bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic and Therapeutic Strategies to Severe Hyponatremia in the Intensive Care Unit
Authors: Rondon-Berrios Helbert
Published: October 2023

Hyponatremia is the most common electrolyte abnormality encountered in critically ill patients and is linked to heightened morbidity, mortality, and healthcare resource utilization. However, its causal role in these poor outcomes and the impact of treatment remain unclear. Plasma sodium is the main determinant of plasma tonicity; consequently, hyponatremia commonly indicates hypotonicity but can also occur in conjunction with isotonicity and hypertonicity. Plasma sodium is a function of total body exchangeable sodium and potassium and total body water. Hypotonic hyponatremia arises when total body water is proportionally greater than the sum of total body exchangeable cations, that is, electrolyte-free water excess; the latter is the result of increased intake or decreased (kidney) excretion. Hypotonic hyponatremia leads to water movement into brain cells resulting in cerebral edema. Brain cells adapt by eliminating solutes, a process that is largely completed by 48 h. Clinical manifestations of hyponatremia depend on its biochemical severity and duration. Symptoms of hyponatremia are more pronounced with acute hyponatremia where brain adaptation is incomplete while they are less prominent in chronic hyponatremia. The authors recommend a physiological approach to determine if hyponatremia is hypotonic, if it is mediated by arginine vasopressin, and if arginine vasopressin secretion is physiologically appropriate. The treatment of hyponatremia depends on the presence and severity of symptoms. Brain herniation is a concern when severe symptoms are present, and current guidelines recommend immediate treatment with hypertonic saline. In the absence of significant symptoms, the concern is neurologic sequelae resulting from rapid correction of hyponatremia which is usually the result of a large water diuresis. Some studies have found desmopressin useful to effectively curtail the water diuresis responsible for rapid correction.
Adoptions of reference management software among the research scholars of India
Authors: Singh Avinash Kumar , Mahawar KL , Singh Varsha
Published: October 2023

Background: There were only a few reference management softwares accessible in the 1980s, but presently there are more than 30 reference management softwares available to consumers. Reference management software is an extremely important tool for researchers; it gives error-free references and allows users to move from one referencing style to another in a matter of seconds, such as APA to MLA, MLA to Chicago, and many more. Import, export, highlight, cooperate with others, establish your own library, and so on are all vital functions of reference management software. It also helps us save time.

Purpose: The study's purpose was to determine how frequently reference management software is recognized and used in India's central universities.

Research Design: The survey method and questionnaire were used to collect data from research scholars at central universities in India.

Study Sample: The researchers chose 18 central universities in India, which are offering Ph.D. course in Library and Information Science.

Data Collection: 264 out of 347 responses received from respondents.

Conclusion: The findings of the study showed that the respondents are aware of reference management software in central universities in India, and hypothesis 1 also proved that library and information science research scholars are aware of reference management software in central universities in India.

Suggestion: The study strongly supports the necessity for a training program for the correct use of reference management technologies.
Improving the Procedure of Delivering Serious News: Impact of a Six-Month Curriculum for Second Year Pediatric Residents
Authors: Kube Paige , Levy Carly , Diaz Maria Carmen G. , Dickerman Mindy
Published: October 2023

Objective: We implemented and studied a novel curriculum that combined role play, didactic education, and the use of a procedure card for asynchronous learning to improve second-year pediatric residents’ skills in delivering serious news. Design: Phase 1 established baseline performance with a self-efficacy survey and observed simulation delivering serious news. Phase 2 included directed education of participants with a validated communication skills training framework. During Phase 3, participants were instructed to review the communication procedure card as a just-in-time reference prior to delivering serious news to patients and their families over 6 months. Following this period, participants completed a second self-efficacy survey and engaged in another observed simulation session delivering serious news. Pre and post intervention performance and self-efficacy were compared. Results: A total of 21 out of 26 (81%) participants completed all phases of this study. Participants had a statistically significant increase ( p < .001) in self-efficacy scores post-intervention compared to pre-intervention for each of the skills to effectively deliver serious news: assess understanding, communicate news clearly, allow for silence, respond to emotion, and equip for next steps. Additionally, investigator assessments of participants showed an overall statistically significant improvement ( p < .001) in all five communication skills post intervention compared to pre intervention. Conclusions: This curriculum resulted in significantly improved self-efficacy and observed ratings of communication skills in second-year pediatric residents over a 6-month period.
Between Election Rivalry and the Agency Costs of Government: The Effectiveness of Party Competition Across Indian States, 1957–2018
Authors: Ferris J. Stephen , Dash Bharatee Bhusana
Published: October 2023

Two dimensions of the intensity of interparty rivalry are used to test the hypothesis that greater interparty competition enhances government efficiency. Using data from a set of 14 large Indian state governments between 1957 and 2018, we find confirmation for two political rivalry hypotheses. The first is that the ex-post size of the first versus second place seat share winning margin is a useful metric of the (in)effectiveness of rival party policing of incumbent spending behavior. The second is the hypothesis that excessive spending by the incumbent governing party is decreased by the expectation of greater election contestability and that contestability is related to the expected effective number of competing parties ( ENPSeats) nonmonotonically. Our analysis suggests that contestability across Indian States reaches a maximum when the incumbent faces an expectation of ENPSeats that is closer to 5 than to Duverger's 2.
‘It was just a joke!’ Comedy and freedom of speech
Authors: Goldstraw Simeon
Published: October 2023

Debates about controversial comedy are rife in public discourse. However, despite a great interest in wider issues surrounding freedom of expression, political philosophers have had curiously little to say about comedy. This is a costly omission because in mainstream public debates, many of the worries about the potential harms of comedy are often confused or conflated, and both the defences of comedians to use controversial material and calls for censorship of such material are usually under-theorised. This paper takes a step towards correcting this oversight by explaining the potential harms of comedy and identifying who should be held responsible for these harms. By transposing existing work on hate speech, three harms of comedy are diagnosed: that it can cause status harms, that it can silence speakers, and that it can motivate violence. Using linguistic theory and the philosophy of language, the paper argues that often, it is audience members and third parties who ought to be held morally responsible for these harms, and therefore, that comedians are not usually under moral duties to modify their comedic expression, even if it is harmful.
Productive entities and citation patterns of highly cited papers in public administration domain: An informetric profile
Authors: Lyu Peng-Hui , Du Jia-wen , Ma Liang , Ngai Eric WT
Published: October 2023

This study aimed to analyze the characteristics of highly cited public administration articles in the Social Science Citation Index published from 1900 to 2022. Results show that classic works were revealed to frequently occur in the 1970s, and most of articles are on collaborative governance research. The output of countries, institutions, authors, and journals in the field of public administration also was revealed. In addition, the study discovers the life cycle of highly cited articles, including three types: “delayed growth,” “steady growth,” and “rapid growth.” This study describes the citation behavior characteristics of academic entities in the discipline of public administration and the common rules of highly cited papers, which provides insights for the future development direction of the discipline of public administration research.
Appropriateness of proton pump inhibitor therapy in an ambulatory geriatrics clinic: A retrospective cross-sectional analysis
Authors: Dixon Ryan , Bolt Jennifer
Published: October 2023

Background:

Proton pump inhibitors are considered potentially inappropriate medications in the geriatric population. The use of proton pump inhibitors by older adults has increased over the past several decades; however, existing literature suggests that only one-third of patients prescribed these medications have a valid indication for use. The aim of this study was to assess the appropriateness of proton pump inhibitor therapy in a population of ambulatory geriatric patients and to determine the impact of an interdisciplinary clinic on their use.

Methods:

This was a retrospective, cross-sectional study of patients referred to an ambulatory geriatrics clinic between October 2017 and March 2021. Participants were eligible for inclusion if they were taking a proton pump inhibitor at the time of clinic admission. Appropriateness of proton pump inhibitor therapy was assessed based on indication and dosing regimen.

Results:

In total, 280 participants were included. The mean age was 79.6 years (SD 7.7) and 60% were female. Overall, 94 of 280 (33.6%) participants had a documented valid indication for their proton pump inhibitor. The clinic team intervened to reduce the dose or discontinue 76 of 186 (40.8%) inappropriate proton pump inhibitors.

Interpretation:

Only one-third of proton pump inhibitors used by ambulatory geriatric patients have a documented appropriate indication for use. Given the medical complexity of this population and their vulnerability to adverse effects, the ambulatory geriatric population should be a priority target for proton pump inhibitor deprescribing initiatives.
The pre-match talk: A multiple-method examination of youth-elite football coaches’ motivational content
Authors: Raya-Castellano Pablo E , García-Calvo Tomás , López-Gajardo Miguel A , Marzano-Felisatti Joaquín Martín , Pulido Juan J
Published: October 2023

Pre-match meetings are popular scenes in team sports, with coaches typically gathering the full squad within the dressing room and sharing their thoughts before the warm-up and/or competition. Whilst researchers have outlined the effects of informational or emotional talks, little is known about the actual verbal strategies that coaches adopt to influence their players. Therefore, this study examined the motivational content of football coaches’ verbal behaviours and underpinning perceptions of pre-match talks’ delivery. Five coaches ( Mage = 36.2 years) working at a La Liga academy were involved in six pre-match talks ( n = 30) and one semi-structured interview each. Talks were analysed using a two-stage coding process after adaptation of validated and motivationally relevant instruments, and interviews were assessed following thematic analysis procedures. Game strategy units were the most commonly employed topic across all coaches, which involved ‘neutral’ behaviours such as role description, game objective specification, and opposition statements. These were complemented with autonomy and competence supportive messages such as facilitating choices/opinions, offering rationales, supporting past performance, or ego-oriented and social climate support dimensions, depending on the coach. Data suggested that contextual factors could strengthen or attenuate the use of these verbal behaviours/dimensions. Build-up play contents were more likely to feature autonomy support game strategy comments than defending aspects, whereas lower-ranked and underdog opponents were associated with increased disapproving past performance and ego-involving statements compared to when facing higher-ranked opponents or playing derbies. Thus, it is suggested that the use of autonomy-, competence- and relatedness-supportive dimensions in addition to task-oriented messages should be reconsider by coaches if attempting to convey a need-supportive motivational climate.
Could this be sepsis?
Authors: Morgan Dr Elizabeth
Published: October 2023

Sepsis is a common and dangerous condition. Early recognition and consequent initiation of appropriate management has significant impact on the morbidity and mortality of this condition. This article aims to help GPs to suspect sepsis and put into action an initial management plan in primary care. This article references all the latest guidance, helping GPs to manage sepsis effectively and safely.
Modulation of gut microbiota: a novel approach to enhancing the effects of immune checkpoint inhibitors
Authors: Huang Jinglong , Gong Caifeng , Zhou Aiping
Published: October 2023

Although immune checkpoint inhibitors (ICIs) have greatly improved the prognosis of some cancer patients, the majority still fail to respond adequately, and the available biomarkers cannot reliably predict drug efficacy. The gut microbiota has received widespread attention among the various intrinsic and extrinsic factors contributing to drug resistance. As an essential regulator of physiological function, the impact of gut microbiota on host immunity and response to cancer therapy is increasingly recognized. Several studies have demonstrated significant differences in gut microbiota between responders and nonresponders. The gut microbiota associated with better clinical outcomes is called ‘favorable gut microbiota’. Significantly, interventions can alter the gut microbiota. By shifting the gut microbiota to the ‘favorable’ one through various modifications, preclinical and clinical studies have yielded more pronounced responses and better clinical outcomes when combined with ICIs treatment, providing novel approaches to improve the efficacy of cancer immunotherapy. These findings may be attributed to the effects of gut microbiota and its metabolites on the immune microenvironment and the systemic immune system, but the underlying mechanisms remain to be discovered. In this review, we summarize the clinical evidence that the gut microbiota is strongly associated with the outcomes of ICI treatment and describe the gut microbiota characteristics associated with better clinical outcomes. We then expand on the current prevalent modalities of gut microbiota regulation, provide a comprehensive overview of preclinical and clinical research advances in improving the therapeutic efficacy and prognosis of ICIs by modulating gut microbiota, and suggest fundamental questions we need to address and potential directions for future research expansion.
Effect of Patient Age on Clinical and Radiological Outcomes After Medial Open-Wedge High Tibial Osteotomy: A Comparative Study With 344 Knees
Authors: Yabuuchi Koji , Kondo Eiji , Kaibara Takuma , Onodera Jun , Iwasaki Koji , Matsuoka Masatake , Onodera Tomohiro , Iwasaki Norimasa , Yagi Tomonori , Yasuda Kazunori
Published: October 2023

Background:

There exists some controversy regarding whether patient age is a predictive factor for outcomes after high tibial osteotomy (HTO).

Purpose/Hypothesis:

The purpose of this study was to evaluate whether patient age affects clinical and radiological outcomes after medial open-wedge HTO (OWHTO) in a large population with a wider age range than previous studies. It was hypothesized that there would be no differences in outcomes when compared across age-groups.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective comparative study was conducted using 344 patients (303 knees) who underwent OWHTO from 2009 to 2018. These patients were divided into 3 groups based on age at the time of surgery: ≥55 years (group Y: 76 knees in 57 patients), 56 to 64 years (group M: 129 knees in 120 patients), and ≤65 years (group O: 139 knees in 126 patients). Clinical and radiological evaluations were performed immediately before surgery and at the final follow-up period, at a mean of 5.1 years (range, 3-11 years). Comparisons among the 3 groups were conducted with 1-way analysis of variance for continuous variables. When a significant result was obtained, a post hoc test with Bonferroni correction was conducted for multiple comparisons.

Results:

In clinical evaluations, there were no significant differences among the 3 groups either preoperatively or postoperatively concerning the Japanese Orthopaedic Association score, the Lysholm score, or the Knee injury and Osteoarthritis Outcome Score (KOOS), with the exception of the preoperative KOOS Symptoms subscale, which was significantly higher in group Y versus group O (48.9 ± 18.7 vs 58.7 ± 15.4, respectively; P = .011). The Tegner activity score was significantly different among the groups, both preoperatively and postoperatively ( P < .001 for both). There was no significant difference in the occurrence of complications or the survival rate at final follow-up among the 3 groups.

Conclusion:

The study findings suggest that patient age does not affect clinical and radiological outcomes after OWHTO.
Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis
Authors: Nagasawa Hiroki , Omori Kazuhiko , Muramatsu Ken-ichi , Takeuchi Ikuto , Ohsaka Hiromichi , Ishikawa Kouhei , Yanagawa Youichi
Published: October 2023

Background

Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS.

Methods

The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians’ interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed.

Results

Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11–5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16–6.64) may have increased the return of spontaneous circulation (ROSC) rate.

Conclusions

The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.
Development and validation of the short form domestic elder abuse assessment questionnaire (SF-DEAQ)
Authors: Zobdeh Amirreza , Bandari Razieh , Heravi-Karimooi Majideh , Mashayekh Maryam , Hazrati Maryam , Montazeri Ali
Published: October 2023

Background

The present study aimed to design and determine the psychometric properties of a short-form questionnaire to investigate the domestic elder abuse.

Methods

This study consisted of two phases: in phase 1 we employed a modified Delphi approach with 18 participants. Consequently, content and face validity, and item analysis were applied. In Phase 2 we evaluated structural validity and convergent validity. Reliability was assessed by looking at internal consistency, stability, and absolute reliability.

Results

The findings led to the development of a 27-items short form of domestic elder abuse in four domains that jointly accounted for 74.14% of the variance observed. The short form showed high internal consistency (Cronbach’s alpha = 0.93) and significantly correlated (r = 0.91; p < 0.001 for both scales) with the comprehensive (49-item) domestic elder abuse.

Conclusion

The short form of domestic elder abuse was found to be reliable and valid as the longer version. The short form of domestic elder abuse could lessen the burden on respondents.
Ascending aortic aneurysm and histopathology in Alport syndrome: a case report
Authors: Kamiar Ali , Alitter Qusai , Capcha Jose M. C. , Saad Ali , Webster Keith A. , Shehadeh Lina A.
Published: October 2023

Background

Alport syndrome (AS) is caused by mutations in type IV collagen genes that typically target and compromise the integrity of basement membranes in kidney, ocular, and sensorineural cochlear tissues. Type IV and V collagens are also integral components of arterial walls, and whereas collagenopathies including AS are implicated in aortic disease, the incidence of aortic aneurysm in AS is unknown probably because of underreporting. Consequently, AS is not presently considered an independent risk factor for aortic aneurysm and more detailed case studies including histological evidence of basement membrane abnormalities are needed to determine such a possible linkage.

Case presentation

Here, we present unique histopathological findings of an ascending aortic aneurysm collected at the time of surgery from an AS patient wherein hypertension was the only other known risk factor.

Conclusions

The studies reveal classical histological features of aortic aneurysm, including atheroma, lymphocytic infiltration, elastin disruption, and myxoid degeneration with probable AS association.
Prediction model for cognitive impairment in maintenance hemodialysis patients
Authors: Chen Ding , Xiao Chang , Xiao Wangyan , Lou Linjing , Gao Zhuo , Li Xinlun
Published: October 2023

Purpose

To explore the risk factors for cognitive impairment in patients undergoing maintenance hemodialysis (MHD) and construct a predictive model for cognitive impairment.

Methods

A total of 146 patients with end-stage renal disease (ESRD) undergoing MHD were recruited at our hospital between December 2021 and April 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and scores of < 26 were considered indicative of cognitive impairment. Risk factors were identified using a multivariate logistic regression model, and a receiver operating characteristic curve was applied to construct the prediction model. Cognitive impairment risk was categorized using a multifactorial prediction model based on the weight of evidence.

Results

46 patients with cognitive impairment were identified, with a prevalence of 31.5% in ESRD patients undergoing MHD. Multivariate logistic regression analyses indicated that the following factors were associated with an increased risk of cognitive impairment in patients undergoing MHD: aged 55.0–64.0 years (OR:6.24; 95%CI:1.81–21.48; P = 0.001), aged 65.0–74.0 years (OR:16.10; 95%CI:4.03–64.37; P < 0.001), aged ≥ 75.0 years (OR:90.22; 95%CI:16.86-482.86; P < 0.001), duration of dialysis ≥ 5 years (OR:3.99; 95%CI:1.58–10.04; P = 0.003), and current smoker (OR:4.61; 95%CI:1.46–14.57; P = 0.009). The predictive value of the constructed model based on the aforementioned factors for cognitive impairment was 84% (95%CI,77-91%). The prevalence of cognitive impairment for patients at low, moderately low, moderately high, and high risk was 0% (95%CI:0-17%), 10% (95%CI:3-22%), 32% (95%CI:16-52%), and 65% (95%CI:50-78%), respectively.

Conclusions

This study constructed a multifactorial prediction model with a high predictive value for cognitive impairment in patients with ESRD undergoing MHD.
Hyperthermia inhibits cellular function and induces immunogenic cell death in renal cell carcinoma
Authors: Huaqi Yin , Bingqi Dong , Yanhui Zhao , Yongkang Ma , Shiming Zhao , Zhenghui Sun , Zheng Du , Jiangshan Peng , Tiejun Yang
Published: October 2023

Background

In recent years, hyperthermia has been widely applied as a novel strategy for cancer treatment due to its multiple antitumour effects. In particular, the potential influences of hyperthermia on the tumour immune microenvironment may improve the efficacy of immunotherapies. However, the effect of hyperthermia on renal cell carcinoma (RCC) has not been well characterized until now.

Methods

In the present study, we primarily evaluated the effects of hyperthermia on cellular function via cellular proliferation, migration, invasion and apoptosis assays. In addition, the influence of hyperthermia on the immunogenicity of RCC cells was analysed using flow cytometry analysis, enzyme-linked immunosorbent assays, and immunofluorescent (IF) staining.

Results

Our results demonstrate that hyperthermia significantly inhibits RCC cell proliferation, migration, and invasion and promotes cell apoptosis. In addition, we verified that hyperthermia improves the immunogenicity of RCC cells by inducing immunogenic cell death.

Conclusion

Our findings suggest that hyperthermia is a promising therapeutic strategy for RCC.
Evaluation of dynamic recurrence risk for locally advanced gastric cancer in the clinical setting of adjuvant chemotherapy: a real-world study with IPTW-based conditional recurrence analysis
Authors: Wu Dong , Lu Jun , Xue Zhen , Zhong Qing , Xu Bin-bin , Zheng Hua-Long , Lin Guo-sheng , Shen Li-li , Lin Jia , Huang Jiao-bao , Hakobyan Davit , Li Ping , Wang Jia-Bin , Lin Jian-Xian , Chen Qi-Yue , Cao Long-Long , Xie Jian-Wei , Huang Chang-Ming , Zheng Chao-Hui
Published: October 2023

Background

The long-term dynamic recurrence hazard of locally advanced gastric cancer (LAGC) in the clinical setting of adjuvant chemotherapy (ACT) remains unclear.

Purpose

This study aimed to investigate the dynamic recurrence risk of LAGC in patients who received ACT or not.

Methods

The study assessed data from patients with LAGC who underwent radical gastrectomy between January, 2010 and October, 2015. Inverse probability of treatment weighting (IPTW) was performed to reduce selection bias between the ACT and observational (OBS) groups. Conditional recurrence-free survival (cRFS) and restricted mean survival time (RMST) were used to assess the survival differences.

Results

In total, 1,661 LAGC patients were included (ACT group, n = 1,236 and OBS group, n = 425). The recurrence hazard gradually declined; in contrast, cRFS increased with RFS already accrued. Following IPTW adjustment, the cRFS rates were higher in the ACT group than those in the OBS group for patients at baseline or with accrued RFS of 1 and 2 years (p˂0.05). However, the cRFS rates of the ACT group were comparable with those of the OBS group for patients with accrued RFS of 3 or more years (p > 0.05). Likewise, the 5-year △RMST between the ACT and OBS groups demonstrated a similar trend. Moreover, the hematological metastasis rate of the ACT group was significantly lower than that of the OBS group for patients at baseline or with accrued RFS of 1 and 2 years, respectively (p˂0.05).

Conclusions

Although ACT could provide substantial benefits for patients with LAGC, the differences in recurrence hazard between the ACT and OBS groups may attenuate over time, which could help guide surveillance and alleviate patients’ anxiety. Further prospective large-scale studies are warranted.
The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study
Authors: Wang Yu-jing , Ke Min , Yan Ming
Published: October 2023

Purpose

The aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.

Methods

We used the wide-field digital imaging system to sequentially capture images of the neonates’ eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.

Results

Among 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.

Conclusions

The anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.
The preferred IT sources and tools of Iranian people for accessing health information
Authors: Salmanizadeh Farzad , Jannati Nazanin , Ahmadian Leila , Jahani Yunes , Balouchi Mohsen , Khajouei Reza
Published: October 2023

Introduction

People need health information to maintain their health. Despite the variety of sources and tools for providing health information, there is little evidence about Iranian people's preferences in using these sources and tools. The objective of this study was to identify the preferred health information sources, tools, and methods for presenting health information in these tools.

Methods

This national survey was conducted among a sample of 4000 Iranian people between April and September 2021. The data was collected using a valid and reliable questionnaire (α = 0.86) consisting of four sections: participants' demographic information, current sources of obtaining health information, preferred information technology (IT) tools for accessing health information, and the method of presenting this information. Linear regression was used to investigate the relationship between demographic factors and other questions.

Results

The participants received health information mostly from the "Internet" (3.62), "family or friends" (3.43), "social networks" (3.41), "specific websites" (3.41), and "mobile apps" (3.27). "Social networks" (3.67), Internet "websites" (3.56), and "mobile apps" (3.50) were the most suitable tools for receiving health information. The participants preferred the presentation of health information in the form of "Images" (3.85), "educational videos" (3.69), and "texts" (3.53). Age, education, and marital status had a significant relationship with most of the preferred information sources, tools, and information presentation methods (p < 0.05).

Conclusion

The results of this study showed that Iranian people are more active information seekers than passive ones compared to a decade ago. The preferred sources and tools identified in this research can be used by healthcare planners and policy-makers in Iran and other developing countries to design and develop IT interventions that meet people's needs. Improving access to the Internet, social networks, and mobile apps and providing health information via images, educational videos, and texts on these platforms enhance access to the information people need.
Forward step down test - clinical rating is correlated with joint angles of the pelvis and hip: an observational study
Authors: Peleg Smadar , Pelleg-Kallevag Ruth , Almog Yuval , Herman Gideon , Nakdimon Oren , Arnon Michal , Dar Gali
Published: October 2023

Background

Clinical methods for assessing quality of movement and functional tests are important to clinicians. Typical deviations from normal kinematics during the clinical test of Forward Step Down Test (FSDT) are pelvic tilt and hip adduction which are associated with the risk of knee pain.

Objectives

(1) to examine the correlation between clinical assessment of the FSDT and joint angle measurements of pelvis, hip, knee and ankle joints in males and females; (2) to examine the differences in joint angles between individuals rated as good, fair or poor in a FSDT performance test.

Methods

Ninety-two healthy individuals performing FSDT were video-taped with two-dimensional digital video cameras. The clinical assessment of the FSDT was rated by two experienced physical therapists as good, fair, or poor based on a Crossley et al. (2011) validated scale. Measurements of pelvic drop, hip adduction and knee valgus were taken using Image J software.

Results

Out of 177 lower limbs, 74 (37 in each limb) were clinically rated as “good/fair” (41.80%) while 103 (52 in the dominant leg and 51 in the non-dominant leg) were rated as “poor” (58.19%). No significant differences were observed between dominant and non-dominant legs or between males and females in clinical rating of the FSDT. Pelvic drop angle was significantly higher and hip adduction angle was significantly lower for “poor” clinical rating compared to “good/fair” in both dominant and non-dominant legs (p < 0.001) in males and females. Females demonstrated higher pelvic drop, lower hip adduction and higher knee valgus angles compared with males (p < 0.05).

Conclusions

This study showed that the clinical rating of FSDT is correlated with joint angle measurements suggesting that this assessment can be utilized in clinical practice. Individuals with poor quality performance of FSDT showed higher pelvic drop and hip adduction movement. Further studies examining different populations with diverse disorders or pathologies are essential.
What we should consider to facilitate recovery of the hematological profile in all patients after pancreaticoduodenectomy: the role of preoperative intravenous iron treatment
Authors: Kim Eun Young , Park Sung Eun , Hong Tae Ho
Published: October 2023

Background

In pancreaticoduodenectomy (PD), the duodenum and upper jejunum responsible for iron absorption are removed, which can lead to massive hemorrhage during surgery and cause iron deficiency anemia after PD. The aim of this study was to evaluate overall changes in hematologic profiles of patients who underwent pancreaticoduodenectomy. Effect of preoperative intravenous iron treatment on recovery of anemia after surgery was also investigated.

Methods

From March 2021 to December 2021, patients who underwent curative PD at our institution due to periampullary lesions were enrolled. They were divided into two groups according to whether or not iron was administered before surgery. In the IV iron group, all patients had been routinely administered with 1000 mg of ferric carboxymaltose intravenously once about 3–7 days before the operation day. Contrarily, patients in the control group did not receive intravenous iron before PD. Changes in hematological profile were measured preoperatively and at 5, 14, and 30 days postoperatively. Clinical results of the two groups were compared and analyzed. Additionally, a subgroup analysis was performed for selected non-anemic patients who had preoperative hemoglobin level of 12.0 g/dl or higher to compare changes in hematologic profiles between the two groups.

Results

Thirty patients of the IV iron group and 34 patients of the control group were analyzed. Although no difference was observed in postoperative complications or mortality, hemoglobin and iron levels were recovered significantly faster at two weeks postoperatively in the IV iron group than in the control group. Iron levels were significantly higher in the IV iron group throughout the postoperative period. In subgroup analysis conducted for non-anemic patients, hemoglobin levels were recovered significantly faster and maintained higher in the IV iron group throughout the postoperative period, although baseline levels of hemoglobin were similar between the two groups. In addition, the length of intensive care unit stay was significantly shorter in the IV iron group than in the control group.

Conclusions

Preoperative intravenous iron treatment might be effective in facilitating recovery of hematologic profiles of patients during the recovery period after PD regardless of the presence of preoperative anemia, thus preventing postoperative iron deficiency anemia.
Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study
Authors: Latessa Robyn A. , Galvin Shelley L. , Swendiman Robert A. , Onyango Joshua , Ostrach Bayla , Edmondson Amy C. , Davis Scott A. , Hirsh David A.
Published: October 2023

Background

Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students’ educational experiences in longitudinal integrated clerkships.

Methods

We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs—at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates.

Results

Analysis of 20 graduates’ interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates’ descriptions with both high psychological safety and high accountability characterized optimized learning and performance.

Conclusions

This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates’ experiences as students. Graduates described high and low psychological safety and accountability. Graduates’ descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review
Authors: Lukhele Sanele , Mulaudzi Fhumulani Mavis , Sepeng Nombulelo , Netshisaulu Khathutshelo , Ngunyulu Roinah Nkhensani , Musie Maurine , Anokwuru Rafiat
Published: October 2023

Introduction

Ultrasound scan is one of the essential assessments that is crucial in the early identification of health risks during antenatal care. Its accessibility to women in low-and middle-income countries remains a serious challenge because ultrasound scans are not within the scope of practice for midwives. However, task shifting and extension of scope of practice aim to train midwives to assess pregnant women through an ultrasound scan. This paper aims to report the findings of a scoping review on the training of midwives to perform obstetric ultrasound scans in Africa.

Methods

The 6-step iterative framework for scoping reviews by Arksey and O’Malley was used to determine the extent of qualitative and quantitative evidence available on the training of midwives on obstetric ultrasound scans, which includes specifying the research question, identifying relevant studies, selecting studies, extracting and charting data, collating, summarising, and synthesising and reporting findings.

Results

A total of 12 articles from eight African countries were included in this scoping review. Three main themes and 13 sub-themes emerged and they are: obstetric ultrasound scan training, challenges experienced by midwives from task shifting and extension of scope of practice regarding obstetric ultrasound scan, and the value of task shifting and extension of scope of practice regarding obstetric ultrasound scan to midwives.

Discussion

Despite the available evidence that the training of midwives on obstetric ultrasound scans is essential to ensure the accessibility of quality antenatal health services, the training of midwives on obstetric ultrasound scans in some African countries remains a serious challenge. It is evident from this scoping review results that there is a need for African countries to incorporate obstetric ultrasound scans as part of the scope of practice of midwives. Task shifting necessitates prioritising the training of midwives on the use of obstetric ultrasound scans as one of the steps towards the achievement of the United Nations Sustainable Development Goal number 3 targets by 2030.
Human ACE2 protein is a molecular switch controlling the mode of SARS-CoV-2 transmission
Authors: Yang Chao-Fu , Liao Chun-Che , Hsu Hung-Wei , Liang Jian-Jong , Chang Chih-Shin , Ko Hui-Ying , Chang Rue-Hsin , Tang Wei-Chun , Chang Ming-Hao , Wang I-Hsuan , Lin Yi-Ling
Published: October 2023

Background

Human angiotensin-converting enzyme 2 (hACE2) is the receptor mediating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. hACE2 expression is low in the lungs and is upregulated after SARS-CoV-2 infection. How such a hACE2-limited pulmonary environment supports efficient virus transmission and how dynamic hACE2 expression affects SARS-CoV-2 infection are unclear.

Methods

We generated stable cell lines with different expression levels of hACE2 to evaluate how the hACE2 expression level can affect SARS-CoV-2 transmission.

Results

We demonstrated that the hACE2 expression level controls the mode of SARS-CoV-2 transmission. The hACE2-limited cells have an advantage for SARS-CoV-2 shedding, which leads to cell-free transmission. By contrast, enhanced hACE2 expression facilitates the SARS-CoV-2 cell-to-cell transmission. Furthermore, this cell-to-cell transmission is likely facilitated by hACE2-containing vesicles, which accommodate numerous SARS-CoV-2 virions and transport them to neighboring cells through intercellular extensions.

Conclusions

This hACE2-mediated switch between cell-free and cell-to-cell transmission routes provides SARS-CoV-2 with advantages for either viral spread or evasion of humoral immunity, thereby contributing to the COVID-19 pandemic and pathogenesis.
How do the year’s seasons and specific weather indices affect physical activity and the patterns of use of public open spaces in the Brazilian context?
Authors: Rech Cassiano Ricardo , Godtsfriedt Carla Elane Silva , Arins Gabriel Claudino Budal , de Zorzi Viviane Nogueira , Pazin Joris , Hino Adriano Akira Ferreira , Lopes Adalberto Aparecido dos Santos
Published: October 2023

Background

Public open spaces (POS) can offer various resources to promote visitation and engagement in moderate-to-vigorous physical activity (MVPA). However, the influence of seasonal variations and specific meteorological conditions on this relationship remains unclear. Thus, this study aims to investigate the effect of seasonal variations and specific meteorological elements on different days of the week and times of day on POS use and POS-based MVPA in the Brazilian context.

Methods

In 2018, repeated measurements carried out in Southern Brazil used a systematic observation to identify the presence of users in the POS and their engagement in MVPA. The meteorological elements (temperature, thermal sensation, and relative humidity), as well as seasonality (summer, autumn, winter, and spring), were aggregated into the observations.

Results

A total of 19,712 systematic observations were conducted across nine POS. During these observations, a total of 59,354 users were identified. Out of theses, 39,153 (66.0%) were engaged in POS-based MVPA. The presence of users was found to be more frequent during the spring season (38.7%) and on weekends (ranging from 37.6 to 50.1% across seasons). Additionally, user presence was higher in the late afternoon (ranging from 36.4 to 58.2% across seasons) and at higher temperatures with lower relative humidity (p-value < 0.001). Regarding POS-based MVPA, it was more frequent during the winter season (36.4%) and on weekdays (ranging from 73.2 to 79.9% across seasons). Similarly, MVPA was higher in the late afternoon (ranging from 58.3 to 67.5% across seasons) and at lower temperatures and thermal sensations (p-value < 0.005).

Conclusions

Higher presence of users in POS, as well as their visiting, to practice POS-based MVPA, depending on the seasons and specific meteorological elements. By creating infrastructure and conducive conditions, cities can encourage individuals to adopt more active and healthy behaviors. These findings emphasize the importance of designing urban spaces that promote physical activity and contribute to overall well-being.