bluuebunny/crossref_metadata_2025 huggingface dataset:
Buprenorphine with Bupivacaine 0.5% Heavy Versus Clonidine with Bupivacaine 0.5% Heavy Versus Bupivacaine 0.5% Heavy Alone in Patients Undergoing Total Abdominal Hysterectomy: A Comparative Study
Authors: Thankaraj Pradeesh Johny , Pranavadhyani Gauthamabuddha , Chandrasekaran Rajesh Prabhu
Published: September 2024

Background and Aims:

This research aimed to determine which of three spinal anaesthetic medication combinations—clonidine–bupivacaine, buprenorphine–bupivacaine and bupivacaine alone—is the most effective for total abdominal hysterectomy.

Material and Methods:

In this prospective study, approved by the Institutional Ethical Committee, 120 patients aged 35–60 years scheduled for elective total abdominal hysterectomy under spinal anaesthesia were included, following informed consent. Comprehensive pre-anaesthetic assessments, including detailed medical histories, clinical examinations and routine surgical investigations, were conducted. The study, spanning 24 months, utilised purposive sampling and a cross-sectional design. The inclusion criteria encompassed ASA I and II patients aged 35–60 years, undergoing elective total abdominal hysterectomy with a weight exceeding 45 kg, height over 150 cm, and valid informed consent. Exclusion criteria involved ASA Class III or higher, patient unwillingness for spinal anaesthesia, gross spinal deformities, bleeding diathesis, known allergy to the test drug, history of cardiac, respiratory, or central nervous system disease, hepatic or renal dysfunction and elevated intracranial pressure.

Results:

The onset time of sensory blockade was faster in the Bupivacaine + Buprenorphine group than in the Clonidine + Bupivacaine group, with the Bupivacaine group exhibiting the slowest onset. The Bupivacaine + Buprenorphine group had a significantly faster onset of motor block than the Clonidine + Bupivacaine and Bupivacaine groups. The total duration of motor block was shorter in both the Bupivacaine + Buprenorphine and Bupivacaine groups than in the Clonidine + Bupivacaine group. The Clonidine + Bupivacaine group showed higher incidences of bradycardia and hypotension than the other groups. The Bupivacaine + Buprenorphine group reported more side effects, including chest pain, cough, nausea and vomiting, than the other groups.

Conclusion:

This study found that spinal clonidine, in comparison to bupivacaine alone, gives better post-operative analgesia and sensory and motor blockage over a longer period of time.
A Qualitative Study of the Views of Ethnic Minority Healthcare Workers Towards COVID-19 Vaccine Education (CoVE) to Support Vaccine Promotion and Uptake
Authors: Blake Holly , Premakumar Vinishaa , Premakumar Abishaa , Fecowycz Aaron , Khulumula Sala Kamkosi , Jones Wendy , Somerset Sarah
Published: September 2024

Ethnic minority healthcare workers (EMHCW) are at high risk of COVID-19 infection and adverse health outcomes, but vaccine uptake is low among ethnic minority communities, including EMHCW. We explored the views of EMHCW towards COVID-19 Vaccine Education (CoVE), a digital training resource to improve knowledge and confidence for promoting the COVID-19 vaccine. Thirty EMHCW completed CoVE, then participated in a semi-structured qualitative interview. Principles of framework analysis were used to deductively analyse data using concepts from the Kirkpatrick New World Model of training evaluation. CoVE was viewed to be engaging, accessible and relevant to EMHCW. This training increased EMHCW perceived knowledge and confidence to provide evidence-based information to others, dispel myths, and reduce vaccine hesitancy. Participants reported changes in vaccine promotion behaviours and vaccine uptake. CoVE could be used to help improve vaccine literacy among EMHCW, enhance health communications about vaccines, and ultimately help facilitate uptake of occupational vaccination programs.
Damage and fracture studies of continuous flax fiber-reinforced composites 3D printed by in-nozzle impregnation additive manufacturing
Authors: Wu Xikun , Ginoux Geoffrey , Paux Joseph , Allaoui Samir
Published: September 2024

Additive manufacturing (AM) of continuous yarn-reinforced biobased composites presents multi-functional properties and low environmental impact of this technology. Few studies focused on the mechanical damage mechanisms of continuous biobased composites obtained by AM processes, while it is a topic of high interest for the mastery of mechanical behaviors and optimization of the materials for high requirement applications. This study aims to assess the damage and fracture modes of continuous flax yarn-reinforced PLA manufactured by AM, with different yarn orientations. The additively manufactured biobased composites were characterized by tensile test, 3D microscopy and micro-tomography to link the process-structure-properties relationships regarding the damage and fracture modes. The results showed that the 0° manufactured composite had a significant enhancement of tensile properties compared to other configurations. The damage mechanism presented fiber rupture with polymer transverse cracks at 0°, while the 45° and 90°-oriented composites showed premature fiber/matrix interface debonding. This study aims to find the relationship between damage mechanisms, deposition strategy, and anisotropy of the additively manufactured long vegetal fibers-reinforced biobased composite materials. The results bring a new understanding of the anisotropy and defects in printed composite materials regarding their mechanical behaviors during damage.
A Case Study of a High-Grade Serous Carcinoma of the Fallopian Tube Transformed into Carcinosarcoma at the Site of Peritoneal Dissemination With Immunohistological Evidence of an Epithelial–Mesenchymal Transition
Authors: Taninaka Naoko , Ishida Kazuyuki , Takada-Owada Atsuko , Noda Shuhei , Onozaki Masato , Matsuda Hadzki , Kaneko Yuko , Mitsuhashi Akira , Toyoda Akihiko
Published: September 2024

We report a patient in whom a primary high-grade serous carcinoma (HGSC) of the fallopian tube transformed into a carcinosarcoma at the site of peritoneal dissemination, and immunohistological analysis suggested the involvement of an epithelial–mesenchymal transition (EMT). The patient, a 70-year-old woman, had an abdominal mass palpated on admission, and a laparotomy was performed after a close examination. The resected right fallopian tube was cystically dilated, and a solid mass was observed in its lumen. The histological diagnosis was HGSC of the right fallopian tube with a papillary or complex tubular structure composed of tumor cells with marked nuclear irregularities. p53 was overexpressed, and no mesenchymal tumor component was observed. The resected left-sided abdominal mass of the omentum was a solid with a long diameter of 100 mm. Microscopically, the tumor exhibited a mixture of HGSC and high-grade sarcoma with nonspecific differentiation. Furthermore, a heterologous chondrosarcoma was subsequently observed from the high-grade sarcoma. The HGSC component was E-cadherin positive. The high-grade sarcoma component was positive for EMT-related proteins such as zinc finger E-box–binding homeobox 1 (ZEB1) and twist family bHLH transcription factor 1 (TWIST1). The chondrosarcoma component was ZEB1 positive and TWIST1 negative. p53 overexpression was found in all 3 components. The tumor of the omentum suggested that an EMT phenomenon was involved in the tumorigenesis. In this scenario, the primary HGSC of the fallopian tube with obvious invasion demonstrated that the conversion from carcinoma to sarcoma by EMT occurs only with peritoneal dissemination.
Multi-objective optimization of inerter-based building mass dampers
Authors: Garrido Hernán , Domizio Martín , Curadelli Oscar , Ambrosini Daniel
Published: September 2024

The building mass damper (BMD) is a design concept in which a structure is substructured in such a way that the upper substructure behaves as a large-mass tuned mass damper for the lower one. Its correct tuning usually requires softening (partial isolating) the upper substructure, which limits its application for retrofitting. The recently proposed inerter-based building mass damper (IBMD) solves, reasonably, the softening dynamically through the use of an inerter. This implies an in parallel intervention, which drastically simplifies the practicability of the BMD for retrofitting. The present paper involves comprehensive numerical simulations for multi-objective optimization of an IBMD, accounting for inherent structural damping. In particular, the deformation of the upper substructure is an additional objective function, besides the deformation of the lower substructure as considered in a previous work. Results demonstrate that the IBMD outperforms various benchmark interventions, including dampers, stiffeners, softening devices, and inerters without dampers. Additionally, it was found that the inherent structural damping partially replaces the need for additional damping. Finally, it was also shown that emphasizing the optimization of the lower substructure deformation enhances the overall structural safety in most cases. Nevertheless, the multi-objective optimization increases the versatility of the design concept in the case of substructures with different allowable deformations.
No room! Of course there’s room
Authors: Locke Lana
Published: September 2024

This article is an adaptation of a workshop provocation given at the University of the Arts London (UAL) Education Conference in July 2023, which I set up as an ‘Alice in Wonderland’ ‘Mad Hatter’s’ table. I dressed the table on theme and equipped it with props, as a set to share with fellow educators a focus group project I had undertaken with students on overcrowding in their college art studios. I held up the lack of room in the studios as a social justice issue for exploration, first, as the inflation of numbers and knock-on impact of overcrowding of studios felt by students was acknowledged as result of over-recruitment to the course during and post pandemic; and second, exploring the question of whether minority students are most impacted; including those who are less confident to claim space due to factors such as accessibility, language barriers, financial issues and lack of peer support within the course. By putting workshop participants in the position of taking a seat at a fictional table space, loaded with caricature, I sought to provoke a creative dialogue around positionality and our relationship to shared space, while contemplating anonymised transcripts of the focus group dialogue that had taken place with students around a different table earlier in the academic year. The workshop gave reference to the ideas of Nirmal Puwar regarding positionality and the negotiation of space; and to Mikhail Bakhtin when considering student utterances in the focus group dialogue.
AI and disability: A systematic scoping review
Authors: El Morr Christo , Kundi Bushra , Mobeen Fariah , Taleghani Sarah , El-Lahib Yahya , Gorman Rachel
Published: September 2024

Background: Artificial intelligence (AI) can enhance life experiences and present challenges for people with disabilities. Objectives: This study aims to investigate the relationship between AI and disability, exploring the potential benefits and challenges of using AI for people with disabilities. Methods: A systematic scoping review was conducted using eight online databases; 45 scholarly articles from the last 5 years were identified and selected for thematic analysis. Results: The review’s findings revealed AI’s potential to enhance healthcare; however, it showed a high prevalence of a narrow medical model of disability and an ableist perspective in AI research. This raises concerns about the perpetuation of biases and discrimination against individuals with disabilities in the development and deployment of AI technologies. Conclusion: We recommend shifting towards a social model of disability, promoting interdisciplinary collaboration, addressing AI bias and discrimination, prioritizing privacy and security in AI development, focusing on accessibility and usability, investing in education and training, and advocating for robust policy and regulatory frameworks. The review emphasizes the urgent need for further research to ensure that AI benefits all members of society equitably and that future AI systems are designed with inclusivity and accessibility as core principles.
Making them pay: Comparing how environmental facts matter in two accountability contexts
Authors: Donald Rosalind , Graves Lucas
Published: September 2024

This article makes the case for what we call accountability contexts as a valuable heuristic to think about how facts matter in public life, drawing attention to how different discursive and institutional contexts shape the ways in which facts can count. We examine two environmental case studies: The Territory, a documentary about the struggle of the Uru-eu-wau-wau community in Brazil to protect their land from illegal invaders, and the fact-checking organization Climate Feedback’s partnership with Facebook to flag misinformation on the platform. Popular stories about accountability hinge on using facts to change the public’s mind. In contrast, we find that publicity is only part of a much more complex picture. By analyzing factors such as appeals to relevant publics, institutional rigidity, the uses of knowledge and narrative, and the role of the state, we investigate the real, messy processes that people take part in as they seek change. Accountability contexts provide a valuable heuristic for scholars of political journalism and communication as well as a practical tool for analyzing which pathways have led to success or failure in the pursuit of accountability.
In Situ Mapping of the Glucose Metabolism Heterogeneity in Atherosclerosis: Correlation With 2-Deoxyglucose Uptake
Authors: Haddad Joseph , Demirdelen Selim , Barnes Clayton E. , Leers Steven A. , Tavakoli Sina
Published: September 2024

Objective

2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is widely used for noninvasive imaging of atherosclerosis. However, knowledge about metabolic processes underlying [18F]FDG uptake is mostly derived from in vitro cell culture studies, which cannot recapitulate the complexities of the plaque microenvironment. Here, we sought to address this gap by in situ mapping of the activity of selected major dehydrogenases involved in glucose metabolism in atherosclerotic plaques.

Methods

In situ activity of lactate dehydrogenase (LDH), glucose-6-phosphate dehydrogenase (G6PD), succinate dehydrogenase (SDH), and isocitrate dehydrogenase (IDH) was assessed in plaques from murine aortic root and brachiocephalic arteries and human carotid arteries. High-resolution 2-deoxy-D-[1,2-3H]glucose ([3H]2-deoxyglucose) autoradiography of murine brachiocephalic plaques was performed.

Results

LDH activity was heterogeneous throughout the plaques with the highest activity in medial smooth muscle cells (SMCs). G6PD activity was mostly confined to the medial layer and to a lesser extent to SMCs along the fibrous cap. SDH and IDH activities were minimal in plaques. Plaque regions with increased [3H]2-deoxyglucose uptake were associated with a modestly higher LDH, but not G6PD, activity.

Conclusions

Our study reveals a novel aspect of the metabolic heterogeneity of the atherosclerotic plaques, enhancing our understanding of the complex immunometabolic biology that underlies [18F]FDG uptake in atherosclerosis.
Sarcoma or haematoma? If only it was that simple! Part 1
Authors: Berry Catharine , Charnock Mark
Published: September 2024

Introduction:

Imaging appearances and clinical presentation of soft tissue sarcoma and soft tissue haematomas are similar. It is imperative that sarcoma is differentiated from benign soft tissue lesions due to the poor outcomes and high morbidity associated with sarcoma.

Topic description:

Part 1 of this pictorial review will summarise the paucity of guidance in management of suspected haematomas, the clinical features and ultrasound techniques used in the assessment of soft tissue masses.

Discussion:

Ultrasound is the first-line test in the investigation of soft tissue masses. With the overlapping ultrasound appearances of soft tissue sarcoma and soft tissue haematoma, thorough and methodical clinical examination and scanning technique is fundamental so that practitioners understand when to escalate cases for further investigation.

Conclusion:

The clinical assessment and clinical history taking into consideration the intensity of trauma and ecchymosis must correlate with the ultrasound appearances. This will facilitate an accurate diagnosis, timely management and improved patient outcomes.
Characteristics, clinical outcomes, and prognostic factors of colorectal cancer in patients with Crohn’s disease: American versus Korean tertiary referral center perspectives
Authors: Suttichaimongkol Tanita , Hwang Sung Wook , Coelho-Prabhu Nayantara , Kisiel John B. , Ye Byong Duk , Yang Suk-Kyun , Loftus Edward V. , Park Sang Hyoung
Published: September 2024

Background:

Crohn’s disease (CD) exhibits variability in colorectal cancer (CRC) incidence and prognostic factors due to diverse clinical and behavioral characteristics, presenting inconsistencies between Western and Eastern patients.

Objectives:

This study compared clinical characteristics between CD patients with CRC from the US and Korean tertiary referral centers and defined the prognostic factors related to mortality.

Design:

Retrospective study.

Methods:

We reviewed the electronic medical records of 236 adult CD patients with colorectal adenocarcinoma evaluated at Mayo Clinic Rochester, Florida, or Arizona ( N = 200) and Asan Medical Center in Korea ( N = 36) between January 1989 and August 2022.

Results:

Asan patients had a younger age, shorter CD duration, more colonic involvement (L2 plus L3), penetrating behavior, perianal fistula, and shorter biological treatment duration before CRC diagnosis than Mayo patients. Furthermore, despite significant differences in body mass index, smoking status, primary sclerosing cholangitis, immunomodulators, CRC diagnosis period, clinical presentation, CRC location, surgery, and some histopathological details between the two groups, overall survival was not statistically different ( p value, 0.29, log-rank test). Advanced age (adjusted hazard ratio (aHR), 1.03 per year; 95% confidence interval (CI), 1.01–1.04; p value, <0.01), unresectable CRC (aHR, 5.02; 95% CI, 2.49–10.12; p value, <0.01), and advanced CRC stage (aHR, 1.45 per stage; 95% CI, 1.07–1.97; p value, 0.02) were significantly associated with increased risk of death. CD remission at CRC diagnosis (aHR, 0.26; 95% CI, 0.08–0.91; p value, 0.04), CRC diagnosis period of 2011–2022 (aHR relative to 1989–2000, 0.46; 95% CI, 0.25–0.87; p value, 0.02), and CRC diagnosis by surveillance (aHR, 0.56; 95% CI, 0.32–0.98; p value, 0.04) were significantly associated with decreased risk of death.

Conclusion:

Notably, some clinical features of CD with CRC differed between Asan and Mayo patients; however, overall survival was not different. CD remission, CRC surveillance, and more recent diagnosis of CRC were associated with a reduced risk of death.
The ‘structural pessimism’ of the EU periphery: Measures to establish a new revitalisation paradigm
Authors: Jurić Tado
Published: September 2024

Throughout the EU’s history, developed regions have consistently drawn young people, with the phenomenon of ‘escaping from the province’ being a significant driver of youth migration. As peripheral regions become increasingly depopulated, the ‘ring of desert’ effect that appears in these areas also starts to impact developed regions (because depopulated areas are more vulnerable to illegal migration, the loss of social capital in the periphery results in the reduced competitiveness of the entire EU, social and political tensions increase, etc.). Instead of increasing solidarity, the opposite is happening. For example, Croatia has subsidised Germany by investing €18 billion in the education of its emigrated citizens. In the future, however, peripheral areas might become more attractive places to live due to an increase in threats such as pandemics, climate change, pollution and terrorism. Remote work could lead to a resurgence in the population of the EU’s peripheries, provided there is access to broadband Internet, public transportation, mobile healthcare services and distance education in rural areas.
Allograft-prosthesis composite after proximal femur bone tumor resection in pediatric age: Is it effective in preserving bone stock?
Authors: Campanacci Domenico Andrea , Scanferla Roberto , Muratori Francesco , Scolari Federico , Scoccianti Guido , Tamburini Angela , Beltrami Giovanni
Published: September 2024

Purpose:

The purpose of the study was to answer the following questions. What was functional results of pediatric patients receiving a short stem allograft-prosthesis composite of the proximal femur? What was complication rate and revision-free implant survival? Was it possible to preserve the bone stock of the proximal femur in pediatric patients?

Methods:

We reviewed 10 pediatric patients treated with proximal femur resection for a primary bone tumor and reconstruction with short stem allograft-prosthesis composite, with at least 24 months follow-up. The median age was 9 years (4–13) at surgery. The mean resection length was 15 cm (6–29). In six cases, fixation was performed with a short plate positioned under the great trochanter while in four cases a long plate extended over the great trochanter was employed.

Results:

Nine complications that required surgical revision were assessed in six patients (one wound dehiscence, two nonunions, two fractures, one acetabular wear, three hypometria), while allograft-prosthesis composite removal was required in three patients. The revision-free survival was 57% (95% confidence interval 33%–100%) at 5 and 10 years. The graft removal-free survival was 75% (95% confidence interval 50%–100%) at 5 and 10 years. The mean Musculo-Skeletal Tumor Society Score was 28 (20–30).

Conclusions:

Allograft-prosthesis composites with short stem and compression plate represents an effective reconstructive option after proximal femur resection for primary bone tumors in growing patients, preserving bone stock. The use of a compression plate extended over the greater trochanter seemed to reduce failure rate.
The Influence of Resilience on Outcomes After Total Ankle Arthroplasty
Authors: McCahon Joseph A. S. , Massaglia Joseph , Moncman Tara G. , Riebesell Samantha , Parekh Selene G. , Pedowitz David I. , Daniel Joseph N.
Published: September 2024

Background

Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA.

Methods

A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3–4.30, and >4.3, respectively.

Results

High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA.

Conclusion

Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery.

Level of Evidence:

Level III
Systematic literature review of the indirect costs and humanistic burden of β-thalassemia
Authors: Aydinok Yesim , Purushotham Sneha , Yucel Aylin , Glassberg Mrudula , Deshpande Sohan , Potrata Barbara , Trapali Myrto , Shah Farrukh
Published: September 2024

Background:

β-Thalassemia is an inherited blood disorder requiring lifetime management of anemia and its complications.

Objective:

This study aimed to determine the indirect costs and humanistic burden of β-thalassemia.

Design:

A systematic literature review was conducted.

Data sources and methods:

Searches were conducted in Embase, MEDLINE, MEDLINE In-Process, and EconLit (November 1, 2010, to November 25, 2020). Studies reporting indirect costs and health-related quality of life (HRQoL) for patients with β-thalassemia were eligible.

Results:

Seventy-five publications were included. Mean annual days lost due to transfusion-related absenteeism ranged from 15.6 to 35 days. Patients spent a mean of 592 min (standard deviation (SD): 349) daily on disease management on transfusion days and 91 min (SD: 221) daily on non-transfusion days. Patients with non-transfusion-dependent β-thalassemia (NTDT) showed worse HRQoL versus those with transfusion-dependent β-thalassemia (TDT) on the 36-item Short Form Health Survey (75.8 vs 66.5; p = 0.021). Caregivers of patients with TDT had more severe stress compared with patients (20.17 vs 18.95; p = 0.006), as measured by the standardized Cohen Perceived Stress Questionnaire.

Conclusion:

TDT is associated with substantial indirect costs and caregiver burden, and NTDT is associated with worse HRQoL. There is an unmet need for novel treatments in both TDT and NTDT that minimize patient and caregiver burden.
Clinical decision support systems for 3-month mortality in elderly patients admitted to ICU with ischemic stroke using interpretable machine learning
Authors: Huang Jian , Liu Xiaozhu , Jin Wanlin
Published: September 2024

Background

Elderly patients are more likely to suffer from severe ischemic stroke (IS) and have worse outcomes, including death and disability. We aimed to develop and validate predictive models using novel machine learning algorithms for the 3-month mortality in elderly patients with IS admitted to the intensive care unit (ICU).

Methods

We conducted a retrospective cohort study. Data were extracted from Medical Information Mart for Intensive Care (MIMIC)-IV and International Stroke Perfusion Imaging Registry (INSPIRE) database. Ten machine learning algorithms including Categorical Boosting (CatBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Network (NN), Gradient Boosting Machine (GBM), K-Nearest Neighbors (KNNs), Multi-Layer Perceptron (MLP), Naive Bayes (NB), eXtreme Gradient Boosting (XGBoost) and Logistic Regression (LR) were used to build the models. Performance was measured using area under the curve (AUC) and accuracy. Finally, interpretable machine learning (IML) models presenting as Shapley additive explanation (SHAP) values were applied for mortality risk prediction.

Results

A total of 1826 elderly patients with IS admitted to the ICU were included in the analysis, of whom 624 (34.2%) died, and endovascular treatment was performed in 244 patients. After feature selection, a total of eight variables, including minimum Glasgow Coma Scale values, albumin, lactate dehydrogenase, age, alkaline phosphatase, body mass index, platelets, and types of surgery, were finally used for model construction. The AUCs of the CatBoost model were 0.737 in the testing set and 0.709 in the external validation set. The Brier scores in the training set and testing set were 0.12 and 0.21, respectively. The IML of the CatBoost model was performed based on the SHAP value and the Local Interpretable Model-Agnostic Explanations method.

Conclusion

The CatBoost model had the best predictive performance for predicting mortality in elderly patients with IS admitted to the ICU. The IML model would further aid in clinical decision-making and timely healthcare services by the early identification of high-risk patients.
Tackling anxiety through innovation: Development and pilot study of an in-the-moment messaging intervention for young adults
Authors: Dobson Rosie , Stowell Melanie , Tane Taria , Gardiner Chelsey , McCool Judith , Ni Lin , Whittaker Robyn
Published: September 2024

Objective

Anxiety disorders are highly prevalent around the world and are associated with significant disability, comorbidity and costs to society. Digital tools have the potential to deliver equitable, convenient and sustainable interventions for anxiety. We aimed to co-design and pilot-test an in-the-moment intervention to help young people manage anxiety. Young people with lived experience of anxiety were recruited to participate in co-design workshops with the results informing the development of the Tackling Anxiety through Innovation (TAI) intervention. TAI delivers personally tailored messaging prompting engagement in self-care behaviours at times of high anxiety/stress.

Methods

Young people aged 16 to 24 years were recruited into a four-week pilot study. Participants completed the Depression Anxiety Stress Scale – 21 Items (DASS-21) at baseline and four-week follow up, as well as a survey to assess the acceptability of the intervention and its components.

Results

Participants (n = 24) reported the intervention to be highly acceptable and useful. Participants scheduled an average of eight events over the 4 weeks. DASS-21 scores improved significantly from baseline to follow up: anxiety (mean difference 2.42 (SD = 3.65), p = 0.004), depression (3.79 (SD = 3.65), p < 0.001) and stress (3.50 (SD = 3.30), p < 0.001). Participants particularly liked the ability to personalise the messages, the timing and format of the messages, and the reminders to engage in helpful behaviours.

Conclusions

This study adds to the evidence for the use of digital tools in delivering tailored anxiety self-management support to young people. Further refinement and expansion of the intervention are needed to determine its efficacy on a larger scale.
Exploring community pharmacists’ attitudes in Thailand towards ChatGPT usage: A pilot qualitative investigation
Authors: Boonrit Nuntapong , Chaisawat Kornchanok , Phueakong Chanakarn , Nootong Nantitha , Ruanglertboon Warit
Published: September 2024

Background

ChatGPT has recently emerged as a disruptive technology, potentially impacting various societal dimensions, including pharmacy practices. In Thailand, community pharmacists are navigating transitions as patients increasingly rely on digital tools for healthcare recommendations. This study explores the attitudes of community pharmacists in Hatyai, one of Thailand's most populated cities, towards the integration of ChatGPT in pharmacy services.

Method

ChatGPT-3.5 was used to generate responses to three questions concerning the use of medicine in special populations in the Thai language. These responses were then incorporated into a questionnaire and evaluated using a Likert scale from 1 to 5. Participants who consented were asked to rate the responses and participate in an in-depth interview.

Results

The majority of participants rated the responses favorably, with scores of 4 and 5 accounting for at least 60% of the ratings. Only a small proportion of responses received doubtful ratings (score of 3) or was in disagreement, ranging from 20% to 40%. Moreover, open opinions extracted from the interviews suggested that participants viewed ChatGPT as a capable assistant, as it provided fast yet reasonably accurate information in the Thai language.

Conclusion

The findings indicate that community pharmacists view ChatGPT as a capable assistant, albeit noting the need for further refinements. The study underscores the importance for pharmacists to proactively adapt to technological advancements, particularly those affecting patient safety, to enhance healthcare delivery and optimize treatment outcomes.
Stability of Patient Social Determinants of Health With a Focus on Food Insecurity
Authors: Chagin Kevin , Sehgal Ashwini R.
Published: September 2024

Introduction/Objectives:

Many health systems screen patients for social determinants of health and refer patients with social needs to community service organizations for assistance. However, few studies have examined how social determinants of health change over time in the same individuals.

Methods:

We examined patients screened by The MetroHealth System in Cleveland, Ohio for 11 social determinants of health, including food insecurity, financial strain, transportation, housing stability, utilities affordability, other housing problems, intimate partner violence, social connection, physical activity, daily stress, and digital connectivity. We determined changes in these social determinants among patients screened at baseline and again after 6 to 18 months of follow-up. We further examined correlates of changes in food insecurity, because it is a common need among our patients and leads to numerous referrals to community organizations for assistance.

Results:

A substantial majority of patients had no change in each social determinant. For example, among 18 038 patients screened twice for food insecurity, 13 913 (77.1%) did not screen positive for food insecurity at baseline and follow-up and 1726 (9.6%) screened positive for food insecurity at both times. A total of 1080 (6.0%) did not screen positive for food insecurity at baseline but screened positive at follow-up while 1319 (7.3%) screened positive for food insecurity at baseline but not at follow-up. Among patients screening positive for food insecurity at baseline, screening negative at follow-up was independently associated with being age ≥60 years (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.02-2.10), not screening positive for financial strain (OR = 1.64, CI = 1.27-2.13), not screening positive for housing problems (OR = 1.65, CI = 1.28-2.13), and not screening positive for intimate partner violence (OR = 1.45, OR = 1.02-2.08). A longer duration between baseline and follow-up screening was also independently associated with not screening positive for food insecurity at follow-up. Being referred for food assistance was not associated with absence of food insecurity at follow-up (OR = 0.71, CI = 0.47-1.08).

Conclusions:

Most patients report no change in specific social determinants of health over 6 to 18 months. Examining changes may identify subgroups at greatest risk for persistence of adverse determinants and help to evaluate the impact of assistance efforts.
Decreasing the Anxiety and Shame of Medical Students Not Placing into a Residency Using an Innovative Fifth-Year Educational Intervention
Authors: Ferrill Heather P , Brooks Amanda
Published: September 2024

US medical students, even before the COVID-19 pandemic, exhibited higher rates of mental health challenges than age-matched cohorts. The National Resident Matching Program (NRMP) match process, which places medical students into residency, is the culmination of medical school training and a well-recognized stressor that amplifies anxiety levels and the mental strain that accompanies medical school. Facing an unprecedented year with a decrease in 2021 NRMP placement percentages, Rocky Vista University College of Osteopathic Medicine (RVUCOM) introduced an innovative new program, the predoctoral internship (PDI), to support students who did not match into a residency program. At no extra expense to the student, this program offers a year-long opportunity to customize experiences in both clinical and academic settings, along with leadership training, aimed at bolstering their residency applications. Alternatively, students could participate in a Master's PDI (MPDI), which allowed students to concurrently pursue a master's degree of their choosing with an external program. RVUCOM achieved 100% placement for students completing the PDI or MPDI program, aligning with the institution's historical graduate trends. Perhaps equally important, students in the program reported feeling supported and less ashamed, fostering loyalty to RVUCOM. Transparency in communication and leaning into institutional values reinforced trust within community partners. The intentional balance of rigor and support, coupled with faculty investment, proved crucial for success. The experience held students accountable, allowing personal and professional growth and fostering the development of a deeper professional identity. RVUCOM's innovative approach to unplaced students not only addresses the challenges faced by RVUCOM students not achieving a residency placement, but also transforms an unforeseen circumstance into an opportunity for growth, resilience, and the development of more competitive and accountable medical graduates.
Review of Oreste Vaccari’s Pictorial Chinese-Japanese Characters (漢字の母體)
Authors: Hong Youbin
Published: September 2024

This review examines the organization and content of Pictorial Chinese-Japanese Characters (1964), a textbook for learning Chinese characters written by Oreste Vaccari (1886–1980), and examines its features and limitations. Pictorial Chinese-Japanese Characters (漢字の母體) is a textbook for westerners who are new to Chinese characters, and seems to have been written with this in mind judging from the level of Chinese characters included and the editorial organization. This book has the advantage of teaching Chinese characters in a systematic way, explaining how they are organized. However, if we look at the details, we find that the explanations of the interpretation of the characters are sometimes incorrect, and there are also errors such as overinterpreting the meaning of the sound part of the phonetic characters (形聲字). This review will examine the organization and content of this book and identify its strengths and limitations.
Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9)
Authors: Noonan Kerrie , Grindrod Andrea , Shrestha Sumina , Lee Sora , Leonard Rosemary , Johansson Therese
Published: September 2024

Background:

Since the development of the Death Literacy Index (DLI) in 2019 in Australia, subsequent internationally validated versions have prompted rewording and refinement of the original survey questions. Use of the DLI in the community has also resulted in requests for a short format.

Objectives:

To examine and report on the psychometric properties of a revised version of the DLI-R and develop a short format DLI-9.

Design:

A cross-sectional national survey was conducted for the validation of the revised DLI.

Methods:

The DLI items were revised by the research team using the international literature. DLI data were collected from a representative online non-probability panel of 1202 Australian adults, based on age, gender, and geographical location. Confirmatory factor analysis (CFA) was conducted to ensure the revised version (DLI-R) was consistent with the original. To develop a short format version of the DLI (DLI-9), items were first removed based on face validity, followed by an exploratory factor analysis (EFA) and CFA. The internal reliability of the DLI-R and the DLI-9 was assessed using Cronbach’s alpha. The intraclass correlation coefficient was calculated to examine the inter-rater reliability between the DLI-R and DLI-9.

Results:

Twenty-four questions in the DLI were reworded for clarity. A CFA on the 29 items of this modified version of the DLI indicated a good model fit (Tucker-Lewis Index (TLI): 0.93; Comparative Fit Index (CFI): 0.93; root mean square of approximation (RMSEA): 0.06; standardized root mean residual (SRMR): 0.06), with six latent variables and an underlying latent variable “death literacy.” For the DLI-9, an EFA identified a nine-item, two-factor structure model (DLI-9). A subsequent CFA in a separate sample demonstrated a good model fit for the DLI-9 (TLI: 0.92; CFI: 0.94; RMSEA: 0.089; SRMR: 0.07). Excellent inter-rater reliability (0.98) was observed between DLI-9 and DLI-R. Cronbach’s alpha coefficients for DLI-R scales and subscales and the DLI-9 all exceeded 0.8, indicating high internal consistency.

Conclusion:

The DLI-R and the DLI-9 were found to have acceptable psychometric properties. The development of a shorter version of the DLI provides a valid measure of overall death literacy.
Measurable residual disease by mass spectrometry and next-generation flow to assess treatment response in myeloma
Authors: Puig Noemí , Agulló Cristina , Contreras Teresa , Cedena María-Teresa , Martínez-López Joaquín , Oriol Albert , Blanchard María-Jesús , Ríos Rafael , Íñigo María-Belén , Sureda Anna , Lakhwani Sunil , de la Rubia Javier , González-Calle Verónica , Cabañas Valentín , Palomera Luis , Moraleda José-María , Bargay Joan , Castro Sergio , Rosiñol Laura , Bladé Joan , San-Miguel Jesús F. , Lahuerta Juan-José , Paiva Bruno , Mateos María-Victoria
Published: September 2024

Quantitative immunoprecipitation mass spectrometry (QIP-MS) allows the identification of the M-protein in patients with multiple myeloma (MM) otherwise in complete response, and could be considered suitable for measurable residual disease (MRD) evaluation in peripheral blood. In the context of the GEM2012MENOS65 and GEM2014MAIN trials, we compared the performance of QIP-MS in serum with next-generation flow (NGF) cytometry in bone marrow to assess MRD in paired samples obtained postinduction, transplant, consolidation and after 24 cycles of maintenance. At each time point, both NGF and QIP-MS were able to segregate 2 groups of patients with significantly different progression-free survival; when the evolution of the results obtained with either method was considered, maintaining or converting to MRD negativity was associated with longer survival, significantly better when compared with sustaining or converting to MRD positivity. Reemergence of MRD by QIP-MS was associated with high risk of imminent clinical progression. In conclusion, MRD evaluation by NGF and MS achieves similar prognostic value based in single time point assessments and kinetics. Thus, the minimally invasive nature of MRD monitoring by MS represents a breakthrough in highly sensitive response assessment in MM. The trials were registered at www.clinicaltrials.gov as #NCT01916252 (GEM2012MENOS65) and at EudraCT as #2012-005683-10; and as #NCT02406144 (GEM2014MAIN) and at EudraCT as 2014-00055410.
Hemoglobin-based transfusion strategies for cardiovascular and other diseases: restrictive, liberal, or neither?
Authors: Natanson Charles , Applefeld Willard N. , Klein Harvey G.
Published: September 2024

A “restrictive” red blood cell transfusion threshold, a hemoglobin concentration <7 to 8 g/dL, has long been recommended for most hospitalized patients including anemic patients with stable cardiovascular disease (CVD). Although no threshold recommendation is given for acute coronary syndromes (ACSs), recent evidence suggests that “liberal” rather than “restrictive” transfusion strategies are associated with significantly improved safety for hospitalized patients with stable CVD and/or ACS. This finding suggests that previously available data were misinterpreted. Conclusions drawn from earlier transfusion trigger trials have been confounded by unintentional trial design and analysis flaws that have contributed to erroneous recommendations regarding the safety of a restrictive threshold. Subsequently, these conclusions have been incorporated into widely accepted guidelines and clinical practice. Management with a restrictive vs liberal transfusion strategy (<10 g/dL) increases the risk of new-onset ACS in patients with CVD by ∼2%. We estimate that since 2019, using hospital databases and a recent meta-analysis, this practice may have resulted in ∼700 excess ACS events per year in orthopedic surgical patients. Given these findings, transfusion practices in other clinical conditions, particularly those derived from similar transfusion trigger trials, should be questioned. Restrictive and liberal transfusion policies merit a general reconsideration. Rather than a single numerical transfusion trigger, transfusion therapy should be personalized. Consideration of an individual patient’s age, clinical status, and comorbidities is integral to transfusing. To avoid making similar errors, future trials of transfusion therapy should determine common practices before study inception and incorporate them as a usual-care “control” comparator arm into the trial design. Such studies should more reliably improve current transfusion practice.
Neutrophil serine proteases in cystic fibrosis: role in disease pathogenesis and rationale as a therapeutic target
Authors: Mall Marcus A. , Davies Jane C. , Donaldson Scott H. , Jain Raksha , Chalmers James D. , Shteinberg Michal
Published: September 2024

Chronic airway inflammation is a central feature in the pathogenesis of bronchiectasis (BE), which can be caused by cystic fibrosis (CFBE; hereafter referred to as CF lung disease) and non-CF-related conditions (NCFBE). Inflammation in both CF lung disease and NCFBE is predominantly driven by neutrophils, which release proinflammatory cytokines and granule proteins, including neutrophil serine proteases (NSPs). NSPs include neutrophil elastase, proteinase 3 and cathepsin G. An imbalance between NSPs and their antiproteases has been observed in people with CF lung disease and people with NCFBE. While the role of the protease/antiprotease imbalance is well established in both CF lung disease and NCFBE, effective therapies targeting NSPs are lacking. In recent years, the introduction of CF transmembrane conductance regulator (CFTR) modulator therapy has immensely improved outcomes in many people with CF (pwCF). Despite this, evidence suggests that airway inflammation persists, even in pwCF treated with CFTR modulator therapy. In this review, we summarise current data on neutrophilic inflammation in CF lung disease to assess whether neutrophilic inflammation and high, uncontrolled NSP levels play similar roles in CF lung disease and in NCFBE. We discuss similarities between the neutrophilic inflammatory profiles of people with CF lung disease and NCFBE, potentially supporting a similar therapeutic approach. Additionally, we present evidence suggesting that neutrophilic inflammation persists in pwCF treated with CFTR modulator therapy, at levels similar to those in people with NCFBE. Collectively, these findings highlight the ongoing need for new treatment strategies targeting neutrophilic inflammation in CF lung disease.
Respiratory management of acute chest syndrome in children with sickle cell disease
Authors: Ahmed Bushra , Arigliani Michele , Gupta Atul
Published: September 2024

Acute chest syndrome (ACS) is a leading cause of respiratory distress and hospitalisation in children with sickle cell disease (SCD). The aetiology is multifactorial and includes fat embolism, venous thromboembolism, alveolar hypoventilation and respiratory infections, with the latter being particularly common in children. These triggers contribute to a vicious cycle of erythrocyte sickling, adhesion to the endothelium, haemolysis, vaso-occlusion and ventilation–perfusion mismatch in the lungs, resulting in the clinical manifestations of ACS. The clinical presentation includes fever, chest pain, dyspnoea, cough, wheeze and hypoxia, accompanied by a new pulmonary infiltrate on chest radiography. Respiratory symptoms may overlap with those of acute asthma, which may be difficult to distinguish. Patients with ACS may deteriorate rapidly; thus prevention, early recognition and aggressive, multidisciplinary team management is essential. In this narrative review, we highlight the current evidence regarding the epidemiology, pathophysiology, treatment and preventative strategies for ACS, focusing on the aspects of major interest for the paediatric pulmonologist and multidisciplinary team who manage children with SCD.