bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic Omental Harvest for Flap Coverage in Complex Mediastinitis
Authors: Reade Clifton C. , Meadows William M. , Bower Curtis E. , Lalikos Janice F. , Zeri Richard S. , Wooden William A.
Published: August 2022

Mediastinitis is one of the most serious complications of cardiac surgery. The standard of care in mediastinitis includes thorough sequential debridement, flap coverage, and culture-directed antibiotics. The most frequently utilized muscles for flap reconstruction include the rectus abdomi-nus and the pectoralis major. However, in some instances these flaps may be inadequate, unavailable, or fail, thus requiring an alternative choice or adjuvant. Most coronary graft procedures utilize the left internal mammary artery, frequently eliminating the left rectus muscles, while prior open cholecystectomy patients frequently lose availability of their right rectus muscle. In addition, radiation therapy or prior flap failure may exclude other muscle transfer procedures. The omentum offers excellent coverage due to mobility and superb arterial and lymphatic flow. Unfortunately, in the past, this has required a celiotomy in an already critically ill patient. We present a series of 5 patients where the omentum was mobilized laparoscopically and passed through an anterior diaphragmatic incision. This option spares a celiotomy, seals the wound, and hastens recovery in very ill patients. We also present a complete review of literature on the topic and provide an algorithm for complex sternal wound reconstruction.
Improving infection prevention behaviours in schools: Feasibility study to measure the impact of educational resources
Authors: Cooper Emily , Chen Gina , Godsell Sarah , Verlander Neville Q , Thacker Amy , Eley Charlotte V , Demirjian Alicia
Published: August 2022

Background:

Evidence indicates that tailored educational resources such as e-Bug in schools can improve students’ knowledge of infection prevention. This study aimed to (1) understand the feasibility of using soap use data as a proxy for measuring student handwashing behaviours and (2) refine a study method that could be implemented by local authorities and schools to assess impact as a result of the implementation of e-Bug.

Design:

A stepped-wedge design was employed, and 10 primary schools were randomly assigned to groups where teachers were trained to use e-Bug, either in July 2019 (early intervention group) or in January 2020 (late intervention group). Pre/post student knowledge-retention questionnaire data and soap use measurements were collected from all schools before and after the early group teachers used e-Bug. The sample included 16 soap use measures, 561 students in the early group and 601 students in the late group. Statistical analysis involved single/multivariable mixed-effects linear and logistic regression.

Setting:

A local authority in England.

Results:

In 15–18 questions, there was a significant relationship between training and students answering questions about microbes, hand/respiratory hygiene and antibiotic use/resistance correctly (degree of change varied). There was not enough power to comment on the relationship between the intervention and soap use.

Conclusion:

This study informs the feasibility of cluster, randomised, controlled trials in educational settings to measure the impact of educational resources. It can be used to inform future studies and highlights the need to ensure adequate sample size to estimate soap use and improve the measurement accuracy of data collection tools.
Draw it, Check it, Change it: Reviving Lewin's Topology to Facilitate Organizational Change Theory and Practice
Authors: Endrejat Paul C. , Burnes Bernard
Published: August 2022

The purpose of this paper is to explain and update Kurt Lewin's concept of topological psychology and show how it can improve how we think about and undertake organizational change. To illustrate the use of this concept, we have created an imaginary dialogue in which Lewin helps an organization to move from fixed- to hot-desking. In this dialogue, we draw on Lewin's writings to show how he might have responded to criticisms of his work (e.g., that his diagnostic approach is too mechanistic to work in a socially constructed world). Based on our discussion of topological psychology, we offer three recommendations to better connect theory building with managerial thinking: (1) use plain language to explain your concepts; (2) use drawings to illustrate and explain the change situation; and (3) focus on the exceptions and not the rules in order to generate a better understanding of the nature of organizational life.
Sociological writing as resonant writing
Authors: Felski Rita
Published: August 2022

This article focuses on two examples of sociological writing that have attracted wide public interest: Didier Eribon’s best-selling memoir about his working-class origins, Returning to Reims, and Hartmut Rosa’s door-stopper work of social theory, Resonance, featured on the cover of the German news magazine Stern. These two very different works – one indebted to Bourdieu and Foucault, the other located in the tradition of the Frankfurt School – share certain qualities. First, a formal feature I’ll call scale-shifting: a leavening of theoretical claims with vivid examples and resonant details. And second, a commitment to doing justice to the phenomenological depth of ordinary persons’ self-understanding. Both writers, in other words, approach the world as deserving of a poet’s attentive and appreciative eye as well as a theorist’s critical gaze.
Encouraging Replotting to Promote Persuasion: How Imagining Alternative Plotlines Influences Message Processing and Intentions
Authors: Lillie Helen M. , Ratcliff Chelsea L. , Pokharel Manusheela , Jensen Jakob D.
Published: August 2022

This set of studies investigated replotting as a mechanism of narrative persuasion. Replotting involves both the cognitive act of imagining alternative plot lines to avoid an undesirable story outcome and an accompanying emotion such as anger, anxiety, or sadness. Both studies utilized a 2 (story outcome: death vs. survivor) × 2 (efficacy appeal: present vs. absent) message experiment design. Study 1 ( N = 1,207) tested a non-narrative efficacy appeal appended to the story and assessed replotting anger. Study 2 ( N = 716) tested an efficacy appeal embedded within the narrative and assessed replotting anger, anxiety, and sadness. Death narratives generated greater replotting sadness across efficacy conditions and greater replotting anger and anxiety when a narrative efficacy appeal was not included in the story. Replotting was negatively related to counterarguing and positively related to message elaboration. Replotting influenced behavioral intention either via counterarguing or message elaboration dependent on the efficacy condition.
Functional and Psychological Impact of Nasal Bone Fractures Sustained during Sports Activities: A Survey of 87 Patients
Authors: Lennon Paul , Jaber Sam , Fenton John E.
Published: August 2022

Nasal bone fractures that require reduction are a common sequela of sports injuries. We conducted a survey to ascertain the outcomes of patients who had experienced a nasal bone fracture and who subsequently underwent manipulation under anesthesia. We reviewed data on 217 nasal bone fractures that had been seen at our institution over a 3-year period. Of these, 133 (61.3%) had occurred as a result of a sports activity. Thirty of the 133 patients (22.6%) had been managed conservatively, while the other 103 (77.4%) had undergone manipulation under anesthesia. We were able to contact 87 of the 103 patients (84.5%) by telephone, who served as the study population. The most common sports associated with these 87 injuries were hurling (n = 26; 29.9%), rugby (n = 22; 25.3%), Gaelic football (n =20; 23.0%), and soccer (n = 13; 14.9%). Patients who had undergone treatment within 2 weeks were significantly more satisfied with their outcome than were those who had been treated later (p < 0.01). Twenty-six patients (29.9%) reported that their injury had had a detrimental impact on their subsequent performance in their sport; 12 (13.8%) described a fear of reinjury when they returned to play, 7 (8.0%) experienced functional problems, 3 (3.4%) complained of diminished performance, and 4 others (4.6%) quit playing contact sports altogether. To the best of our knowledge, our study is the first to demonstrate that a fracture of the nasal bones may have a notable psychological impact on an athlete and that it can lead to diminished performance or a complete withdrawal from contact sports.
Patient Perspectives on Acute Exacerbations of Chronic Rhinosinusitis: A Qualitative Study
Authors: Walker Victoria , Trope Michal , Tichavakunda Antar A. , Speth Marlene M. , Sedaghat Ahmad R. , Phillips Katie M.
Published: August 2022

Objective

Acute exacerbations of chronic rhinosinusitis (AECRS) are currently defined as a transient worsening of symptoms that return to baseline. This definition is narrow and can only be made retrospectively. The literature has studied this phenomenon from the physician perspective, yet a key stakeholder's—the patient's perspective is not well elucidated in the literature. To understand AECRS from the patient's perspective, we performed this study to further clarify this phenomenon.

Study Design

Basic qualitative study via patient interviews using constant comparative methodology was conducted.

Setting

Tertiary care academic center.

Methods

Two of the authors served as coders, and via group discussion, a common codebook was created and used to identify recurrent themes. The themes were analyzed for meaning and conclusions were summarized.

Results

Ten interviews were conducted with chronic rhinosinusitis (CRS) patients. Recurring themes included the following: (1) patients identify with the term flare or sinus infection more than exacerbation; (2) consistent with the current definition, patients identify AECRS by worsening sinonasal symptoms but also relate secondary symptoms, including poor sleep, fatigue, exacerbation of lower respiratory tract symptoms, and malaise to AECRS; and (3) patients are greatly affected by AECRS via decreased quality of life (QOL), worsening of general health, and decreasing productivity.

Conclusion

Beyond worsening of sinonasal symptoms, the concept of AECRS reflects a more complex construct to patients with associated extranasal symptoms and systemic manifestations. In addition, AECRS have a large impact on patients, and therefore, understanding this component of CRS is pivotal in improving disease control and QOL in this patient population.
Changes in plasma IRAK-M in patients with prediabetes and its relationship with related metabolic indexes: a cross-sectional study
Authors: Xie Xiaomin , Bai Guirong , Zhang Li , Liu Huili , Qiang Dan , Li Ling
Published: August 2022

Objective

To investigate whether IL-1R-associated kinase (IRAK)-M is associated with prediabetes and type 2 diabetes (T2D).

Methods

In this cross-sectional study, enrolled subjects were assigned to different groups according to their fasting plasma glucose (FPG) values. IRAK-M and metabolic parameters, including fasting insulin (FINS), glycosylated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β), and thioredoxin-interacting protein (TXNIP), were evaluated. The area under the receiver operating characteristic curve of IRAK-M and TXNIP for prediabetes and T2D was determined.

Results

IRAK-M decreased significantly with increasing FPG levels. IRAK-M was negatively correlated with TXNIP, FPG, FINS, HbA1c, and HOMA-IR and positively correlated with HOMA-β. The diagnostic cutoff value of IRAK-M was 3.76 ng/mL for prediabetes and 3.45 ng/mL for T2D. After stratifying by IRAK-M (<3.76 and ≥3.76 ng/mL), patients with a higher TXNIP level showed a greater risk of prediabetes or T2D in the subgroup with low IRAK-M (<3.76 ng/mL).

Conclusions

IRAK-M is independently and positively associated with prediabetes and T2D, while TXNIP is independently and negatively associated with prediabetes and T2D. IRAK-M and TXNIP serve as diagnostic factors for prediabetes.
Overall Infectious Complications Related to Belatacept Conversion in Comparison to Tacrolimus in Kidney Transplant Recipients
Authors: Marvin Jennifer E. , Azar Marwan M. , Belfield Kristen D. , Do Vincent , Formica Richard , Cohen Elizabeth A.
Published: August 2022

Introduction: Belatacept has demonstrated effectiveness for preventing rejection in kidney transplant and has a favorable side effect profile. Studies assessing long-term infectious complications with belatacept compared to tacrolimus are limited. Project Aims: The purpose of this program evaluation was to determine the proportion of patients who developed an infection when converted to belatacept compared to those on tacrolimus. Design: In this retrospective evaluation, kidney transplant recipients receiving belatacept were matched 1:1 to those receiving tacrolimus, based on transplant date, age, induction immunosuppression, and cytomegalovirus risk. Data collection was initiated in tacrolimus patients on the date of belatacept conversion in the belatacept-matched patients. Data were extracted until study conclusion, death, or discontinuation of belatacept. Patients were stratified into 3 groups based on time of conversion posttransplant, which included early, late, and very late conversion. The primary outcome was the proportion of patients with an infection in belatacept compared to tacrolimus. Outcome data were calculated using chi-square, Fisher's exact test, student's t-test or Mann-Whitney U test where appropriate. Results: A total of 328 matched patients were included in the analysis. More patients on belatacept developed an infection compared to tacrolimus (42.7% vs 29.9%, P = 0.02), which was primarily driven by pneumonia (6.1% vs 0.5%; P = 0.01). Higher incidences of infections were identified in those converted within 6 months from transplant. Conclusions: Belatacept was associated with a higher proportion of patients with infections compared to tacrolimus, particularly in those converted within 6 months from time of transplant.
Assessing the effectiveness of the transformational coaching workshop using behavior change theory
Authors: Hummell Caroline , Herbison Jordan D , Turnnidge Jennifer , Côté Jean
Published: August 2022

The current study assessed how participation in the Transformational Coaching Workshop (TCW) influenced youth sport coaches’ perceived capability, opportunity, and motivation to incorporate transformational coaching behaviors into their coaching practices. Sixty-three volunteer youth sport coaches participated in the study as part of an intervention ( n = 31; Mage = 45.65 years; SDage = 8.82 years) or comparison group ( n = 32; Mage = 44.59 years; SDage = 11.86 years). The study employed a two-arm, pre- and post-intervention, non-randomized intervention design. Dependent- and independent-sample t-tests were conducted to assess within and between-group differences. Results indicated that participants in the intervention group reported slight improvements in their perceived capability and opportunity to use transformational coaching behaviors post-intervention. There were no significant differences between groups post-intervention. This study provides support for the effectiveness of the TCW, and the application of behavior change frameworks to evaluate coach development programs.
Legal and illegal ruck cleanouts in South African non-professional youth rugby
Authors: Kruger Stephanie , Moore Lee , Viljoen Wayne , Lambert Mike , Readhead Clint , Kraak Wilbur
Published: August 2022

The ruck area is responsible for the second-highest number of rugby union injuries, therefore it is necessary to investigate and understand the ruck better for improved player safety. The study aimed to investigate and compare incidents of legal and illegal ruck cleanouts in non-professional youth rugby. Using Nacpsort Scout Plus software, 118 South African Rugby Union under 18 Youth Week tournament matches were coded between 2015 and 2019. In total, 35,545 ruck cleanouts were coded, of which 32,641 (91.8%) were legal and 2904 (8.2%) were illegal. Of the 2904 illegal cleanouts, 2676 (92.2%) were deemed ‘not dangerous’ and 228 (7.8%) were considered ‘dangerous’. The ‘dangerous’ ruck cleanouts represented 0.6% of the total ruck cleanouts. Of the most common illegal ruck cleanouts, ‘not supporting own body weight’ were mostly ‘not dangerous’ (2498; 99.4%, p = 0.01); and all ‘neck rolls’ were considered ‘dangerous’ (147; 100.0%, p = 0.02). The findings of the study suggest player behaviour can still be improved, with regular participation in regular safe and effective technique training drills. The risk of injury during the ruck can further be influenced positively by coaches, through regular coaching and training on safe and effective ruck techniques.
Machine learning approaches for the mortality risk assessment of patients undergoing hemodialysis
Authors: Yang Cheng-Hong , Chen Yin-Syuan , Moi Sin-Hua , Chen Jin-Bor , Wang Lin , Chuang Li-Yeh
Published: August 2022

Introduction:

Mortality is a major primary endpoint for long-term hemodialysis (HD) patients. The clinical status of HD patients generally relies on longitudinal clinical observations such as monthly laboratory examinations and physical examinations.

Methods:

A total of 829 HD patients who met the inclusion criteria were analyzed. All patients were tracked from January 2009 to December 2013. Taken together, this study performed full-adjusted-Cox proportional hazards (CoxPH), stepwise-CoxPH, random survival forest (RSF)-CoxPH, and whale optimization algorithm (WOA)-CoxPH model for the all-cause mortality risk assessment in HD patients. The model performance between proposed selections of CoxPH models were evaluated using concordance index.

Results:

The WOA-CoxPH model obtained the highest concordance index compared with RSF-CoxPH and typical selection CoxPH model. The eight significant parameters obtained from the WOA-CoxPH model, including age, diabetes mellitus (DM), hemoglobin (Hb), albumin, creatinine (Cr), potassium (K), Kt/V, and cardiothoracic ratio, have also showed significant survival difference between low- and high-risk characteristics in single-factor analysis. By integrating the risk characteristics of each single factor, patients who obtained seven or more risk characteristics of eight selected parameters were dichotomized as high-risk subgroup, and remaining is considered as low-risk subgroup. The integrated low- and high-risk subgroup showed greater discrepancy compared with each single risk factor selected by WOA-CoxPH model.

Conclusion:

The study findings revealed WOA-CoxPH model could provide better risk assessment performance compared with RSF-CoxPH and typical selection CoxPH model in the HD patients. In summary, patients who had seven or more risk characteristics of eight selected parameters were at potentially increased risk of all-cause mortality in HD population.
Comfort With Telehealth Among Residents of an Underserved Urban Area
Authors: Bagchi Ann D. , Damas Kasny , Salazar de Noguera Nayeli , Melamed Benjamin , Menifield Charles , Baveja Alok , Weber Paul , Swaminathan Shobha
Published: August 2022

Background:

Deployment of telehealth has been touted as a means of reducing health disparities in underserved groups. However, efforts to reduce regulatory barriers have not been associated with greater telehealth uptake. The goal of this study was to examine engagement with technology among low-income people of color living in Newark, New Jersey.

Methods:

Using surveys and focus groups, we examined study participants’ daily use of technology (eg, Internet) and comfort with telehealth services (eg, use of teleconferencing for medication refills) before and after COVID-related social distancing mandates went into effect.

Results:

Use of technology was significantly lower in the pre-COVID period. However, prior months’ use of technology had a weak but significant correlation with comfort with telehealth ( r = .243, P = .005) in bivariate analyses and was the only significant predictor in multivariate analyses. Analyses of focus group discussions confirmed that lack of experience with technology and distrust of the security and privacy of digital systems were the most important barriers to comfort with telehealth in our sample.

Conclusion:

Our study found that approximately 20% of people in this under-resourced community lacked access to basic technologies necessary for successful deployment of telehealth services. The study’s timing provided an unexpected opportunity to compare experiences and attitudes relating to telehealth in 2 regulatory environments. Although uptake of telehealth services increased with the Federal governments’ relaxation of regulatory barriers, there was not a similar increase in comfort with telehealth use. Investments in broadband access and equipment should be accompanied by educational programs to increase day-to-day use of and comfort with associated technologies which would improve consumer confidence in telehealth.
Complications of Corticosteroid Therapy: A Comprehensive Literature Review
Authors: Koshi Elliott J. , Young Kurtis , Mostales Joshua C. , Vo Kristine B. , Burgess Lawrence P.
Published: August 2022

Relevance to Patient Care and Clinical Practice: Corticosteroids are among the most prescribed medications, particularly during the COVID-19 era. The literature has clearly highlighted the dangers of prolonged, high-dose corticosteroid use, which is important for clinicians to consider before treating patients in their clinical practices. Objective: The objective of this article is to review the literature on complications of corticosteroid use, review corticosteroid pharmacokinetics, and provide an updated reference on risks associated with corticosteroid therapy, especially at higher doses. Data Sources: A conventional literature search of PubMed was conducted without restrictions on publication date. Search terms included “corticosteroids,” “avascular necrosis,” “gastrointestinal bleeding,” and “complications.” Study Selection and Data Extraction: Pertinent systematic review/meta-analyses and randomized controlled trials were reviewed for study inclusion. Data Synthesis: Corticosteroids were associated with complications including avascular necrosis, gastrointestinal bleeding, myocardial infarction, heart failure, cerebrovascular events, diabetes mellitus, psychiatric syndromes, ophthalmic complications, tuberculosis reactivation, and bacterial sepsis. Increased daily and cumulative doses were associated with increased excess risk of complications. Cumulative doses greater than 430 mg prednisone equivalent were shown to increase the excess risk of avascular necrosis, with progressively higher rates with higher doses. Risk of gastrointestinal bleeding was significantly increased with corticosteroid usage in the in-patient but not out-patient setting. Conclusion: Since corticosteroids have been associated with the aforementioned severe complications and frequent medicolegal malpractice claims, counseling and informed consent should be performed when prescribing moderate-high dosages of corticosteroids. Further research is needed to characterize the long-term effects of corticosteroid usage in COVID-19 patients.
Germicide Fenaminosulf Promots Gall Formation of Zizania latifolia without directly affecting the growth of endophytic fungus Ustilago esculenta
Authors: Li Fang , Zhang Juefeng , Zhong Haiying , Chen Jianming
Published: August 2022

Zizania latifolia is a popular aquatic vegetable in China because of its enlarged edible stems resulting from persistent infection by a fungal endophyte, Ustilago esculenta. Fenaminosulf (FM) is a germicide that can be used to improve agricultural crop yields. In Z. latifolia fields, appropriate spraying of FM not just controls diseases, but also promotes an earlier harvest of Z. latifolia. In this study, we show that the timing of gall formation was advanced and the plant’s yield was increased significantly under a high concentration treatment of FM. Yet FM had a strong inhibitory effect on the growth of U. esculenta in vitro, while the transcript levels of mating-type alleles, cell metabolism-related genes and chitin synthase genes were all substantially downregulated. Through a transcriptome analysis, we investigated changes in gene expression of the host Z. latifolia and fungal endophyte U. esculenta in response to FM. FM directly affected the growth of Z. latifolia by altering the expression level of genes involved in plant-pathogen interactions, plant hormone signal transduction and some metabolism pathways. By contrast, FM had little effect on U. esculenta growing inside of Z. latifolia. Collectively, our results provide a more in-depth understanding of the molecular processes that promote gall formation in Z. latifolia, while also identifying potential targets for genetic manipulation to improve the yield and quality of Z. latifolia, in a safer and more effective way.
Lidocaine promotes apoptosis in breast cancer cells by affecting VDAC1 expression
Authors: Long Dingde , Fang Xingjun , Yuan Peihua , Cheng Liqin , Li Hongtao , Qu LiangChao
Published: August 2022

Objective

To investigate the effect of lidocaine on the expression of voltage-dependent anion channel 1 (VDAC1) in breast invasive carcinoma (BRCA) and its impact on the apoptosis of breast cancer cells.

Methods

We collected clinical data from patients with invasive breast cancer from 2010 to 2020 in the First affiliated hospital of Nanchang University, evaluated the prognostic value of VDAC1 gene expression in breast cancer, and detected the expression of VDAC1 protein in breast cancer tissues and paracancerous tissues by immunohistochemical staining of paraffin sections. Also, we cultured breast cancer cells (MCF-7) to observe the effect of lidocaine on the apoptosis of MCF-7 cells.

Results

Analysis of clinical data and gene expression data of BRCA patients showed VDAC1 was a differentially expressed gene in BRCA, VDAC1 may be of great significance for the diagnosis and prognosis of BRCA patients. Administration of lidocaine 3 mM significantly decreased VDAC1 expression, the expression of protein Bcl-2 was significantly decreased (p < 0.05), and the expression of p53 increased significantly (p < 0.05). Lidocaine inhibited the proliferation of MCF-7 breast cancer cells, increased the percentage of G2 / M phase cells and apoptosis.

Conclusion

Lidocaine may inhibit the activity of breast cancer cells by inhibiting the expression of VDAC1, increasing the apoptosis in breast cancer cells.
Clinical and laboratory features in patients with positive syphilis serology presenting with acute ischemic stroke or transient ischemic attack: a prospective cohort study
Authors: Jitpratoom Pornpong , Boonyasiri Adhiratha
Published: August 2022

Background

Neurosyphilis (NS) can lead to acute ischemic stroke (AIS) or transient ischemic attack (TIA). We compared the clinical characteristics and laboratory features among AIS and TIA patients who were syphilis-seronegative (control group) or had latent syphilis (LS) or NS to evaluate their stroke outcome.

Methods

This prospective cohort study was conducted on patients who had recently suffered AIS or TIA. After serological syphilis screening, clinical and laboratory data were collected, and brain imaging and spinal tap (serologically syphilis-positive patients only) were performed. Stroke outcome was re-evaluated approximately three months later.

Results

The 344 enrolled patients were divided into three groups: control group (83.7%), LS (13.1%), and NS (3.2%). A multivariate analysis revealed: 1) age of ≥ 70 years, generalized brain atrophy via imaging, and alopecia (adjusted odds ratio [AOR] = 2.635, 2.415, and 13.264, respectively) were significantly associated with LS vs controls; 2) age of ≥ 70 years (AOR = 14.633) was significantly associated with NS vs controls; and 3) the proportion of patients with dysarthria was significantly lower (AOR = 0.154) in the NS group than in the LS group. Regarding the NS patient cerebrospinal fluid (CSF) profile, only 2/11 cases had positive CSF-Venereal Disease Research Laboratory (VDRL) test results; the other nine cases were diagnosed from elevated white blood cell counts or protein levels combined with positive CSF fluorescent treponemal antibody absorption (FTA-ABS) test results. Regarding disability, the initial modified Rankin scale (mRS) score was lower in the control group than in the NS group (p = 0.022). At 3 months post-stroke, the mRS score had significantly decreased in the control (p < 0.001) and LS (p = 0.001) groups. Regarding activities of daily living, the 3-month Barthel Index (BI) score was significantly higher in control patients than in LS (p = 0.030) or NS (p = 0.002) patients. Additionally, the 3-month BI score was significantly increased in the control (p < 0.001) and LS (p = 0.001) groups.

Conclusions

Because syphilis was detected in many AIS and TIA patients, especially those aged ≥ 70 years, routine serological syphilis screening may be warranted in this population. Patients with syphilitic infection had worse stroke outcomes compared with NS patients.
Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review
Authors: Snowden Lonnie R. , Graaf Genevieve , Keyes Latocia , Kitchens Katherine , Ryan Amanda , Wallace Neal
Published: August 2022

Objectives

To investigate the impact of the Affordable Care Act’s (ACA) Medicaid expansion on African American-white disparities in health coverage, access to healthcare, receipt of treatment, and health outcomes.

Design

A search of research reports, following the PRISMA-ScR guidelines, identified twenty-six national studies investigating changes in health care disparities between African American and white non-disabled, non-elderly adults before and after ACA Medicaid expansion, comparing states that did and did not expand Medicaid. Analysis examined research design and findings.

Results

Whether Medicaid eligibility expansion reduced African American-white health coverage disparities remains an open question: Absolute disparities in coverage appear to have declined in expansion states, although exceptions have been reported. African American disparities in health access, treatment, or health outcomes showed little evidence of change for the general population.

Conclusions

Future research addressing key weaknesses in existing research may help to uncover sources of continuing disparities and clarify the impact of future Medicaid expansion on African American health care disparities.
A feasibility randomised trial comparing therapeutic thoracentesis to chest tube insertion for the management of pleural infection: results from the ACTion trial
Authors: Arnold David T. , Tucker Emma , Morley Anna , Milne Alice , Stadon Louise , Patole Sonia , Nava George W. , Walker Steven P. , Maskell Nick A.
Published: August 2022

Background

Pleural infection is a complex condition with a considerable healthcare burden. The average hospital stay for pleural infection is 14 days. Current standard of care defaults to chest tube insertion and intravenous antibiotics. There have been no randomised trials on the use of therapeutic thoracentesis (TT) for pleural fluid drainage in pleural infection.

Aims and objectives

To assess the feasibility of a full-scale trial of chest tube vs TT for pleural infection in a single UK centre. The primary outcome was defined as the acceptability of randomisation to patients.

Methods

Adult patients admitted with a pleural effusion felt to be related to infection and meeting criteria for drainage (based on international guidelines) were eligible for randomisation. Participants were randomised (1:1) to chest tube insertion or TT with daily review assessing need for further drainages or other therapies. Neither participant nor clinician were blinded to treatment allocation. Patients were followed up at 90 days post-randomisation.

Results

From September 2019 to June 2021, 51 patients were diagnosed with pleural infection (complex parapneumonic effusion/empyema). Eleven patients met the inclusion criteria for trial and 10 patients were randomised (91%). The COVID-19 pandemic had a substantial impact on recruitment. Data completeness was high in both groups with no protocol deviations. Patients randomised to TT had a significantly shorter overall mean hospital stay (5.4 days, SD 5.1) compared to the chest tube control group (13 days, SD 6.0), p = 0.04. Total number of pleural procedures required per patient were similar, 1.2 in chest tube group and 1.4 in TT group. No patient required a surgical referral. Adverse events were similar between the groups with no readmissions related to pleural infection.

Conclusions

The ACTion trial met its pre-specified feasibility criteria for patient acceptability but other issues around feasibility of a full-scale trial remain. From the results available the hypothesis that TT can reduce length of stay in pleural infection should be explored further.

Trial registration: ISRCTN: 84674413.
Unmet needs in palliative care for patients with common non-cancer diseases: a cross-sectional study
Authors: Jang Hyoeun , Lee Kyunghwa , Kim Sookyung , Kim Sanghee
Published: August 2022

Background

Non-cancer patients experience the chronic process of disease that increases the patients’ suffering as well as families’ care burden. Although two-thirds of deaths are caused by non-cancer diseases, there is a lack of studies on palliative care for non-cancer patients. This study identified the palliative care needs and satisfaction, anxiety and depression, and health-related quality of life (HRQOL) of non-cancer patients and identified the factors influencing their HRQOL.

Methods

A cross-sectional survey design was employed. Participants were 114 non-cancer patients with chronic heart failure, stroke, end-stage renal disease, or end-stage liver disease who were admitted to the general ward of a tertiary hospital in South Korea. Measures included the Palliative Care Needs and Satisfaction Scale, the Hospital Anxiety and Depression Scale, and the Medical Outcome Study 36-items Short Form Health Survey version 2. Data were analysed with descriptive statistics, independent t-tests, analyses of variance, Pearson’s correlations, and multiple linear regression analyses.

Results

The average score of palliative care needs was 3.66 ± 0.62, which falls between ‘moderate’ and ‘necessary’. Among the four domains, the average score of palliative care needs in the psychosocial domain was the highest: 3.83 ± 0.67. Anxiety was nearly in the normal range (7.48 ± 3.60; normal range = 0–7) but depression was higher than normal (9.17 ± 3.71; normal range = 0–7). Similar to patients with cancer, physical HRQOL (38.89 ± 8.69) and mental HRQOL (40.43 ± 11.19) were about 80% of the general population’s score (50 points). Duration of disease and physical performance were significant factors associated with physical HRQOL, whereas physical performance, anxiety, and depression were significant factors associated with mental HRQOL.

Conclusion

It is necessary to maintain non-cancer patients’ physical performance and assess and manage their mental health in advance for effective palliative care. This study provides relevant information that can be used to develop a tailored palliative care model for non-cancer patients.
Comparison of learning outcomes of interprofessional education simulation with traditional single-profession education simulation: a mixed-methods study
Authors: Chen Hui-Wen , O’Donnell John M. , Chiu Yu-Jui , Chen Yi-Chun , Kang Yi-No , Tuan Yueh-Ting , Kuo Shu-Yu , Wu Jen-Chieh
Published: August 2022

Background

Interprofessional collaborative practice is essential for meeting patients’ needs and improving their health outcomes; thus, the effectiveness of interprofessional education (IPE) should be clearly identified. There is insufficient evidence in the literature to determine the outcomes of IPE compared to traditional single-profession education (SPE). This study aimed to compare the outcomes of IPE and SPE during a simulation training course.

Methods

The study design was a mixed-methods, incorporated cross-over design and a qualitative survey. A total of 54 students including 18 medical students and 36 nursing students were recruited from March to April 2019. The 4-week simulation course was designed based on Kolb’s experimental learning theory and Bandura’s social learning theory. Participants were evenly divided into group 1 (received IPE-learning followed by SPE-learning), and group 2 (received SPE-learning followed by IPE-learning). Students’ medical task performance, team behavior performance, teamwork attitude, and patient safety attitude were collected at pretest, mid-test, and posttest. Descriptive statistics and repeated measures analysis of variance were used. End-of-study qualitative feedback was collected, and content analysis was performed.

Results

Both groups demonstrated moderate-to-large within-group improvements for multiple learning outcomes at mid-test. Group 1 students’ medical task performance (F = 97.25; P < 0.001) and team behavior performance (F = 31.17; P < 0.001) improved significantly. Group 2 students’ medical task performance (F = 77.77; P < 0.001), team behavior performance (F = 40.14; P < 0.001), and patient safety attitude (F = 6.82; P < 0.01) improved significantly. Outcome differences between groups were nonsignificant. Qualitative themes identified included: personal factor, professional factor, interprofessional relationship, and learning. The IPE program provided students with exposure to other professions and revealed differences in expertise and responsibilities.

Conclusion

IPE-simulation and SPE-simulation were effective interventions that enabled medical and nursing students to develop critical medical management and team behavior performance. IPE-simulation provided more opportunities for improving competencies in interprofessional collaborative practice. In circumstances with limited teaching resources, SPE-simulation can be an acceptable alternative to IPE-simulation.
Haematological profile of malaria patients with G6PD and PKLR variants (erythrocytic enzymopathies): a cross-sectional study in Thailand
Authors: Mungkalasut Punchalee , Kiatamornrak Patcharakorn , Jugnam-Ang Watcharapong , Krudsood Srivicha , Cheepsunthorn Poonlarp , Cheepsunthorn Chalisa Louicharoen
Published: August 2022

Background

Glucose 6-phosphate dehydrogenase (G6PD) and pyruvate kinase (PKLR) deficiencies are common causes of erythrocyte haemolysis in the presence of antimalarial drugs such as primaquine and tafenoquine. The present study aimed to elucidate such an association by thoroughly investigating the haematological indices in malaria patients with G6PD and PKLRR41Q variants.

Methods

Blood samples from 255 malaria patients from Thailand, Myanmar, Laos, and Cambodia were collected to determine haematological profile, G6PD enzyme activity and G6PD deficiency variants. The multivariate analysis was performed to investigate the association between anaemia and G6PD MahidolG487A, the most common mutation in this study.

Results

The prevalence of G6PD deficiency was 11.1% (27/244) in males and 9.1% (1/11) in female. The MAFs of the G6PD MahidolG487A and PKLRR41Q variants were 7.1% and 2.6%, respectively. Compared with patients with wildtype G6PD after controlling for haemoglobinopathies, G6PD-deficient patients with hemizygous and homozygous G6PD MahidolG487A exhibited anaemia with low levels of haemoglobin (11.16 ± 2.65 g/dl, p = 0.041). These patients also exhibited high levels of reticulocytes (3.60%). The median value of G6PD activity before treatment (Day 0) was significantly lower than that of after treatment (Day 28) (5.51 ± 2.54 U/g Hb vs. 6.68 ± 2.45 U/g Hb; p < 0.001). Reticulocyte levels on Day 28 were significantly increased compared to that of on Day 0 (2.14 ± 0.92% vs 1.57 ± 1.06%; p < 0.001). PKLRR41Q had no correlation with anaemia in malaria patients. The risk of anaemia inpatients with G6PDMahidolG487A was higher than wildtype patients (OR = 3.48, CI% 1.24–9.75, p = 0.018). Univariate and multivariate analyses confirmed that G6PDMahidolG487A independently associated with anaemia (< 11 g/dl) after adjusted by age, gender, Plasmodium species, parasite density, PKLRR41Q, and haemoglobinopathies (p < 0.001).

Conclusions

This study revealed that malaria patients with G6PD MahidolG487A, but not with PKLRR41Q, had anaemia during infection. As a compensatory response to haemolytic anaemia after malaria infection, these patients generated more reticulocytes. The findings emphasize the effect of host genetic background on haemolytic anaemia and the importance of screening patients for erythrocyte enzymopathies and related mutations prior to anti-malarial therapy.
Social Accountability Reporting for Research (SAR4Research): checklist to strengthen reporting on studies on social accountability in the literature
Authors: Kraft Joan Marie , Paina Ligia , Boydell Victoria , Elnakib Shatha , Sihotang Andreas , Bailey Angela , Tolmie Courtney
Published: August 2022

Background

An increasing number of evaluations of social accountability (SA) interventions have been published in the past decade, however, reporting gaps make it difficult to summarize findings. We developed the Social Accountability Reporting for Research (SAR4Research) checklist to support researchers to improve the documentation of SA processes, context, study designs, and outcomes in the peer reviewed literature and to enhance application of findings.

Methods

We used a multi-step process, starting with an umbrella review of reviews on SA to identify reporting gaps. Next, we reviewed existing guidelines for reporting on behavioral interventions to determine whether one could be used in its current or adapted form. We received feedback from practitioners and researchers and tested the checklist through three worked examples using outcome papers from three SA projects.

Results

Our umbrella review of SA studies identified reporting gaps in all areas, including gaps in reporting on the context, intervention components, and study methods. Because no existing guidelines called for details on context and the complex processes in SA interventions, we used CONSORT-SPI as the basis for the SAR4Research checklist, and adapted it using other existing checklists to fill gaps. Feedback from practitioners, researchers and the worked examples suggested the need to eliminate redundancies, add explanations for items, and clarify reporting for quantitative and qualitative study components.

Conclusions

Results of SA evaluations in the peer-reviewed literature will be more useful, facilitating learning and application of findings, when study designs, interventions and their context are described fully in one or a set of papers. This checklist will help authors report better in peer-reviewed journal articles. With sufficient information, readers will better understand whether the results can inform accountability strategies in their own contexts. As a field, we will be better able to identify emerging findings and gaps in our understanding of SA.
Inequality in the distribution of Covid-19 vaccine: a systematic review
Authors: Bayati Mohsen , Noroozi Rayehe , Ghanbari-Jahromi Mohadeseh , Jalali Faride Sadat
Published: August 2022

Background

The equality in the distribution of vaccines between and within countries along with follow sanitation tips and observe social distance, are effective strategies to rid the world of COVID-19 pandemic. Inequality in the distribution of COVID-19 vaccine, in addition to causing inequity to the population health, has a significant impact on the process of economic recovery.

Methods

All published original papers on the inequality of Covid-19 vaccine distribution and the factors affecting it were searched in PubMed, Web of Science, Scopus and ProQuest databases between December 2020 to 30 May 2022. Selection of articles, extraction of their data and qualitative assessment (by STROBE) were performed by two researchers separately. Data graphing form was used to extract detailed data from each study and then, the collected data were classified.

Results

A total of 4623 articles were evaluated. After removing duplicates and screening the title, abstract and full text of articles, 22 articles were selected and entered into the study. Fifteen (68.17%) studies were conducted in the United States, three (13.64%) in Europe, three (13.64%) in Asia and one (6.66%) in Oceania. Factors affecting the inequality in the distribution of COVID-19 vaccine were classified into macro and micro levels determinants.

Conclusion

Macro determinants of inequality in the Covid-19 vaccine distribution were consisted of economic (stability and country’s economic status, Gross Domestic Product (GDP) per capita, financial support and human development index), infrastructure and health system (appropriate information system, functional cold chains in vaccine transport, transport infrastructure, medical and non-medical facilities per capita, healthcare access and quality), legal and politics (vaccination allocation rules, health policies, political ideology and racial bias), and epidemiologic and demographic factors (Covid-19 incidence and deaths rate, life expectancy, vulnerability to Covid-19, working in medical setting, comorbidities, social vulnerability, incarceration and education index). Moreover, micro/ individual level factors were included in economic (household’s income, home ownership, employment, poverty, access to healthy food and residency in the deprived areas) and demographic and social characteristics (sex, age, race, ethnic, religion, disability, location (urban/rural) and insurance coverage).
Lipid signatures of chronic pain in female adolescents with and without obesity
Authors: Gonzalez Paula A. , Simcox Judith , Raff Hershel , Wade Gina , Von Bank Helaina , Weisman Steven , Hainsworth Keri
Published: August 2022

Background

Chronic pain in adolescence is associated with diminished outcomes, lower socioeconomic status in later life, and decreased family well-being. Approximately one third of adolescents with chronic pain have obesity compared to the general population. In obesity, lipid signals regulate insulin sensitivity, satiety, and pain sensation. We determined whether there is a distinct lipid signature associated with chronic pain and its co-occurrence with obesity in adolescents.

Methods

We performed global lipidomics in serum samples from female adolescents (N = 67, 13–17 years old) with no pain/healthy weight (Controls), chronic pain/healthy weight (Pain Non-obese), no pain/obesity (Obese), or chronic pain/obesity (Pain Obese).

Results

The Pain Non-obese group had lipid profiles similar to the Obese and Pain Obese groups. The major difference in these lipids included decreased lysophosphatidylinositol (LPI), lysophosphatidylcholine (LPC), and lysophosphatidylethanolamine (LPE) in the three clinical groups compared to the Control group. Furthermore, ceramides and sphingomyelin were higher in the groups with obesity when compared to the groups with healthy weight, while plasmalogens were elevated in the Pain Obese group only.

Conclusions

Serum lipid markers are associated with chronic pain and suggest that specific lipid metabolites may be a signaling mechanism for inflammation associated with co-occurring chronic pain and obesity.