bluuebunny/crossref_metadata_2025 huggingface dataset:
Early and midterm outcomes of in situ fenestration via adjustable puncture needle for Ankura aortic stent graft: A single-center experience
Authors: Yu Zuanbiao , Hu Songjie , Wang Di , Yang Tiequan , Lang Dehai
Published: July 2023

Objectives

An analysis was conducted to demonstrate early and midterm outcomes of using adjustable puncture needle-based in situ fenestration (ISF) technique for Ankura aortic stent graft to reconstruct the supra-arch branch in thoracic endovascular aortic repair (TEVAR).

Methods

A retrospective analysis of 68 cases of aortic lesions with insufficient proximal anchoring area admitted to our department from March 2017 to December 2021 was performed. In situ fenestration thoracic endovascular repair (TEVAR) was performed at the same time during the operation. Among them, there were fifty-eight cases of thoracic aortic dissection, seven cases of thoracic aortic aneurysm, and three cases of thoracic aortic ulcer. Intraoperative adjustable puncture with needle was used for the Ankura aorta stent graft to perform ISF and reconstruction of the supra-arch branch.

Results

The success rate of ISF was 94.1% (64/68). Only in four cases, attempts were made to create ISF in the left subclavian artery (LSA), and all the four were unsuccessful because of sharp and tortuosity angle. Among them, forty-four cases were only LSA fenestration, and one case was left common carotid artery (LCCA) fenestration + LSA embolism. LSA + left vertebral artery (LVA) fenestration was performed in two cases, LSA fenestration +LCCA chimney was performed in fourteen cases, LCCA + LSA fenestration + innominate artery (INA) chimney was performed in one case, and LCCA fenestration + INA chimney + LSA embolism was performed in two cases. The overall neurologic event rate was 3.1% (spinal cord ischemia 0, with stroke observed in two cases). Postoperatively, one patient (1.6%) died on the third day after TEVAR due to the retrograde dissections. There were four cases of endoleak (6.3%; three type I and one type II). The average follow-up was 29.2 ± 14.4 months, and no patient died during the follow-up period. Three cases of endoleak disappeared, and one case did not increase further. In addition, other two cases of retrograde dissections were observed at 3 and 5 months after TEVAR. Fortunately, they were scheduled for emergency surgery with ascending aorta replacement and improved well. There was only one case of LSA occlusion after ISF which was reconstructed by endovascular treatment. Two patients were found with distal stent graft-induced new entries (dSINE), and TEVAR was performed again during the follow-up period.

Conclusion

Early and midterm outcomes demonstrated that ISF via the adjustable puncture needle device for the Ankura aorta stent graft is a feasible and effective treatment method, which can achieve high technical success and satisfactory short-term results.
Endovascular stenting techniques for blunt carotid injury
Authors: Abdou Hossam , Treffalls Rebecca N , Stonko David P , Kundi Rishi , Morrison Jonathan J
Published: July 2023

Objectives

While methods of endovascular carotid artery stenting have improved over time, concerns surrounding the safety and efficacy of stenting for blunt carotid injury (BCI) remain. This study aims to present our approach to carotid artery stenting (CAS) by incorporating new technologies such as flow-diverting stents and circuits.

Methods

There is no robust evidence to support routine carotid artery stenting; however, there are several therapeutic options and approaches for treating BCI that currently require an individualized approach. Endovascular stenting and specific stent selection are largely dictated by the disease process the surgeon intends to treat. We will discuss patient selection, medical management, and the most common revascularization techniques, including transfemoral stenting, trans-carotid arterial revascularization using flow reversal, and stent-assisting coiling.

Results

It must be stressed that endovascular intervention is not an alternative to or preclusive of antithrombotic or anticoagulant therapy. In the setting of BCI, transfemoral CAS is most appropriate in patients who are symptomatic, have a rapidly progressing or large lesion, and do not have a soft thrombus present due to risk of embolism. Unlike transfemoral CAS, TCAR offers an elegant solution for embolic protection when patients have a soft thrombus present. In the case of a large pseudoaneurysm, we perform stent-assisted coiling.

Conclusions

We practice selective endovascular intervention, stenting lesions that are flow-limiting or have large or rapidly expanding pseudoaneurysms, and only in patients for whom anticoagulation and antiplatelet agents are not contraindicated. As technology and investigation progress, the concerns regarding the safety and the role of endovascular intervention in the treatment of BCI will be more clearly defined.
The Moderating Effect of Values on the Relationship between Subjective Social Status and Depression: Evidence from MIDUS
Authors: Ekl Emily A. , Gallati Benjamin
Published: July 2023

The relationship between subjective social status (SSS) and mental health and its underlying mechanisms remain an area of interest in the social sciences. Using data from the Midlife in the United States 2 (MIDUS 2), we examine how individual differences in valuing achievement and autonomy moderate the relationship between SSS and symptoms of depression. We find evidence of a moderation effect; there is a weaker relationship between SSS and depression for individuals who strongly hold the values of achievement or autonomy. In addition, at low levels of SSS, there are significant differences in the number of depression symptoms depending on personal values which are not seen at higher rungs of the SSS ladder, indicating a difference in this relationship dependent on how strongly one holds values of achievement and autonomy. We conclude by speculating on the mechanisms by which values shape the link between SSS and mental well-being and suggest future directions in studying values.
Effect of Prevention Focus on the Relationships Among Driving Accident History, Risk Perception, and Consumers’ Automobile Insurance Coverage Decisions
Authors: Jiang Shi-jie , Xiang Feiyun , Yang Iris
Published: July 2023

The primary aim of our research was to examine the moderating role of prevention focus (PRE) and the mediating role of risk perception (RP) on the relationship between driving accident history (DAH) and insurance coverage (IC) decisions to test this moderated mediation mechanism. We collected survey data from 808 newly eligible voluntary automobile liability insurance policyholders in Taiwan and analyzed the data using PROCESS macro. The estimated results showed that PRE moderated the indirect effect of DAH on IC through RP. In general, a worse DAH would increase the RP of people who were high prevention-focused, thereby increasing their willingness to purchase a higher IC. Conversely, a worse DAH would not increase the RP of people who were low prevention-focused, and such people would not increase or would even decrease their IC. The results provide an explanation for the inconsistent paths from DAH to IC in the literature. From a marketing perspective of psychographic segmentation, our research helps insurance companies to determine what types of consumers they should pay more attention to and to formulate marketing strategies.

JEL: D91 G52 E21
Independent Prognostic Factors and Nomogram Prediction of Cancer-Specific Survival in Postoperative Patients With Spinal Cord Astrocytoma
Authors: Wang Yang , Jiao Jianhang , Yu Tong , Wang Zhonghan , Jiang Weibo , Gong Xuqiang , Zhang Han , Yue Jing , Wu Minfei
Published: July 2023

Study Design

Retrospective cohort study.

Objective

Spinal cord astrocytoma (SCA) is a rare central nervous system malignancy that typically requires early surgical intervention. However, the substantial frequency of relapse and bad outcomes limit the surgical advantage for patients. Herein, we aimed to determine the independent prognostic factors of cancer-specific survival (CSS) in post-surgical patients with primary SCA and to develop a new method to estimate the chances of CSS in these patients at 3-, 5- and 10-year.

Methods

A total of 364 postoperative patients with SCA were recruited from the Surveillance, Epidemiology, and End Results database and randomly assigned to the training and validation sets. Univariate and multivariate Cox regression assessments were used to identify independent prognostic indicators. Second, a nomogram was established by integrating these indicators to estimate 3-, 5-, and 10-year CSS in patients with SCA who underwent surgery. Subsequently, the discriminatory power and predictive performance of the nomogram were assessed using the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis (DCA). Finally, a mortality risk stratification system was generated.

Results

Age, tumor stage, histological type, and radiotherapy were recognized as potential predictive indicators of CSS for postoperative patients with SCA. The ROC curve and DCA indicate that the nomogram has good accuracy and high clinical utility. Furthermore, the mortality risk stratification system efficiently divides patients into 3 risk subgroups.

Conclusions

The nomogram could accurately anticipate the 3-, 5-, and 10-year percentages of CSS in postoperative patients with SCA. It could assist clinicians with personalized medical counseling, risk stratification management, and clinical decision-making, improving the clinical outcomes of these patients.
Voice of the Customer: Factors Impacting Beneficiary Choice of Programs in TRICARE
Authors: Korona-Bailey Jessica , Janvrin Miranda Lynn , Juman Luke , Koehlmoos Tracey Perez
Published: July 2023

Little is known about how a consumer would choose a health plan if cost was not an option such as in the Military Health System. We sought to identify how to recruit TRICARE beneficiaries into new pilot programs challenged by low recruitment. We developed a semistructured interview guide by adapting a framework established by Klinkman to assess factors in choosing a health plan. Using social media platforms, we recruited TRICARE Prime and Select beneficiaries to participate in key informant interviews from October to December 2022. We conducted inductive thematic analysis to determine key areas of concern. We interviewed a total of 20 TRICARE Prime and Select beneficiaries. The majority were women, above age 40, had a master's degree, a sponsor in the US Army and of senior officer rank. Four overarching themes emerged: (I) patient choice; (II) access to care; (III) quality of care; and (IV) cost. This evaluation of TRICARE beneficiaries explores how to motivate high-quality value-based care in a traditionally fee for service system.
Conspiratorial Ideation Is Associated with Lower Perceptions of Policy Effectiveness: Views from Local Governments during the COVID-19 Pandemic
Authors: Mayer Adam , Ryder Stacia
Published: July 2023

Governments around the world struggled to formulate an effective response to the coronavirus disease 2019 pandemic, which was hampered by the widespread diffusion of various conspiracy theories about the virus. Local governments are often responsible for the implementing mitigation measures such as mask mandates and curfews but have received very limited attention in the scholarly literature. In this article, the authors use data from local policy actors in Colorado to evaluate the relationship between conspiratorial beliefs and perceptions of mitigation policy effectiveness. The authors find that many local policy actors hold conspiratorial beliefs, which combine with partisanship to contribute to lower perceptions of policy effectiveness. The authors conclude by discussing future research directions, noting that the broad adoption of conspiracy theories likely changes enforcement at the local scale.
Structured Engagement of Community Partners to Revise a Pregnancy Options Counseling Curriculum for Pediatric Residents
Authors: Kirkpatrick Laura , Goldman Paula , Bell Lauren Arnold , Tyler Crystal Pirtle , Harrison Elizabeth , Russell Margaret , Syed Tahniat , Szoko Nicholas , Kazmerski Traci M
Published: July 2023

OBJECTIVE

The engagement of community partners, including patients, is increasingly recognized as important in developing medical education curricula. Structured methodology for partner engagement in curriculum development is lacking in the existing literature. This article describes a structured approach to engaging community partners to provide input on revising a curriculum for pediatric residents about pregnancy options counseling with adolescents.

METHODS

We used the five-step Method for Program Adaptation through Community Engagement: (1) development of a panel of community partners including patients and professionals, (2) and (3) partner evaluation of the existing curriculum and recommendations for revisions, (4) summarization of partner feedback, and (5) development of the revised curriculum. We surveyed partners about their perceived impact on the revision and satisfaction with the process.

RESULTS

Seventeen partners participated. Five experienced adolescent pregnancy, while the remaining 12 included healthcare and social service professionals. All partners provided multiple recommendations, generating 124 discrete recommendations. Twenty recommendations were suggested by multiple individuals. The authors reviewed all recommendations by category during consensus meetings and determined which recommendations would be incorporated into the revised curriculum to meet stated learning objectives. We implemented 14 of these 20 recommendations, including adding a values clarification exercise, information about mental health crisis resources, and more detail about adoption. We also incorporated 15 individual recommendations pertaining to curriculum clarity. Recommendations from professionals and patients were similar. Fourteen out of 17 participants completed the survey at the close of the project. All respondents understood their roles, were satisfied with their degree of engagement, and felt that their expectations for participation were met or exceeded.

CONCLUSIONS

This study describes a methodology for a formal process to engage community partners in curriculum development and revision processes. Such methodology can ensure that medical education curricula are optimally attuned to the needs of key community members and integrate the patient’s voice.
Book review: Shrayana Bhattacharya, Desperately Seeking Shah Rukh: India’s Lonely Young Women and the Search for Intimacy and Independence
Authors: Varma Promodini
Published: July 2023

Shrayana Bhattacharya, Desperately Seeking Shah Rukh: India’s Lonely Young Women and the Search for Intimacy and Independence (Harper Collins, 2021), 445 pp., ₹699 (Paperback). ISBN: 978-93- 5489-193-9.
Book review: Sushmita Pati, Properties of Rent: Community, Capital and Politics in Globalising Delhi
Authors: Vanaik Anish
Published: July 2023

Sushmita Pati, Properties of Rent: Community, Capital and Politics in Globalising Delhi (Cambridge: Cambridge University Press, 2022), ISBN: 978-1-316-51727-7 (Price not known).
Book review: Camelia Dewan, Misreading the Bengal Delta: Climate Change, Development, and Livelihoods in Coastal Bangladesh
Authors: Bhargava Radhika
Published: July 2023

Camelia Dewan, Misreading the Bengal Delta: Climate Change, Development, and Livelihoods in Coastal Bangladesh. Seattle: University of Washington Press, 2022, 245 pp., US$30 (paperback), ISBN: 9780295749617.
The heterogeneous politics of infrastructure: Claims of authority in Accra’s drainage
Authors: Foli Afra
Published: July 2023

In many parts of the world, the modernist ideal of centralised and networked infrastructure provided by the state remains just that – an ideal. Instead, the reality is a patchwork of infrastructural solutions engineered by both state and private actors. While critical studies have highlighted how states use infrastructure projects to legitimize their authority, how do infrastructure projects shape relations between the state and urban residents when the state is not the sole actor in building and maintaining infrastructure? Drawing on scholarship on the socio-material dynamics of infrastructure, this article examines infrastructure’s politics in Accra’s drainage system. Studying these material interventions shows that drainage is politicised with state actors, aspiring politicians, and urban residents advancing and evaluating performances of authority in relation to this infrastructure. This politicization of drainage infrastructure reproduces patterns of urban socio-economic inequality. As residents experience the consequences of each other’s actions, they recognize the need for a centralised approach to tackle drainage problems and express a desire for the state to assume responsibility. Although ‘heterogeneous infrastructure configurations’ more accurately captures the reality on the ground in rapidly growing cities such as Accra, this analysis of everyday infrastructural politics helps explain why expectations of centrally organized drainage infrastructure persist.
Reference equations for quadriceps strength, endurance and power: a multicentre study
Authors: Tanguay Sophie , Saey Didier , Marklund Sarah , Nyberg Andre , Gephine Sarah , Frykholm Erik , De Brandt Jana , Burtin Chris , Maltais François
Published: July 2023

Introduction

The lack of reference values of lower-limb muscle function hinders the clinical recommendations of its measurement in patients with COPD. Therefore, this study aimed to develop reference equations to predict reference values for quadriceps strength, endurance and power and evaluate their construct validity in patients with COPD.

Methods

Quadriceps strength, endurance and power were assessed in 158 healthy individuals and 87 patients with COPD. In addition, patients with COPD performed a 6-min walk test (6MWT) and a 1-min sit-to-stand test (1STS). Multiple linear regressions were performed to develop reference equations. The proportion of patients with COPD with reduced quadriceps function was determined, and correlations between quadriceps strength, endurance and power expressed in percentage of predicted values and 6MWT and 1STS performance were used to document the construct validity of the reference equation.

Results

Except for quadriceps isometric endurance, the proposed reference equations explained 50–70% of the variance of the quadriceps properties in healthy individuals. All quadriceps properties were systematically reduced in a large proportion of patients with COPD compared to healthy individuals. Correlation coefficients between quadriceps properties expressed in percentage of predicted values and 6MWT and 1STS performance ranged between 0.28 and 0.49 (all p<0.05).

Conclusion

In healthy individuals, age, sex, height and body mass index explained 50–70% of the variance of quadriceps strength, endurance and power. When expressed in percentage of predicted values, these quadriceps properties correlated with 6MWT and 1STS performance, suggesting construct validity of the reference values in patients with COPD.
Oral corticosteroid use and sarcopenia-related traits in older people with chronic airway disease: a population-based study
Authors: Benz Elizabeth , Lahousse Lies , Arinze Johnmary T. , Wijnant Sara , de Ridder Maria , Rivadeneira Fernando , Brusselle Guy , Stricker Bruno H.
Published: July 2023

Background

Sarcopenia is characterised by two major phenotypic components: low handgrip strength (HGS) and appendicular skeletal muscle index (ASMI). Oral corticosteroid (OCS) use is an important medication for acute respiratory exacerbations in patients with COPD and asthma. However, the association of OCS and sarcopenia components in older people is largely unexplored. The aim of this study was to examine the association between OCS use and HGS or ASMI in the general population and explore interactions with chronic airway diseases.

Methods

From the population-based Rotterdam Study, 5054 participants (age 69.0±8.8 years; 56% females) were included in the cross-sectional analysis and 1324 in the longitudinal analysis. Associations between OCS and muscle strength and mass were analysed using linear regression models adjusted for age, sex, fat %, height, kidney function, smoking and comorbidities.

Results

At baseline, ever-OCS users had lower handgrip strength (β= −0.48, 95% CI −0.84– −0.12) than never-OCS users, with cumulative frequency (≥10 OCS prescriptions)-dependent effects (β= −1.25, 95% CI −2.16– −0.33). COPD ever-OCS users, but not asthma, had lower handgrip strength (β= −0.98, 95% CI −1.91– −0.06) and lower lean mass (β= −0.14, 95% CI −0.27– −0.01) than never-OCS users. After 5.6 years of follow-up in those free of sarcopenia traits at baseline, COPD ever-OCS users developed lower handgrip strength (β= −1.64, 95% CI −2.87– −0.40) with frequency (β= −3.64, 95% CI −6.57– −0.72) and duration (β= −1.51, 95% CI −2.87– −0.15) association compared to never-OCS users.

Conclusions

OCS use is associated with a decline in handgrip strength in people with COPD in a cumulative frequency and duration-dependent manner. Routine muscle examination may be necessary for patients with COPD.
Comparative proteomics analysis in different stages of urothelial bladder cancer for identification of potential biomarkers: highlighted role for antioxidant activity
Authors: Tabaei Samira , Haghshenas Mohammad Reza , Ariafar Ali , Gilany Kambiz , Stensballe Allan , Farjadian Shirin , Ghaderi Abbas
Published: July 2023

Background

Non-muscle-invasive bladder cancer (NMIBC) has a high recurrence rate and muscle-invasive bladder cancer (MIBC) has unfavorable outcomes in urothelial bladder cancer (UBC) patients. Complex UBC-related protein biomarkers for outcome prediction may provide a more efficient management approach with an improved clinical outcome. The aim of this study is to recognize tumor-associated proteins, which are differentially expressed in different stages of UBC patients compared non-cancerous tissues.

Methods

The proteome of tissue samples of 42 UBC patients (NMIBC n = 25 and MIBC n = 17) was subjected to two-dimensional electrophoresis (2-DE) combined with Liquid chromatography–mass spectrometry (LC–MS) system to identify differentially expressed proteins. The intensity of protein spots was quantified and compared with Prodigy SameSpots software. Functional, pathway, and interaction analyses of identified proteins were performed using geneontology (GO), PANTHER, Reactome, Gene MANIA, and STRING databases.

Results

Twelve proteins identified by LC-MS showed differential expression (over 1.5-fold, p < 0.05) by LC-MS, including 9 up-regulated in NMIBC and 3 up-regulated in MIBC patients. Proteins involved in the detoxification of reactive oxygen species and cellular responses to oxidative stress showed the most significant changes in UBC patients. Additionally, the most potential functions related to these detected proteins were associated with peroxidase, oxidoreductase, and antioxidant activity.

Conclusion

We identified several alterations in protein expression involved in canonical pathways which were correlated with the clinical outcomes suggested might be useful as promising biomarkers for early detection, monitoring, and prognosis of UBC.
The impact of fast food marketing on brand preferences and fast food intake of youth aged 10–17 across six countries
Authors: Bagnato Mariangela , Roy-Gagnon Marie-Hélène , Vanderlee Lana , White Christine , Hammond David , Potvin Kent Monique
Published: July 2023

Background

Consumption of fast food, which is associated with poor diet, weight gain and the development of noncommunicable diseases, is high amongst youth. Fast food marketing, a modifiable determinant of excess weight and obesity, affects youth’s food-related behaviours. This study aimed to examine the relationship between exposure to fast food marketing and the fast food brand preferences and intake amongst youth aged 10–17 across six countries.

Methods

Data from 9,695 youth respondents living in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) were analyzed from the 2019 International Food Policy Study (IFPS) Youth Survey. Survey measures assessed exposure to fast food marketing and brand-specific marketing, and preference for these brands and fast food intake. Regression models adjusted for age, sex, income adequacy and ethnicity were used to examine the associations.

Results

Exposure to fast food marketing was positively associated with brand preferences and intake consistently across most countries. Overall, preference for McDonald’s (OR:1.97; 95% CI:1.52, 2.56), KFC (OR:1.61; 95% CI:1.24, 2.09) and Subway (OR:1.73; 95% CI:1.34, 2.24) were highest when exposed to general fast food marketing ≥ 2x/week compared to never. Preference for McDonald’s (OR:2.32; 95% CI:1.92, 2.79), KFC (OR:2.28; 95% CI:1.95, 2.68) and Subway (OR:2.75; 95% CI:2.32, 3.27) were also higher when exposed to marketing for each brand compared to not. Fast food intake was highest in Chile (IRR:1.90; 95% CI:1.45, 2.48), the UK (IRR:1.40; 95% CI:1.20, 1.63), Canada (IRR:1.32; 95% CI:1.19, 1.48), Mexico (IRR:1.26; 95% CI:1.05, 1.53) and the US (IRR:1.21; 95% CI:1.05, 1.41) when exposed to general fast food marketing ≥ 2x/week compared to never and was higher across most countries when exposed to brand-specific marketing compared to not. Respondents classified as ethnic minorities were more likely to report consuming fast food than ethnic majorities, and females were less likely to report consuming fast food than males.

Conclusions

Exposure to fast food marketing is consistently and positively associated with brand preferences and fast food intake in all six countries. Our results highlight the need for strict government regulation to reduce exposure of unhealthy food marketing to youth in all six countries.
A cluster randomized trial of a comprehensive intervention nesting family and clinic into school centered implementation to reduce myopia and obesity among children and adolescents in Beijing, China: study protocol
Authors: Wang Xinxin , Dang Jiajia , Liu Jieyu , Liu Yunfei , Wang Yaqi , Shi Di , Chen Ziyue , Yuan Wen , Cai Shan , Mi Jie , Xiao Pei , Li Li , Fan Yunwei , Gao Aiyu , Chen Haihua , Zhuang Lili , Yu Zhaocang , Li Jianhui , Yang Dongmei , Yang Gang , Guo Lipo , Li Yuanyuan , Song Jieyun , Li Jing , Ma Jun , Dong Yanhui , Song Yi
Published: July 2023

Background

Myopia and obesity in children and adolescents have become serious public health problems that endanger public health, especially in China. Unhealthy lifestyle behaviors are environmental drivers of both myopia and obesity. This protocol describes a study to evaluate the effectiveness of “22510SS”, that is 2 h of daytime outdoor activities (‘2’); Limit screen time to no more than 2 h per day (‘2’); Consume at least 5 servings of fruits and vegetables daily (‘5’); Attain 1 h of physical activity daily (‘1’); Consume 0 sugar-sweetened beverages (‘0’); Reasonable sleep duration (‘S’); Regular supervision (‘S’). A school-based, multifaceted intervention strategy for myopia and obesity prevention, and to assess and explore the implementation of “22510SS” with regards to acceptability, feasibility, adoption, usage and maintenance.

Methods and analysis

This study aims to develop a comprehensive intervention strategy "22510SS" based on the socio-ecological model, and A two-arm cluster randomized trial with a parallel-group of a 1:1 allocation ratio in 36 primary and secondary schools to test its evidence-based intervention programs on the effects and implementation of myopia and obesity epidemics in children and adolescents in grades 4 and 7. The primary outcomes will include differences in visual acuity, body mass index, outdoor activity indicators, screen time, fruit and vegetable intake, high-quality protein intake, sugar-sweetened beverage intake, sleep duration, and level of monitoring among children and adolescents. Secondary outcomes will assess the acceptability, feasibility, uptake, use, and maintenance of the intervention. Effects on the primary and secondary outcomes will be analyzed using linear and logistic regression analyses, as well as difference-in-difference analysis, taking into account cluster effects and possible confounding factors. Process assessments will also be conducted through quantitative and qualitative analyses, including acceptability, feasibility, gender, adoption, implementation, and sustainability.

Discussion

This study will evaluate the effectiveness of “22510SS” and examine its implementation in the school-based network nesting family and clinic. Following this intervention study, the integrated intervention program focused on myopia and obesity among children and adolescents have great potential to be implemented in China to promote and support healthy lifestyle behavior change and reduce the risk of myopia and obesity in children and adolescents.

Trial registration

NCT05275959. Registered 23 Mach 2022.
The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study
Authors: Burrell Lisa Victoria , Rostad Hanne Marie , Wentzel-Larsen Tore , Skinner Marianne Sundlisæter , Sogstad Maren Kristine Raknes
Published: July 2023

Background

Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality.

Methods

This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions.

Results

In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities’ structural characteristics and care service models were weak.

Conclusions

The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.
Dissociated response to PD-1 inhibitors combined with radiotherapy in patients with advanced metastatic solid tumors: a single-center experience
Authors: Yu Qin , Zhang Haiyan , Song Yan , Chen Chen , Chen Jin , Shen Junkang
Published: July 2023

Background

Anti-programmed death 1/anti-programmed death ligand 1 (PD-1/PD-L1) combined with radiotherapy (RT) has a synergistic effect on systemic tumor control. A dissociated response (DR), characterized by some lesions shrinking and others growing, has been recognized with immune checkpoint inhibitor (ICI) monotherapy or combination therapy. The objective of this study was to assess the frequency and clinical benefit of DR in patients with advanced metastatic solid tumors receiving PD-1 inhibitors in combination with RT.

Methods

We conducted a single-center retrospective analysis of patients with advanced metastatic solid tumors receiving PD-1 inhibitor combined with RT at the Department of Radiotherapy & Oncology, The Second People’s Hospital Affiliated with Soochow University. Treatment response was assessed for each measurable lesion according to the Response Evaluation Criteria in Solid Tumours ( RECIST) v 1.1 guidelines. Patterns of response are divided into four groups: (1) DR, (2) uniform response, (3) uniform progression, and (4) only stable lesions. The overall survival (OS) of different groups was compared using Kaplan–Meier methods and log-rank tests.

Results

Between March 2019 and July 2022, 93 patients were included. The median follow-up was 10.5 months (95% CI 8.8–12.1). The most common tumor types were lung cancer (19.8%), colorectal adenocarcinoma (17.2%), and esophageal cancer (10.8%). DR was observed in 22 (23.7%) patients. The uniform progression and DR are two different patterns of progression. After confirming progression, the overall survival of patients with DR was significantly longer than that of patients with uniform progression (9.9 months (95%CI 5.7-14.1) vs. 4.2 months (95%CI 1.9-6.5), P = 0.028). Compared with DR patients who did not continue PD-1 inhibitor combined with RT or PD-1 inhibitor monotherapy (n = 12), DR patients who continued treatment (n = 10) had significantly longer OS (15.7 (95%CI 3.5-27.9) vs 8.2 (95%CI 5.6-10.8) months, P = 0.035).

Conclusions

DR is not uncommon (23.7%) in patients with advanced metastatic solid tumors treated with PD-1 inhibitors combined with RT and shows a relatively favorable prognosis. Some patients with DR may benefit from continued PD-1 inhibitor therapy in combination with RT or PD-1 inhibitor monotherapy and may have longer OS.
Factors associated with poor mental health during mandatory home work: a cross-sectional study in university staff
Authors: Kiss Philippe , De Meester Marc , Vingerhoets Ilse , Garmyn Bart , Raemdonck Annemie
Published: July 2023

Background

During the first wave of the Covid-19 pandemic in 2020, a total lockdown of universities was implemented by the government in Belgium. University staff was required to work at home. The purpose of the study was to identify factors associated with poor mental health in university staff during mandatory home work.

Methods

Mental well-being of 702 university employees was assessed by need for recovery after work and presence of burnout symptoms. Following factors were considered: personal factors (gender, age), professional status, specific home work environment factors (quiet place to work, taking care of ill or old people, number of children < 12yrs. at home, family member at risk for Covid-19), work-private life balance and worries about long- and short-term work situation. Multivariable logistic regression analyses were used to calculate the odds ratios for the presence a high need for recovery and burnout symptoms.

Results

The presence of a high need for recovery and the presence of burnout symptoms were significantly associated with poor work-private life balance (OR 5.14 and 2.80, respectively), no quiet place to work (OR 3.23 and 2.00, respectively) and being worried about long-term work situation (OR’s increasing with increasing degree of worries). Being able to discuss the worries with the supervisor was only significant with a decreased risk of burnout symptoms for the lowest level of discussability with the supervisor. Following factors were not associated with both mental health outcomes: professional status, being worried about short-term work situation, taking care of ill or old people, number of children < 12yrs. at home and having a family member at risk for Covid-19.

Conclusions

When working at home special attention should be paid to work-private life balance and the presence of a quiet place to work. Additionally, in the case of mandatory home work in university personnel, specific worries about long-term work situation should be tackled. Universities and/or governments should provide measures to ensure an extension of research deadlines and, if applicable, job security.
Effectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial
Authors: Chang Andrew Y. , Rahman Mushfiqur , Talukder Animesh , Shah Humyra , Mridha Malay Kanti , Hasan Mehedi , Sarker Malabika , Geldsetzer Pascal
Published: July 2023

Background

High blood pressure is a major public health problem in low- and middle-income countries. Low-sodium salt substitute (LSSS) is a promising population-level blood pressure-lowering intervention requiring minimal behavioral change. The optimal method of delivering LSSS to individuals, however, is currently unknown. Community health workers (CHWs) have successfully been used to implement health interventions in Bangladesh and may provide a venue for the dissemination of LSSS.

Methods

We aim to conduct a cluster-randomized controlled trial involving 309 households in rural Bangladesh previously identified and characterized by the BRAC James P Grant School of Public Health, BRAC University (BRAC JPGSPH). These households will be randomly assigned to three arms: (1) control, i.e., no intervention; (2) information only, i.e., community health workers will provide basic information on high blood pressure, the health consequences of excessive salt consumption, and feedback to the participant on the likely quantity of salt s/he consumes (estimated using a questionnaire); (3) free LSSS arm: the same information as in arm 2 will be provided, but participants will receive 6 months of free low-sodium salt along with education on the benefits of LSSS. One male and one female adult (age ≥ 18 years) in each household will be invited to participate, the exclusion criteria being households with members known to have high serum potassium levels, are taking medications known to elevate potassium levels (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics), are already taking potassium supplements, or those who have known kidney disease or abnormal serum creatinine at baseline. The primary endpoint will be blood pressure at 6 months post-intervention.

Discussion

Recent large clinical trials of LSSS in China and India have shown not only blood pressure improvements, but also stroke, major cardiac event, and all-cause mortality reductions. Nevertheless, how to best translate this intervention to population-level effectiveness remains unclear. Our study would test whether a community health worker-based program could be effectively used to disseminate LSSS and achieve measurable blood pressure benefits.

Trial registration

ClinicalTrials.gov NCT05425030. Registered on June 21, 2022.
Synthesis of phthalazine-based derivatives as selective anti-breast cancer agents through EGFR-mediated apoptosis: in vitro and in silico studies
Authors: Emam Sara M. , Rayes Samir M. El , Ali Ibrahim A. I. , Soliman Hamdy A. , Nafie Mohamed S.
Published: July 2023

The parent 2-(4-benzyl-1-oxophthalazin-2(1H)-yl)-acetohydrazide (4) has twenty-nine compounds. The starting material for their corresponding mono, dipeptides and reactions with active methylene compounds were produced by chemoselective N-alkylation of 4-Benzyl-2H-phthalazin-1-one (2) with ethyl chloroacetate to afford (4-benzyl-1-oxo-1H-phthalazin-2-yl) methyl acetate (3). The ester 3 was hydrazinolyzed to give hydrazide 4, then azide 5 coupled with amino acid ester hydrochloride and/or amines to produce several monopeptides, then the methyl (2-(4-benzyl-1-oxophthalazin-2(1H)-yl) acetyl) glycinate (7a) was hydrazinolyzed to produce corresponding hydrazide 2-(4-benzyl-1-oxophthalazin-2(1H)-yl)-N-(2-hydrazineyl-2-oxo ethyl) acetamide (8a). The hydrazide 8a under azide coupling method was coupled with amino acid ester hydrochloride and/or amines to produce several dipeptides, and the hydrazide 8a was also condensed and/or cyclized with several carbonyl compounds. The cytotoxicity of the synthesized compounds was tested using MTT assay, as well as apoptosis-induction through EGFR inhibition. Compounds 11d, 12c and 12d exhibited potent cytotoxic activities with IC50 values of 0.92, 1.89 and 0.57 μM against MDA-MB-231 cells compared to Erlotinib (IC50 = 1.02 μM). Interestingly compound 12d exhibited promising potent EGFR inhibition with an IC50 value 21.4 nM compared to Erlotinib (IC50 = 80 nM). For apoptosis, compound 12d induced apoptosis in MDA-MB-231 cells by 64.4-fold (42.5% compared to 0.66 for the control); hence, this compound may serve as a potential target-oriented anti-breast cancer agent. These results agreed with the molecular docking studies that highlighted the binding disposition of compound 12d towards EGFR protein. Hence, compound 12d may serve as a potential and selective anti-breast cancer agent.
Adjusted green spectrophotometric determination of favipiravir and remdesivir in pharmaceutical form and spiked human plasma sample using different chemometric supported models
Authors: Imam Mohamed S. , Abdelazim Ahmed H. , Ramzy Sherif , Batubara Afnan S. , Gamal Mohammed , Abdelhafiz Safwan , Zeid Abdallah M.
Published: July 2023

The environmentally friendly design of analytical methods is gaining interest in pharmaceutical analysis to reduce hazardous environmental impacts and improve safety and health conditions for analysts. The adaptation and integration of chemometrics in the development of environmentally friendly analytical methods is strongly recommended in the hope of promising benefits. Favipiravir and remdesivir have been included in the COVID-19 treatment guidelines panel of several countries. The main objective of this work is to develop green, tuned spectrophotometric methods based on chemometric based models for the determination of favipiravir and remdesivir in spiked human plasma. The UV absorption spectra of favipiravir and remdesivir has shown overlap to some extent, making simultaneous determination difficult. Three advanced chemometric models, classical least squares, principal component regression, and partial least squares, have been developed to provide resolution and spectrophotometric determination of the drugs under study. A five-level, two-factor experimental design has been used to create the described models. The spectrally recorded data of favipiravir and remdesivir has been reviewed. The noise region has been neglected as it has a negative impact on the significant data. On the other hand, the other spectral data provided relevant information about the investigated drugs. A comprehensive evaluation and interpretation of the results of the described models and a statistical comparison with accepted values have been considered. The proposed models have been successfully applied to the spectrophotometric determination of favipiravir and remdesivir in pharmaceutical form spiked human plasma. In addition, the environmental friendliness of the described models was evaluated using the analytical eco-scale, the green analytical procedure index and the AGREE evaluation method. The results showed the compliance of the described models with the environmental characteristics.
Development of a robust induced pluripotent stem cell atrial cardiomyocyte differentiation protocol to model atrial arrhythmia
Authors: Thorpe Jordan , Perry Matthew D. , Contreras Osvaldo , Hurley Emily , Parker George , Harvey Richard P. , Hill Adam P. , Vandenberg Jamie I.
Published: July 2023

Background

Atrial fibrillation is the most common arrhythmia syndrome and causes significant morbidity and mortality. Current therapeutics, however, have limited efficacy. Notably, many therapeutics shown to be efficacious in animal models have not proved effective in humans. Thus, there is a need for a drug screening platform based on human tissue. The aim of this study was to develop a robust protocol for generating atrial cardiomyocytes from human-induced pluripotent stem cells.

Methods

A novel protocol for atrial differentiation, with optimized timing of retinoic acid during mesoderm formation, was compared to two previously published methods. Each differentiation method was assessed for successful formation of a contractile syncytium, electrical properties assayed by optical action potential recordings and multi-electrode array electrophysiology, and response to the G-protein-gated potassium channel activator, carbamylcholine. Atrial myocyte monolayers, derived using the new differentiation protocol, were further assessed for cardiomyocyte purity, gene expression, and the ability to form arrhythmic rotors in response to burst pacing.

Results

Application of retinoic acid at day 1 of mesoderm formation resulted in a robust differentiation of atrial myocytes with contractile syncytium forming in 16/18 differentiations across two cell lines. Atrial-like myocytes produced have shortened action potentials and field potentials, when compared to standard application of retinoic acid at the cardiac mesoderm stage. Day 1 retinoic acid produced atrial cardiomyocytes are also carbamylcholine sensitive, indicative of active Ikach currents, which was distinct from ventricular myocytes and standard retinoic addition in matched differentiations. A current protocol utilizing reduced Activin A and BMP4 can produce atrial cardiomyocytes with equivalent functionality but with reduced robustness of differentiation; only 8/17 differentiations produced a contractile syncytium. The day 1 retinoic acid protocol was successfully applied to 6 iPSC lines (3 male and 3 female) without additional optimization or modification. Atrial myocytes produced could also generate syncytia with rapid conduction velocities, > 40 cm s−1, and form rotor style arrhythmia in response to burst pacing.

Conclusions

This method combines an enhanced atrial-like phenotype with robustness of differentiation, which will facilitate further research in human atrial arrhythmia and myopathies, while being economically viable for larger anti-arrhythmic drug screens.
Insights from a randomized controlled trial of flipped classroom on academic achievement: the challenge of student resistance
Authors: Buhl-Wiggers Julie , la Cour Lisbeth , Kjærgaard Annemette Leonhardt
Published: July 2023

Flipped classroom has been found to positively influence student achievement but the magnitude of the effect varies greatly according to discipline and local design, and few studies have been methodologically rigorous enough to establish causal evidence. Using a randomized controlled trial, this study addresses a gap in current knowledge by exploring how student responses mediate the impact of flipped classroom on academic achievement. The empirical setting is a first-year undergraduate macroeconomics course with 415 students. Comparing students in the treatment group with those in a traditional class, we find a positive, yet statistically insignificant effect on academic achievement. However, this overall effect masks important mediating effects, as students were unexpectedly reluctant to actively participate in the flipped classroom intervention. Consequently, the intervention has a substantially greater effect on academic achievement when controlling for the mediating effect of student participation which leads to consideration of the challenges of student resistance to flipped classroom.