule, on the meniscotibial ligament at the bottom and the meniscocapsular ligament at the top, but never ended directly in the meniscal tissue. On average, the tendon directly inserted 11 ± 2.8 mm below the articular surface of the tibial plateau. The length of the capsular expansion was 14.3 ± 4.4 mm. The meniscotibial ligament was inserted in the posterior-inferior edge of the posterior segment of the medial meniscus and the meniscocapsular ligament in the posterior-superior edge. There was a particularly vascularized adipocyte space delimited by the posterior segment of the medial meniscus, the meniscotibial ligament, the meniscocapsular ligament and the capsular expansion of the semimembranosus tendon.

Conclusion:

We repeatedly noted capsular expansion of the semimembranosus tendon that inserted behind the medial meniscus. There is an interposing zone between the tendon insertion and the body of the meniscus which creates a fragile zone. The capsular tendon expansion also inserts in the meniscotibial ligaments at the bottom and meniscocapsular ligaments at the top.
Patients’ Experiences of Life Challenges After Liver Transplantation: A Qualitative Study
Authors: Taher Mohammad , Toossi Mohssen Nassiri , Jafarian Ali , Rasti Arezoo , Nayeri Nahid Dehghan
Published: February 2021

Patients experience a new life with different challenges after liver transplantation (LT). Identifying these challenges can facilitate the improvement of their quality of life. This study aimed to explore patients’ experiences of post-LT life challenges. This qualitative study was performed in 2019 through the content analysis approach. Participants were liver transplant recipients purposively recruited from a LT clinic. Semistructured interviews were conducted for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach. Meaning units were identified and coded, and the codes were grouped into subcategories and categories according to their similarities. In total, 18 transplant recipients were interviewed. Their age mean was 51 years and their transplant age ranged from 4 months to 12 years. Their post-LT life challenges were categorized into 4 main categories, that is, self-care deficit, the need for seeking information, fears and concerns, and hope–despair duality. Nurses and members of LT team are recommended to assess transplant recipients’ life challenges and develop comprehensive plans for managing their challenges and problems and improving their quality of life.
A phase 2 trial of GVHD prophylaxis with PTCy, sirolimus, and MMF after peripheral blood haploidentical transplantation
Authors: Bejanyan Nelli , Pidala Joseph A. , Wang Xuefeng , Thapa Ram , Nishihori Taiga , Elmariah Hany , Lazaryan Aleksandr , Khimani Farhad , Davila Marco L. , Mishra Asmita , Faramand Rawan , Jain Michael D. , Ochoa Leonel , Perez Lia Elena , Liu Hien , Alsina Melissa , Kharfan-Dabaja Mohamed A. , Fernandez Hugo , Nieder Michael L. , Locke Frederick L. , Anasetti Claudio , Ayala Ernesto
Published: February 2021

The introduction of posttransplant cyclophosphamide (PTCy) made performing allogeneic hematopoietic cell transplantation (HCT) from HLA haplotype–incompatible donors possible. In a setting of PTCy and tacrolimus/mycophenolate mofetil (MMF) as a graft-versus-host disease (GVHD) prophylaxis, a peripheral blood (PB) graft source as compared with bone marrow reduces the relapse rate but increases acute GVHD (aGVHD) and chronic GVHD (cGVHD). This phase 2 trial assessed sirolimus and MMF efficacy following PTCy as a GVHD prophylaxis after PB haploidentical HCT (haplo-HCT). With 32 evaluable patients (≥18 years) enrolled, this study had 90% power to demonstrate a reduction in 100-day grade II-IV aGVHD to 20% from the historical benchmark of 40% after haplo-HCT using PTCy/tacrolimus/MMF. At a median follow-up of 16.1 months, the primary end point of the trial was met with a day-100 grade II-IV aGVHD cumulative incidence of 18.8% (95% confidence interval [CI], 7.5% to 34.0%). There were no graft-failure events and the 1-year probability of National Institutes of Health (NIH) moderate/severe cGVHD was 18.8% (95% CI, 7.4% to 34.0%), nonrelapse mortality was 18.8% (95% CI, 7.4% to 34.0%), relapse was 22.2% (95% CI, 9.6% to 38.2%), disease-free survival was 59.0% (95% CI, 44.1% to 79.0%), GVHD-free relapse-free survival was 49.6% (95% CI, 34.9% to 70.5%), and overall survival was 71.7% (95% CI, 57.7% to 89.2%) for the entire cohort. These data demonstrate that GVHD prophylaxis with sirolimus/MMF following PTCy effectively prevents grade II-IV aGVHD after PB haplo-HCT, warranting prospective comparison of sirolimus vs tacrolimus in combination with MMF following PTCy as GVHD prophylaxis after PB HCT. This trial was registered at www.clinicaltrials.gov as #NCT03018223.
Exosomal miR-335 derived from mature dendritic cells enhanced mesenchymal stem cell-mediated bone regeneration of bone defects in athymic rats
Authors: Cao Zhongliu , Wu Yanfeng , Yu Lingling , Zou Lingfeng , Yang Liu , Lin Sijian , Wang Jue , Yuan Zhen , Dai Jianghua
Published: February 2021

Background

Transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) embedded in a bio-compatible matrix has been demonstrated as a promising strategy for the treatment of bone defects. This study was designed to explore the effect and mechanism of exosomes derived from mature dendritic cells (mDC-Exo) on the BM-MSCs-mediated bone regeneration using the matrix support in an athymic rat model of femoral bone defect.

Methods

The BM-MSCs were isolated from rats and incubated with osteoblast induction medium, exosomes derived from immature DCs (imDC-Exo), mDC-Exo, and miR-335-deficient mDC-Exo. BM-MSCs treated without or with mDC-Exo were embedded in a bio-compatible matrix (Orthoss®) and then implanted into the femoral bone defect of athymic rats.

Results

mDC-Exo promoted the proliferation and osteogenic differentiation of BM-MSCs by transferring miR-335. Mechanistically, exosomal miR-335 inhibited Hippo signaling by targeting large tongue suppressor kinase 1 (LATS1) and thus promoted the proliferation and osteogenic differentiation of BM-MSCs. Animal experiments showed that mDC-Exo enhanced BM-MSCs-mediated bone regeneration after bone defect, and this effect was abrogated when miR-335 expression was inhibited in mDC-Exo.

Conclusion

mDC-Exo promoted osteogenic differentiation of BM-MSCs and enhanced BM-MSCs-mediated bone regeneration after femoral bone defect in athymic rats by transferring miR-335.
Administration of zoledronic acid alleviates osteoporosis in HIV patients by suppressing osteoclastogenesis via regulating RANKL expression
Authors: Lin Wei , Li Xing-fu , Ren Dong-cheng , Song Meng , Duan Li , Liu Jin-zhu , Zhan Zi-rui
Published: February 2021

Background

Osteoporosis is a common phenomenon in HIV patients on tenofovir treatment, but its underlying mechanisms remain to be explored.

Methods

Quantitative real-time PCR was performed to analyze the expression of miR-302, miR-101, miR-145 and osteoclast-specific genes in the serum of HIV patients treated with tenofovir and ZOL. ELISA was used to evaluate the expression of RANKL, SMAD3 and PRKACB in the serum of these patients. Luciferase assay was carried out to explore the inhibitory effects of miR-302, miR-101 and miR-145 on the expression of PRKACB, RANKL and SMAD3, respectively. Western blot was used to examine the expression of genes involved in NF‑κB and JNK signaling pathways.

Results

ZOL treatment significantly suppressed the expression of CTx and osteocalcin in HIV patients treated with tenofovir. The BMD loss of HIV patients treated with tenofovir was effectively hindered by ZOL treatment. Mechanistically, the expression of miR-302, miR-101, miR-145, RANKL, SMAD3 and PRKACB in the serum was remarkably activated by ZOL treatment. Luciferase assays showed that miR-302, miR-101 and miR-145 effectively suppressed the expression of PRKACB, RANKL and SMAD3, respectively, through binding to their 3′ UTR. Furthermore, ZOL treatment notably restored the normal expression of osteoclast‑specific genes while activating NF‑κB and JNK signaling pathways.

Conclusion

The findings of this study demonstrated that administration of ZOL suppressed the expression of RANKL via modulating signaling pathways of miR-101-3p/RANKL, miR-302/PRKACB/RANKL and miR-145/SMAD3/RANKL. Furthermore, down-regulated expression of RANKL by ZOL treatment alleviated osteoporosis in HIV-positive subjects treated with tenofovir.
Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults
Authors: Bimou Charlotte , Harel Michel , Laubarie-Mouret Cécile , Cardinaud Noëlle , Charenton-Blavignac Marion , Toumi Nassima , Trimouillas Justine , Gayot Caroline , Boyer Sophie , Hebert Réjean , Dantoine Thierry , Tchalla Achille
Published: February 2021

Background

Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies.

Methods

Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory.

Results

Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD.

Conclusions

Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.
A myriad of factors influencing the implementation of transitional care innovations: a scoping review
Authors: Fakha Amal , Groenvynck Lindsay , de Boer Bram , van Achterberg Theo , Hamers Jan , Verbeek Hilde
Published: February 2021

Background

Care transitions of older persons between multiple care settings are frequently hampered by various issues such as discontinuous care delivery or poor information transfer among healthcare providers. Therefore, several innovations have been developed to optimize transitional care (TC). This review aims to identify which factors influence the implementation of TC innovations.

Methods

As part of TRANS-SENIOR, an international innovative training and research network focusing on enhancing or avoiding care transitions, a scoping review was conducted. The five stages of the Arksey and O’Malley framework were followed. PubMed/MEDLINE, EMBASE, and CINAHL were searched, and eligible studies published between years 2000 and 2020 were retrieved. Data were extracted from the included studies and mapped to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and Care Transitions Framework (CTF).

Results

Of 1537 studies identified, 21 were included. Twenty different TC innovations were covered and aimed at improving or preventing transitions between multiple care settings, the majority focused on transitions from hospital to home. Key components of the innovations encompassed transition nurses, teach-back methods, follow-up home visits, partnerships with community services, and transfer units. Twenty-five prominent implementation factors (seven barriers, seven facilitators, and eleven factors with equivalent hindering/facilitating influence) were shown to affect the implementation of TC innovations. Low organizational readiness for implementation and the overall implementation climate were topmost hindering factors. Similarly, failing to target the right population group was commonly reported as a major barrier. Moreover, the presence of skilled users but with restricted knowledge and mixed attitudes about the innovation impeded its implementation. Among the eminent enabling factors, a high-perceived advantage of the innovation by staff, along with encouraging transition roles, and a continuous monitoring process facilitated the implementation of several innovations. Other important factors were a high degree of organizational networks, engaging activities, and culture; these factors had an almost equivalent hindering/facilitating influence.

Conclusions

Addressing the right target population and instituting transition roles in care settings appear to be specific factors to consider during the implementation of TC innovations. Long-term care settings should simultaneously emphasize their organizational readiness for implementation and change, in order to improve transitional care through innovations.
Do risk profiles moderate the relation between age of onset of disruptive behaviour and two types of externalising problems among adolescents admitted to secure residential care?
Authors: Knoops Miranda G. W. G. , Bongers Ilja L. , Janssen-de Ruijter Elisabeth A. W. , van Nieuwenhuizen Chijs
Published: February 2021

Background

Adolescents with externalising problems in secure residential care differ in age of onset of disruptive behaviour and in cumulative risks in several domains. In order to reduce negative consequences of externalising behaviour for society and the adolescents themselves, it is important to gain more insight into the complexity and heterogeneity of disruptive behaviour in these adolescents. To look beyond the influence of single risk factors, the aim of this study is to investigate the moderator effect of co-occurring risk factors in multiple domains on the relation between age of onset of disruptive behaviour and two types of externalising problems in adolescence.

Methods

Retrospectively collected data of 225 adolescents admitted to secure residential care were analysed. The four risk profiles were based on co-occurring pre-admission risk factors in four domains, which were identified in a previous study by latent class analysis. Multiple regression models were used to test whether the independent variable age of onset and dummy-coded moderator variable risk profiles had statistically significant associations with aggressive behaviour and rule-breaking behaviour of the adolescents, as reported by professional caregivers in the first months of admission.

Results

Risk profiles moderated the relation between age of onset of disruptive behaviour and rule-breaking behaviour. Adolescents with childhood-onset disruptive behaviour within the risk profile with mainly family risks showed more rule-breaking behaviour in the first months of their admission to secure residential care than adolescents with an onset in adolescence within the same risk profile. Risk profiles, however, did not moderate the relation between age of onset of disruptive behaviour and aggressive behaviour.

Conclusion

Heterogeneity of aggressive and rule-breaking behaviour was established in this study by finding differences on these two types of externalising behaviour between the childhood- and adolescence-onset groups and between the four risk profiles. Furthermore, risk profiles moderated the effect between age of onset of disruptive behaviour and rule-breaking behaviour—not aggressive behaviour—in adolescents admitted to secure residential care. While respecting the limitations, adolescents’ childhood-onset disruptive behaviour within a profile with mainly family risk factors appear to be distinctive from adolescents with adolescence-onset disruptive behaviour within the same risk profile.
Helicopter transport of critical care COVID-19 patients in the Netherlands: protection against COVID-19 exposure-a challenge to critical care retrieval personnel in a novel operation
Authors: Spoelder Ed J. , Tacken Marijn C. T. , van Geffen Geert-Jan , Slagt Cor
Published: February 2021

Background

During the Coronavirus Disease 2019 (COVID-19) outbreak in the Netherlands, the demand for intensive care beds exceeded availability within days. Initially, patients were redistributed regionally by ground transport. When transport over longer distances became necessary, we initiated a new Helicopter Emergency Medical Service (HEMS) operation. We hypothesize that the transport of contagious COVID-19 patients is feasible and safe for patients and HEMS personnel.

Methods

In this retrospective, single-centre observational study, flight and monitor data were used to calculate the exposure time of the retrieval team to COVID-19 patients. All the crew members (n = 18) were instructed on the proper use of personal protective equipment (PPE), dressing and undressing routine using buddy check supervision and cleaning procedures. All the team members were monitored for possible COVID-19 symptoms, as advised by our National Institute for Health and Environment.

One month after completing the aeromedical transport all crew members were asked to donate a blood sample which was examined for the presence of IgG antibodies to SARS-CoV-2.

Results

From March 24 to May 25, 2020 the HEMS team transported 67 ventilated critical care COVID-19 patients. The exposure time was 7451 min (124 h and 11 min). One HEMS member reported pneumonia 6 weeks before the start of the patient transport. He tested positive for IgG SARS-CoV-2 by serology testing. We speculate that he was infected before the start of the operation; irrefutable evidence is lacking to support this claim because we did not perform serology testing before this operation started.

Conclusion

Occupational COVID-19 exposure during helicopter transport of ventilated critical care COVID-19 patients can be performed safely when proper PPE is applied.
StayBalanced: implementation of evidence-based fall prevention balance training for older adults—cluster randomized controlled and hybrid type 3 trial
Authors: Halvarsson Alexandra , Roaldsen Kirsti Skavberg , Nilsen Per , Dohrn Ing-Mari , Ståhle Agneta
Published: February 2021

Background

The StayBalanced programme has shown positive effects on fall prevention, balance control and fear of falling. Despite convincing evidence on the efficacy and effectiveness of balance training, there is a gap between research findings and what is provided in community-based and clinical health care settings. Therefore, transferring evidence-based balance training into clinical practice is needed.

Methods

This project, designed as a hybrid type 3 trial, is a cluster-randomized study with a mixed-method design, carried out in primary health care settings. The aim is to investigate the effectiveness of two different strategies to facilitate the implementation of an intervention, the StayBalanced balance training programme, in primary health care, including evaluation of relative changes and maintenance in patient outcomes between intervention arms over 24 months. The StayBalanced programme will be launched through a website with information on the balance training and how to use it in clinical practice. One implementation strategy will include close facilitation, i.e. support and close follow-ups initiated by the researchers, in addition to access to the website. The other strategy simply includes access to the StayBalanced website. Outcome measures in the project consist of implementation outcomes, such as acceptability, feasibility, fidelity and sustainability of the StayBalanced programme. Outcomes at an individual level for older adults participating in the training will include fall-related concerns, health-related quality of life, balance performance, gait, physical activity, muscle strength in lower extremities, number of falls and compliance with training.

Discussion

This study will generate new understanding of effective strategies for transferring research to clinical practice and thereby reduce an important knowledge gap, as well as aid decision-making for future implementation of evidence-based methods. Furthermore, it will contribute to improved balance and gait, increased level of physical activity and function, and improved health-related quality of life for the individuals participating in the programme.

Trial registration

ClinicalTrials.govNCT02909374. Registered on September 21, 2016
A case of inguinal hernia associated with atypical Dirofilaria repens infection in a dog
Authors: Deak Georgiana , Ionică Angela Monica , Szasz Izabela , Taulescu Marian , Mihalca Andrei Daniel
Published: February 2021

Background

Dirofilaria repens is a filarioid nematode transmitted by mosquitoes. Adult D. repens are typically localized in the subcutaneous tissue of the host, but other, atypical localizations have also been reported. There have been several reports of clinical cases involving an association of parasites and hernias in both animals and humans. However, it is unclear if parasitic infection can act as a triggering factor in the development of hernias.

Methods

A 12-year-old dog was referred to a private veterinarian clinic in Satu Mare, northwestern Romania due to the presence of a swelling in the lateral side of the penis (inguinal area). The dog underwent hernia repair surgery during which four long nematodes were detected in the peritoneal serosa of the inguinal hernial sac. One female specimen was subjected to genomic DNA extraction to confirm species identification, based on amplification and sequencing of a 670-bp fragment of the cytochrome c oxidase subunit 1 (cox1) gene. Treatment with a single dose of imidacloprid 10% + moxidectin 2.5% (Advocate, Bayer AG) was administered.

Results

The nematodes were morphologically identified as adult D. repens, and the BLAST analyses revealed a 100% nucleotide similarity to a D. repens sequence isolated from a human case in Czech Republic.

Conclusions

We report a case of an atypical localization of D. repens in the peritoneal cavity of a naturally infected pet dog with inguinal hernia and discuss the associations between hernia and parasitic infections.

Graphical Abstract
Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study
Authors: Wang Limin , Lu Han , Chen Hongbo , Jin Shida , Wang Mengqi , Shang Shaomei
Published: February 2021

Objectives

We aimed to develop a model for predicting the 4-year risk of knee osteoarthritis (KOA) based on survey data obtained via a random, nationwide sample of Chinese individuals.

Methods

Data was analyzed from 8193 middle-aged and older adults included in the China Health and Retirement Longitudinal Study (CHARLS). The incident of symptomatic KOA was defined as participants who were free of symptomatic KOA at baseline (CHARLS2011) and diagnosed with symptomatic KOA at the 4-year follow-up (CHARLS2015). The effects of potential predictors on the incident of KOA were estimated using logistic regression models and the final model was internally validated using the bootstrapping technique. Model performance was assessed based on discrimination—area under the receiver operating characteristic curve (AUC)—and calibration.

Results

A total of 815 incidents of KOA were identified at the 4-year follow-up, resulting in a cumulative incidence of approximately 9.95%. The final multivariable model included age, sex, waist circumference, residential area, difficulty with activities of daily living (ADLs)/instrumental activities of daily living (IADLs), history of hip fracture, depressive symptoms, number of chronic comorbidities, self-rated health status, and level of moderate physical activity (MPA). The risk model showed good discrimination with AUC = 0.719 (95% confidence interval [CI] 0.700–0.737) and optimism-corrected AUC = 0.712 after bootstrap validation. A satisfactory agreement was observed between the observed and predicted probability of incident symptomatic KOA. And a simple clinical score model was developed for quantifying the risk of KOA.

Conclusion

Our prediction model may aid the early identification of individuals at the greatest risk of developing KOA within 4 years.
Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?
Authors: Haklai Ziona , Aburbeh Miriam , Goldberger Nehama , Gordon Ethel-Sherry
Published: February 2021

Background

Excess all-cause mortality has been used in many countries as an estimate of mortality effects from COVID-19. What was the excess mortality in Israel in 2020 and when, where and for whom was this excess?

Methods

Mortality rates between March to November 2020 for various demographic groups, cities, month and week were compared with the average rate during 2017–2019 for the same groups or periods.

Results

Total mortality rates for March–November were significantly higher by 6% in 2020, than the average of 2017–2019, 14% higher among the Arab population and 5% among Jews and Others. Significantly higher monthly mortality rates were found in August, September and October by 11%, 13% and 19%, respectively, among Jews and Others, and by 19%, 64% and 40% in the Arab population.

Excess mortality was significant only at older ages, 7% higher rates at ages 65–74 and 75–84 and 8% at ages 85 and above, and greater for males than females in all ages and population groups. Interestingly, mortality rates decreased significantly among the younger population aged under 25.

The cities with most significant excess mortality were Ramla (25% higher), Bene Beraq (24%), Bat Yam (15%) and Jerusalem (8%).

Conclusion

Israel has seen significant excess mortality in August–October 2020, particularly in the Arab sector. The excess mortality in March–November was statistically significant only at older ages, over 65. It is very important to protect this susceptible population from exposure and prioritize them for inoculations. Lockdowns were successful in lowering the excess mortality. The excess mortality is similar to official data on COVID-19 deaths.
Early Covid-19 vaccination rollout: a commentary from England
Authors: Sim Fiona
Published: February 2021

Early, rapid, nationally orchestrated vaccine rollout has been a feature in the response to the global coronavirus pandemic in Israel and the UK, two countries with long established, universal socialised health care systems. Although there are many differences between England and Israel, the factors influencing the early days of the rollout merit exploration and learning that could be of benefit to other countries as they grapple to plan their own Covid-19 vaccine programmes. This commentary considers aspects of the rollout in both countries, in response to the article by Rosen and colleagues that identified contributing and facilitating factors in Israel. Whilst vaccine procurement and authorisation has been on a UK basis, and many features of rollout have been similar throughout the UK, the details provided pertain to England.
C-X-C motif chemokine 16, modulated by microRNA-545, aggravates myocardial damage and affects the inflammatory responses in myocardial infarction
Authors: Liang Fang-Qian , Gao Jing-Yuan , Liu Ji-Wei
Published: February 2021

Background

Myocardial infarction (MI), a common type of coronary heart disease, is the major cause of morbidity and mortality around the world. Chemokine-mediated inflammatory cell infiltration and local inflammatory damage response are recent research hotspots. Hence, we attempted to examine the role of C-X-C motif chemokine 16 (CXCL16) as a potential candidate in MI.

Methods

Human cardiomyocytes were treated with hypoxia/reoxygenation (H/R) to establish an in vitro cell model. GEO database provided the clinical data of MI patients and GSEA verified the relationship of chemokine and MI. CCK-8 and flow cytometry analyses were used to measure cell viability and apoptosis. Bioinformatics analysis and luciferase reporter assay were conducted to determine the correlation between CXCL16 and miR-545. qRT-PCR and western blot assays were performed to investigate the expression level of the indicated genes. The activity of lactate dehydrogenase (LDH) and the levels of TNF-α, IL-6, IL-1β, and IL-10 were explored using ELISA assay.

Results

CXCL16 was increased in MI. CXCL16 knockdown can reverse the inhibitory effect of H/R treatment on cell viability, while overexpression of CXCL16 showed the opposite trend. MiR-545 directly targeted CXCL16 and negatively regulated CXCL16 levels. MiR-545 promoted cell proliferation and inhibited apoptosis in the MI cell model, which attenuated the CXCL16-induced injury on cardiomyocytes.

Conclusion

These findings demonstrated that CXCL16 aggravated MI damage through being directly targeted by miR-545 and mediating inflammatory responses, thereby providing potential therapeutic targets for MI therapy.