bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Implementation of a Fully Online Introductory Data Analysis Course to Better Prepare Students for the Public Health Workforce
Authors: Ellis Amanda R.
Published: November 2021

The adversity of the 2020 to 2021 academic year highlighted the need for quality online courses. Challenges of teaching data analysis and helping students meet the Council on Education for Public Health (CEPH) competencies increase in an online environment. To address recent competency changes by the CEPH, a fully online asynchronous course was developed to address the MPH evidence-based approaches to public health competencies and prepare students for the Public Health Workforce. Both problem-based learning and experiential learning theory methodologies informed course design. In the Spring of 2020, with feedback from our Public Health partners, we re-designed a traditional biostatistics course with a holistic approach to data analysis. Students in the class were expected to work individually and as team scientists. They were exposed to data analysis elements from project initiation to dissemination while simultaneously learning methodologic concepts. This article outlines the structure and implementation of an online introductory data analysis course designed for MPH students as a model for re-designing the traditional MPH introductory biostatistics course. Both course development and design are discussed, and evaluations from both students and the instructor are provided.
Burden of Intimate Partner Violence among Nurses and Nursing Students in a Tertiary Hospital in Abakaliki, Ebonyi State, Nigeria
Authors: Anikwe Chidebe Christian , Umeononihu Osita Samuel , Anikwe Ifeyinwa Helen , Ikeoha Cyril Chijioke , Eleje George U. , Ewah Richard Lawrence , Okorochukwu Bartholomew Chukwunonye , Nwokoye Basil Izuchukwu , Ogah Christian Okechukwu , Chigozie Okoroafor Francis
Published: November 2021

Introduction

Nurses are the largest healthcare workforce and are not immune to intimate partner violence (IPV) and its consequences.

Objective

This study is aimed at determining the prevalence, types of IPV, and its determinants among female nurses and nursing students in a tertiary teaching hospital in Abakaliki, Ebonyi State, Nigeria.

Methods

This cross-sectional study was done in a teaching hospital in Abakaliki between 1st March 2018 and 31st May 2018 to evaluate the prevalence of IPV in the past 12 months among 460 female nursing students and 460 nurses in the facility. Data were obtained with a structured questionnaire and a Composite Abuse Scale. The data were analyzed using IBM SPSS Statistics version 20 and represented using frequency table, percentages, and odds ratios. The level of significance is at P-value < 0.05.

Results

The prevalence of IPV was 48.2% for the nursing student and 58.7% for the nurses. The most common form of IPV among nursing students was Emotional and/or Harassment abuse (27.1%) while it was Severe combined abuse (23.9%) among the nurses. The significant determinants of IPV among nursing students were age [OR =  0.61(95%CI0.41-0.92)] and year of study [OR = 0.67 (95%CI 0.51–0.89)]. Male partner being unemployed was associated with increased odds of a female partner experiencing violence. Nurses’ marital status and being in the low socioeconomic class were associated with increased odds of a nurse witnessing IPV.

Conclusion

The prevalence of IPV in the studied group is unacceptably high. Efforts are therefore needed to prevent IPV in the study groups. Health care managers in the study area should make policies to support nurses/nursing students who have experienced IPV.
Prospective Changes of Pancreatic Iron in Thalassemia Major
Authors: Pepe Alessia , Pistoia Laura , Argento Crocetta , Rigoli Luciana , Benni Monica , Paci Cristina , Giovangrossi Piera , Maggio Aurelio , Restaino Gennaro , Riva Ada , Positano Vincenzo , Meloni Antonella
Published: November 2021

Introduction. Pancreatic iron deposition is a common finding in thalassemia major, being detected in more than one third of patients undergoing their first T2* Magnetic Resonance Imaging scan (MRI) for this purpose. However, no longitudinal studies on pancreatic iron are available in literature.

Aim: The aim of this multicenter study was to evaluate the changes in pancreatic iron overload in TM patients enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) Network who performed a baseline and a follow-up (FU) MRI scan at 18 months.

Methods. We considered 416 TM patients (37.77±10.46 years; 220 females) consecutively enrolled. Iron overload was quantified by the T2* technique. T2* measurements were performed over pancreatic head, body and tail and global value was the mean.

Results. Pancreatic iron overload (global pancreas T2*<26 ms) was detected in 367 (88.2%) patients. Of them, only 14 (3.8%) improved at the FU. Out of the 49 (11.8%) patients without baseline pancreatic iron overload, 15 (30.6%) showed pancreatic iron overload at the FU MRI.

A significant inverse association was detected between % change in global pancreas T2*and baseline global pancreas T2* values (R=-0.369; P<0.0001). Patients with baseline pancreatic iron overload showed significantly higher % changes in global pancreas T2* values (see Figure).

Changes (%) in global pancreas T2* were not associated with baseline serum ferritin levels or MRI liver iron concentration (LIC) values but were inversely correlated with % changes in serum ferritin levels (R=-0.199; P<0.0001) and % changes in MRI LIC values (R=-0.255; P<0.0001). A significant positive association was found between % changes in global pancreas and global heart T2* values (R=0.133; P=0.007).

At baseline MRI, 169 patients showed an alteration of glucidic metabolism: 32 had impaired fasting glucose, 65 impaired glucose tolerance, and 72 diabetes mellitus. These patients showed significantly higher % changes in global pancreas T2* than patients with a normal glucidic metabolism (33.06±79.48% vs 11.93±59.47%; P=0.003).

Conclusions. Our data showed that it is difficult to remove the iron from the pancreas and higher improvements were detected in more heavily loaded patients, with alterations of glucidic metabolism. The reduction in pancreatic iron was paralleled by a decrease in hepatic and cardiac iron.

Figure 1 Figure 1.

Disclosures

Pepe: Bayer S.p.A.: Other: no profit support; Chiesi Farmaceutici S.p.A: Other: no profit support. Maggio: Bluebird Bio: Membership on an entity's Board of Directors or advisory committees; Celgene Corp: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees.
Contemporary Clinical Management and Course of ACUTE Pulmonary Embolism: The COPE Study
Authors: Becattini Cecilia , Agnelli Giancarlo , Maggioni Aldo P , Dentali Francesco , Fabbri Andrea , Enea Iolanda , Pomero Fulvio , Ruggeri Maria P , Di Lenarda Andrea , Cimini Ludovica A , Pepe Giuseppe , Cozzio Susanna , Diamanti Michele , Vanni Simone , Lucci Donata , Gulizia Michele M
Published: November 2021

Background. New management strategies, risk stratification procedures and treatments have become available over the last years for patients with acute pulmonary embolism (PE), leading to changes in clinical practice and potentially influencing patient's course and outcome.

Methods: The COntemporary management of Pulmonary Embolism (COPE) is an academical prospective, non-interventional, multicentre study in patients with confirmed acute symptomatic PE. In-hospital and 30-day mortality were the co-primary study outcomes. At first evaluation, patients were categorized at low-risk (simplified PESI [sPESI]=0), intermediate-risk (further classified based presence/absence of increased levels and right ventricle dysfunction [RVD] at echocardiography) and high-risk (shock or cardiac arrest).

Results. Among 5213 study patients, PE was confirmed by computed tomography in 96.3% and at least one test for risk stratification was obtained in more than 80% (81% echocardiography, 83% troponin, 56% brain natriuretic peptide/NT-pro BNP). Among 4885 patients entering the Emergency Department for acute PE, 1.2% were managed as outpatients and 5.8% by short-observation. In-hospital, 289 patients underwent reperfusion (5.5%); at discharge, 6.7% received a vitamin K antagonist and 75.6% a direct oral anticoagulant. Median duration of hospitalization was 7 days (IQR 5-12 days).

Overall in-hospital mortality was 3.4% (49% due to PE, 16% cancer and 4.5% major bleeding) and 30-day mortality 4.8% (36% PE, 28% cancer and 4% major bleeding). In-hospital major bleeding was 2.6%.

Death at 30 days occurred in 22.6% of 177 high-risk patients, in 6% of the 3281 intermediate-risk and in 0.5% of 1702 low-risk patients. Time to death at 30 days in patients at low, intermediate and high risk for death is reported in the Figure.

Conclusions: COPE is the largest ever cohort of patients with acute PE. In this contemporary scenario, the majority of patients received CT for diagnosis, at least one test for risk stratification and direct oral anticoagulants as long-term treatment. Short term death remains not negligible in patients with high and intermediate-risk PE.

Figure 1 Figure 1.

Disclosures

Becattini: Bristol Myers Squibb: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Agnelli: Bristol Myers Squibb: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Honoraria; Bayer HealthCare: Honoraria. Dentali: Daiichi Sankyo: Honoraria; Bayer: Honoraria; Sanofi: Honoraria; Pfizer: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria; Boehringer: Honoraria; Alfa Sigma: Honoraria.
Long-Term Efficacy of Psoralen Plus Ultraviolet a Irradiation and Low-Dose Interferon-Alpha Therapy According to Conventional and Emerging Clinical Endopoints of Early Stage Cutaneous T Cell Lymphoma
Authors: Rupoli Serena , Goteri Gaia , Morsia Erika , Torre Elena , Garvey Kimberly Blaine , Giantomassi Federica , Campanati Anna , Offidani Anna Maria , Brandozzi Giuliano , Giorgio Mozzicafreddo , Simonacci Marco , Olivieri Attilio
Published: November 2021

Introduction: Patients with early stage Cutaneous T cell Lymphoma (CTCL) usually have a benign and chronic disease course. Refractoriness under skin directed therapies and/or more extensive disease pose some therapeutic changes. Using the combination of psoralen plus ultraviolet A irradiation (PUVA) and low-dose Interferon-α (INF), the principal treatment goal is to keep confined the disease to the skin, preventing disease progression.

Methods: We carry out a prospective data on 87 patients with early stage IA to IIA MF treated with low-dose IFN-α2b and PUVA, enrolled from 1997 to 2010. We collected data regarding clinical characteristics of MF, efficacy and outcome. Subcutaneous IFN-α2b was administered 1.5 MU/day during the first week; in the second week the dose was increased to 3MU/day. PUVA irradiation was started on the 3th week with IFN-α2b 3 MU 3 times weekly until CR, of for a maximum of 2 months. During maintenance therapy, IFN-α2b was scheduled for 3 MU 3 times weekly for 2 months and subsequently 3 MU 2 times weekly for 10 months and PUVA was gradually reduced every 2 months over a period of 12 months. Diagnostic, risk and response assignments were according to EORTC criteria.

Results: Patient characteristics at time diagnosis, staging, response rates and overall outcome are shown in Table 1. Among the 87 patients, overall response rate (ORR) was 97.8% (n=85) and included complete remission (CR) in 70 patients (80.5%), very good partial remission in 5 patients (5.8%) and partial remission (PR) in another 10 (11.5%). The best response to therapy was seen after a median of 5 months (range, 1-30) and the 74.3% of patients who achieved a CR after induction therapy kept the complete response at the last follow up. Among the responders, 40 (47.1%) relapsed with minor event with in median time of 21 months (range, 0-71) and 7(8.2%) relapsed with major event in a median time of 6 months (range, 1-81).

After a median follow up of 207 months (range, 6-295), 25 (28.7) patients died, only 1 for progressive disease. Median overall survival (OS) for our cohort was not reached (95% CI; 235-NR months) and median time to next treatment (TTNT) was 38.5 months (95% CI, 33-46 months). Moreover, disease free survival (DFS) in CR patients was 210 months (95% CI; 200-226 months).

Conclusions: The long follow up of this study verifies our preliminary results and confirms the efficacy of INF-PUVA combination therapy in a real world setting, according conventional (OS and DFS) and emerging (TTNT) clinical endpoints of treatment efficacy.

Figure 1 Figure 1.

Disclosures

No relevant conflicts of interest to declare.
Chromatin Accessibility Landscapes of Acute Lymphoblastic Leukemia
Authors: Barnett Kelly R. , Diedrich Jonathan D. , Bergeron Brennan P. , Yang Wenjian , Crews Kristine R. , Stock Wendy , Paietta Elisabeth M. , Kornblau Steven M. , Inaba Hiroto , Jeha Sima , Pui Ching-Hon , Relling Mary V. , Evans William E. , Yang Jun J. , Savic Daniel
Published: November 2021

Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric patients spanning both B- and T-cell lineages. ALL also occurs less commonly in adults but with cure rates of only around 30%. Past work has characterized ALL into molecular subtypes spanning a range of aberrant chromosomal rearrangements and oncogene chimeric fusions driving malignancy. While transcriptional profiling of these subtypes has been extensively examined, the accompanying chromatin accessibility landscape and corresponding gene regulatory repertoire is not well characterized for many subtypes. To better profile the ALL epigenomic and gene regulatory repertoire we examined chromatin accessibility of 12 distinct molecular subtypes (BCR-ABL1, ETV6-RUNX1, Hyperdiploid, Hypodiploid, KMT2A rearranged, Ph-Like, PAX5, DUX4/ERG, TCF3-PBX1, T-ALL, Early T Precursor and B-other) across 189 primary patient samples of pediatric ALL (n = 106) and adult ALL (n = 83) origin using ATAC-seq. To our knowledge, this represents the largest collection of chromatin accessibility data in primary ALL samples spanning multiple molecular subtypes to date. Collectively, we identified over 600,000 accessible chromatin sites in the ALL genome with over 50,000 regions of differentially accessible chromatin encompassing both common and subtype-specific modalities. Further, transcription factor (TF) footprint profiling of ATAC-seq yielded tens of thousands of candidate TF binding events and identified key TF drivers within distinct molecular subtypes. We additionally performed H3K27ac ChIP-seq in a subset of 12 primary ALL patient samples, with integration of these histone data for select patient samples allowing inferences about candidate super-enhancer drivers of ALL molecular subtypes. Overall, these analyses and data offer a window into the gene regulatory and epigenetic landscape of ALL, and further highlight the complexity and heterogeneity of accessible chromatin landscapes among distinct molecular subtypes of ALL.

Disclosures

Stock: Pfizer: Consultancy, Honoraria, Research Funding; amgen: Honoraria; agios: Honoraria; jazz: Honoraria; kura: Honoraria; kite: Honoraria; morphosys: Honoraria; servier: Honoraria; syndax: Consultancy, Honoraria; Pluristeem: Consultancy, Honoraria. Pui: Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Data Monitoring Committee. Evans: Princess Máxima Center for Pediatric Oncology, Scientific Advisory Board, Chair: Membership on an entity's Board of Directors or advisory committees; St. Jude Children's Research Hospital, Emeritus Member (began Jan 2021): Ended employment in the past 24 months; BioSkryb, Inc.: Membership on an entity's Board of Directors or advisory committees.
Efficacy and safety of fremanezumab in clinical trial participants aged ≥60 years with episodic or chronic migraine: pooled results from 3 randomized, double-blind, placebo-controlled phase 3 studies
Authors: Nahas Stephanie J. , Naegel Steffen , Cohen Joshua M. , Ning Xiaoping , Janka Lindsay , Campos Verena Ramirez , Krasenbaum Lynda J. , Holle-Lee Dagny , Kudrow David , Lampl Christian
Published: November 2021

Background

Although migraine is less common in older people, preventive treatment of migraine in these individuals may be more challenging due to the presence of multiple comorbidities and polypharmacy. Additionally, evidence for migraine treatment efficacy, safety, and tolerability is limited in this population. We evaluated efficacy, safety, and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene–related peptide (CGRP), in clinical trial participants aged ≥60 years with episodic migraine (EM) or chronic migraine (CM).

Methods

This analysis included data from 3 randomized, double-blind, placebo-controlled phase 3 studies: the HALO EM study, HALO CM study, and FOCUS study in participants with EM or CM and prior inadequate response to 2–4 migraine preventive medication classes. Participants in all studies were randomized 1:1:1 to receive 12 weeks of subcutaneous treatment with quarterly fremanezumab (Months 1/2/3: EM/CM, 675 mg/placebo/placebo), monthly fremanezumab (Months 1/2/3: EM, 225 mg/225 mg/225 mg; CM, 675 mg/225 mg/225 mg), or matched monthly placebo.

Results

These pooled analyses included 246 participants aged ≥60 years. Reductions in monthly migraine days from baseline over 12 weeks were significantly greater with fremanezumab (least-squares mean change from baseline [standard error]: quarterly fremanezumab, − 4.3 [0.59]; monthly fremanezumab, − 4.6 [0.54]) versus placebo (placebo, − 2.3 [0.57]; bothP < 0.01 vs placebo). As early as Week 1, significant reductions from baseline in weekly migraine days were observed with fremanezumab versus placebo (bothP < 0.01). With fremanezumab treatment versus placebo, a significantly higher proportion of participants achieved ≥50% reduction in monthly migraine days, and significant improvements in disability and quality-of-life outcomes were observed (P < 0.05). Proportions of participants experiencing serious adverse events and adverse events leading to discontinuation were low and similar in the fremanezumab and placebo groups. Efficacy and safety results were comparable to the overall pooled population (N = 2843).

Conclusions

This pooled subgroup analysis demonstrates that fremanezumab treatment is efficacious and well-tolerated over 12 weeks in participants aged ≥60 years with EM or CM. These data may help healthcare providers with clinical decision making and preventive treatment selection for older patients with migraine.

Trial registration

ClinicalTrials.govidentifiers: HALO CM:NCT02621931; HALO EM:NCT02629861; FOCUS:NCT03308968.
Graphitic Carbon Nitride as a Platform for the Synthesis of Silver Nanoclusters
Authors: Starukh Halyna , Koštejn Martin , Matějka Vlastimil , Praus Petr
Published: November 2021

Graphitic carbon nitride (CN) synthetized by the thermal polycondensation of melamine at 550 °C for 4 h was further exfoliated by heating at 500 °C for 3 h. Silver cations were adsorbed on the exfoliated graphitic carbon nitride (CNE) and then reduced by sodium borohydride forming silver nanoclusters (NCs) with a size of less than 1 nm. The NCs were located on the CNE surface and did not change the CNE properties except for its pore size distribution and thereby specific surface area (SSA). The Ag NCs were able to collect the photoinduced electrons of CNE and thus reduce their recombination with the holes. It was also documented by the increase in the CNE photocatalytic activity in terms of the degradation of antibiotic Ofloxacin. This study demonstrates the ability of CNE to serve as a platform for a simple and fast synthesis of Ag NCs without any stabilizing compounds.

Graphic Abstract
Urinary peptidomics reveals proteases involved in idiopathic membranous nephropathy
Authors: Lin Baoxu , Liu Jianhua , Zhang Yue , Wu Yabin , Chen Shixiao , Bai Yibo , Liu Qiuying , Qin Xiaosong
Published: November 2021

Background

Idiopathic membranous nephropathy (IMN) is a cause of nephrotic syndrome that is increasing in incidence but has unclear pathogenesis. Urinary peptidomics is a promising technology for elucidating molecular mechanisms underlying diseases. Dysregulation of the proteolytic system is implicated in various diseases. Here, we aimed to conduct urinary peptidomics to identify IMN-related proteases.

Results

Peptide fingerprints indicated differences in naturally produced urinary peptide components among 20 healthy individuals, 22 patients with IMN, and 15 patients with other kidney diseases. In total, 1,080 peptide-matched proteins were identified, 279 proteins differentially expressed in the urine of IMN patients were screened, and 32 proteases were predicted; 55 of the matched proteins were also differentially expressed in the kidney tissues of IMN patients, and these were mainly involved in the regulation of proteasome-, lysosome-, and actin cytoskeleton-related signaling pathways. The 32 predicted proteases showed abnormal expression in the glomeruli of IMN patients based on Gene Expression Omnibus databases. Western blot revealed abnormal expression of calpain, matrix metalloproteinase 14, and cathepsin S in kidney tissues of patients with IMN.

Conclusions

This work shown the calpain/matrix metalloproteinase/cathepsin axis might be dysregulated in IMN. Our study is the first to systematically explore the role of proteases in IMN by urinary peptidomics, which are expected to facilitate discovery of better biomarkers for IMN.
Profile of gene expression changes during estrodiol-17β-induced feminization in the Takifugu rubripes brain
Authors: Shen Xufang , Yan Hongwei , Jiang Jieming , Li Weiyuan , Xiong Yuyu , Liu Qi , Liu Ying
Published: November 2021

Background

As the critical tissue of the central nervous system, the brain has been found to be involved in gonad development. Previous studies have suggested that gonadal fate may be affected by the brain. Identifying brain-specific molecular changes that occur during estrodiol-17β (E2) -induced feminization is crucial to our understanding of the molecular control of sex differentiation by the brains of fish.

Results

In this study, the differential transcriptomic responses of the Takifugu rubripes larvae brain were compared after E2 treatment for 55 days. Our results showed that 514 genes were differentially expressed between E2-treated-XX (E-XX) and Control-XX (C-XX) T. rubripes, while 362 genes were differentially expressed between E2-treated-XY (E-XY) and Control-XY (C-XY). For example, the expression of cyp19a1b, gnrh1 and pgr was significantly up-regulated, while st, sl, tshβ, prl and pit-1, which belong to the growth hormone/prolactin family, were significantly down-regulated after E2 treatment, in both sexes. The arntl1, bhlbe, nr1d2, per1b, per3, cry1, cipc and ciart genes, which are involved in the circadian rhythm, were also found to be altered. Differentially expressed genes (DEGs), which were identified between E-XX and C-XX, were significantly enriched in neuroactive ligand-receptor interaction, arachidonic acid metabolism, cytokine-cytokine receptor interaction and the calcium signaling pathway. The DEGs that were identified between E-XY and C-XY were significantly enriched in tyrosine metabolism, phenylalanine metabolism, arachidonic acid metabolism and linoleic acid metabolism.

Conclusion

A number of genes and pathways were identified in the brain of E2-treated T. rubripes larvae by RNA-seq. It provided the opportunity for further study on the possible involvement of networks in the brain-pituitary-gonadal axis in sex differentiation in T. rubripes.
Effects of minimally invasive and traditional surgeries on the quality of life of children with congenital heart disease: a retrospective propensity score-matched study
Authors: Tan Hui , Huang Erjia , Deng Xicheng , Li Dongping , Ouyang Shayuan
Published: November 2021

Background

The focus of clinical care after treating congenital heart disease (CHD) has shifted from saving patients’ lives to improving their quality of life. This study aimed to examine the influence of minimally invasive and traditional surgeries on the quality of life of children with CHD.

Methods

This was a retrospective cross-sectional study. A total of 459 children aged 2–18 years with CHD treated at Second Xiangya Hospital of Central South University from July 2016 to June 2017 were enrolled, among whom 219 underwent minimally invasive surgery and 240 traditional surgery. The quality of life of children with CHD after surgery was reported by the patients’ parents. We applied propensity score matching to correct for confounding factors and conducted multiple linear regression analysis to examine the related effects of minimally invasive and traditional surgeries on the quality of life of children with CHD.

Results

The scores of problems related to perceived physical appearance in children undergoing minimally invasive surgery was higher than those in those undergoing traditional surgery (p = 0.004). Different treatment modes were independent influencing factors for problems related to perceived physical appearance in children with CHD. There was no significant difference in average treatment effect scores of children undergoing different surgical procedures in other quality of life dimensions (problems related to cardiac symptoms and their treatment, drug treatment, anxiety regarding treatment, cognitive psychology, and communication), suggesting that different operation modes were not independent influencing factors for these related problems.

Conclusion

Compared with traditional surgery, minimally invasive surgery can significantly improve the physical appearance perception scores of children with CHD after surgery. Therefore, minimally invasive surgery can improve the quality of life of children with CHD.
Evaluating the usability and acceptability of a geographical information system (GIS) prototype to visualise socio-economic and public health data
Authors: Wells Joshua , Grant Robert , Chang John , Kayyali Reem
Published: November 2021

Background

Understanding the impact of socio-economic inequality on health outcomes is arguably more relevant than ever before given the global repercussions of Covid-19. With limited resources, innovative methods to track disease, population needs, and current health and social service provision are essential. To best make use of currently available data, there is an increasing reliance on technology. One approach of interest is the implementation and integration of mapping software. This research aimed to determine the usability and acceptability of a methodology for mapping public health data using GIS technology.

Methods

Prototype multi-layered interactive maps were created demonstrating relationships between socio-economic and health data (vaccination and admission rates). A semi-structured interview schedule was developed, including a validated tool known as the System Usability Scale (SUS), which assessed the usability of the mapping model with five stakeholder (SH) groups. Fifteen interviews were conducted across the 5 SH and analysed using content analysis. A Kruskal-Wallis H test was performed to determine any statistically significant difference for the SUS scores across SH. The acceptability of the model was not affected by the individual use of smart technology among SHs.

Results

The mean score from the SUS for the prototype mapping models was 83.17 out of 100, indicating good usability. There was no statistically significant difference in the usability of the maps among SH (p = 0.094). Three major themes emerged with respective sub-themes from the interviews including: (1) Barriers to current use of data (2) Design strengths and improvements (3) Multiple benefits and usability of the mapping model.

Conclusion

Irrespective of variations in demographics or use of smart technology amongst interviewees, there was no significant difference in the usability of the model across the stakeholder groups. The average SUS score for a new system is 68. A score of 83.17 was calculated, indicative of a “good” system, as falling within the top 10% of scores. This study has provided a potential digital model for mapping public health data. Furthermore, it demonstrated the need for such a digital solution, as well as its usability and future utilisation avenues among SH.
Mental distress among young adults – gender differences in the role of social support
Authors: Johansen Rune , Espetvedt Mari Nicholls , Lyshol Heidi , Clench-Aas Jocelyne , Myklestad Ingri
Published: November 2021

Background

The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people.

Methods

This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter of 2015–2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18–24 years old (n = 624), 25–31 (n = 582), and 32–38 years old (n = 795).

Results

Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association between low social support and mental distress was significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis.

Conclusion

Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.
Prevalence and sociodemographic factors associated with vision difficulties in Ghana, Gambia, and Togo: a multi-country analysis of recent multiple Indicator cluster surveys
Authors: Seidu Abdul-Aziz , Agbadi Pascal , Duodu Precious Adade , Dey Nutifafa Eugene Yaw , Duah Henry Ofori , Ahinkorah Bright Opoku
Published: November 2021

Background

The sense of sight is one of the important human sensory abilities that is required for independent functioning and survival. The highest burden of sight-related problems is recorded in low-and middle-income countries, especially in sub-Saharan Africa. Despite the burden, nationally representative analyses to understand the prevalence and determinants of vision difficulties are hard to find. Therefore, this study addressed this knowledge gap by estimating the prevalence of vision difficulties and its correlates in gender-stratified models in three West African countries: Ghana, Gambia, and Togo.

Methods

The study used the most recent Multiple Indicator Cluster Surveys of Ghana (2017–2018), Gambia (2018), and Togo (2017). Summary statistics were used to describe the participants and logistic regression was used to perform the bivariate and multivariate analyses. The analyses were performed using Stata version 14 and the complex survey design of the datasets was accounted for using the ‘svyset’ command.

Results

Gendered differences were observed for vision difficulties. More women than men reported vision difficulties in Ghana (men: 14.67% vs women: 23.45%) and Togo (men: 14.86% vs women: 23.61%), but more men than women reported vision difficulties in Gambia (men: 11.64% vs women: 9.76%). We also observed gender differences in how age, education, marital status, and region of residence were significantly associated with reported vision difficulties. The direction and magnitude of these relationships were different among men and women across the survey data in Ghana, Gambia, and Togo.

Conclusion

The findings imply the need to tackle the existing gender inequities that are associated with vision difficulties to promote the quality of life of individuals, especially among older adults.
Immersive 360° videos in health and social care education: a scoping review
Authors: Blair Carolyn , Walsh Colm , Best Paul
Published: November 2021

Background

Research on the pedagogical use of immersive 360° videos is a rapidly expanding area within health and social care education. Despite this interest, there is a paucity of empirical data on its application.

Method

A scoping review methodology framework was used to search for relevant articles published between 1970 and July 2021. Six databases were used to identify studies using immersive 360° videos for training and education purposes within health and social care: PubMed, Ovid Medline, Psych Info, Psych Articles, Cochrane Database and Embase. Research questions included: Is there any evidence that immersive 360° videos increase learning outcomes and motivation to learn in health and social care education? What are the key pedagogical concepts and theories that inform this area of research? What are the limitations of using immersive 360° videos within health and social education? The four dimensions contained within Keller’s ARCS model (attention, relevance, confidence and satisfaction) frame the results section.

Results

Fourteen studies met our inclusion criteria. Learning outcomes confirm that immersive 360° videos as a pedagogical tool: increases attention, has relevance in skill enhancement, confidence in usability and user satisfaction. In particular, immersive 360° videos has a positive effect on the user’s emotional response to the learning climate, which has a significant effect on users’ motivation to learn. There was a notable lack of pedagogical theory within the studies retrieved and a general lack of clarity on learning outcomes.

Conclusion

Studies examining the effectiveness of such interventions remains weak due to smaller sample sizes, lack of randomised control trials, and a gap in reporting intervention qualities and outcomes. Nevertheless, 360° immersive video is a viable alternative to VR and regular video, it is cost-effective, and although more robust research is necessary, learning outcomes are promising.

Future directions

Future research would do well to focus on interactivity and application of pedagogical theory within immersive 360° videos experiences. We argue that more and higher quality research studies, beyond the scope of medical education, are needed to explore the acceptability and effective implementation of this technology.
Causal effects of atrial fibrillation on brain white and gray matter volume: a Mendelian randomization study
Authors: Park Sehoon , Lee Soojin , Kim Yaerim , Cho Semin , Kim Kwangsoo , Kim Yong Chul , Han Seung Seok , Lee Hajeong , Lee Jung Pyo , Lee Soryoung , Choi Eue-Keun , Joo Kwon Wook , Lim Chun Soo , Kim Yon Su , Kim Dong Ki
Published: November 2021

Background

Atrial fibrillation (AF) and brain volume loss are prevalent in older individuals. We aimed to assess the causal effect of atrial fibrillation on brain volume phenotypes by Mendelian randomization (MR) analysis.

Methods

The genetic instrument for AF was constructed from a previous genome-wide association study (GWAS) meta-analysis (15,993 AF patients and 113,719 controls of European ancestry). The outcome summary statistics for head-size-normalized white or gray matter volume measured by magnetic resonance imaging were provided by a previous GWAS of 33,224 white British participants in the UK Biobank. Two-sample MR by the inverse variance–weighted method was performed, supported by pleiotropy-robust MR sensitivity analysis. The causal estimates for the effect of AF on ischemic stroke were also investigated in a dataset that included the findings from the MEGASTROKE study (34,217 stroke patients and 406,111 controls of European ancestry). The direct effects of AF on brain volume phenotypes adjusted for the mediating effect of ischemic stroke were studied by multivariable MR.

Results

A higher genetic predisposition for AF was significantly associated with lower grey matter volume [beta −0.040, standard error (SE) 0.017, P=0.017], supported by pleiotropy-robust MR sensitivity analysis. Significant causal estimates were identified for the effect of AF on ischemic stroke (beta 0.188, SE 0.026, P=1.03E−12). The total effect of AF on lower brain grey matter volume was attenuated by adjusting for the effect of ischemic stroke (direct effects, beta −0.022, SE 0.033, P=0.528), suggesting that ischemic stroke is a mediator of the identified causal pathway. The causal estimates were nonsignificant for effects on brain white matter volume as an outcome.

Conclusions

This study identified that genetic predisposition for AF is significantly associated with lower gray matter volume but not white matter volume. The results indicated that the identified total effect of AF on gray matter volume may be mediated by ischemic stroke.
Mutational signatures among young-onset testicular cancers
Authors: Mealey Nicole E. , O’Sullivan Dylan E. , Peters Cheryl E. , Heng Daniel Y. C. , Brenner Darren R.
Published: November 2021

Background

Incidence of testicular cancer is highest among young adults and has been increasing dramatically for men born since 1945. This study aimed to elucidate the factors driving this trend by investigating differences in mutational signatures by age of onset.

Methods

We retrieved somatic variant and clinical data pertaining to 135 testicular tumors from The Cancer Genome Atlas. We compared mutational load, prevalence of specific mutated genes, mutation types, and mutational signatures between age of onset groups (< 30 years, 30–39 years, ≥ 40 years) after adjusting for subtype. A recursively partitioned mixture model was utilized to characterize combinations of signatures among the young-onset cases.

Results

Mutational load was significantly higher among older-onset tumors (p < 0.05). There were no highly prevalent driver mutations among young-onset tumors. Mutated genes and types of nucleotide mutations were not significantly different by age group (p > 0.05). Signatures 1, 8 and 29 were more common among young-onset tumors, while signatures 11 and 16 had higher prevalence among older-onset tumors (p < 0.05). Among young-onset tumors, clustering of signatures resulted in four distinct tumor classes.

Conclusions

Signature contributions differ by age with signatures 1, 8 and 29 were more common among younger-onset tumors. While these signatures are connected with endogenous deamination of 5-methylcytosine, late replication errors and chewing tobacco, respectively, additional research is needed to further elucidate the etiology of young-onset testicular cancer. Large studies of mutational signatures among young-onset patients are required to understand epidemiologic trends as well as inform targeted prevention and treatment strategies.
Stability of blood eosinophils in acute exacerbation of chronic obstructive pulmonary disease and its relationship to clinical outcomes: a prospective cohort study
Authors: Cui Yanan , Zhang Wenye , Ma Yiming , Zhan Zijie , Chen Yan
Published: November 2021

Background

The clinical value of blood eosinophils and their stability in chronic obstructive pulmonary disease (COPD) remains controversial. There are limited studies on association between the stability of blood eosinophils in acute exacerbation of COPD (AECOPD) and clinical outcomes. This study aimed to evaluate the stability of blood eosinophils in hospitalized AECOPD and its relationship to clinical outcomes.

Methods

This prospective observational study recruited patients hospitalized with AECOPD from November 2016 to July 2020. The eligible patients were divided into four groups according to their blood eosinophil counts at admission and discharge: persistently < 300 cells/μl (LL), < 300 cells/μl at admission but ≥ 300 cells/µl at discharge (LH), ≥ 300 cells/μl at admission but < 300 cells/µl at discharge (HL), and persistently ≥ 300 cells/μl (HH). Cox hazard analyses were used to study the association between eosinophil changes and exacerbations or mortality.

Results

In 530 patients included, 90 (17.0%) had a high blood eosinophil count (BEC) ≥ 300 cells/µl at admission but 32 (35.6%) of them showed a decreased BEC at discharge. The proportions and distribution for group LL, LH, HL, and HH were 381 (71.9%), 59 (11.1%), 32 (6.0%), and 58 (10.9%), respectively. During hospitalization, the LH group had a higher C-reactive protein level, higher rate of intensive care unit (ICU) admission, and higher total cost. The length of hospital stay of the LH group was longer compared with group LL, HL, or HH (P = 0.002, 0.017, and 0.001, respectively). During a follow-up of 12 months, the HH group was associated with a higher risk of moderate-to-severe exacerbations compared to the LL group (hazard ratio 2.00, 95% confidence interval 1.30–3.08,P = 0.002). Eosinophil changes had no significant association with mortality at 12 months. Sensitivity analyses in patients without asthma and without use of systemic corticosteroids prior to admission did not alter the results.

Conclusions

More attention should be paid to the LH group when evaluating the short-term prognosis of AECOPD. A persistently high BEC was a risk factor for long-term exacerbations. Eosinophil changes during hospitalization could help to predict outcomes.
Epicardial adipose tissue volume and myocardial ischemia in asymptomatic people living with diabetes: a cross-sectional study
Authors: Cosson Emmanuel , Nguyen Minh Tuan , Rezgani Imen , Berkane Narimane , Pinto Sara , Bihan Hélène , Tatulashvili Sopio , Taher Malak , Sal Meriem , Soussan Michael , Brillet Pierre-Yves , Valensi Paul
Published: November 2021

Background

Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition.

Methods

We included asymptomatic patients with diabetes and no coronary history, who had undergone both a stress a myocardial scintigraphy to diagnose myocardial ischemia, and a computed tomography to measure their coronary artery calcium (CAC) score. EAT volume was retrospectively measured from computed tomography imaging. Determinants of EAT volume and asymptomatic myocardial ischemia were evaluated.

Results

The study population comprised 274 individuals, including 153 men. Mean (± standard deviation) age was 62 ± 9 years, and 243, 23 and 8 had type 2, type 1, or another type of diabetes, respectively. Mean body mass index was 30 ± 6 kg/m2, and mean EAT volume 96 ± 36 cm3. Myocardial ischemia was detected in 32 patients (11.7%). EAT volume was positively correlated with age, body mass index and triglyceridemia, but negatively correlated with HbA1c, HDL- and LDL-cholesterol levels. Furthermore, EAT volume was lower in people with retinopathy, but higher in men, in current smokers, in patients with nephropathy, those with a CAC score > 100 Agatston units, and finally in individuals with myocardial ischemia (110 ± 37 cm3 vs 94 ± 37 cm3 in those without myocardial ischemia, p < 0.05). The association between EAT volume and myocardial ischemia remained significant after adjustment for gender, diabetes duration, peripheral macrovascular disease and CAC score. We also found that area under the ROC curve analysis showed that EAT volume (AROC: 0.771 [95% confidence interval 0.683–0.858]) did not provide improved discrimination of myocardial ischemia over the following classic factors: gender, diabetes duration, peripheral macrovascular disease, retinopathy, nephropathy, smoking, atherogenic dyslipidemia, and CAC score (AROC 0.773 [0.683–0.862]).

Conclusions

EAT may play a role in coronary atherosclerosis and coronary circulation in patients with diabetes. However, considering EAT volume is not a better marker for discriminating the risk of asymptomatic myocardial ischemia than classic clinical data.
A double-blind randomised controlled trial on the effect of Tocovid, a tocotrienol-rich capsule on postoperative atrial fibrillation at the National Heart Institute, Kuala Lumpur: an interim blinded analysis
Authors: Musa Ahmad Farouk , Dillon Jeswant , Md Taib Mohamed Ezani , Yunus Alwi Mohamed , Sanusi Abdul Rais , Nordin Mohd Nazeri , Smith Julian A.
Published: November 2021

Introduction

Post-operative atrial fibrillation (POAF) is associated with poorer outcomes, increased resource utilisation, morbidity and mortality. Its pathogenesis is initiated by systemic inflammation and oxidative stress. It is hypothesised that a potent antioxidant and anti-inflammatory agent such as tocotrienol, an isomer of Vitamin E, could reduce or prevent POAF.

Aims

The aim of this study is to determine whether a potent antioxidative and anti-inflammatory agent, Tocovid, a tocotrienol-rich capsule, could reduce the incidence of POAF and affect the mortality and morbidity as well as the duration of ICU, HDU and hospital stay.

Methods

This study was planned as a prospective, randomised, controlled trial with parallel groups. The control group received placebo containing palm superolein while the treatment group received Tocovid capsules. We investigated the incidence of POAF, the length of hospital stay after surgery and the health-related quality of life.

Results

Recruitment commenced in January 2019 but the preliminary results were unblinded as the study is still ongoing. Two-hundred and two patients have been recruited out of a target sample size of 250 as of January 2021. About 75% have completed the study and 6.4% were either lost during follow-up or withdrew; 4% of participants died. The mean age group was 61.44 ± 7.30 years with no statistical difference between the groups, with males having a preponderance for AF. The incidence of POAF was 24.36% and the mean time for developing POAF was 55.38 ± 29.9 h post-CABG. Obesity was not a predictive factor. No statistically significant difference was observed when comparing left atrial size, NYHA class, ejection fraction and the premorbid history. The mean cross-clamp time was 71 ± 34 min and the mean bypass time was 95 ± 46 min, with no difference between groups. There was a threefold increase in death among patients with POAF (p = 0.008) and an increase in the duration of ICU stay (p = 0.01), the total duration of hospital stay (p = 0.04) and reintubation (p = 0.045).

Conclusion

A relatively low incidence rate of POAF was noted although the study is still ongoing. It remains to be seen if our prophylactic intervention using Tocovid would effectively reduce the incidence of POAF.

Clinical Registration Number: US National Library of Medicine. Clinical Trials - NCT03807037. Registered on 16th January 2019. Link:https://clinicaltrials.gov/ct2/show/NCT03807037