bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of a Portable Electrical Muscle Stimulation on Brain-Derived Neurotrophic Factor in Elderly People: Three Case Studies
Authors: Nishikawa Yuichi , Watanabe Kohei , Kawade Shuhei , Maeda Noriaki , Maruyama Hirofumi
Published: October 2021

Brain-derived neurotrophic factor (BDNF), which plays an important role in cognitive and nerve function, is released from skeletal muscle cells into the blood by muscle contractions and/or electrical muscle stimulation (EMS). However, the influence of EMS administered by a portable device on BDNF is unclear. The purpose of this case report was to quantify the influence of EMS administered by a portable device on BDNF and physical function. Three elderly people (age, 69.7 ± 1.5 years) were included in the present study. The participants used a portable EMS device to stimulate the bilateral quadriceps muscles for 8 weeks (23 min for 5 days/week). To determine the effects of EMS, the following parameters were assessed at baseline, 8 weeks, and 12 weeks (follow-up): knee extensor strength, muscle mass of the lower limb, Berg balance score, and blood BDNF level. All outcomes improved after the EMS intervention, but the improvements did not persist for 12 weeks. These findings suggest that portable EMS is potentially useful for improving the blood BDNF level and physical function.
A Review of Unsolicited Comments on the CAHPS 5.0 Health Plan Survey
Authors: Fifolt Matthew , Patel Kunal , Rucks Andrew , Ford Eric W.
Published: October 2021

The CAHPS Health Plan Survey (CAHPS 5.0) collects invaluable information regarding consumer experiences with their health plans, and these data inform healthcare policies at both the state and federal levels. The purpose of this paper was to explore unsolicited comments provided on the CAHPS 5.0 survey of one state's Medicaid program. Secondary data analysis was conducted of unsolicited, written comments received from Medicaid recipients who completed the CAHPS 5.0 adult or child postal survey between 2016 and 2018. The majority of unsolicited comments were moderately or very negative in attitude (or tone) for adult and child surveys. Analysis of unsolicited comments yielded 3 themes: positive experiences with Medicaid, limitations of coverage, and direct requests for assistance. Providing space for Medicaid patients to share comments and receiving further guidance for content analysis would provide valuable context for interpreting overall survey results. Comments may also help Medicaid program administrators respond to the frequently complex and challenging experiences of navigating a continually evolving state health insurance program by the most vulnerable populations.
A Patient-Centered Environmental Scan of Inpatient Visitor Policies During the COVID-19 Pandemic
Authors: Harrison James D , Weiss Rachel , Radhakrishnan Nila S , Hanson Catherine , Carnie Martha B , Evans Patricia , Banta Jim , Symczak Gina , Ziegler Georgiann , Holmes D’Anna , Michel-Leconte Safia J , Rogers Beverly , Wurst Melissa , Alikhaani Jacqueline , Davis Clark , Lee Tiffany , Schnipper Jeffrey L , Auerbach Andrew D , Romond John
Published: October 2021

Researchers and patients conducted an environmental scan of policy documents and public-facing websites and abstracted data to describe COVID-19 adult inpatient visitor restrictions at 70 academic medical centers. We identified variations in how centers described and operationalized visitor policies. Then, we used the nominal group technique process to identify patient-centered information gaps in visitor policies and provide key recommendations for improvement. Recommendations were categorized into the following domains: 1) provision of comprehensive, consistent, and clear information; 2) accessible information for patients with limited English proficiency and health literacy; 3) COVID-19 related considerations; and 4) care team member methods of communication.
Experiences of Patients With Diabetes Attending a Publicly Funded Eye Care Pathway in Western Sydney: A Qualitative Study
Authors: Ford Belinda K , Angell Blake , White Andrew JR , Duong Annita , Hiidome Saya , Keay Lisa
Published: October 2021

Diabetic retinopathy (DR) complications can be prevented with regular screening and timely access to an ophthalmologist for treatment. But there are patient and health system barriers that can impact access to DR services. This study aims to identify enablers and barriers for accessing public DR eye care services in a low socio-economic urban area of Australia. We conducted a qualitative study using semi-structured interviews for patients with diabetes aged 35 years and older attending public ophthalmology services. Interviews were analyzed to identify themes and subthemes; and the COM-B framework was used to interpret the complex behavioral mechanisms, including capability, opportunity, and motivation factors, to explain adherence to DR eye care. Three main themes and 7 sub-themes relating to patient experiences of DR care were derived. Patients were found to be passive actors in their DR eye care, but patients trusted clinicians and were determined to maintain their vision and quality of life. The barriers and facilitators of care related to the health system (service availability and recall–reminder systems) and patient experiences (choices, knowledge, and fear). The findings of this study will guide patient-centered initiatives to target and improve access to DR care. Strategies should focus on improving communication between eye care providers, and communication with patients to empower them to become more active players in healthcare decisions.
Leadership Styles and Small Enterprises’ Performance: Is Gender an Issue? Empirical Study from Democratic Republic of Congo
Authors: Akonkwa Deogratias Bugandwa Mungu , Lunanga Elie , Mukulu Joseph Bahati , Bugandwa Toussaint Ciza , Mwaza Elizabeth Furaha
Published: October 2021

In this paper, we provide new empirical evidence to the relationships between leadership styles (LS) and organizational performance, introducing gender as moderator variable. Data have been collected in two Congolese towns (Bukavu and Goma); an African post-conflict region dominated by very small family businesses that have not received enough attention. Combining exploratory factor analysis with a multivariate regression we found three main results. First, both leadership and performance are confirmed to be multidimensional. LS comprised participative/democratic leadership, and autocratic/directive leadership, while performance has three dimensions: employee efficiency/productivity, effectiveness, and customer satisfaction/retention. Second, the autocratic leadership is the more adopted both by men and women, with a slight non-significant difference for men. Although democratic leadership is underscored, it appears to be more adopted by women with significant difference. Third, controlling for other variables, only participative/democratic leadership styles have positive impact on SMEs’ performance, while autocratic leadership does not influence it. This implies that, in the growing competition facing SMEs, managers should adopt leadership style that allows their employees to internalize the firm’s objectives and to be committed. Also, our research confirms that women have much to give in managing enterprises, as they appear to be stronger in leadership styles, which have more impact on main dimensions of firms’ performance. Moreover, our results suggest new avenues for deeper research about leadership styles in family-owned enterprises.
Reliability, validity, and responsiveness to change of the Patient-Reported Outcomes Measurement Information System self-efficacy for managing chronic conditions measure in systemic sclerosis
Authors: Murphy Susan L , Berrocal Veronica J , Poole Janet L , Khanna Dinesh
Published: October 2021

Objective:

The aim of this study is to examine validity, reliability, and responsiveness to change of Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Chronic Conditions in persons with systemic sclerosis.

Methods:

We conducted a post hoc analysis of the Patient-Reported Outcomes Measurement Information System Self-Efficacy measure and other quality-of-life measures from systemic sclerosis participants from a 16-week randomized control trial. The trial compared an Internet-based self-management program to a control condition where participants were provided an educational book. All participants completed outcome measures at baseline and following the 16-week trial period.

Results:

The mean age of participants was 53.7 years, 91% were female and systemic sclerosis subtype included 44.9% limited/sine and 43.1% diffuse; mean disease duration was 9.0 years. All self-efficacy subscales (Managing Emotions, Symptoms, Daily Activities, Social Interactions, and Medications/Treatment) demonstrated good internal consistency (.92–.96). All subscales showed statistically significant correlations with other validated measures of depressive symptoms and quality of life (.20–.86) but were not associated with satisfaction nor with appearance. The subscales appropriately discriminated between those with and without depressive symptoms and demonstrated responsiveness to change over the 16-week period for those who had a corresponding increase in reported quality of life.

Conclusion:

The Patient-Reported Outcomes Measurement Information System Self-Efficacy measure is valid, reliable, and responsive to change for persons with systemic sclerosis.
The Dombo: A Sociological Investigation of Dalits in Odisha
Authors: Naik Iswar Chandra
Published: October 2021

The Dalit people in Odisha have been socio-economically deprived and antagonized with a social discrimination. In Odisha, the number of Dalits is 93, and out of it, in numerically Pana, Dewar and Dombo are the most populous and remain in first, second and third respectively. The Dombo people residing in South Odisha, especially in the unified Koraput and Kalahandi district. They have been known as drum beaters, weavers, performers and gramarakhi. Traditionally, the Dombo people live in the village as caretakers ( gramarakhi or choukidar). In each village, there were a choukidar or gramarakhi, and their task was to report the instances of downfall, labour, self-destruction, murder and other lawful issues occurring in the village at the closest police headquarters and convey the news about birth, death of upper caste to their family members, discarded corpses of cows and attend the dignitaries and visiting officials. They used to declare any news concerning people in general by the beat of drums and help the Gauntia or village headmen on the issue of income assortment and everyday organization of the village issues. The gramarakhi or choukidar was a notable person at the village level in the primitive organization. The reason for this article is to study and preserve, promote and protect the economy, political and social existence of the Dombo people in South Odisha.
Preserving the Past in Soviet Georgia: Restoration of Religious Monuments Behind the ‘Iron Curtain’
Authors: Meladze Tamar
Published: October 2021

This article explores the characteristics of preservation and restoration of religious monuments in Georgian SSR during the Soviet rule in the country. The nature of architectural restoration is analysed in the context of the USSR’s twofold approach to heritage sites—from disregard and demolition of ecclesiastical monuments as part of the anti-religious activism and modernization to the emergence of preservationist movement, which gained institutional coherence following World War II. The article shows that despite the controversial heritage politics of Soviet Union, it was during those years that the scientific-methodological approaches to restoration developed in Georgia (at that time, Georgian Soviet Socialist Republic). However, rather than following the Soviet post-war reconstruction tendencies, it was implementing the Western European principles of conservation.
Suture Tape Augmentation in Lateral Ankle Ligament Surgery: Current Concepts Review
Authors: Lan Rae , Piatt Eric T. , Bolia Ioanna K. , Haratian Aryan , Hasan Laith , Peterson Alexander B. , Howard Mark , Korber Shane , Weber Alexander E. , Petrigliano Frank A. , Tan Eric W.
Published: October 2021

Chronic lateral ankle instability (CLAI) is a condition that is characterized by persistent disability and recurrent ankle sprains while encompassing both functional and mechanical (laxity) instability. Failure of conservative treatment for CLAI often necessitates operative intervention to restore the stability of the ankle joint. The traditional or modified Broström techniques have been the gold standard operative approaches to address CLAI with satisfactory results; however, patients with generalized ligament laxity (GLL), prior unsuccessful repair, high body mass index, or high-demand athletes may experience suboptimal outcomes. Synthetic ligament constructs have been tested as an adjunct to orthopedic procedures to reinforce repaired or reconstructed ligaments or tendons with the hope of early mobilization, faster rehabilitation, and long-term prevention of instability. Suture tape augmentation is useful to address CLAI. Multiple operative techniques have been described. Because of the heterogeneity among the reported techniques and variability in postoperative rehabilitation protocols, it is difficult to evaluate whether the use of suture tape augmentation provides true clinical benefit in patients with CLAI. This review aims to provide a comprehensive outline of all the current techniques using suture tape augmentation for treatment of CLAI as well as present recent research aimed at guiding evidence-based protocols.
Alloreactive T cells deficient of the short-chain fatty acid receptor GPR109A induce less graft-versus-host disease
Authors: Docampo Melissa D. , da Silva Marina B. , Lazrak Amina , Nichols Katherine B. , Lieberman Sophia R. , Slingerland Ann E. , Armijo Gabriel K. , Shono Yusuke , Nguyen Chi , Monette Sebastien , Dwomoh Emmanuel , Lee Nicole , Geary Clair D. , Perobelli Suelen M. , Smith Melody , Markey Kate A. , Vardhana Santosha A. , Kousa Anastasia I. , Zamir Eli , Greenfield Itamar , Sun Joseph C. , Cross Justin R. , Peled Jonathan U. , Jenq Robert R. , Stein-Thoeringer Christoph K. , van den Brink Marcel R. M.
Published: October 2021

The intestinal microbiota is essential for the fermentation of dietary fiber into short-chain fatty acids (SCFA) such as butyrate, acetate, and propionate. SCFAs can bind to the G-protein-coupled receptors GPR43 and GPR109A (HCAR2), with varying affinities to promote cellular effects in metabolism or changes in immune function. We explored the role of GPR109A as the main receptor for butyrate in mouse models of allogeneic hematopoietic cell transplantation (allo-HCT) and graft-versus-host disease (GVHD). Deletion of GPR109A in allo-HCT recipients did not affect GVHD, but transplantation of T cells from GPR109A knockout (KO) (Gpr109a−/−) mice into allo-HCT recipient mice significantly reduced GVHD morbidity and mortality compared with recipients of wild-type (WT) T cells. Recipients of Gpr109a−/− T cells exhibited less GVHD-associated target organ pathology and decreased proliferation and homing of alloreactive T cells to target tissues. Although Gpr109a−/− T cells did not exhibit immune deficits at a steady state, following allo-activation, Gpr109a−/− T cells underwent increased apoptosis and were impaired mitochondrial oxidative phosphorylation, which was reversible through antioxidant treatment with N-acetylcysteine (NAC). In conclusion, we found that GPR109A expression by allo-activated T cells is essential for metabolic homeostasis and expansion, which are necessary features to induce GVHD after allo-HCT.
Autophagy in mesenchymal progenitors protects mice against bone marrow failure after severe intermittent stress
Authors: Landspersky Theresa , Saçma Mehmet , Rivière Jennifer , Hecker Judith S. , Hettler Franziska , Hameister Erik , Brandstetter Katharina , Istvánffy Rouzanna , Romero Marquez Sandra , Ludwig Romina , Götz Marilena , Buck Michèle , Wolf Martin , Schiemann Matthias , Ruland Jürgen , Strunk Dirk , Shimamura Akiko , Myers Kasiani , Yamaguchi Terry P. , Kieslinger Matthias , Leonhardt Heinrich , Bassermann Florian , Götze Katharina S. , Geiger Hartmut , Schreck Christina , Oostendorp Robert A. J.
Published: October 2021

The cellular mechanisms required to ensure homeostasis of the hematopoietic niche and the ability of this niche to support hematopoiesis upon stress remain elusive. We here identify Wnt5a in Osterix+ mesenchymal progenitor and stem cells (MSPCs) as a critical factor for niche-dependent hematopoiesis. Mice lacking Wnt5a in MSPCs suffer from stress-related bone marrow (BM) failure and increased mortality. Niche cells devoid of Wnt5a show defective actin stress fiber orientation due to an elevated activity of the small GTPase CDC42. This results in incorrect positioning of autophagosomes and lysosomes, thus reducing autophagy and increasing oxidative stress. In MSPCs from patients from BM failure states which share features of peripheral cytopenia and hypocellular BM, we find similar defects in actin stress fiber orientation, reduced and incorrect colocalization of autophagosomes and lysosomes, and CDC42 activation. Strikingly, a short pharmacological intervention to attenuate elevated CDC42 activation in vivo in mice prevents defective actin-anchored autophagy in MSPCs, salvages hematopoiesis and protects against lethal cytopenia upon stress. In summary, our study identifies Wnt5a as a restriction factor for niche homeostasis by affecting CDC42-regulated actin stress-fiber orientation and autophagy upon stress. Our data further imply a critical role for autophagy in MSPCs for adequate support of hematopoiesis by the niche upon stress and in human diseases characterized by peripheral cytopenias and hypocellular BM.
A phase 2 biomarker-driven study of ruxolitinib demonstrates effectiveness of JAK/STAT targeting in T-cell lymphomas
Authors: Moskowitz Alison J. , Ghione Paola , Jacobsen Eric , Ruan Jia , Schatz Jonathan H. , Noor Sarah , Myskowski Patricia , Vardhana Santosha , Ganesan Nivetha , Hancock Helen , Davey Theresa , Perez Leslie , Ryu Sunyoung , Santarosa Alayna , Dowd Jack , Obadi Obadi , Pomerantz Lauren , Yi Nancy , Sohail Samia , Galasso Natasha , Neuman Rachel , Liotta Brielle , Blouin William , Baik Jeeyeon , Geyer Mark B. , Noy Ariela , Straus David , Kumar Priyadarshini , Dogan Ahmet , Hollmann Travis , Drill Esther , Rademaker Jurgen , Schoder Heiko , Inghirami Giorgio , Weinstock David M. , Horwitz Steven M.
Published: October 2021

Signaling through JAK1 and/or JAK2 is common among tumor and nontumor cells within peripheral T-cell lymphoma (PTCL). No oral therapies are approved for PTCL, and better treatments for relapsed/refractory disease are urgently needed. We conducted a phase 2 study of the JAK1/2 inhibitor ruxolitinib for patients with relapsed/refractory PTCL (n = 45) or mycosis fungoides (MF) (n = 7). Patients enrolled onto 1 of 3 biomarker-defined cohorts: (1) activating JAK and/or STAT mutations, (2) ≥30% pSTAT3 expression among tumor cells by immunohistochemistry, or (3) neither or insufficient tissue to assess. Patients received ruxolitinib 20 mg PO twice daily until progression and were assessed for response after cycles 2 and 5 and every 3 cycles thereafter. The primary endpoint was clinical benefit rate (CBR), defined as the combination of complete response, partial response (PR), and stable disease lasting at least 6 months. Only 1 of 7 patients with MF had CBR (ongoing PR > 18 months). CBR among the PTCL cases (n = 45) in cohorts 1, 2, and 3 were 53%, 45%, and 13% (cohorts 1 & 2 vs 3, P = .02), respectively. Eight patients had CBR > 12 months (5 ongoing), including 4 of 5 patients with T-cell large granular lymphocytic leukemia. In an exploratory analysis using multiplex immunofluorescence, expression of phosphorylated S6, a marker of PI3 kinase or mitogen-activated protein kinase activation, in <25% of tumor cells was associated with response to ruxolitinib (P = .05). Our findings indicate that ruxolitinib is active across various PTCL subtypes and support a precision therapy approach to JAK/STAT inhibition in patients with PTCL. This trial was registered at www.clincialtrials.gov as #NCT02974647.
Multiple myeloma cells induce lipolysis in adipocytes and uptake fatty acids through fatty acid transporter proteins
Authors: Panaroni Cristina , Fulzele Keertik , Mori Tomoaki , Siu Ka Tat , Onyewadume Chukwuamaka , Maebius Allison , Raje Noopur
Published: October 2021

Adipocytes occupy 70% of the cellular volume within the bone marrow (BM) wherein multiple myeloma (MM) originates and resides. However, the nature of the interaction between MM cells and adipocytes remains unclear. Cancer-associated adipocytes support tumor cells through various mechanisms, including metabolic reprogramming of cancer cells. We hypothesized that metabolic interactions mediate the dependence of MM cells on BM adipocytes. Here we show that BM aspirates from precursor states of MM, including monoclonal gammopathy of undetermined significance and smoldering MM, exhibit significant upregulation of adipogenic commitment compared with healthy donors. In vitro coculture assays revealed an adipocyte-induced increase in MM cell proliferation in monoclonal gammopathy of undetermined significance/smoldering MM compared with newly diagnosed MM. Using murine MM cell/BM adipocyte coculture assays, we describe MM-induced lipolysis in adipocytes via activation of the lipolysis pathway. Upregulation of fatty acid transporters 1 and 4 on MM cells mediated the uptake of secreted free fatty acids (FFAs) by adjacent MM cells. The effect of FFAs on MM cells was dose dependent and revealed increased proliferation at lower concentrations vs induction of lipotoxicity at higher concentrations. Lipotoxicity occurred via the ferroptosis pathway. Exogenous treatment with arachidonic acid, a very-long-chain FFA, in a murine plasmacytoma model displayed a reduction in tumor burden. Taken together, our data reveal a novel pathway involving MM cell–induced lipolysis in BM adipocytes and suggest prevention of FFA uptake by MM cells as a potential target for myeloma therapeutics.
Aged healthy mice acquire clonal hematopoiesis mutations
Authors: Chin Desmond Wai Loon , Yoshizato Tetsuichi , Virding Culleton Stina , Grasso Francesca , Barbachowska Magdalena , Ogawa Seishi , Jacobsen Sten Eirik W. , Woll Petter S.
Published: October 2021

Chin and colleagues used detailed mutational analysis of aged mice and transplantation to evaluate the mouse as a model of clonal hematopoiesis (CH). Their data suggest that while murine hematopoietic stem cells acquire mutations in CH-associated genes when aged and CH clones can expand after transplantation (as in humans), these are rare events. Nevertheless, genetically manipulated murine models mimicking human CH are feasible and may prove useful in the future.
Thymic tumours and their special features
Authors: Basse Clémence , Girard Nicolas
Published: October 2021

Thymic tumours are rare thoracic malignancies, that may be aggressive and difficult to treat. The pillars of the management include pathological review, consideration of differential diagnoses, staging and multidisciplinary discussion. Assessment of resectability is key to drive the treatment sequencing. Association with autoimmune diseases, especially myasthenia gravis, is observed, which impacts the oncological management. Networks are being built at the national and international levels. This article provides an overview of the most recent findings in the diagnosis, staging, histology, and management strategies of thymic tumours.
Co-structure analysis and genetic associations reveal insights into pinworms (Trypanoxyuris) and primates (Alouatta palliata) microevolutionary dynamics
Authors: Solórzano-García Brenda , Vázquez-Domínguez Ella , Pérez-Ponce de León Gerardo , Piñero Daniel
Published: October 2021

Background

In parasitism arm race processes and red queen dynamics between host and parasites reciprocally mold many aspects of their genetics and evolution. We performed a parallel assessment of population genetics and demography of two species of pinworms with different degrees of host specificity (Trypanoxyuris multilabiatus, species-specific; andT. minutus,genus-specific) and their host, the mantled howler monkey (Alouatta palliata), based on mitochondrial DNA sequences and microsatellite loci (these only for the host). Given that pinworms and primates have a close co-evolutionary history, covariation in several genetic aspects of their populations is expected.

Results

Mitochondrial DNA revealed two genetic clusters (West and East) in both pinworm species and howler monkeys, although population structure and genetic differentiation were stronger in the host, while genetic diversity was higher in pinworms than howler populations. Co-divergence tests showed no congruence between host and parasite phylogenies; nonetheless, a significant correlation was found between both pinworms andA. palliatagenetic pairwise distances suggesting that the parasites’ gene flow is mediated by the host dispersal. Moreover, the parasite most infective and the host most susceptible haplotypes were also the most frequent, whereas the less divergent haplotypes tended to be either more infective (for pinworms) or more susceptible (for howlers). Finally, a positive correlation was found between pairwise p-distance of host haplotypes and that of their associated pinworm haplotypes.

Conclusion

The genetic configuration of pinworm populations appears to be molded by their own demography and life history traits in conjunction with the biology and evolutionary history of their hosts, including host genetic variation, social interactions, dispersal and biogeography. Similarity in patterns of genetic structure, differentiation and diversity is higher between howler monkeys andT. multilabiatusin comparison withT. minutus, highlighting the role of host-specificity in coevolving processes.Trypanoxyuris minutusexhibits genetic specificity towards the most frequent host haplotype as well as geographic specificity. Results suggest signals of potential local adaptation in pinworms and further support the notion of correlated evolution between pinworms and their primate hosts.
A time-driven activity-based costing approach for identifying variability in costs of childbirth between and within types of delivery
Authors: Dubron Kathia , Verschaeve Mathilde , Roodhooft Filip
Published: October 2021

Background

Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is the application of a time-driven activity-based method in order to estimate the cost of childbirth at a maternal department. Moreover, this study shows how this costing method can be used to outline how childbirth costs vary according to considered patient and disease characteristics. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.

Methods

A prospective cohort study design is performed in a maternity department. Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly.

Results

Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+ 33,3 min) and monitoring (+ 775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >  25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.

Conclusions

TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.
Does the use of telephone reminders to increase survey response rates affect outcome estimates? An ancillary analysis of a prospective cohort study of patients with low back pain
Authors: Udby Christina Lyngsø , Riis Allan , Thomsen Janus Laust , Rolving Nanna
Published: October 2021

Background

Research is often undertaken using patient-reported outcomes from questionnaires. Achieving a high response rate demands expensive and time-consuming methods like telephone reminders. However, it is unknown whether telephone reminders change outcome estimates or only affect the response rate in research of populations with low back pain (LBP). The aim is to compare baseline characteristics and the change in outcome between patients responding before and after receiving a telephone reminder.

Methods

This is an ancillary analysis of data from a prospective cohort study employing questionnaires from 812 adults with LBP lasting more than 3 months. Patients not responding to the 52-week questionnaire were sent reminder emails after two and 3 weeks and delivered postal reminders after 4 weeks. Patients still not responding were contacted by telephone, with a maximum of two attempts. Patients were categorised into three groups: 1) patients responding before a telephone reminder was performed; 2) patients responding after the telephone reminder and 3) patients not responding at all. A positive outcome was defined as a 30% improvement on the Roland Morris Disability Questionnaire after 52 weeks.

Results

A total of 695 patients (85.2%) responded. Of these, 643 patients were classified in Group 1 and 52 patients were classified in Group 2. One hundred seventeen were classified in Group 3. No differences in outcome or baseline characteristics was found. In Group 1, 41.3% had a positive outcome, and in Group 2 48.9% had a positive outcome (P = 0.297). In group 3, non-respondents were younger, more often unemployed, more often smokers, more often reported co-morbidity, and reported higher depression scores than respondents.

Conclusions

Using a telephone reminder had no consequence on outcome estimates nor were there any differences in baseline characteristics between patients who responded before or after the telephone reminder.

Trial registration

The initial trial was registered in Clinicaltrials.gov (NCT03058315).
Increasing rates of laparoscopic gastrointestinal surgery and decreasing rates of surgical site infections: an observational study in Japan from 2012–2017
Authors: Takahashi Tomoko , Nishiura Hiroshi
Published: October 2021

Background

Surgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of SSI. Epidemiological analysis of the temporal trends in SSI following gastrointestinal surgery has yet to be performed in Japan. Our purpose was to descriptively investigate these trends.

Methods

Extracting national surveillance data from the Japan Nosocomial Infections Surveillance (JANIS) system, we analyzed the frequency of SSI events following gastrointestinal surgery, which consisted of seven surgical procedures, from 2012–2017. We calculated the standardized infection ratio to compute risk-adjusted SSI frequency, and used the trend test to detect time-dependent changes.

Results

The frequency of SSI events, except for those associated with surgery of the upper gastrointestinal tract, revealed a decreasing time-dependent trend. The use of laparoscopic surgery increased dramatically over time (p < 0.01 for the six applicable surgical sites), while the frequency of SSI events during laparoscopic surgery remained unchanged.

Conclusions

The increasing use of laparoscopic surgery was identified, and the observation coincided with the decreasing trend in SSI, especially in lower gastrointestinal tract surgery. If the relationship is causal, the overall SSI incidence among previously healthy individuals is expected to decrease, because the use of laparoscopic surgery has large growth potential in Japan.
When it’s needed most: a blueprint for resident creative writing workshops during inpatient rotations
Authors: Edwards Lauren Michelle , Kim Yeuen , Stevenson Matthew , Johnson Tyler , Sharp Nora , Reisman Anna , Srinivasan Malathi
Published: October 2021

Background

Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents.

Objective

To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions.

Methods

We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1–7; 3–4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017–2018, weeks 1 and 4), and implementation year (2018–2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators.

Results

Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions.

Conclusions

Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.
A statistical quality assessment method for longitudinal observations in electronic health record data with an application to the VA million veteran program
Authors: Wang Hui , Belitskaya-Levy Ilana , Wu Fan , Lee Jennifer S. , Shih Mei-Chiung , Tsao Philip S. , Lu Ying ,   on behalf of VA Million Veteran Program
Published: October 2021

Background

To describe an automated method for assessment of the plausibility of continuous variables collected in the electronic health record (EHR) data for real world evidence research use.

Methods

The most widely used approach in quality assessment (QA) for continuous variables is to detect the implausible numbers using prespecified thresholds. In augmentation to the thresholding method, we developed a score-based method that leverages the longitudinal characteristics of EHR data for detection of the observations inconsistent with the history of a patient. The method was applied to the height and weight data in the EHR from the Million Veteran Program Data from the Veteran’s Healthcare Administration (VHA). A validation study was also conducted.

Results

The receiver operating characteristic (ROC) metrics of the developed method outperforms the widely used thresholding method. It is also demonstrated that different quality assessment methods have a non-ignorable impact on the body mass index (BMI) classification calculated from height and weight data in the VHA’s database.

Conclusions

The score-based method enables automated and scaled detection of the problematic data points in health care big data while allowing the investigators to select the high-quality data based on their need. Leveraging the longitudinal characteristics in EHR will significantly improve the QA performance.
Evaluation of the stability of cucurbit[8]uril-based ternary host−guest complexation in physiological environment and the fabrication of a supramolecular theranostic nanomedicine
Authors: Wu Han , Chen Zuobing , Qi Shaolong , Bai Bing , Ye Jiajun , Wu Dan , Shen Jie , Kang Fei , Yu Guocan
Published: October 2021

Background

Supramolecular theranostics have exhibited promising potentials in disease diagnosis and therapy by taking advantages of the dynamic and reversible nature of non-covalent interactions. It is extremely important to figure out the stability of the driving forces in physiological environment for the preparation of theranostic systems.

Methods

The host−guest complexation between cucurbit[8]uril (CB[8]), 4,4′-bipyridinium, and napththyl guest was fully studied using various characterizations, including nuclear magnetic resonance spectroscopy, ultraviolet–visible (UV–vis) spectroscopy, isothermal titration calorimetry (ITC). The association constants of this ternary complex were determined using isothermal titration calorimetry. The stability of the non-covalent interactions and self-assemblies form from this molecular recognition was confirmed by UV–vis spectroscopy and dynamic light scattering (DLS). A supramolecular nanomedicine was constructed on the basis of this 1:1:1 ternary recognition, and its in vitro and in vivo anticancer efficacy were thoroughly evaluated. Positron emission tomography (PET) imaging was used to monitor the delivery and biodistribution of the supramolecular nanomedicine.

Results

Various experiments confirmed that the ternary complexation between 4,4′-bipyridinium, and napththyl derivative and CB[8] was stable in physiological environment, including phosphate buffered solution and cell culture medium. Supramolecular nanomedicine (SNM@DOX) encapsulating a neutral anticancer drug (doxrubincin, DOX) was prepared based on this molecular recognition that linked the hydrophobic poly(ε-caprolactone) chain and hydrophilic polyethylene glycol segment. The non-covalent interactions guaranteed the stability of SNM@DOX during blood circulation and promoted its tumor accumulation by taking advantage of the enhanced permeability and retention effect, thus greatly improving the anti-tumor efficacy as compared with the free drug.

Conclusion

Arising from the host-enhanced charge-transfer interactions, the CB[8]-based ternary recognition was stable enough in physiological environment, which was suitable for the fabrication of supramolecular nanotheranostics showing promising potentials in precise cancer diagnosis and therapy.

Graphic Abstract
Esthetic and functional reconstruction of large mandibular defects using free fibula flap and implant-retained prosthetics - a case series with long-term follow-up
Authors: Sass Tamás , Piffkó József , Braunitzer Gábor , Oberna Ferenc
Published: October 2021

Background

The reconstructive and rehabilitative management of large mandibular defects with basal continuity is challenging in many respects, especially in the vertical dimension. The free fibula flap is an under-utilised but efficient approach in this indication. The aim of this case series is to demonstrate its use and long-term success.

Case presentation

Three cases are presented, where the patient had a large bone defect (at least 5 cm in length and 1 cm in the vertical dimension), but the continuity of the mandible was maintained. Two cases were related to pathological fracture and one was a large defect due to oncological surgery. Vertical augmentation with free microvascularised fibula flap was carried out, followed by implant-retained prosthetic therapy. Clinical status has been followed up for 5 to 6 years, with special attention to the condition of the peri-implant tissues and any radiographically detectable alterations or complications. No complications occurred during the follow-up. Function and esthetics have remained unchanged throughout.

Conclusions

Free microvascularised fibula flap reconstruction combined with implant-retained prosthetics allows a lasting functional and esthetic solution in the discussed indication.
Polymethyl methacrylate cure time in simulated in vivo total knee arthroplasty versus in vitro conditions
Authors: Funk Daniel A. , Nguyen Quang-Viet , Swank Michael
Published: October 2021

Background

The present means of confirming the cure of intra-operative polymethyl methacrylate (PMMA) cement are to wait for the remainder cement to harden. To our knowledge, there is no available technique to determine the precise moment of cure for in-vivo cement beneath the tibial tray. This study uses a novel means to determine cement curing time in two environments. One environment represents the operating theater, and the other environment attempts to model cement conditions under the tibial tray during surgery.

Materials and methods

We determined the temperature-versus-time plot of cement curing using the following two temperature sensors: one in a simulated implanted tibial tray and another in the remainder cement. We performed 55 tests using dental methyl methacrylate cement mixed in the same ratio as the orthopedic cement. To simulate in vivo conditions, a simulated stainless-steel tibial tray was implanted on a cancellous bone substitute (Sawbones, Vashon Island, WA, USA) using standard cement technique and subsequently placed in a 90°F (32.2 °C) circulating water bath. We positioned a temperature sensor in the cement mantel and positioned a second sensor in a portion of the remaining cement. The temperature from both sensors was measured simultaneously, beginning at 5 min after mixing and continuing for 20 min. The first derivative of the temperature provided the precise curing time for each condition. We analyzed the results of 55 repeated experiments with an independent samples t-test.

Results

With the described technique, we were able to accurately determine the moment of cure of the cement beneath the simulated tray. There was a mean difference between cure time of 5 min and 26 s (p value < 0.001) between the two conditions.

Conclusions

We validated that our technique was successful in determining the precise time to cure in two different environments.

Level of evidence

This was not a clinical trial and did not involve patients as such the level of evidence was Grade A: Consistent 1 and 2.
Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections
Authors: Surat Güzin , Bernsen Dominik , Schimmer Christoph
Published: October 2021

Objective

The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team.

Methods

This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed.

Results

A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group.

Conclusions

The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.
Recent advances in understanding the effects of lignin structural characteristics on enzymatic hydrolysis
Authors: Yuan Yufeng , Jiang Bo , Chen Hui , Wu Wenjuan , Wu Shufang , Jin Yongcan , Xiao Huining
Published: October 2021

Enzymatic hydrolysis of lignocellulose for bioethanol production shows a great potential to remit the rapid consumption of fossil fuels, given the fact that lignocellulose feedstocks are abundant, cost-efficient, and renewable. Lignin results in low enzymatic saccharification by forming the steric hindrance, non-productive adsorption of cellulase onto lignin, and deactivating the cellulase. In general, the non-productive binding of cellulase on lignin is widely known as the major cause for inhibiting the enzymatic hydrolysis. Pretreatment is an effective way to remove lignin and improve the enzymatic digestibility of lignocellulose. Along with removing lignin, the pretreatment can modify the lignin structure, which significantly affects the non-productive adsorption of cellulase onto lignin. To relieve the inhibitory effect of lignin on enzymatic hydrolysis, enormous efforts have been made to elucidate the correlation of lignin structure with lignin–enzyme interactions but with different views. In addition, contrary to the traditional belief that lignin inhibits enzymatic hydrolysis, in recent years, the addition of water-soluble lignin such as lignosulfonate or low molecular-weight lignin exerts a positive effect on enzymatic hydrolysis, which gives a new insight into the lignin–enzyme interactions. For throwing light on their structure–interaction relationship during enzymatic hydrolysis, the effect of residual lignin in substrate and introduced lignin in hydrolysate on enzymatic hydrolysis are critically reviewed, aiming at realizing the targeted regulation of lignin structure for improving the saccharification of lignocellulose. The review is also focused on exploring the lignin–enzyme interactions to mitigate the negative impact of lignin and reducing the cost of enzymatic hydrolysis of lignocellulose.