bluuebunny/crossref_metadata_2025 huggingface dataset:
Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review
Authors: Shu Lijuan , Luo Linli , Zuo Yunxia
Published: August 2023

Background

Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications.

Case presentation

A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient’s oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula.

Conclusion

Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.
COVID-19 vaccine attitudes among youth experiencing homelessness: a qualitative analysis with opportunities for action
Authors: Balma Brandon , Vasilakos Lauren , Osman Ingie , Elgonda Asha , Gewirtz O’Brien Janna R.
Published: August 2023

Youth experiencing homelessness (YEH) are uniquely vulnerable to COVID-19 infection, yet are often excluded from response planning during the COVID-19 pandemic and other public health crises. As part of a larger community- and youth-engaged project through a national network of Prevention Research Centers, our qualitative study sought to describe youth perspectives that influence COVID-19 vaccine confidence and uptake, and identify youth-driven strategies to guide public health efforts to improve vaccine confidence and access. We conducted focus groups with youth experiencing homelessness (n = 20) and semi-structured interviews with staff members (n = 10) at youth-serving agencies to solicit youth perspectives about COVID-19 vaccination. Focus groups and interviews were recorded, transcribed, and analyzed using thematic qualitative analysis. In partnership with youth and cross-sector partners, we distilled eight salient themes that influenced COVID-19 vaccine uptake and confidence among YEH: 1. historical harms and mistrust of systems, 2. access to reliable health information, 3. prioritization of basic needs, 4. personal health influence, 5. barriers to healthcare, 6. fear and uncertainty of the vaccines, 7. sense of bodily autonomy, and 8. community influence. We also identified three youth-driven opportunities to increase COVID-19 vaccination among this population: emphasizing autonomy, leveraging trusted sources of information, and improving vaccine access.Our study elucidates perspectives of YEH on COVID-19 vaccination, and identifies several opportunities to improve youth vaccine confidence and access. It also underscores the importance of centering youth voice in response planning during current and future public health crises.
The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study
Authors: Sharma Palak , Dilip T. R. , Mishra Udaya Shankar , Kulkarni Anjali
Published: August 2023

Background

Incidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai.

Methods

The research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011–2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group.

Results

A total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40–44 years old to 4.2% among those age 70 years and above.

Conclusion

The findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.
Bronchoscopic treatment of multiple bronchial myelolipomas: a case report and literature review
Authors: Ji Jiali , Zhong Hongqin , Ren Xian , He Ting , Xie Guijuan , Wang Xun
Published: August 2023

Background

Extra-adrenal myelolipoma is an unusual entity, and endobronchial myelolipoma is rarer, which is often ignored by clinicians, delaying the disease and affecting the prognosis.

Case presentation

A 71-year-old man with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus, with recurrent fever, cough, and expectoration for more than 2 weeks experienced relief in cough, phlegm reduction, and glycemic control with anti-inflammatory treatment. Further examination revealed that new growths obstructing all lobar bronchi impaired flexible bronchoscope entry. In order to relieve the patient’s symptoms, under general anesthesia, we performed liquid nitrogen cryobiopsy at multiple bronchial openings, and then used argon plasma coagulation (APC) to achieve hemostasis. The pathological diagnosis was bronchial myelolipoma. The largest volume of the resected tissue was a mass measuring 0.6 cm × 0.4 cm × 0.3 cm at the bronchial opening of the upper lobe of the left lung. The patient’s condition was stable and the symptoms were partially relieved after surgery. No recurrence was observed during the 12-month follow-up, although the long-term treatment efficacy is unknown.

Conclusion

Pathological biopsy is key to the diagnosis of endobronchial myelolipoma, and the development of the endobronchial myelolipomas may have been associated with long-term poor control of steroid levels in this patient.
Real-time quantification of bowel perfusion using Laparoscopic Laser Speckle Contrast Imaging (LSCI) in a porcine model
Authors: Mehrotra Saloni , Liu Yao Z. , Nwaiwu Chibueze A. , Buharin Vasiliy E. , Stolyarov Roman , Schwaitzberg Steven D. , Kalady Matthew F. , Kim Peter C. W.
Published: August 2023

Background/purpose

Real-time quantification of tissue perfusion can improve intraoperative surgical decision making. Here we demonstrate the utility of Laser Speckle Contrast Imaging as an intra-operative tool that quantifies real-time regional differences in intestinal perfusion and distinguishes ischemic changes resulting from arterial/venous obstruction.

Methods

Porcine models (n = 3) consisted of selectively devascularized small bowel loops that were used to measure the perfusion responses under conditions of control/no vascular occlusion, arterial inflow occlusion, and venous outflow occlusion using laser speckle imaging and indocyanine green fluoroscopy. Laser Speckle was also used to assess perfusion differences between small bowel antimesenteric-antimesenteric and mesenteric-mesenteric anastomoses. Perfusion quantification was measured in relative perfusion units calculated from the laser speckle perfusion heatmap.

Results

Laser Speckle distinguished between visually identified perfused, watershed, and ischemic intestinal segments with both color heatmap and quantification (p < .00001). It detected a continuous gradient of relative intestinal perfusion as a function of distance from the stapled ischemic bowel edge. Strong positive linear correlation between relative perfusion units and changes in mean arterial pressure resulting from both arterial (R2 = .96/.79) and venous pressure changes (R2 = .86/.96) was observed. Furthermore, Laser Speckle showed that the antimesenteric anastomosis had a higher perfusion than mesenteric anastomosis (p < 0.01).

Conclusions

Laser Speckle Contrast Imaging provides objective, quantifiable tissue perfusion information in both color heatmap and relative numerical units. Laser Speckle can detect spatial/temporal differences in perfusion between antimesenteric and mesenteric borders of a bowel segment and precisely detect perfusion changes induced by progressive arterial/venous occlusions in real-time.
The relation between atherogenic index of plasma and cardiovascular outcomes in prediabetic individuals with unstable angina pectoris
Authors: Liu Yang , Feng Xunxun , Yang Jiaqi , Zhai Guangyao , Zhang Bin , Guo Qianyun , Zhou Yujie
Published: August 2023

Background

The atherogenic index of plasma (AIP) is a novel biomarker associated with atherosclerosis, and an important risk factor for atherosclerosis, but its relation with cardiovascular prognosis in prediabetic patients with unstable angina pectoris (UAP) is still uncertain.

Methods

This study included 1096 prediabetic patients with UAP who were subjected to follow-up for a maximum of 30 months, with cardiac death, refractory angina, and non-fatal myocardial infarction (MI) being the primary cardiovascular endpoints.

Results

A significantly increased AIP was observed for the group with primary cardiovascular endpoints. Kaplan–Meier curves corresponding to these endpoints revealed pronounced differences between these two AIP groups (Log-rank P < 0.001). Multivariate Cox proportional hazards analyses highlighted AIP as being independent related to this primary endpoint (HR 1.308, 95% CI: 1.213–1.412, P < 0.001). AIP addition to the baseline risk model improved the prediction of the primary endpoint (AUC: baseline model, 0.622, vs. baseline model + AIP, 0.739, P < 0.001).

Conclusions

AIP could be used to predict cardiovascular events in prediabetic individuals with UAP.
Secondary traumatic stress and posttraumatic growth in newly graduated nurses: the mediating role of compassion satisfaction
Authors: Zeng Li , Zhang Xiangeng , Liu Guiling , Liu Dong , Li Lan , Jin Man , Li Xin , Wang Jialin
Published: August 2023

Background

Nurses’ secondary traumatic stress, compassion satisfaction and posttraumatic growth are closely related, but for newly graduated nurses, there are few reports to evaluate the specific path between these three. The aim of this study was to investigate examine the mediating role of compassion satisfaction in secondary traumatic stress and posttraumatic growth among newly graduated nurses.

Methods

From March 2021 to May 2021, a total of 330 newly graduated nurses from five tertiary hospitals in China were enrolled, and asked to complete questionnaires regarding secondary traumatic stress, compassion satisfaction and posttraumatic growth. Descriptive statistics, independent-samples T-test, one-way analysis of variance (ANOVA), Pearson correlation analysis and structural equation model were used in this study. A STROBE checklist was used to report findings.

Results

The scores of secondary traumatic stress, compassion satisfaction and posttraumatic growth of newly graduated nurses were 27.11 ± 4.94 (score range: 10–50), 31.89 ± 6.22 (score range: 10–50) and 56.47 ± 20.41 (score range: 0-100), respectively. Additionally, structural equation modeling showed that compassion satisfaction mediated the relationship between secondary traumatic stress and posttraumatic growth with the partial mediating effect of 0.089.

Conclusions

Newly graduated nurses may experience moderate secondary traumatic stress, but their posttraumatic growth is at a low level, and compassion satisfaction significantly affects the relationship between the two. Nursing managers should strengthen psychological evaluation, and promote their posttraumatic growth by improving their level of compassion satisfaction.
An innovative model of access and triage to reduce waiting in an outpatient epilepsy clinic: an intervention study
Authors: Lewis Annie K. , Taylor Nicholas F. , Carney Patrick W. , Li Xia , Harding Katherine E.
Published: August 2023

Background

Delayed access to outpatient care may negatively impact on health outcomes. We aimed to evaluate implementation of the Specific Timely Appointments for Triage (STAT) model of access in an epilepsy clinic to reduce a long waitlist and waiting time.

Methods

This study is an intervention study using pre-post comparison and an interrupted time series analysis to measure the effect of implementation of the STAT model to an epilepsy clinic. Data were collected over 28 months to observe the number of patients on the waitlist and the waiting time over three time periods: 12 months prior to implementation of STAT, ten months during implementation and six months post-intervention. STAT combines one-off backlog reduction with responsive scheduling that protects time for new appointments based on historical data. The primary outcomes were the number of patients on the waitlist and the waiting time across the three time periods. Secondary outcomes evaluated pre- and post-intervention changes in number of appointments offered weekly, non-arrival and discharge rates.

Results

A total of 938 patients were offered a first appointment over the study period. The long waitlist was almost eliminated, reducing from 616 during the pre-intervention period to 11 post-intervention (p = 0.002), but the hypothesis that waiting time would decrease was not supported. The interrupted time series analysis indicated a temporary increase in waiting time during the implementation period but no significant change in slope or level in the post- compared to the pre-intervention period. Direct comparison of the cohort of patients seen in the pre- and post-intervention periods suggested an increase in median waiting time following the intervention (34 [IQR 25–86] to 46 [IQR 36–61] days (p = 0.001)), but the interquartile range reduced indicating less variability in days waited and more timely access for the longest waiters.

Conclusions

The STAT model was implemented in a specialist epilepsy outpatient clinic and reduced a large waitlist. Reductions in the waitlist were achieved with little or no increase in waiting time. The STAT model provides a framework for an alternative way to operate outpatient clinics that can help to ensure that all people referred are offered an appointment in a timely manner.
“The most culturally safe training I’ve ever had”: the co-design of a culturally safe Managing hepatitis B training course with and for the Aboriginal health workforce of the Northern Territory of Australia
Authors: Hosking Kelly , De Santis Teresa , Vintour-Cesar Emily , Wilson Phillip Merrdi , Bunn Linda , Gurruwiwi George Garambaka , Wurrawilya Shiraline , Bukulatjpi Sarah Mariyalawuy , Nelson Sandra , Ross Cheryl , Binks Paula , Schroder Phoebe , Davis Joshua S. , Taylor Sean , Connors Christine , Davies Jane ,   on behalf of the Hep B PAST partnership
Published: August 2023

Background

The Aboriginal health workforce provide responsive, culturally safe health care. We aimed to co-design a culturally safe course with and for the Aboriginal health workforce. We describe the factors which led to the successful co-design, delivery, and evaluation of the “Managing hepatitis B” course for the Aboriginal health workforce.

Methods

A Participatory Action Research approach was used, involving ongoing consultation to iteratively co-design and then develop course content, materials, and evaluation tools. An Aboriginal and Torres Strait Islander research and teaching team received education in chronic hepatitis B and teaching methodologies. Pilot courses were held, in remote communities of the Northern Territory, using two-way learning and teach-back methods to further develop the course and assess acceptability and learnings. Data collection involved focus group discussions, in-class observations, reflective analysis, and use of co-designed and assessed evaluation tools.

Results

Twenty-six participants attended the pilot courses. Aboriginal and Torres Strait Islander facilitators delivered a high proportion of the course. Evaluations demonstrated high course acceptability, cultural safety, and learnings. Key elements contributing to success and acceptability were acknowledging, respecting, and integrating cultural differences into education, delivering messaging and key concepts through an Aboriginal and Torres Strait Islander lens, using culturally appropriate approaches to learning including storytelling and visual teaching methodologies. Evaluation of culturally safe frameworks and findings from the co-design process led to the creation of a conceptual framework, underpinned by meeting people’s basic needs, and offering a safe and comfortable environment to enable productive learning with attention to the following: sustenance, financial security, cultural obligations, and gender and kinship relationships.

Conclusions

Co-designed education for the Aboriginal health workforce must embed principles of cultural safety and meaningful community consultation to enable an increase in knowledge and empowerment. The findings of this research can be used to guide the design of future health education for First Nations health professionals and to other non-dominant cultures. The course model has been successfully transferred to other health issues in the Northern Territory.
How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data
Authors: Panteli Dimitra , Mauer Nicole , Tille Florian , Nimptsch Ulrike
Published: August 2023

Background

The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further.

Methods

Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy.

Results

Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves.

Conclusions

Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.
Piercing the veil on the functioning and effectiveness of district health system governance structures: perspectives from a South African province
Authors: Tshabalala Khanyisile , Rispel Laetitia C.
Published: August 2023

Background

Leadership and governance are critical for achieving universal health coverage (UHC). In South Africa, aspirations for UHC are expressed through the proposed National Health Insurance (NHI) system, which underscores the importance of primary health care, delivered through the district health system (DHS). Consequently, the aim of this study was to determine the existence of legislated District Health Councils (DHCs) in Gauteng Province (GP), and the perceptions of council members on the functioning and effectiveness of these structures.

Methods

This was a mixed-methods, cross-sectional study in GP’s five districts. The population of interest was members of existing governance structures who completed an electronic-self-administered questionnaire (SAQ). Using a seven-point Likert scale, the SAQ focuses on members’ perceptions on the functioning and effectiveness of the governance structures. In-depth interviews with the chairpersons of the DHCs and its technical committees complemented the survey. STATA® 13 and thematic analysis were used to analyze the survey data and interviews respectively.

Results

Only three districts had constituted DHCs. The survey response rate was 73%. The mean score for perceived functioning of the structures was 4.5 (SD = 0.7) and 4.8. (SD = 0.7) for perceived effectiveness. The interviews found that a collaborative district health development approach facilitated governance. In contrast, fraught inter-governmental relations fueled by the complexity of governing across two spheres of government, political differences, and contestations over limited resources constrained DHS governance. Both the survey and interviews identified gaps in accountability to communities.

Conclusion

In light of South Africa’s move toward NHI, strengthening DHS governance is imperative. The governance gaps identified need to be addressed to ensure support for the implementation of UHC reforms.
Food patch use of Japanese quail (Coturnix japonica) varies with personality traits
Authors: Li Chunlin , Zhang Xinyu , Cheng Lin , Zhang Baowei , Zhang Feng
Published: August 2023

Background

The classic optimal foraging theory (OFT) predicts animals’ food patch use assuming that individuals in a population use the same strategy while foraging. However, due to the existence of animal personality, i.e. repeatable inter-individual differences and intra-individual consistency in behaviours over time and/or across contexts, individuals often exhibit different behavioural strategies, challenging the basic assumptions of the OFT. Here, we tested whether personality traits (boldness and exploration in open arena) of Japanese quail (Coturnix japonica, 38 females and 34 males) influenced their patch use in two foraging experiments with different inter-patch distances (i.e. 2 m in Experiment 1 and 3 m in Experiment 2).

Results

The total feeding time and food intake of individuals did not differ between Experiment 1 and 2, but in both experiments, proactive (i.e. bolder and more explorative) individuals had longer feeding time and higher food intake than reactive individuals. In Experiment 1, proactive quails changed patches more frequently and had shorter mean patch residence time than reactive individuals, while the effects were not significant in Experiment 2. The quails reduced patch residence time along with feeding, and this trend was weakened in Experiment 2 which had longer inter-patch distance.

Conclusions

The above results suggest that personality traits affect animals’ patch use, while the effects might be weakened with longer inter-patch distance. Our study highlights that animal personality should be considered when investigating animals’ foraging behaviours because individuals may not adopt the same strategy as previously assumed. Furthermore, the interaction between personality traits and inter-patch distances, which is related to movement cost and capacity of information gathering, should also be considered.
Nerve excitability test and lead toxicity: a case-control study
Authors: Chien Chung-Yao , Wang Jung-Der , Lin Chou-Ching
Published: August 2023

Background

Although conventional electrophysiological parameters have been proposed as clinical indicators for monitoring lead neuropathies, their correlations with blood lead level are weak. In this study, we investigated the applicability of nerve excitability tests (NETs) to evaluate lead intoxication.

Methods

Fourteen workers who were exposed to lead with an elevated blood level ranging from 17.8 to 64.9 µg/dL and 20 healthy controls with similar ages and body heights were enrolled. Both workers and controls underwent nerve conduction studies (NCSs), motor evoked potentials (MEPs) with transcranial magnetic stimulation (TMS), and NETs.

Results

NCSs showed prolonged distal latencies and decreased motor nerve conduction velocity of median nerves in the workers but without significant correlation to blood lead level (BLL). Significantly prolonged MEP latency was observed in the workers (+ 6 ms). NETs demonstrated hyperpolarized resting membrane potentials in stimulus-response curves and changes in the property of potassium channels under a hyperpolarized current in threshold electrotonus, implying that lead hyperpolarized nerves by interfering with potassium channels. NETs also showed a better correlation with BLL than conventional electrophysiological parameters.

Conclusions

Axonal hyperpolarization and central conduction delay are more apparently reflecting elevated BLL than NCS. NET may have the potential for early detection of lead neuropathy.
A cluster randomised controlled trial, process and economic evaluation of quality improvement collaboratives aligned to a national audit to improve the care for people with diabetes (EQUIPD): study protocol
Authors: Sykes Michael , Copsey Bethan , Finch Tracy , Meads David , Farrin Amanda , McSharry Jenny , Holman Naomi , Young Bob , Berry Alex , Ellis Kat , Moreau Lauren , Willis Thomas , Alderson Sarah , Girling Melissa , O’Halloran Elaine , Foy Robbie
Published: August 2023

Background

People with type 1 diabetes and raised glucose levels are at greater risk of retinopathy, nephropathy, neuropathy, cardiovascular disease, sexual health problems and foot disease. The UK National Institute for Health and Care Excellence (NICE) recommends continuous subcutaneous ‘insulin pump’ therapy for people with type 1 diabetes whose HbA1c is above 69 mmol/mol. Insulin pump use can improve quality of life, cut cardiovascular risk and increase treatment satisfaction. About 90,000 people in England and Wales meet NICE criteria for insulin pumps but do not use one. Insulin pump use also varies markedly by deprivation, ethnicity, sex and location. Increasing insulin pump use is a key improvement priority.

Audit and feedback is a common but variably effective intervention. Limited capabilities of healthcare providers to mount effective responses to feedback from national audits, such as the National Diabetes Audit (NDA), undermines efforts to improve care. We have co-developed a theoretically and empirically informed quality improvement collaborative (QIC) to strengthen local responses to feedback with patients and carers, national audits and healthcare providers. We will evaluate whether the QIC improves the uptake of insulin pumps following NDA feedback.

Methods

We will undertake an efficient cluster randomised trial using routine data. The QIC will be delivered alongside the NDA to specialist diabetes teams in England and Wales. Our primary outcome will be the proportion of people with type 1 diabetes and an HbA1c above 69 mmol/mol who start and continue insulin pump use during the 18-month intervention period. Secondary outcomes will assess change in glucose control and duration of pump use. Subgroup analyses will explore impacts upon inequalities by ethnicity, sex, age and deprivation. A theory-informed process evaluation will explore diabetes specialist teams’ engagement, implementation, fidelity and tailoring through observations, interviews, surveys and documentary analysis. An economic evaluation will micro-cost the QIC, estimate cost-effectiveness of NDA feedback with QIC and estimate the budget impact of NHS-wide QIC roll out.

Discussion

Our study responds to a need for more head-to-head trials of different ways of reinforcing feedback delivery. Our findings will have implications for other large-scale audit and feedback programmes.

Trial registration

ISRCTN82176651 Registered 18 October 2022.
Screening for late-onset Pompe disease in Internal Medicine departments in Spain
Authors: López-Rodríguez Mónica , Torralba-Cabeza Miguel Angel , de Pedro Iván Pérez , Rivera Alberto , Gil Roi Suarez , Gómez-Belda Ana , de la Peña Jose Luis Patier , de los Santos Moreno Alberto , Selva-O’Callaghan Albert , Gárate Igor Gómez , García Andrés González , Hurtado Roberto , de Ureta Pablo Tutor , Barba-Romero Miguel Ángel , Milisenda José C. , Grau-Junyent Josep M. ,   POMPE study group
Published: August 2023

Background

The screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain.

Methods

This epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing.

Results

The diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis.

Conclusions

Our study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.
Seawater-Mixed Lightweight Aggregate Concretes with Dune Sand, Waste Glass and Nanosilica: Experimental and Life Cycle Analysis
Authors: Sikora Pawel , Afsar Levent , Rathnarajan Sundar , Nikravan Morteza , Chung Sang-Yeop , Stephan Dietmar , Abd Elrahman Mohamed
Published: August 2023

The use of alternative and locally available materials is encouraged in the construction industry to improve its sustainability. Desert regions with shortages in freshwater and river sand as fine aggregates in concrete have to search for alternative materials such as seawater, dune sand, and waste glass powder to produce lightweight concretes. The potential negative effects of adding these alternative materials can be reduced by adding nanosilica to the cementitious system at very low quantities. This study evaluates the feasibility of using these alternative materials and nanosilica (NS) in producing lightweight aggregate concretes (LWACs). A systematic study was carried out to understand the synergistic effect of nanosilica and seawater in improving the hydration characteristics of the developed cementitious systems. Also, the effect of these alternative materials on the fresh properties of the cementitious system was assessed by slump flow tests. The evolution of compressive strength at early ages was investigated after 2, 7, and 28 days of moist curing and an improvement in the strength development in concretes with seawater was observed. Furthermore, the integrity of the developed LWACs was analyzed using oven-dry density, thermal conductivity, water porosity and shrinkage measurements. Moreover, the capillary porosity and sorptivity measurements revealed the denser microstructure in the nano-modified seawater lightweight concretes. In the end, the life-cycle assessment study calculated the benefit of alternative materials in terms of carbon footprint and water consumption. As an outcome, a sustainable solution for producing LWACs containing seawater, dune sand or glass powder was proposed.
The need to increase antimicrobial resistance surveillance among forcibly displaced persons (FDPs)
Authors: Yusuff Sodiq Inaolaji , Tajudeen Yusuf Amuda , Oladunjoye Iyiola Olatunji , Oladipo Habeebullah Jayeola , Bolarinwa Olufunmilayo Victoria , Popoola Olalekan Tolulope , Ahmed Abdulhakeem Funsho , Olana Matifan Dereje
Published: August 2023

Antimicrobial resistance (AMR) poses a significant threat to human health as 4.95 million deaths were associated with bacterial AMR in 2019 and is projected to reach 10 million by 2050. To mitigate AMR, surveillance is an essential tool for determining the burden of AMR and providing the necessary information for its control. However, the global AMR surveillance is inadequate and particularly limited among forcibly displaced persons (FDPs) despite having higher risks of harboring these pathogens. Predisposing factors among this group include poor living conditions, limited access to treatment and diagnostic tests, and inadequate trained health professionals in refugee camps. Strengthening AMR surveillance among FDPs would address the identified gaps and facilitate formulation and implementation of evidence-based policies on AMR control and prevention response. This article provides information on the growing population of FDPs, factors contributing to the AMR burden and AMR surveillance gaps in FDPs and highlighted recommendations for control.
Self-reported interoception, worries and protective behaviors during the COVID-19 pandemic: a longitudinal study
Authors: Vig Luca , Ferentzi Eszter , Köteles Ferenc
Published: August 2023

Background

Protective behaviors were essential for minimizing the spread of the virus during the coronavirus disease 2019 (COVID-19) pandemic. It is often assumed that awareness of bodily sensations (interoception) can improve decision-making and facilitate adaptive behavior.

Objective

This paper investigates cross-sectional and longitudinal relationships between different aspects of self-reported interoception, trait anxiety, COVID-related worry, and health protective behaviors.

Methods

The study was conducted on a community sample of 265 adults. The two data collection phases took place online, before (baseline) and during the second wave of the COVID-19 pandemic in Hungary.

Results

Contrary to our expectations, neither cross-sectional nor longitudinal associations were found between protective behaviors and indicators of self-reported interoception. However, worry at baseline predicted protective behaviors during the second wave, even after controlling for socio-economical characteristics and protective behaviors at baseline.

Conclusion

Our results highlight the adaptivity of health-related worry when behavioral steps to avoid threats are known and available. Also, higher level of perceived interoception did not appear to be health protective under these circumstances.
Using social presence theory to predict online consumer engagement in the emerging markets
Authors: Yeboah Abraham , Agyekum Ofosu , Owusu-Prempeh Vida , Prempeh Kwadwo Boateng
Published: August 2023

The purpose of this paper was to contribute to the dimension of online consumer engagement in the emerging markets. The study is based on the social presence theory factors. The study evaluated 443 data sets obtained through a standardized Qualtrics online survey to examine social presence theory to predict online consumer engagement in the emerging markets. The study employed AMOS v24 with the covariance-based structural equation modelling technique to investigate the relationship between social context, online communication, interactivity, privacy and online consumer engagement. The study also assessed social gratification as a mediator in the relationship between online communication and online consumer engagement. Furthermore, the study evaluated technology gratification as a moderator of interaction effect in the relationship between online communication and online consumer engagement. The study results showed that the effect of social context was not significant. In contrast, online communication, interactivity and privacy’s effects on online consumer engagement were significant. The social gratification as a mediator and technology gratification as a moderator were significant towards online consumer engagement. This paper is pioneering in that it generates the effects of social presence theory factors and some intervening variables in the context of online consumer engagement in the emerging markets at the micro-level. This area is relevant to scholars, marketing and brand practitioners in digital consumer social behaviour.
Bempegaldesleukin Plus Nivolumab in Untreated Advanced Melanoma: The Open-Label, Phase III PIVOT IO 001 Trial Results
Authors: Diab Adi , Gogas Helen , Sandhu Shahneen , Long Georgina V. , Ascierto Paolo A. , Larkin James , Sznol Mario , Franke Fabio , Ciuleanu Tudor E. , Pereira Caio , Muñoz Couselo Eva , Bronzon Damian Fernanda , Schenker Michael , Perfetti Aldo , Lebbe Celeste , Quéreux Gaëlle , Meier Friedegund , Curti Brendan D. , Rojas Carlos , Arriaga Yull , Yang Haisu , Zhou Ming , Ravimohan Shruthi , Statkevich Paul , Tagliaferri Mary A. , Khushalani Nikhil I.
Published: August 2023

PURPOSE

Despite marked advances in the treatment of unresectable or metastatic melanoma, the need for novel therapies remains. Bempegaldesleukin (BEMPEG), a pegylated interleukin-2 (IL-2) cytokine prodrug, demonstrated efficacy in the phase II PIVOT-02 trial. PIVOT IO 001 (ClinicalTrials.gov identifier: NCT03635983 ) is a phase III, randomized, open-label study that builds on the PIVOT-02 results in first-line melanoma.

METHODS

Patients with previously untreated, unresectable, or metastatic melanoma were randomly assigned 1:1 to receive BEMPEG plus nivolumab (NIVO) or NIVO monotherapy. Primary end points were objective response rate (ORR) and progression-free survival (PFS) by blinded independent central review and overall survival (OS). Secondary and exploratory end points included additional efficacy measures, safety, and pharmacokinetics (PKs) and pharmacodynamics analyses.

RESULTS

In 783 patients (n = 391, BEMPEG plus NIVO; n = 392, NIVO monotherapy), the median follow-up was 11.6 months in the intent-to-treat population. The ORR with BEMPEG plus NIVO was 27.7% versus 36.0% with NIVO (two-sided P = .0311). The median PFS with BEMPEG plus NIVO was 4.17 months (95% CI, 3.52 to 5.55) versus 4.99 months (95% CI, 4.14 to 7.82) with NIVO (hazard ratio [HR], 1.09; 97% CI, 0.88 to 1.35; P = .3988). The median OS was 29.67 months (95% CI, 22.14 to not reached [NR]) with BEMPEG plus NIVO versus 28.88 months (95% CI, 21.32 to NR) with NIVO (HR, 0.94; 99.929% CI, 0.59 to 1.48; P = .6361). Grade 3-4 treatment-related adverse events (AEs) and serious AE rates were higher with the combination (21.7% and 10.1%, respectively) versus NIVO (11.5% and 5.5%, respectively). BEMPEG PK exposure and absolute lymphocyte count changes after BEMPEG plus NIVO were comparable between PIVOT IO 001 and PIVOT-02.

CONCLUSION

The PIVOT IO 001 study did not meet its primary end points of ORR, PFS, and OS. Increased toxicity was observed with BEMPEG plus NIVO versus NIVO.
Burnout and Appreciation: A Cross-Sectional Study Assessing Preferences for Appreciation Among Oncology Clinicians
Authors: Heimbeck Doerte , Gore Laurence R. , Bickel-Young Jennifer L.
Published: August 2023

PURPOSE

Feeling appreciated is related to increased well-being/reduced burnout. We developed a health care–specific appreciation assessment for clinicians, exploring what impactful appreciation looks like and whether it differs across a diverse provider population.

METHODS

The cross-sectional study was conducted with a diverse oncology clinician population in academic medicine as part of a general well-being survey. A total of 28 different methods of appreciation were assessed for their impact on feeling appreciated.

RESULTS

A total of 405 clinicians participated (response rate, 58%). No single method of appreciation showed high/low impact for everyone, although seven methods received high impact ratings from 60% or more, including inclusion in decision making (76%), private words of affirmation (64%), positive feedback about skills (63%), positive comments about clinical care from patients/families (62%), efforts to reduce daily frustrations (62%), signs of trust in medical skills (62%), and time for self-care (62%). The least impactful methods of appreciation describe public expression of accomplishments, leadership rounding, and awards but each still receive a rating of moderate/high impact from 33% of participants.

CONCLUSION

Appreciation comes from many different places and takes on multiple forms, suggesting that making healthcare workers (HCWs) feel valued takes the efforts of colleagues, leaders, the system as well as patients. There exists no one perfect way of showing appreciation, and no one method is meaningless for all. The impact on feeling valued is primarily a function of the specific appreciation method and not the demographic/personal characteristics of the recipient. The findings highlight modifiable factors that—when intervened upon—can reduce burnout and address organization-level determinants of burnout impactfully.
Analysis of the higher-harmonics radiation suppression in tapered free-electron lasers with phase shifters
Authors: Kalitenko A. M.
Published: August 2023

The article presents a study of the higher-harmonics radiation suppression in tapered free-electron lasers (FELs) with phase shifters. To increase the power and efficiency of the FEL, tapering is used —a decrease in the parameter K along the laser axis. Undulator tapering is one of the methods for designing multi-terawatt X-ray FELs (XFELs), which are necessary for research in the field of non-linear optics. In the FELs, in addition to the fundamental harmonic there are also higher harmonics of the radiation field. In this article, we propose methods to suppress the higher harmonics of radiation to improve the quality of radiation for the study of the higher-harmonic generation in crystals, etc. Our method can be transferred to other systems as well.
The Unequal Consequences of Job Loss across Countries
Authors: Bertheau Antoine , Acabbi Edoardo Maria , Barceló Cristina , Gulyas Andreas , Lombardi Stefano , Saggio Raffaele
Published: August 2023

We document the consequences of losing a job across countries using a harmonized research design applied to seven matched employer-employee datasets. Workers in Denmark and Sweden experience the lowest earnings declines following job displacement, while workers in Italy, Spain, and Portugal experience losses three times as high. French and Austrian workers face earnings losses somewhere in between. Key to these differences is that southern European workers are less likely to find employment following displacement. Loss of employer-specific wage premiums explains a substantial portion of wage losses in all countries. (JEL J31, J63, J64)
Reducing Frictions in Health Care Access: The ActionHealthNYC Experiment for Undocumented Immigrants
Authors: Sabety Adrienne , Gruber Jonathan , Bae Jin Yung , Sood Rishi
Published: August 2023

In 2016, New York City designed and implemented an intervention to reduce frictions in accessing safety net care: randomly making initial primary care appointments for 2,428 undocumented immigrants. We leverage a novel survey-administrative data linkage to show that the program increased self-reported access to primary care, leading to 23 percent fewer emergency department (ED) visits. High-risk individuals’ ED visits fell by 32 percent on average, driving the aggregate effect. Preventive care also increased among individuals visiting sponsored clinics. (JEL H75, I11, I12, I13, I14, I18, J15)
Anatomical variations of the frontal sinus: A computed tomography-based study
Authors: Al Hatmi Asma Sulaiman , Al Ajmi Eiman , Albalushi Halima , Al Lawati Meetham , Sirasanagandla Srinivasa Rao
Published: August 2023

Background: The pneumatization of the frontal sinus is variable between individuals, including monozygotic twins. The volumetric anatomic variants of the frontal sinus are classified into aplasia, hypoplasia, medium-sized, and hyperplasia. We aimed to study the frontal sinus morphology in Omani patients using computed tomography (CT) evaluations.

Methods: Retrospectively, 1220 frontal sinus CT scans from 610 patients investigated at Sultan Qaboos University Hospital, Oman, from January 2019 to December 2020 were reviewed. The frontal sinus morphology was classified according to the classification proposed by Guerram et al. The Chi-square test was used to determine the influence of sex.

Results: With regard to the unilateral occurrence, the most prevalent frontal sinus category observed was medium-sized (13.3%), followed by hyperplasia (7.9%), hypoplasia (5.4%), and aplasia (2%) categories. Similarly, in bilateral occurrence, the most common frontal sinus category observed was medium-sized (53%), followed by hyperplasia (13.1%), hypoplasia (3.4%) and aplasia (2%) categories. Right and left frontal sinus aplasia were observed in 2.1% and 1.8% of cases, respectively. In terms of sex influence, the left unilateral (p<0.01) and the bilateral hypoplasia (p<0.05) were significantly higher in females. On the other hand, the left unilateral (p<0.01) and the bilateral hyperplasia (p<0.05) were higher in males.

Conclusions: The baseline data of frontal sinus category frequencies reported in the present study is helpful in the diagnostic evaluation of sinusitis in the clinical setting. The preoperative recognition of frontal sinus types, particularly frontal sinus aplasia in multiplanar CT scans, is crucial to avoid unexpected complications while performing endoscopic sinus surgery.