bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19142: Is Malnutrition Associated With Worse Outcomes in Patients With Acute Decompensated Heart Failure (ADHF)? ; Insights From Nationwide Inpatient Sample 2015-2020
Authors: Garg Nadish , Kurpad Krishna Prasad , Desai Aditya , Desai Darshi , Mehta Sanjay , Varadarajan Padmini , Pai Ramdas G
Published: November 2023

Introduction:
Is Malnutrition associated with worse outcomes in patients admitted with acute decompensated heart failure? Insights from nationwide inpatient sample 2015-2020

Hypothesis:
Heart Failure affects >5 million US patients resulting in >1 million annual hospitalizations due to Acute Decompensated Heart Failure (ADHF). The impact of malnutrition on hospitalized patients with ADHF is not well described. Patients with heart failure are prone to malnutrition because of reduced intake, cytokine dysfunction, and increased basal metabolic rate. We aim to assess the effect of malnutrition on hospital outcomes in ADHF.

Methods:

Using the NIS database we identified all the patients who were admitted for ADHF with history of heart failure with reduced ejection fraction from 2015-2020. Predictors and effects of malnutrition were studied using univariate and multivariate models.

Results:
A total of 4,224,869 patients were admitted for ADHF from 2015-2020 among which 253,915 patients had associated malnutrition. Baseline characteristics and comorbidities are outlined in the table below. Patients with malnutrition had higher inpatient mortality (9.6% vs 3.61% p-value:0.0000), a longer length of stay (10.8 days vs 5.9 days p-value: 0.0000), doubling of the cost of care (147485 USD vs 74077 USD p-value:0.001). After adjusting for baseline co-morbidities patients with malnutrition had 2 times higher mortality (Odds ratio: 2.01, p-value: 0.0001)

Conclusions:
Our study demonstrates that Malnutrition in ADHF patients results in higher mortality, longer length of stay, and higher costs of care. This highlights the importance of optimizing of nutritional status in these patients.
Abstract 19151: Late Gadolinium Enhancement (LGE) in Recurrent Pericarditis Patients on Il-1 Blockers and Standard Anti-Inflammatory Therapy
Authors: Syed Alveena B , Yesilyaprak Abdullah , Saraswati Ushasi , Bayat Aqieda , Cremer Paul C , Klein Allan L
Published: November 2023

Introduction:
Recurrent pericarditis is defined as the recurrence of pericarditis after a symptom-free interval of 4-6 weeks. Our study aimed to investigate the improvement in the late gadolinium enhancement on cardiac resonance imaging (CMR) in recurrent patients on IL-1 blockers and standard anti-inflammatory therapy.

Hypothesis:
We hypothesize that patients on IL-1 inhibitor show a better improvement of LGE on CMR in recurrent pericarditis.

Methods:
This is a retrospective comparative cohort study of 37 recurrent pericarditis patients on IL-1 inhibitor and 107 recurrent pericarditis patients on standard anti-inflammatory therapy. We included patients with LGE tracing and compared both groups. Patients were treated for at least 12 months and were followed for a duration minimum of 12 months.

Results:
The patients' mean age in the IL-1 inhibitor group was 51.16 ±16, and the standard therapy group was 54.26 ± 14.32. Patients had a median baseline ESR of 5 mm/hr and median hs-CRP of 2.2 mg/L in the IL-1 inhibitor group and a median baseline ESR of 7.5 mm/hr and median hs-CRP of 1.5 mg/L in the standard therapy group. At baseline, patients in the IL-1 inhibitor group had 5.4% none LGE, 43.24% mild LGE, 37.83% moderate LGE, and 13.5% severe LGE. Over the follow-up of 12-24 months, IL-1 inhibitor patients had improvement in LGE, with 35.13% of patients having none LGE and 64.86% having mild LGE. In the standard group, 27.1% had none LGE, 54.2% had mild LGE, 15.88% had moderate LGE, and 2.8% had severe LGE at baseline. Over 12-24 months follow-up, standard therapy group patients had some improvement as well as worsening of LGE in some patients, with 35.51% having none LGE, 59.81% having mild LGE, and 4.6% having moderate LGE.

Conclusions:
IL-1 inhibitors serve as a competitive antagonist of IL-1 cytokine and block its pro-inflammatory functions. Pericardial delayed enhancement is significant in determining disease course and improvement in patients with pericarditis.
Abstract 19176: Atrial Fibrillation Prevalence With Mavacamten for Obstructive Hypertrophic Cardiomyopathy
Authors: jaikumar likhitesh , Biswas Monodeep , Kagan Calvin , Amara Richard S , Reck Kim M , Shorofsky Stephen , Dickfeld Timm , Wang Libin , See Vincent Y
Published: November 2023

Introduction:
Mavacamten is a first-in-class, small molecule, selective cardiac myosin inhibitor for treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM). Partial reversal of hypertrophic remodelng, diastolic dysfunction, and sarcomeric calcium sensitivity have been reported. While atrial fibrillation (AF) prevalence is observed in ~10% of pre-approval study subjects, the effects of mavacamten on AF have not been reported.

Hypothesis:
AF prevalence remains elevated after mavacamten therapy for HCM

Methods:
Chart review was performed for standard of care clinical encounters, 12-lead ECG, and echocardiography (TTE) for patients treated mavacamten at a single HCM referral center.

Results:
Among 12 patients prescribed mavacamten, 92% had no prior AF symptoms nor diagnosis. After 6 months of mavacamten therapy, 25% had AF with 17% new-onset. TTE demonstrated resolution of LVOT gradients in 100% of AF patients at 6 months. Case 1: 60-year-old male with OSA and LVOT gradients of 31 mmHg at rest and 41 mm Hg with Valsalva was started on mavacamten for exertional fatigue and dyspnea. After 3 months, he developed new-onset, paroxysmal AF treated by TEE-guided cardioversion, amiodarone and apixiban. Case 2: 66-year-old female with LVOT gradients of 38 mmHg at rest and 74 mm Hg with Valsalva initiated mavacamten for exertional dyspnea. After mavacamten initiation, exertional symptoms improved but frequent episodes of symptomatic AF persisted despite sotalol 120mg. Case 3: 58-year-old female with LVOT gradient of 97 mm Hg at rest and no change with Valsalva and dyspnea on exertion. After unexplained syncopal events, an implantable cardiac monitor recorded AF. After 1 month of mavacamten, she experienced increased frequency of AF.

Conclusions:
In a single center experience with mavacamten, AF prevalence of 25% with 17% new onset AF developed despite improvement in symptoms and hypertrophic remodeling parameters. As a novel cardiac myosin inhibitor that attenuates hypertrophic remodeling, diastolic dysfunction, and calcium sensitivity that are anticipated to reduce AF susceptibility, more observation of arrhythmia incidence and burden in larger cohorts will inform arrhythmia outcomes and mechanisms in HCM.
Abstract 19180: Early Rhythm Control is Associated With Improved Outcomes in Hypertrophic Cardiomyopathy Patients With Atrial Fibrillation
Authors: Ayub Muhammad Talha , Rangavajla Gautam , Newhouse David , Thoma Floyd W , Bhonsale Aditya , Voigt Andrew , Mulukutla Suresh R , Shalaby Alaa , Estes Nathan A , Jain Sandeep , Saba Samir , Kancharla Krishna
Published: November 2023

Background:
Atrial fibrillation in hypertrophic cardiomyopathy (HCM) patients is associated with worse outcomes with regards to stroke, heart failure hospitalization and death. Contemporary data on Rhythm control (RyC) strategies and outcomes in HCM patients is limited.

Objectives:
We aimed to assess the clinical characteristics of HCM patients with AF receiving RyC (antiarrhythmic drug and/or catheter ablation) vs no rhythm control (NRC) and compare clinical outcomes between the two groups.

Methods:
We analyzed the electronic health records of the University of Pittsburgh Medical Center, a large multi-hospital system, between 2010 and 2022. Differences between baseline demographics, cardiovascular risk factors, and comorbidity burden were evaluated with t tests. Adjusted Cox proportional hazards and Kaplan-Meier analyses were performed to evaluate associations between use of rhythm control and all-cause age-adjusted mortality.

Results:
A total of 552 patients with HCM and AF were analyzed, of which 118 received RyC and 434 NRC. The RyC group was relatively younger (age 64 vs 70), received initial evaluation by a cardiologist (70% vs 57%), had lower CHA2DS2VASC scores (mean 2.5 vs 3.1) and fewer comorbidities (mean Elixhauser scores 3.0 vs 4.7). There were no significant differences in either ejection fraction or left atrial diameter between the groups. Among RyC patients, 38 received catheter ablation and 80 received antiarrhythmic drug as the initial RyC strategy. Over a median follow up of 2.9 years (IQR 0.96-6.0), use of RyC was associated with decreased mortality after adjustment for age, Elixhauser score, and CHA2DS2VASC score (HR 0.54, 95% CI 0.30-0.95, p<0.05, figure 1).

Conclusion:
Rhythm control in HCM and AF patients is associated with better outcomes as suggested by decreased overall mortality. Prospective studies are needed to establish the best RyC strategy in this cohort.
Off-Label Dosing of Direct Oral Anticoagulants Among Inpatients With Atrial Fibrillation in the United States
Authors: Sandhu Amneet , Kaltenbach Lisa A. , Chiswell Karen , Shimoga Vijay , Ashur Carmel , Pribish Abby , Fonarow Gregg C. , Piccini Jonathan P. , Ho P. Michael , Varosy Paul D. , Hess Paul L.
Published: November 2023

BACKGROUND:

Among patients hospitalized for atrial fibrillation, the frequency of off-label direct oral anticoagulant (DOAC) dosing, associated factors, hospital-level variation, and temporal trends in contemporary practice are unknown.

METHODS:

Using the Get With The Guidelines–Atrial Fibrillation registry, patients admitted from January 1, 2014, to March 31, 2020, and discharged on DOACs were stratified according to receipt of underdosing, overdosing, or recommended dosing. Factors associated with off-label dosing (defined as underdosing or overdosing) were identified using logistic regression. Median odds ratio (OR) and time-series analyses were used to assess hospital-level variation and temporal trends, respectively.

RESULTS:

Of 22 470 patients (70.1±12.1 years, 48.1% female, 82.5% White) prescribed a DOAC at discharge from hospitalization for atrial fibrillation (66% apixaban, 29% rivaroxaban, and 5% dabigatran), underdosing occurred among 2006 (8.9%), overdosing among 511 (2.3%), and recommended dosing among 19 953 (88.8%). The overall rate of off-label dosing was 11.2%. Patient-related factors associated with off-label dose included age (underdosing: OR, 1.06 per 1-year increase [95% CI, 1.06–1.07]; overdosing: OR, 1.07 per 1-year increase [95% CI, 1.06–1.09]), dialysis dependence (underdosing: OR, 5.50 [95% CI, 3.76–8.05]; overdosing: OR, 5.47 [95% CI, 2.74–10.88]), female sex (overdosing: OR, 0.79 [95% CI, 0.63–0.99]), and weight (overdosing: OR, 0.96 per 1-kg increase [95% CI, 0.95–1.00]). Across hospitals, the adjusted median OR for off-label DOAC dose was 1.45 (95% CI, 1.34–1.65; underdosing: OR, 1.52 [95% CI, 1.39–1.76]; overdosing: OR, 1.32 [95% CI, 1.20–1.84]), indicating significant hospital-level variation. Over the study period, recommended dosing significantly increased over time (81.9%–90.9%;
P
<0.0001 for trend) with a corresponding decline in underdosing (14.4%–6.6%;
P
<0.0001 for trend) and overdosing (3.8%–2.5%;
P
=0.001 for trend).

CONCLUSIONS:

Over 1 in 10 patients hospitalized for atrial fibrillation are discharged on an off-label DOAC dose with significant variation across hospitals. While the proportion of patients receiving recommended dosing has significantly improved over time, opportunities to improve DOAC dosing persist.
Fluctuations in Sustained Attention Explain Moment-to-Moment Shifts in Children’s Memory Formation
Authors: Decker Alexandra L. , Duncan Katherine , Finn Amy S.
Published: November 2023

Why do children’s memories often differ from adults’ after the same experience? Whereas prior work has focused on children’s immature memory mechanisms to answer this question, here we focus on the costs of attentional lapses for learning. We track sustained attention and memory formation across time in 7- to 10-year-old children and adults ( n = 120) to show that sustained attention causally shapes the fate of children’s individual memories. Moreover, children’s attention lapsed twice as frequently as adults’, and attention fluctuated with memory formation more closely in children than adults. In addition, although attentional lapses impaired memory for expected events in both children and adults, they impaired memory for unexpected events in children only. Our work reveals that sustained attention is an important cognitive factor that controls access to children’s long-term memory stores. Our work also raises the possibility that developmental differences in cognitive performance stem from developmental shifts in the ability to sustain attention.
Perceptions, Promotion and Pre-eminence: India’s Presidency of the G20
Authors: Ogden Chris
Published: November 2023

New Delhi’s taking on the G20 Presidency represents a highly important—if not watershed—moment for Indian diplomacy. For an India that is transitioning from being a developing to a developed economy and whose great power rise centres upon core goals relating to development, modernisation, status, leadership, importance, prestige and pride, assuming the G20 Presidency seems transformational. A central part of the G20’s remit also concerns constructing and maintaining global financial architectures and governance mechanisms, which India can now crucially influence as her own economic clout increases on the global stage. Moreover, New Delhi’s Presidency signifies a pivotal time for the legitimacy of the G20 and one which potentially heralds a more representative era for the grouping, which will only enhance India’s global pre-eminence.
Randomized Controlled Pilot Trial: Project Support Positive Parenting Module Following Sexual Abuse
Authors: Rancher Caitlin , McDonald Renee , Cook Katrina , Jouriles Ernest N.
Published: November 2023

Purpose: Support from a nonoffending caregiver can play a critical role in helping children recover from sexual abuse. However, many caregivers lack the skills to effectively support their child during the aftermath of a sexual abuse disclosure. This randomized controlled pilot trial examined a brief parenting intervention (Project Support Positive Parenting module) delivered by paraprofessionals to families waiting for intensive, trauma-focused therapy at a children's advocacy center. Methods: After a pretreatment assessment, 21 families were randomized to the intervention or a treatment-as-usual control group. Families also completed a posttreatment assessment. Results: Caregivers who received the Project Support module reported improved caregiver support and parenting self-efficacy, and their families were more likely to engage in trauma-focused therapy. Caregivers and service providers reported high levels of satisfaction with the program. Discussion: Although the results should be interpreted as preliminary, they offer promising evidence for brief parenting programs following a sexual abuse disclosure.
Creating a Pathway to Health-Care Professions for Historically Marginalized Students
Authors: Bryant Kellie , Lee Allison
Published: November 2023

Developing a diverse talent pool starting at the high-school level, while students are making future education and career decisions, should be a national priority, given the need to build a diverse health-care workforce. This article describes a 6-week immersive simulation-based summer program to introduce 20 junior high-school students (13–15 years old) to the range of health professions. Because precollege students typically receive limited exposure to clinical settings, high-fidelity simulation is an excellent surrogate for providing realistic experiences in health care. Students heard lectures on health careers, earned basic life support certification, learned to perform basic vital signs measurement, practiced the management of acute asthma, and received an introduction to the daily activities in the life of a nurse and an anesthesiologist. They researched, developed, and presented public service announcement videos about a health-care issue affecting their community. Participants reported being excited about health careers. Future programs will focus on longitudinal support and mentoring, essential for mitigating the higher rates of attrition from health professions among minoritized individuals.
Tumor treating fields increases blood-brain barrier permeability and relative cerebral blood volume in patients with glioblastoma
Authors: Iv Michael , Naya Lewis , Sanan Sajal , Van Buskirk Samuel L , Nagpal Seema , Thomas Reena P , Recht Lawrence D , Patel Chirag B
Published: November 2023

Background and objective

200 kHz tumor treating fields (TTFields) is clinically approved for newly-diagnosed glioblastoma (nGBM). Because its effects on conventional surveillance MRI brain scans are equivocal, we investigated its effects on perfusion MRI (pMRI) brain scans.

Methods

Each patient underwent institutional standard pMRI: dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) pMRI at three time points: baseline, 2-, and 6-months on-adjuvant therapy. At each timepoint, the difference between T1 pre- versus post-contrast tumor volume (ΔT1) and these pMRI metrics were evaluated: normalized and standardized relative cerebral blood volume (nRCBV, sRCBV); fractional plasma volume (Vp), volume of extravascular extracellular space (EES) per volume of tissue (Ve), blood–brain barrier (BBB) permeability (Ktrans), and time constant for gadolinium reflux from EES back into the vascular system (Kep). Between-group comparisons were performed using rank-sum analysis, and bootstrapping evaluated likely reproducibility of the results.

Results

Among 13 pMRI datasets (11 nGBM, 2 recurrent GBM), therapies included temozolomide-only ( n = 9) and temozolomide + TTFields ( n = 4). No significant differences were found in patient or tumor characteristics. Compared to temozolomide-only, temozolomide + TTFields did not significantly affect the percent-change in pMRI metrics from baseline to 2 months. But during the 2- to 6-month period, temozolomide + TTFields significantly increased the percent-change in nRCBV (+26.9% [interquartile range 55.1%] vs -39.1% [37.0%], p = 0.049), sRCBV (+9.5% [39.7%] vs -30.5% [39.4%], p = 0.049), Ktrans (+54.6% [1768.4%] vs -26.9% [61.2%], p = 0.024), Ve (+111.0% [518.1%] vs -13.0% [22.5%], p = 0.048), and Vp (+98.8% [2172.4%] vs -24.6% [53.3%], p = 0.024) compared to temozolomide-only.

Conclusion

Using pMRI, we provide initial in-human validation of pre-clinical studies regarding the effects of TTFields on tumor blood volume and BBB permeability in GBM.
“We’ll Be Farmers When We Grow Up”: Education for Humanization and the Legacy of Critical Literacy Education in Korea
Authors: Lee Yoonmi
Published: November 2023

Purpose

This article explores the literary work of a teacher and activist, Yi O-Deok, as a lens to approach historically and culturally embedded notions of humanization in education in Korea. Anchored in the ethos of “Asia as Method,” this study offers a unique perspective that exemplifies the importance of the local sociocultural context in Asia in enriching our understanding of universal concepts.

Design/Approach/Methods

This study adopts a methodological approach centered around the examination of Yi O-Deok's work and his influence on critical literacy education. Key source materials include Yi's extensive five-volume diary and the various literary pieces he edited from the 1950s to the 1980s.

Findings

Yi O-Deok's philosophy on humanizing education, deeply influenced by local contexts, provides a distinct, non-Western perspective. It offers a critical counterpoint to Western-centric educational paradigms and enriches the broader understanding of humanization in education.

Originality/Value

The uniqueness of this study resides in its focus on children's writings, affirming faith in the unfiltered expressions of their pure spirits encapsulated in the raw “languages of the soil,” which have persevered through the sociopolitical upheavals of Korea's modern history. This in turn strengthens the call for a nuanced, non-Western interpretation of the concept of “humanization” in education.
Planning Temporariness: Unpacking Time–Space Planning and Its Socially Just Applications in and Around Kolkata
Authors: Chatterjee Debayan , Khanna Khushboo
Published: November 2023

The growing uncertainties affecting Indian cities, both prior to COVID-19 and in a post-pandemic context, are not only changing the everyday needs of its citizens but also challenging mainstream planning, in envisioning urban futures and demanding new planning interventions and processes that are affordable and flexible, and yield equitable, long-lasting outcomes. This demands adoption of an alternative time–space approach in planning that aligns with Henri Lefebvre’s idea of time being interconnected with space. Consequently, it prompts both formal and informal actors to perceive the city through the ‘prism of the temporary’, a fundamental concept employed by Peter Bishop and Lesley Williams in their analysis of cities in the global South. Here, planning does not discriminate between ‘formal’ and ‘informal’ interventions. Rather, the ‘hybrid’ initiatives are threaded deliberately into the temporal layers of the city and, therefore, allow both formal and informal actors to collaborate in ‘strange’ ways and curate socially just time-bound responses that cope with a range of socio-economical challenges. To elaborate this further, the article adopts a case-study approach and critically examines a few temporary-use practices through various actors and their roles, types of spatial and institutional experiments and their contributions towards just developments in and around Kolkata. The study does not intend to replace long-term macro-spatial interventions with short-term micro-spatial practices. Rather it highlights those situations where formal urban planning fails to address the urban quandaries, and, therefore, planning ‘temporariness’ allows people and planners to explore appropriate possibilities to ‘improvise’ urban lives in India.
Barriers and Facilitators to Uptake of Continuous Glucose Monitoring for Management of Type 2 Diabetes Mellitus in Youth
Authors: Peyyety Vaishnavi , Zupa Margaret F. , Hewitt Brianna , Rodriguez Gonzalez Adriana , Mani Iswariya , Prioleau Temiloluwa , McCurley Jessica , Lin Yu Kuei , Vajravelu Mary Ellen
Published: November 2023

Purpose:

The purpose of this study was to identify factors impacting the acceptability of continuous glucose monitoring (CGM) in adolescents and young adults (AYAs) with type 2 diabetes mellitus (T2DM).

Methods:

In this single-center study, semistructured interviews were conducted with AYAs with T2DM and their parents to determine attitudes about CGM, including barriers and facilitators. Interviews were audio-recorded, transcribed, and evaluated using thematic analysis.

Results:

Twenty AYAs and 10 parents participated (n = 30 total). AYAs were mean age 16.5 years (SD 2.2, range = 13.7-20.1) and had median diabetes duration of 1.3 years. Most were female (65%) and from minoritized background (40% non-Hispanic Black, 10% Hispanic, 5% Asian). Seven (35%) used CGM. The primary facilitator elicited was convenience over glucose meter use. Important barriers included the impact of physically wearing the device and drawing unwanted attention, desire for AYA privacy, and inadequate education about the device.

Conclusions:

In this diverse sample of AYAs with T2DM and their parents, CGM was generally regarded as convenient, although concerns about worsening stigma and conflict with parents were prevalent. These findings can guide the development of patient-centered approaches to CGM for AYAs with T2DM, a critical step toward reducing inequities in diabetes technology uptake.
Reconstruction of the Posterior Cruciate Ligament and Medial Collateral Ligament With a Single Combined Femoral Tunnel
Authors: Giardino Moreira da Silva Andre , Gobbi Riccardo Gomes , Bonadio Marcelo Batista , Angelini Fabio Janson , Pécora José Ricardo , Helito Camilo Partezani
Published: November 2023

Background:

Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery.

Indications:

The indication of this technique is the combined injury of the PCL and the MCL.

Technique Description:

The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it.

Results:

Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature.

Discussion/Conclusion:

This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Effects of laryngeal mask ventilation on postoperative atelectasis in children undergoing day surgery: a randomized controlled trial
Authors: Cai Weiwei , Gu Wei , Ni Huanhuan , Zhao Longde , Zhong Shan , Wang Wei
Published: November 2023

Background

To compare the effects of laryngeal mask mechanical ventilation and preserved spontaneous breathing on postoperative atelectasis in children undergoing day surgery.

Methods

Children aged 3–7 who underwent elective day surgery were randomly divided into a spontaneous breathing group (n = 23) and a mechanical ventilation group (n = 23). All children enrolled in this trial used the same anesthesia induction protocol, the incidence and severity of atelectasis before induction and after operation were collected. In addition, the baseline data, intraoperative vital signs, ventilator parameters and whether there were complications such as reflux and aspiration were also collected. SPSS was used to calculate whether there was a statistical difference between these indicators.

Results

The incidence of atelectasis in the spontaneous breathing group was 91.30%, and 39.13% in the mechanical ventilation group, and the difference was statistically significant (P = 0.001). There was a statistically significant difference in carbon dioxide (P < 0.05), and the severity of postoperative atelectasis in the mechanical ventilation group was lower than that in the spontaneous breathing group (P < 0.05). In addition, there were no significant differences in the vital signs and baseline data of the patients (P > 0.05).

Conclusion

Laryngeal mask mechanical ventilation can reduce the incidence and severity of postoperative atelectasis in children undergoing day surgery, and we didn’t encounter any complications such as reflux and aspiration in children during the perioperative period, so mechanical ventilation was recommended to be used for airway management.

Trial registration

The clinical trial was registered retrospectively at the Chinese Clinical Trial Registry. (https://www.chictr.org.cn. Registration number ChiCTR2300071396, Weiwei Cai, 15 May 2023).
Association between ozone and influenza transmissibility in China
Authors: Yang Jiao , Zhang Ting , Yang Liuyang , Han Xuan , Zhang Xingxing , Wang Qing , Feng Luzhao , Yang Weizhong
Published: November 2023

Background

Common air pollutants such as ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter play significant roles as influential factors in influenza-like illness (ILI). However, evidence regarding the impact of O3 on influenza transmissibility in multi-subtropical regions is limited, and our understanding of the effects of O3 on influenza transmissibility in temperate regions remain unknown.

Methods

We studied the transmissibility of influenza in eight provinces across both temperate and subtropical regions in China based on 2013 to 2018 provincial-level surveillance data on influenza-like illness (ILI) incidence and viral activity. We estimated influenza transmissibility by using the instantaneous reproduction number ($${R}_{t}$$

R
t

) and examined the relationships between transmissibility and daily O3 concentrations, air temperature, humidity, and school holidays. We developed a multivariable regression model for $${R}_{t}$$

R
t

to quantify the contribution of O3 to variations in transmissibility.

Results

Our findings revealed a significant association between O3 and influenza transmissibility. In Beijing, Tianjin, Shanghai and Jiangsu, the association exhibited a U-shaped trend. In Liaoning, Gansu, Hunan, and Guangdong, the association was L-shaped. When aggregating data across all eight provinces, a U-shaped association was emerged. O3 was able to accounted for up to 13% of the variance in $${R}_{t}$$

R
t

. O3 plus other environmental drivers including mean daily temperature, relative humidity, absolute humidity, and school holidays explained up to 20% of the variance in $${R}_{t}$$

R
t

.

Conclusions

O3 was a significant driver of influenza transmissibility, and the association between O3 and influenza transmissibility tended to display a U-shaped pattern.
Religious and traditional beliefs and practices as predictors of mental and physical health outcomes and the role of religious affiliation in health outcomes and risk taking
Authors: Wüthrich-Grossenbacher Ursula , Midzi Nicholas , Mutsaka-Makuvaza Masceline Jenipher , Mutsinze Abigail
Published: November 2023

Background

While many studies from sub-Saharan countries, including Zimbabwe, allude to the important role of religion and tradition for young people living with HIV (YPLHIV), most of these studies tend to be descriptive and lack advanced statistical analysis. This study aims to close this gap.

Methods

Data for this study was collected between July and October 2021 from 804 YPLHIV (aged 14–24) in Zimbabwe. The questionnaire included questions regarding participants’ conceptions of HIV, their health seeking and risk-taking behaviour, current HIV viral load results, the prevalence of opportunistic infections, their mental health status, and demographic characteristics. The analysis was done using multilevel mixed-effects logistic regression.

Results

We found that Traditional religious affiliation was linked to overall lower viral load (OR: 0.34; CI: 0.12–0.96; P: 0.042), Apostolic to more (OR: 1.52; CI: 1-2.3; P: 0.049) and Pentecostal to less (OR: 0.53; CI: 0.32–0.95; P: 0.033) treatment failure. Additionally, conceptions about HIV without spiritual or religious connotation, such as ‘seeing HIV as result of a weak body’ was associated with lower risk of treatment failure (OR: 0.6; CI: 0.4-1.0; P: 0.063), higher chances for undetectable viral load (OR: 1.4; CI: 1–2; P: 0.061), and overall lower viral load (OR: 0.7; CI: 0.5-1; P: 0.067). Moralizing concepts of HIV, like ‘seeing HIV as a result of sin in the family’, was linked to higher risk of opportunistic infections (OR:1.8; CI:1.1-3; P: 0.018), and higher risk of treatment failure (OR: 1.7; CI: 0.7–1.1; P: 0.066). Religious objections toward certain forms of therapy, like toward cervical cancer screening, was linked to higher risk of mental problems (OR: 2.2; CI: 1.35–3.68; P: 0.002) and higher risk of opportunistic infections (OR:1.6; CI:1.1–2.1; P: 0.008). Religious affiliations significantly influenced conceptions of HIV, health seeking behaviour, and risk taking.

Conclusion

To our knowledge, this study is the first to provide evidence about the statistically significant associations between religious and traditional beliefs and practices and current health outcomes and health risk factors of YPLHIV in Zimbabwe. It is also the first to identify empirically the role of religious affiliations as predictors of current viral load results. This new knowledge can inform contextualized approaches to support YPLHIV in Zimbabwe.
Development of a behaviour change intervention to promote sanitation and latrine use in rural India
Authors: Talat Usman , Ravenscroft Luke , Vlaev Ivo
Published: November 2023

Background

Across developing countries poor sanitation is associated with disease often found widespread in rural populations.

Objectives

This objective of this study was to conduct a formative research and feasibility evaluation of the behavioural intervention designed to improve latrine use in rural India.

Methods

Study conducted in four villages of Rajasthan, where latrine use is low and open defecation may spread disease. To identify the intervention a literature review was conducted, a survey of 497 households, and focus groups in village households (8–10 women and children). Seven focus groups with 63 women were conducted. Based on the survey results, the behaviour change intervention is developed utilising the Capability-Opportunity-Motivation-behaviour model and MINDSPACE framework. One intervention component involves psychological aspects that engage villagers through a pledge; the other component is provision of small incentives to facilitate latrine use. Feasibility and acceptability of the intervention was examined in the study population. The 30-day intervention was delivered to women in 38 randomly selected households who despite having a functional latrine did not use it. Thematic analysis, binary logistic regression analysis and feasibility evaluation of the intervention conducted. Post-intervention feedback from 22 participating households was obtained.

Results

The piloted intervention was feasible and so a revised design is offered. Results driving this evaluation include barriers identified, and used to improved intervention design in the current study. Village authority figures influenced behaviours across the villages and so did factors of convenience (β = 5.28, p < 0.01), relief (β = 5.49, p < 0.01), comfort (β = 2.36, p < 0.01), Construction cost (β=-1.98, p < 0.01) and safety (β = 2.93, p < 0.01) were significant concerns associated with latrine use in the context of prevalent OD in the region. The logistic regression baseline model for the dependant variables indicated a significant increase in latrine use. Based on the feasibility study, the intervention is refined in several ways.

Conclusions

Our theory-driven approach improves latrine use in Rajasthan and offers a useful tool to facilitate hygiene behaviour.
Factors influencing behavioral intentions of graduating pharmacy students regarding interprofessional collaboration – a theory-driven qualitative study
Authors: Przymuszała Piotr , Fabianowska Sandra , Zielińska-Tomczak Łucja , Cerbin-Koczorowska Magdalena , Marciniak Ryszard
Published: November 2023

Background

Interprofessional collaboration enhances the use of competencies of different medical team members. Additionally, pharmacists’ involvement in patient care has been shown to improve their outcomes and seems particularly valuable in chronic diseases. Therefore, due to the aging of society and the increasing prevalence of chronic diseases, efforts are needed to involve pharmacists more broadly in patient care. However, there is a limited understanding of what factors could influence their willingness to participate in an interprofessional care team, especially among pharmacy students only entering the profession. This study aimed to fill these knowledge gaps by exploring graduating pharmacy students’ intentions in this regard guided by the theory of planned behavior.

Methods

We conducted seventeen semi-structured interviews with graduating pharmacy students of Poznan University of Medical Sciences, which were then thematically analyzed by two researchers.

Results

Positive attitudes of respondents, who mentioned the possibility of acquiring new knowledge, skills, and competencies, increased prestige and appreciation of the pharmacist’s profession, a better quality of patient care, and the support and relief offered to other team members as a result of collaboration, seem to strengthen their intentions. However, they also expressed their worries about potential errors and knowledge gaps, which constituted an example of some existing negative feelings. The identified sources of generally mixed social pressure toward the behavior included other pharmacists and pharmacy students, physicians, patients, their relatives and friends, and the decision and policymakers. Finally, their intentions may also be weakened by the mentioned perceived behavioral control aspects, like their level of pharmaceutical and clinical knowledge, skills, and experience, their knowledge of representatives of other professions and collaboration, the atmosphere at their future place of work, co-workers’ potential reluctance to collaborate with them, finding time for collaboration, the existence of incentives and gratification system, and existing legal regulations.

Conclusions

The attitudes of graduating pharmacy students toward interprofessional collaboration seem mostly positive, but their intentions might be weakened by the mixed sense of social pressure and factors decreasing their perceived behavioral control.
Greek medical professionals approaches and understanding of health literacy: a qualitative study
Authors: Louizou Eleni , Panagiotou Nikolaos , Smyrnakis Εmmanouil , Anastasiadis Savvas , Diamantis Konstantinos G. , Papamalis Foivos , Bamidis Panagiotis D.
Published: November 2023

Background

Health literacy holds significant importance for medical professionals, as it is widely acknowledged as a key element in enhancing health promotion and overall well-being. The primary objective of this study is to explore Greek physicians’ comprehension of health literacy, the significance they attribute to it, their strategies for addressing patients with low health literacy, and the potential barriers they face while striving to enhance a patient’s health literacy. In this context, we examine the communication methods employed by physicians as an integral part of their approach to improving a patient’s health literacy.

Methods

A qualitative study was conducted between April 29, 2021, and February 17, 2022, utilizing in-depth, semi-structured interviews with 30 Greek medical professionals, of whom 15 were university professors. The research sample selection methodology employed in this study was purposive sampling. Data analysis was conducted using inductive thematic analysis.

Results

The majority of physicians were not familiar with the concept of health literacy. The most significant barriers to the development of health literacy among physicians are a lack of time, issues within the healthcare system, and interference from third parties, although they acknowledge that a significant portion of the responsibility lies with them. Effective communication with patients is important for all physicians, as it plays a crucial role in the therapeutic process. When they realize that their patients are not understanding them, they employ communication methods such as using plain language, providing numerous examples, incorporating visuals like pictures and even using drawings.

Conclusions

The findings of this study underscore the importance of implementing targeted initiatives to promote health literacy within the Greek medical and academic community. Integrating health literacy training for physicians into the educational and training curriculum is essential. To accomplish this goal, it is imperative to first address the shortcomings within the healthcare system and improve the working conditions for physicians.
Genetic association between interleukin-17 and susceptibility to rheumatoid arthritis
Authors: Zhao Rong , Zhang Yi-wen , Yao Jia-yuan , Qiao Jun , Song Shan , Zhang Sheng-xiao , Wang Cai-hong , Li Xiao-feng
Published: November 2023

Background

The pathogenesis of rheumatoid arthritis (RA) is an immune imbalance, in which various inflammatory immune cells and pro-inflammatory factors are involved. Interleukin-17 (IL-17), a potent pro-inflammatory cytokine, has been found to have increased expression in the joints of patients with RA compared to healthy individuals. However, the causal relationship between the expression level of IL-17 or IL-17 receptor (IL-17R) and RA remained unknown. In this study, two-sample Mendelian randomization (MR) was used to investigate the causal relationship between IL-17 and RA.

Methods

Summary statistics for RA (14,361 RA cases and 43,923 healthy controls) and IL-17 (3,301 samples) were obtained from an available meta-analysis of published genome-wide association studies (GWAS). Relevant single nucleotide polymorphisms (SNPs) were selected by executing quality control steps from the GWAS summary results. Then we used bi-directional two-sample Mendelian randomization (MR) and multi-variable MR (MVMR) analysis to examine evidence of causality. MR and MVMR analyses progressed mainly using inverse variance weighted (IVW), weighted median (WM), and MR-Egger regression methods, which were applied to the genetic instrumental variables (IVs) of IL-17A/IL-17 RA, IL-17C/IL-17 RC, and IL-17D/IL-17RD and RA. For assessing the robustness of the results, we also carried out a sensitivity analysis to assess heterogeneity and pleiotropy, such as MR-Egger, leave-one-out, and MR pleiotropy residual sum and outlier (MR-PRESSO).

Results

Two-sample MR Analysis showed the causal relationship between IL-17A/IL-17RA and RA. The presence of genetically high IL-17A/IL-17RA may increase the risk of RA (IL-17A(OR = 1.095; 95% C.I., 0.990-1.210, p.adj = 0.013), IL-17RA(OR = 1.113, 95%CI = 1.006-1.231, p.adj = 0.006)). However, the results indicated that IL-17C/IL-17RC, and IL-17D/IL-17RD demonstrated no causal impact on RA (IL-17C(OR = 1.007, 95%CI = 0.890-1.139, p.adj = 0.152), IL-17RC(OR = 1.006, 95%CI = 0.904-1.119, p.adj = 0.152), IL-17D(OR = 0.979, 95%CI = 0.843-1.137, p.adj = 0.130), IL-17RD(OR = 0.983, 95%CI = 0.876-1.104, p.adj = 0.129)). Furthermore, MVMR analysis shown that IL-17RA(OR = 1.049, 95% CI: 0.997-1.102, p.adj = 0.014) was associated with increased risk of RA. Sensitivity analysis showed no heterogeneity and pleiotropy, suggesting that the above results were robust and reliable.

Conclusion

The MR analysis provides evidence that IL-17A/IL-17RA are risk factors for RA. This emphasizes the importance of intervention on IL-17A/IL-17RA in patients with RA. Developing drugs that limit IL-17A may reduce the risk of RA.
A genomic perspective of the aging human and mouse lung with a focus on immune response and cellular senescence
Authors: He Meng , Borlak Jürgen
Published: November 2023

Background

The aging lung is a complex process and influenced by various stressors, especially airborne pathogens and xenobiotics. Additionally, a lifetime exposure to antigens results in structural and functional changes of the lung; yet an understanding of the cell type specific responses remains elusive. To gain insight into age-related changes in lung function and inflammaging, we evaluated 89 mouse and 414 individual human lung genomic data sets with a focus on genes mechanistically linked to extracellular matrix (ECM), cellular senescence, immune response and pulmonary surfactant, and we interrogated single cell RNAseq data to fingerprint cell type specific changes.

Results

We identified 117 and 68 mouse and human genes linked to ECM remodeling which accounted for 46% and 27%, respectively of all ECM coding genes. Furthermore, we identified 73 and 31 mouse and human genes linked to cellular senescence, and the majority code for the senescence associated secretory phenotype. These cytokines, chemokines and growth factors are primarily secreted by macrophages and fibroblasts. Single-cell RNAseq data confirmed age-related induced expression of marker genes of macrophages, neutrophil, eosinophil, dendritic, NK-, CD4+, CD8+-T and B cells in the lung of aged mice. This included the highly significant regulation of 20 genes coding for the CD3-T-cell receptor complex. Conversely, for the human lung we primarily observed macrophage and CD4+ and CD8+ marker genes as changed with age. Additionally, we noted an age-related induced expression of marker genes for mouse basal, ciliated, club and goblet cells, while for the human lung, fibroblasts and myofibroblasts marker genes increased with age. Therefore, we infer a change in cellular activity of these cell types with age. Furthermore, we identified predominantly repressed expression of surfactant coding genes, especially the surfactant transporter Abca3, thus highlighting remodeling of surfactant lipids with implications for the production of inflammatory lipids and immune response.

Conclusion

We report the genomic landscape of the aging lung and provide a rationale for its growing stiffness and age-related inflammation. By comparing the mouse and human pulmonary genome, we identified important differences between the two species and highlight the complex interplay of inflammaging, senescence and the link to ECM remodeling in healthy but aged individuals.

Graphical Abstract