bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Recovery After Stroke: Memory
Authors: O’Sullivan Michael J. , Li Xuqian , Galligan Dana , Pendlebury Sarah T.
Published: December 2022

Memory impairment occurs in over a third of patients after symptomatic stroke. Memory deficits rarely occur in isolation but are an important component of the poststroke cognitive syndrome because of the strong relationship with the risk of poststroke dementia. In this review, we summarize available data on impairment of episodic memory, with a particular emphasis on the natural history of memory impairment after stroke and the factors influencing trajectory informed by an updated systematic review. We next discuss the pathophysiology of memory impairment and mechanisms of both decline and recovery of function. We then turn to the practical issue of measurement of memory deficits after stroke, emerging biomarkers, and therapeutic approaches. Our review identifies critical gaps, particularly in studies of the natural history that properly map the long-term trajectory of memory and the associations with factors that modulate prognosis. Few studies have used advanced neuroimaging and this, in conjunction with other biomarker approaches, has the potential to provide a much richer understanding of the mechanisms at play and promising therapeutic avenues.
TURKISH ECONOMY IN THE BELT ROAD INITIATIVE: A GRAVITY MODEL FOR INTERNATIONAL TRADE
Authors: YILMAZ Alper
Published: December 2022

In this paper, we attempt to analyze the determinants of international trade flows between Turkey and countries in the One Belt One Road (OBOR) project and their implications for the Turkish economy through the estimation of panel data using a gravity model. In particular, we employ the Poisson Pseudo Maximum Likelihood (PPML) estimation procedure for the nine OBOR nations from the period 2000-2021. This estimator is more robust than other methods such as pooled, fixed, and random models and it is free from the problems of autocorrelation, asymptotic bias, multicollinearity, and heteroscedasticty in the residuals for estimation and inference. First, panel unit root tests show that conducted variables are stationary at the conventional level. Second, the gravity estimations revealed that remoteness, scale, land endowment variables and, dummies (Preferential Trade Agreement and Border) in the gravity model have a positive impact, while GDP Distance and Capital Endowment have an inverse effect on trade flows. Only the language dummy is statistically insignificant. For policy purposes, we concluded that it would be better to promote trade flows with the OBOR countries.
RE-EXAMINATION OF THE SUPPLY LEADING HYPOTHESIS FOR TURKEY: A DISAGGREGATED ANALYSIS
Authors: GÖRÜŞ Muhammed Şehid
Published: December 2022

In this investigation, the causal link among financial development and economic activity is explored to determine whether the supply leading hypothesis (SLH) or the demand following hypothesis (DFH) is valid for the Turkish economy. For this aim, the study employs the Fourier Toda-Yamamoto causality test of Nazlioglu, Gormus, and Soytas (2016) by utilizing annual data covering 1980-2020. To proxy financial development, the Financial Development Index (FDi) of IMF and its eight sub-indices are chosen. The findings of this work show that the FDi Granger causes per capita income in Turkey. Therefore, one can say that the SLH holds for the Turkish economy at the aggregate level. The disaggregated level of data differs across sub-indices. The empirical findings of the paper provide significant policy implications for the economic agents.
ANALYSIS OF CONTROL ACTIVITIES IN PURCHASING PROCESS OF HOTEL OPERATIONS: THE CASE OF SAPANCA
Authors: USTA Sevim , ŞENGÜL Serkan
Published: December 2022

Changes in consumer demands and increasing competition among hotel businesses necessitate the purchasing control process in terms of the quality of the service provided. It is critical to manage the purchasing control process at the point of correctly determining the product needs of the enterprises, determining the quality products, performing daily warehouse controls, performing the performance controls of the purchasing department, and evaluating the complaints received. Successful management of the purchasing control process and minimizing the risks they may encounter will contribute to their differentiation from their competitors in the market. In this study, it is aimed to examine the control activities carried out by hotel enterprises in the purchasing processes. This study is thought to be important in terms of including the control activities in the purchasing process in hotel businesses, as well as the relations with other departments and the evaluation of incoming complaints. A semi-structured interview form has been used to gather data in the study, in which the qualitative research method has been used, As a result of the data obtained, it has been revealed that a material demand list is created in line with the department needs by making end-of-day warehouse controls in the hotel enterprises, strong communication frequency is maintained by ensuring firm stability with reliable suppliers, and attention is paid to interdepartmental coordination and communication with a solution-oriented approach to the complaints.
The Homogenization of Urban Climate Action Discourses
Authors: Westman Linda , Castán Broto Vanesa , Huang Ping
Published: December 2022

The diversification of actors in global climate governance may entail risks, but it is also linked to enhanced democratic performance and opportunities for innovation. To what extent has this diversification fostered a parallel multiplication of perspectives in urban climate policy? To answer this question, we analyze the evolution of urban narratives based on 463 international policy documents issued between 1946 and 2020. Our analysis shows that, instead of leading to diversification, the proliferation of actors is accompanied by a growing homogenization of urban narratives. Language appears to become progressively uniform across organizations and over time, with approaches emphasizing multi-actor governance, integrated planning, and co-benefits becoming dominant. Three factors explain this homogenization. First, actors with a long history of involvement in international development exert a significant amount of influence. Second, there is a tendency toward language harmonization in international policy. Third, urban climate narratives stabilize through association with broader policy paradigms. In conclusion, the diversification of actors in international climate policy is mediated by processes of narrative alignment, which foreclose possibilities for divergent thinking.
Local Allergen-Specific IgE Production in Turbinate Tissue of Pediatric Patients
Authors: Bliss Alessandra , Sheehan Cameron , Erwin Elizabeth , Jatana Kris , Elmaraghy Charles A.
Published: December 2022

Objectives:

The objective of this study is to compare serum allergen-specific IgE to IgE levels in nasal tissue taken from the inferior turbinates of pediatric patients undergoing turbinate reduction.

Methods:

Twenty-six pediatric patients were recruited at the time of turbinate reduction surgery. At the time of recruitment, parents of patients completed the validated 22 item Sinonasal Outcome Test (SNOT-22) to describe symptoms prior to surgery. A sample of turbinate tissue was taken during turbinate reduction and blood was collected. Tissue and serum IgE were measured and differences in the group characteristics were evaluated using Chi-square tests for binary variables and Wilcoxon-Mann-Whitney tests for continuous variables. Student’s t test was used to assess differences in means of total SNOT-22 scoring between the groups, and Wilcoxon-Mann-Whitney tests were used again for the rest of the SNOT-22 analysis.

Results:

Levels of IgE in the serum were compared to levels in the turbinate tissue from all patients for each individual allergen. Every allergen except Alternaria displayed significant correlation between the serum and turbinate IgE levels. Additionally, each allergen except Alternaria and oak tree resulted in a strong correlation ( r > .7) based on the correlation coefficients. Levels of Alternaria were found to be poorly correlative between serum and turbinate tissue, and significance was not achieved ( r = −.346, P = .11).

Conclusion:

Certain allergen-specific IgE antibodies in the nasal mucosa seem to be highly associated with those in the serum, based upon the significant correlations we found between the two.
Equity, Public Health Messaging, and Traditional Māori Knowledge: The Te Ranga Tupua COVID-19 Response
Authors: Devine Tom , Allport (Te Āti Awa) Tanya , Walsh-Tapiata (Te Āti Haunui-a-Pāpārangi Ngā Rauru, Ngāti Ra Wheturangi , Boulton (Ngāti Ranginui, Ngai Te Rangi, Ngāti Pukenga, Ngāti Amohia
Published: December 2022

Throughout the coronavirus disease 2019 (COVID-19) pandemic, the Māori, Indigenous people of New Zealand, public health response has been guided by the collaborative and relationship-centered principles of te ao Māori, the Māori world. This article presents the communications response to COVID-19 by Iwi, tribes, within Te Ranga Tupua (TRT), a collective of Iwi from the South Taranaki/Whanganui/Rangitīkei/Ruapehu regions of Aotearoa, New Zealand. This research uses a qualitative design based on a Kaupapa Māori approach. The research presented here focuses on the intersect between COVID-19-related public health messaging, and the application of Māori knowledge and worldviews to establish equitable protection for Māori. By prioritizing equity, self-determination, and adopting a holistic approach to well-being, TRT have been able to re-frame public health messaging in accordance with our tikanga, customs, and notions of Māori public health. We provide a snapshot of how a unique tribal collective deployed its resource to provide culturally appropriate information and communication responses to the first wave of COVID-19 in 2020, and then built on this knowledge and experience providing a modified and more strategic response to the pandemic in 2021.
An Assessment of Response to Conversation Cues of Uninterest Conducted via Telehealth
Authors: Kishel Catherine , Vollmer Timothy
Published: December 2022

Individuals diagnosed with autism spectrum disorder (ASD) exhibit deficits in social interaction and communication. Kronfli, Vollmer, et al. developed an in-person assessment to evaluate participant response to social cues indicating uninterest in a conversation. In the current study, we sought to extend these procedures to the assessment of conversation skills via telehealth given the ongoing pandemic and so that participants in remote areas could receive services. Participants were exposed to a hierarchy of social cues of uninterest ranging in salience from one-word responses to a clear verbal statement of uninterest until they demonstrated sensitivity to a social cue. One participant who did not demonstrate sensitivity to any cues received instruction using Behavioral Skills Training. Initial results support the utility of using a remote assessment model to screen for sensitivity to specific social cues in conversations and to provide services to participants via telehealth.
A scoping review to identify process and outcome measures used in acceptance and commitment therapy research, with adults with acquired neurological conditions
Authors: Foote Hannah , Bowen Audrey , Cotterill Sarah , Hill Geoff , Pieri Matilde , Patchwood Emma
Published: December 2022

Background

Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available.

Purpose

To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions.

Methods

PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy.

Results

Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire ( n = 21 studies). One hundred and four health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently, and were used in all included neurological conditions. COMET domains most frequently coded were emotional functioning/well-being ( n = 50), physical functioning ( n = 32), role functioning ( n = 22) and psychiatric ( n = 22).

Conclusions

This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures.
Upregulated MYC expression and p53 mutations may contribute to the oncogenesis of canine Meibomian gland carcinomas
Authors: Peterson Cornelia , Hicks J. L. , De Marzo A. M. , Campbell A. A. , Eberhart C. G. , Dubielzig R. R. , Teixeira L. B.
Published: December 2022

Sebaceous carcinomas of the human ocular adnexa commonly exhibit pagetoid spread, mutations in tumor-suppressor genes, and protooncogene copy number gain. Sebaceous carcinomas are rarely reported in other species, and while the Meibomian gland (MG) represents the most common ocular adnexal structure of the canine eyelid to develop neoplasia, most are clinically and histologically benign. The objective of this study was to compare molecular features of canine MG carcinomas and adenomas. Two retrospectively identified MG carcinomas were subject to immunohistochemistry and qPCR. When compared with normal glands, MYC was upregulated in benign and malignant MG neoplasms. Aberrant p53 expression was restricted to the nuclei of intraepithelial neoplastic cells in MG carcinomas. Adipophilin expression was diminished in MG neoplasms compared with the normal MG. Our findings, if confirmed in a larger cohort of cases, could suggest that MG oncogenesis in a dog may exhibit similar molecular features as their human counterparts.
Exposure of Women With and Without Disabilities to Violence and Discrimination: Evidence from Cross-sectional National Surveys in 29 Middle- and Low-Income Countries
Authors: Emerson Eric , Llewellyn Gwynnyth
Published: December 2022

There is a paucity of robust nationally representative data from low- and middle-income countries (LMICs) on the prevalence and risk factors associated with exposure of women with/without disability to either discrimination or violence. We undertook secondary analysis of data collected in Round 6 of UNICEF’s Multiple Indicator Cluster Surveys (MICS) involving nationally representative data from 29 countries with a total sample size of 320,426 women aged 18 to 49 years. We estimated: (1) prevalence rates for exposure to discrimination and violence among women with/without disabilities in the previous year in a range of LMICs; (2) the relative risk of exposure when adjusted for demographic and contextual characteristics; (3) the relative risk of exposure associated with specific functional difficulties associated with disabilities; and (4) the association between country-level estimates and national wealth and human development potential. Our results indicated that women with disabilities were approximately twice as likely as women without disabilities to be exposed to violence and discrimination in the past year, and approximately one-third more likely to feel unsafe in either their home or local neighbourhood and to be at greater risk of domestic violence. Risk of exposure was associated with national characteristics (national wealth, human development potential) and within country factors, especially relative household wealth and level of education. These results must be of concern on two counts. First, they attest to the ongoing violation of the human rights of women with disabilities. Second, they point to increased exposure among women with disabilities to several well-documented social determinants of poorer health.
The cost of flares among patients with systemic lupus erythematosus with and without lupus nephritis in the United States
Authors: Bell Christopher F , Huang Shirley P , Cyhaniuk Anissa , Averell Carlyne M
Published: December 2022

Objective

Assess healthcare costs associated with systemic lupus erythematosus (SLE) flares among patients with and without lupus nephritis (LN).

Methods

This retrospective cohort study used medical and pharmacy claims data from the United States-based Optum Clinformatics database to identify adults with SLE between 1 January 2016, and 31 December 2018. Index was the date of a patient’s earliest SLE diagnosis claim during the identification period. Patients were categorized based on ICD-9/-10 diagnosis codes into one of two cohorts: SLE with LN (LN) and SLE without LN (non-LN). Baseline characteristics were assessed in the 12 months preceding index (baseline period). The presence, severity, and healthcare costs (in 2019 US dollars) of flares were determined in the 12 months following index (follow-up period).

Results

Overall, 11,663 patients with SLE were included (LN, n = 2916; non-LN, n = 8747). During the baseline period, a greater proportion of patients in the LN cohort versus non-LN cohort had a Charlson Comorbidity Index score ≥4 (72.5% vs 13.7%) and inpatient stays (41.0% vs 17.0%). A total of 12,190 flares were identified during the follow-up period (LN, 3494; non-LN, 8696). A greater proportion of flares experienced by patients with LN versus those without LN were moderate (61.2% vs 53.6%) and severe (10.6% vs 5.4%). The mean (standard deviation [SD]) number of moderate and severe flares per patient was greater among the LN cohort than the non-LN cohort (moderate: LN, 1.8 [1.2] and non-LN, 1.4 [1.2]; severe: LN, 0.2 [0.6] and non-LN, 0.1 [0.3]). The mean (SD) total healthcare costs associated with SLE flares of any severity were greater for patients with LN (LN, $5842 [9604]; non-LN, $2600 [4249]). The mean (SD) cost per flare increased with severity (mild: LN, $2753 [4640] and non-LN, $1606 [2710]; moderate: LN, $4561 [7156] and non-LN, $2587 [3720]; severe: LN, $29,148 [27,273] and non-LN, $14,829 [19,533]).

Conclusions

Patients with SLE with LN have greater healthcare costs than those without LN. Flares among patients with LN were more frequent, severe, and costly than among patients without LN. This highlights the need for treatments that prevent or reduce flares among patients with SLE, both with and without LN.
Assessment for Effective Screening and Progress Monitoring of Social and Emotional Learning Skills
Authors: Filderman Marissa J. , McKown Clark , Bailey Pamela , Benner Gregory J. , Smolkowski Keith
Published: December 2022

The collection of student data through screening and progress monitoring of social and emotional learning (SEL) skills is just as important as the implementation of curriculum and practices. Monitoring skill acquisition allows teachers to identify effective practices, provide intervention, and intensify support for students who need it. In this article, we provide a practical demonstration of how to make instructional decisions based on screening and progress monitoring of student SEL skill acquisition.
The Role of Mistrust in Sexual Revictimization: An Analysis of Serial Indirect Effects
Authors: Lutz-Zois Catherine J. , Selvey Alicia M. , Anderson Kirsten L. , Smidt Alec M.
Published: December 2022

A sample of 819 female college students completed measures of childhood sexual abuse (CSA), adult sexual victimization (ASV), mistrust, trauma-related symptoms, and drinking problems. Using a serial indirect effects model, we hypothesized that CSA would be associated with ASV through the indirect effects of mistrust → trauma-related symptoms → drinking problems. The results indicated that this serial indirect effects model was significant. When the order of the first two indirect effects was reversed, the model was not significant. These results highlight the importance of examining potential factors involved in sexual revictimization in tandem rather than in isolation.
Characterization of patients with ocular pain evaluated with ultrasound
Authors: Bechara Isabella , Mercado Carolina , Muñoz-Ortiz Juliana , Montoya Alicia
Published: December 2022

Background

The cause of ocular pain in the quiet eye is challenging to diagnose. It is a common complaint in the ophthalmology clinic and there are no actual guidelines on the exams that should be ordered initially. We decided to characterize patients with eye pain and normal ophthalmological examination who underwent ocular ultrasound, their findings, and systemic work-up.

Methods

A retrospective chart review of patients who underwent ocular ultrasound due to ocular pain and no clinical findings on initial slit-lamp examination. We evaluated patient characteristics and analyzed systemic work-up results in contrast to ocular ultrasound findings.

Results

Two hundred and three patients with normal slit-lamp examination and ocular pain were evaluated using ocular ultrasound at Clinica Barraquer. Most of the patients were women (88.7%), and 55% were older than 50 years. Nearly all of the patients had echographic findings, 87.7% of patients showed evidence of scleral scars, from which 66.5% had signs of activity, and 42.9% had thickened extraocular muscles. In general, most patients with ocular pain had normal results on systemic work-up, but the patients who did have positive results tended to have echographic findings.

Conclusion

Posterior inflammation is present in most patients with ocular pain in a quiet eye, and echography is an optimal tool to identify this. There is a tendency towards abnormal autoimmune test results and echographic findings. This should be considered in the initial work-up of these patients, given the importance of early diagnosis and the threat of vision loss with severe inflammation.
Transmission of Group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence
Authors: Miselli Francesca , Frabboni Ilaria , Di Martino Marianna , Zinani Isotta , Buttera Martina , Insalaco Anna , Stefanelli Francesca , Lugli Licia , Berardi Alberto
Published: December 2022

Group B streptococcus (GBS) late-onset disease (LOD, occurring from 7 through 89 days of life) is an important cause of sepsis and meningitis in infants. The pathogenesis and modes of transmission of LOD to neonates are yet to be elucidated. Established risk factors for the incidence of LOD include maternal GBS colonisation, young maternal age, preterm birth, HIV exposure and African ethnicity. The mucosal colonisation by GBS may be acquired perinatally or in the postpartum period from maternal or other sources. Growing evidence has demonstrated the predominant role of maternal sources in the transmission of LOD. Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset disease reduces neonatal GBS colonisation during delivery; however, a significant proportion of IAP-exposed neonates born to GBS-carrier mothers acquire the pathogen at mucosal sites in the first weeks of life. GBS-infected breast milk, with or without presence of mastitis, is considered a potential vehicle for transmitting GBS. Furthermore, horizontal transmission is possible from nosocomial and other community sources. Although unfrequently reported, nosocomial transmission of GBS in the neonatal intensive care unit is probably less rare than is usually believed. GBS disease can sometime recur and is usually caused by the same GBS serotype that caused the primary infection. This review aims to discuss the dynamics of transmission of GBS in the neonatal LOD.
Concussion Recovery in Children and Adolescents: A Retrospective Study
Authors: Ferderber Megan Lynn , Rizk Christina , Zsoldos Shellie , Meardon Stacey , Lin Chia-Cheng
Published: December 2022

Background:

Concussion is a common injury among children and adolescents, with a growing body of literature supporting a variety of diagnostic and treatment modalities. Recovery is variable and depends on multiple factors that can be evaluated through a clinic visit: a thorough history, physical examination, and use of the Post-concussion Symptom Scale (PCSS).

Purpose/Hypothesis:

The purpose of this study was to evaluate factors associated with overall recovery from concussion in children and adolescents in the clinical setting. It was hypothesized that the presence of 1 of a number of pre- or postinjury characteristics will be associated with poor concussion recovery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We conducted a retrospective chart review of adolescents and children aged 6 to 17 years with a diagnosis of concussion who were evaluated at a single sports medicine center between January 2015 and December 2019. Cases were categorized into recovered (PCSS <7) and poorly recovered (PCSS ≥7) cohorts based on the last PCSS scores during clinical follow-ups for concussion management.

Results:

Of the 162 charts reviewed, 110 cases met inclusion criteria. Significant statistical differences were found between the recovered and poorly recovered cohorts regarding mean days from injury to last clinic visit, previous migraine diagnosis, and emergency room (ER) visit before the first clinic visit ( P < .01 for all). Binary logistic regression analysis revealed that the most predictive factors associated with poorer recovery were having an ER visit before the first clinic evaluation ( P = .01) and previous migraine diagnosis ( P = .04).

Conclusion:

While many factors may contribute to overall recovery from concussion in pediatric populations, our study suggested that a history of migraine and an ER visit before clinic evaluation may be associated with poor recovery of concussive symptoms.
Managers’ Perspectives of Quality of Care in Service Housing and Home Care Services: A Qualitative Study
Authors: Corneliusson Laura , Pesonen Tiina , Ruotsalainen Salla , Sulander Juhani , Noro Anja , Sinervo Timo
Published: December 2022

The aim of this study was to illuminate facilitators and barriers to the quality of care in service housing and home care services, as described by managers. In total, 17 service housing and home care service front-line managers participated in this study. The interviews were conducted in Finland during October 2021 using semi-structured interviews. Qualitative content analysis was used to analyze the data. Described facilitators to the quality of care included: staff dedication and motivation, a positive psycho-social working environment, sufficient staffing, coaching management, and optimized tasks. Described barriers included: increased efficiency demands, staffing challenges, inefficient division of labor, conflicts within the working community, and disruptions due to COVID-19. The results suggest that recruiting and retaining sufficient dedicated and motivated staff is paramount to ensuring quality of care from the managerial perspective, and it seems changes in the working culture may support quality of care in a cost-efficient way.
Predisposition to myeloid malignancies in Shwachman-Diamond syndrome: biological insights and clinical advances
Authors: Reilly Christopher R. , Shimamura Akiko
Published: December 2022

Shwachman-Diamond syndrome (SDS) is an inherited multisystem ribosomopathy characterized by exocrine pancreatic deficiency, bone marrow failure, and predisposition to myeloid malignancies. The pathobiology of SDS results from impaired ribosomal maturation due to the deficiency of SBDS and the inability to evict the antiassociation factor eIF6 from the 60S ribosomal subunit. Clinical outcomes for patients with SDS who develop myeloid malignancies are extremely poor because of high treatment-related toxicities and a high rate of refractory disease/relapse even after allogeneic hematopoietic stem cell transplant (HSCT). Registry data indicate that outcomes are improved for patients with SDS who undergo routine bone marrow surveillance and receive an HSCT before developing an overt malignancy. However, the optimal approach to hematologic surveillance and the timing of HSCT for patients with SDS is not clearly established. Recent studies have elucidated distinct patterns of somatic blood mutations in patients with SDS that either alleviate the ribosome defect via somatic rescue (heterozygous EIF6 inactivation) or disrupt cellular checkpoints, resulting in increased leukemogenic potential (heterozygous TP53 inactivation). Genomic analysis revealed that most myeloid malignancies in patients with SDS have biallelic loss-of-function TP53 mutations. Single-cell DNA sequencing of SDS bone marrow samples can detect premalignant biallelic TP53-mutated clones before clinical diagnosis, suggesting that molecular surveillance may enhance the detection of incipient myeloid malignancies when HSCT may be most effective. Here, we review the clinical, genetic, and biologic features of SDS. In addition, we present evidence supporting the hematologic surveillance for patients with SDS that incorporates clinical, pathologic, and molecular data to risk stratify patients and prioritize transplant evaluation for patients with SDS with high-risk features.
Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study
Authors: Vrijsen Bram E. L. , Haitjema Saskia , Westerink Jan , Hulsbergen-Veelken Cornelia A. R. , van Solinge Wouter W. , ten Berg Maarten J.
Published: December 2022

Background

A longer emergency department length of stay (EDLOS) is associated with poor outcomes. Shortening EDLOS is difficult, due to its multifactorial nature. A potential way to improve EDLOS is through shorter turnaround times for diagnostic testing. This study aimed to investigate whether a shorter laboratory turnaround time (TAT) and time to testing (TTT) were associated with a shorter EDLOS.

Methods

A retrospective cohort study was performed, including all visits to the emergency department (ED) of an academic teaching hospital from 2017 to 2020 during which a standardized panel of laboratory tests had been ordered. TTT was calculated as the time from arrival in the ED to the ordering of laboratory testing. TAT was calculated as the time from test ordering to the reporting of the results, and was divided into a clinical and a laboratory stage. The outcome was EDLOS in minutes. The effect of TTT and TAT on EDLOS was estimated through a linear regression model.

Results

In total, 23,718 ED visits were included in the analysis. Median EDLOS was 199.0 minutes (interquartile range [IQR] 146.0–268.0). Median TTT was 7.0 minutes (IQR 2.0–12.0) and median TAT was 51.1 minutes (IQR 41.1–65.0). Both TTT and TAT were positively associated with EDLOS. The laboratory stage comprised a median of 69% (IQR 59–78%) of total TAT.

Conclusion

Longer TTT and TAT are independently associated with longer EDLOS. As the laboratory stage predominantly determines TAT, it provides a promising target for interventions to reduce EDLOS and ED crowding.
Clinical significance and long-term prognosis of ulcerative colitis patients with appendiceal orifice inflammation
Authors: Kuk Kyong Wook , Gwon Ji Yeon , Soh Jae Seung , Lim Hyun , Kang Ho Suk , Moon Sung-Hoon , Muraga Abebe , Yoo Ji Won
Published: December 2022

Background

Appendiceal orifice inflammation (AOI) or peri-appendiceal red patch is a skip lesion with segments of continuous colitis from the rectum. Frequently observed in ulcerative colitis (UC) patients, this lesion might be associated with proximal extension in some studies. However, the clinical significance of this lesion and long-term outcomes including therapy remain unclear. Thus, the aim of this study was to evaluate the clinical implication of AOI during long-term periods in patients with UC.

Methods

We retrospectively reviewed 376 patients with UC who performed complete colonoscopic examinations between April 2000 and December 2020. We compared clinical characteristics and outcomes of patients manifesting AOI with those who did not show AOI during a mean follow-up period of 66.1 months. Long-term outcomes included maximal extent of colitis, proximal extension, therapeutic medical histories, UC-related hospitalization, and relapse.

Results

Ninety-eight (26.1%) patients showed AOI without evidence of inflammation in the right colon. Mild disease activity at the diagnosis of UC was more included in patients with AOI than in those without AOI. Other baseline characteristics including disease extent, smoking history, external intestinal manifestation, and terminal ileal ulceration were not significantly different between the two groups. During follow-up periods, patients with and without AOI showed no significant difference in proximal extension, Mayo endoscopic score at the last endoscopic examination, UC-related hospitalization, or relapse. Of medication history, patients with AOI were less included in the group treated with high-dose aminosalicylates than those without AOI. However, therapeutic histories of steroids, immunosuppressive agents, and biologics were not significantly different. Of 62 patients with AOI who underwent follow-up colonoscopy, 36 (58.1%) showed resolution of AOI. Clinical outcomes of the resolution group were not different than those of the non-resolution group. Biopsy results of 77 patients with AOI showed chronic active or erosive colitis.

Conclusions

Long-term outcomes of UC patients with AOI were not different from those without AOI. Outcomes of resolution and non-resolution groups of AOI patients were not different either. Thus, AOI might have no prognostic implication in distal UC patients.
Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: a case series
Authors: Fan Shubo , Han GuanPeng , Li Zhihua , Wang Xiang , Li Xinfei , Xiong Shengwei , Li Dan , Zhang Jun , Meng Chang , Zhang Peng , Yang Kunlin , Li Xuesong , Zhou Liqun
Published: December 2022

Background

Complete intracorporal robotic ileal ureteric replacement is challenging. We aimed to present the surgical technique of robotic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures.

Methods

From March 2019 to March 2021, 18 patients underwent robotic ileal ureter replacement with extracorporeal ileal segment preparation by one experienced surgeon. The demographic, perioperative, and follow-up data were recorded. Success was defined as the resolution of the presenting symptom, a stable estimated glomerular filtration rate and unobstructive drainage on imaging examination.

Results

All 18 surgeries were successfully completed without conversion. The median length of the intestinal tube used was 20 (12–30) cm. The median operative time was 248 (170–450) min, the median estimated blood loss was 50 (10–200) ml, and the median postoperative hospital stay was 7 (5–27) days. At a median follow-up of 16 (13–28) months, all patients were symptom-free. No or mild hydronephrosis was confirmed in 17 patients; 1 patient had moderate hydronephrosis without peristalsis of the ileal ureter. The renal function was stable in all patients. The overall success rate was 100%. Postoperative complications, including 4 cases of urinary infections (Grade I), 1 case of an incision hernia (Grade I), 4 cases of kidney stone formation (Grade I), 6 cases of metabolic acidosis (Grade I), 4 cases of incomplete ileus (Grade II), and 1 case of an incision infection (Grade IIIb).

Conclusions

Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation is safe, feasible, and effective for the treatment of long ureteral strictures, especially in high-volume tertiary referral centers with extensive robotic surgery experience capable of managing severe peri-operative complications.
Reasons and risk factors for delayed discharge after day-surgery percutaneous nephrolithotomy
Authors: Zhu Huacai , Liu Bangfeng , Karagöz Mehmet Ali , Yue Gaoyuanzhi , Lei Yeci , Dou Shangwen , Xu Zhanping , Liu Yongda
Published: December 2022

Background

Day-surgery percutaneous nephrolithotomy (PCNL) is being developed quickly but some potential factors are affecting the recovery process. This study is aim to analyze the reasons and risk factors for delayed discharge after day-surgery PCNL.

Methods

The data of 205 patients who accepted day-surgery PCNL in our institution between January 2018 and February 2020 were analyzed, retrospectively. Univariate and multivariate logistic regression analysis were used to analyze the risk factors for delayed discharge. Besides, the nomogram prediction model was established by the multivariable logistic regression analysis.

Results

The rate of delayed discharge was 14.6%. Independent risk factors for delayed discharge were larger stone burden (odds ratio [OR] = 3.814, P = 0.046), positive urine nitrite (OR = 1.001, P = 0.030), longer duration of surgery (OR = 1.020, P = 0.044), multiple nephrostomy tubes (OR = 4.282, P = 0.008). The five main reasons that caused delayed discharge included psychological reasons, pain, bleeding, urosepsis, and urine leakage.

Conclusions

This study identified some independent risk factors for a hospital length of stay longer than 24 h. Patients with larger renal stones or positive urine nitrite may be at increased risk of delayed discharge after day-surgery PCNL. Reducing surgery time and nephrostomy tubes will help to facilitate recovery.
Effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: a pilot study
Authors: Mou Huanyu , Lam Stanley Kam Ki , Chien Wai Tong
Published: December 2022

Background

Stroke is one of the leading causes of disability in China and worldwide, affecting the health and well-being of both stroke survivors and their family caregivers (i.e. stroke dyads). Dyadic interventions targeting both as active participants can be beneficial for the dyads’ health and well-being. Psychoeducation is a potentially acceptable approach to developing participants’ knowledge about their disease management to promote their recovery. This study aims to explore the feasibility, acceptability, and preliminary effects of a family-focused dyadic psychoeducational intervention for stroke dyads.

Methods

This study was a single-blinded, parallel-group randomised controlled trial. Totally, a convenience sample of 40 stroke dyads was recruited. The intervention included three in-hospital face-to-face education sessions and four weekly post-discharge follow-up telephone counselling sessions. Feasibility was assessed by the rates of recruitment, attritions, and adherence to the intervention. Acceptability was evaluated via semi-structured qualitative interviews. Preliminary intervention effects were evaluated on primary (survivors’ functioning and caregivers’ burden) and secondary (caregivers’ competence and dyads’ coping, depressive and anxiety symptoms, family functioning, and dyadic relationship) outcomes.

Results

Intervention feasibility was established with satisfactory recruitment (76.9%), attrition (10%), and intervention completion (75%) rates. Qualitative interviews suggested that the intervention was acceptable and useful to stroke dyads. The intervention effects on survivors’ functioning were significant in the memory and thinking (F = 8.39,p = 0.022,η = 0.18) and mobility (F = 5.37,p = 0.026,η = 0.12) domains, but not significant on their overall functioning (F = 2.39,p = 0.131). Caregiver burden in the intervention group was significantly greater reduced at post-test than the control group, with a large effect size (F = 7.55,p = 0.013,η = 0.28). For secondary outcomes, this intervention suggested a significant effect on caregivers’ competence (F = 5.20,p = 0.034,η = 0.22), but non-significant effects on other outcomes.

Conclusions

The family-focused dyadic psychoeducation programme was feasible and acceptable for stroke dyads and showed preliminary effects for stroke dyads. These findings support a larger-scale controlled trial to further examine its intervention effects over a longer-term follow-up.

Trial registration

This study was retrospectively registered as a randomised controlled trial in the ISRCTN Registry. Registration Date: October 10, 2022. Registration Number: ISRCTN18158500.
Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes
Authors: Peeters S. , Wang C. , Bijnens E. M. , Bullens D. M. A. , Fokkens W. J. , Bachert C. , Hellings P. W. , Nawrot T. S. , Seys S. F.
Published: December 2022

Background

The aetiology of chronic rhinosinusitis (CRS) is multifactorial with a complex interplay between environmental, microbial endogenous and genetic factors. The impact of outdoor air pollution on prevalence or severity of CRS remains largely unknown.

Methods

Real-life geolocation data (2017–2018, Belgium) from 278 CRS patients (2576 health records) using the mySinusitisCoach mobile application were analysed to calculate the patients’ individual exposure to outdoor air pollutants (ozone (O3), black carbon (BC), nitrogen dioxide (NO2) and particulate matter with diameter < 2.5 μm (PM2.5)) and to associate these pollutants with the patients’ sinus related symptoms measured at multiple occasions by visual analogue scale (VAS).

Results

The adjusted seasonal model for the spring–summer (n = 1000 health entries, N = 83 patients) population revealed an increase of 6.07 (p < 0.0001) in overall CRS symptom scoring for an interquartile range (IQR) increase in exposure to O3 (26.9 μg/m3). An increase of 1.69 (p = 0.05) in total CRS symptom scoring was observed for an IQR increase of PM2.5 (7.1 µg/m3) exposure. Sex-stratified analysis in the spring–summer population showed significant interaction between air pollution and sex with male patients having higher total CRS symptom scores for an IQR increase in exposure to PM2.5 (3.52, p = 0.001), and O3 (8.33, p < 0.0001), while no significant association with symptom severity was seen in the female patients. In the analysis stratified by comorbid asthma, CRS patients with comorbid asthma had higher total CRS symptoms for an IQR increase in exposure to PM2.5 (2.58, p = 0.04) and O3 (7.72, p < 0.0001) while the patients without comorbid asthma had no significant symptom increases.

Conclusion

Exposure to outdoor air pollution is associated with increased symptom severity in CRS patients. The extent to which CRS patients are sensitive to outdoor air pollution exposure varies per season and depends on their sex and comorbid asthma status. mHealth technology has the potential to reveal novel insights on the patients’ exposome and disease severity in the real-life situation.
Analysis of four syringe dispensing machine point-of-access data 2017–2020 in Melbourne, Australia: machine utilisation and client demographics
Authors: Kerr Phoebe , Cossar Reece D. , Livingston Michael , Jacka David , Dietze Paul , O’Keefe Daniel
Published: December 2022

Background

Australian needle and syringe distribution occurs via a mix of modalities, including syringe dispensing machines (SDMs). SDMs are electronic vending machines providing (often) 24-h access to needles/syringes and may attract greater numbers of people who are younger, female, and/or have limited connection to health care services compared to individuals accessing fixed-site needle and syringe programs (NSPs). However, validating the demographic characteristics of SDM clients has proven difficult in previous research.

Methods

In this paper, we analyse SDM order and client demographic data from four SDMs located in South-East Melbourne, Australia, and compare this against the managing fixed-site NSP between May 2017 and December 2020. SDM data were collected via a novel 0–9 numeric keypad input tool. Via the tool, SDM clients were requested to input their categorised age, gender and postcode. Given the novelty of the tool, we evaluate the feasibility of the data collection method. We analysed data according to: (1) total SDM orders made, (2) estimated ‘unique SDM presentations’ and (3) describing the demographics of unique SDM clients. Importantly, we noted substantial invalid demographic data, and consequently, severely restricted data for analysis.

Results

There were 180,989 SDM orders made across the four SDMs to an estimated 90,488 unique SDM presentations. There was little variation in unique presentations across days of the week, but 69% occurred out of NSP operating hours. Across the study period, the SDMs distributed 66% of the number of syringes distributed by the fixed-site NSP. Due to invalid demographic data, our restriction method provided only 10,914 (6% of all data) unique presentations for analysis. There were some demographic differences between SDM and NSP client, but these should be treated with caution.

Conclusions

The data collection tool provides a novel means of comparing SDM and fixed-site presentations, demonstrating the substantial expansion of service via the SDMs. However, the validity of the demographic data was highly questionable and requires significant data coding, meaning it is not feasible for community NSPs. While we recommend the inclusion of automatically collected SDM order data, the use of a 0–9 numeric keypad to collect demographic data—while an innovation—requires alteration to support NSP data.
What to expect when girls are expecting: psychosocial support challenges and opportunities in the context and aftermath of teenage pregnancy in Kenya
Authors: Undie Chi-Chi , Birungi Harriet
Published: December 2022

Background

An understanding of the psychosocial support challenges and opportunities in the context of teenage pregnancy is important for developing appropriate interventions for pregnant and parenting girls. This qualitative study was conducted in Homa Bay County, Kenya, to examine the experience of teenage pregnancy and the resultant psychosocial support needs from the perspectives of both pregnant/parenting girls and their own parents, who are typically expected to provide various forms of support.

Methods

The study used a descriptive case study design, drawing on counseling case notes documented by psychologists who held counseling sessions with 20 pregnant or parenting girls and 6 of their parents as part of a psychosocial support intervention. The counseling case notes formed a qualitative data set, which was analyzed thematically.

Results

Emerging master themes were related to pregnant and parenting girls’ experience of sexual violence and adverse childbirth outcomes; psychological trauma confronted by girls and their parents alike; parental need for support in communicating with pregnant/parenting girls about sex and sexuality; and the availability of family support as a resource for teenage mothers.

Conclusion

Pregnant and parenting teenage girls require a range of psychosocial support responses that recognize the realities of sexual violence and other challenges in the lives of the girls themselves, as well as in the lives of their parents and caregivers. While parents and other caregivers can serve as an important resource for supporting affected girls, they often need assistance as well, in order to support pregnant/parenting girls effectively. These realities need to be taken into account to maximize the effectiveness of health and development programs for pregnant and parenting girls. Furthermore, emerging themes from actual counseling sessions with affected girls and parents can provide important insights into the potential psychosocial support needs of the broader population of pregnant and parenting girls.