bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of nurses providing maternity care in a public hospital during the COVID-19 pandemic in Nepal: A qualitative study
Authors: Basnet Bidhya , Chapagain Pratiksha , Subedi Sabitra , Dahal Tulasha , Neupane Saraswati , Khanal Ranjita , Pinder Richard J. , Lucero-Prisno Don Eliseo , Sundar Budhathoki Shyam
Published: May 2022

Maternity service providers have struggled to provide high-quality services to women and newborns during the ongoing COVID-19 pandemic which has substantially impacted health systems and disrupted maternity services globally. Nepal is a resources-limited country that reported a significant impact of the pandemic on maternal health services. It is therefore important to understand better the perspective of health care professionals in this context. This study intends to explore the experiences of nurses providing maternity care in the public sector during the COVID-19 pandemic in Nepal. A qualitative study using a phenomenological design was conducted. Altogether ten nurses working in maternity services were selected using purposive sampling technique. Data were collected by face-to-face in-depth interviews using a semi-structured interview guide. Thematic analysis was conducted using Clarke and Braun 2006 technique. The findings of the study were organized into codes, sub-themes and themes. The six themes identified were fear of COVID-19 at work, challenges at work, changes at work and services, motivations to work, stigma due to COVID-19, and impact on services. Participants described how maternity services could not be stopped during the pandemic. They had experienced decreased utilization of antenatal services as a consequence of ‘lockdown’ thereby leading to an increase in maternal and neonatal mortality. Respondents reported ineffective human resource management compromising the quality of care. The professional responsibility to cope with adverse circumstances and serve society is a major source of motivation that health workers relied upon to get them through the pandemic period. A wide range of challenges were faced by service providers during the pandemic which requires action and support of all levels of government, institutions and society-at-large to assure the continued provision of safe maternity care during such a protracted period of challenging work.
Evaluation of the sensitivity and specificity of three diagnostic tests for Coxiella burnetii infection in cattle and buffaloes in Punjab (India) using Bayesian latent class analysis
Authors: Meletis Eleftherios , Keshavamurthy Ravikiran , Singh Dhaliwal Balbir Bagicha , Aulakh Rabinder Singh , Dhand Navneet , Kostoulas Polychronis
Published: May 2022

Q Fever is a zoonotic disease of significant animal and public health concern, caused by Coxiella burnetii (C. burnetii), an obligate intracellular bacterium. This study was done to evaluate the diagnostic sensitivity (DSe) and diagnostic specificity (DSp) of three diagnostic methods to diagnose C. burnetii infection in cattle and buffaloes in Punjab, India: an indirect ELISA method applied in serum samples and a trans-Polymerase Chain Reaction (trans-PCR) technique applied in milk samples and genital swabs, using a Bayesian latent class analysis. Conditional independence was assumed between the tests, given (i) the different biological principle of ELISA and trans-PCR and (ii) the fact that the trans-PCR was performed on different tissues. The ELISA method in the serum samples showed the highest DSe of 0.97 (95% Probability Intervals (PIs): 0.93; 0.99) compared to the trans-PCR method applied in milk samples 0.76 (0.63; 0.87) and genital swabs 0.73 (0.58; 0.85). The DSps of all tests were high, with trans-PCR in genital swabs recording the highest DSp of 0.99 (0.98; 1), while the DSp of trans-PCR in milk samples and ELISA in serum samples were 0.97 (0.95; 0.99) and 0.95 (0.93; 0.97) respectively. The study results show that none of the applied tests are perfect, therefore, a testing regimen based on the diagnostic characteristic of the tests may be considered for diagnosis of C. burnetii.
Invertebrate communities in springs across a gradient in thermal regimes
Authors: Kreiling Agnes-Katharina , Govoni Daniel P. , Pálsson Snæbjörn , Ólafsson Jón S. , Kristjánsson Bjarni K.
Published: May 2022

In many respects, freshwater springs can be considered as unique ecosystems on the fringe of aquatic habitats. This integrates their uniqueness in terms of stability of environmental metrics. The main objective of our study was to evaluate how environmental variables may shape invertebrate diversity and community composition in different freshwater spring types and habitats within. In order to do so, we sampled invertebrates from 49 springs in Iceland, where we included both limnocrene and rheocrene springs. At each site, samples were taken from the benthic substrate of the spring (“surface”) and the upwelling groundwater at the spring source (“source”). To collect invertebrates from the spring sources we used a modified method of “electrobugging” and Surber sampler for collecting invertebrates from the surface. In total, 54 invertebrate taxa were identified, mostly Chironomidae (Diptera). Chironomid larvae also dominated in terms of abundance (67%), followed by Ostracoda (12%) and Copepoda (9%). The species composition in the surface samples differed considerably between rheocrene and limnocrene springs and was characterised by several indicator species. Alpha diversity was greater at the surface of springs than at the source, but the beta diversity was higher at the source. Diversity, as summarized by taxa richness and Shannon diversity, was negatively correlated with temperature at the surface. At the source, on the other hand, Shannon diversity increased with temperature. The community assembly in springs appears to be greatly affected by water temperature, with the source community of hot springs being more niche-assembled (i.e., affected by mechanisms of tolerance and adaptation) than the source community of cold springs, which is more dispersal-assembled (i.e., by mechanisms of drift and colonization).
Perceived social support on postpartum mental health: An instrumental variable analysis
Authors: Inekwe John Nkwoma , Lee Evelyn
Published: May 2022

The postpartum period is a challenging transition period with almost one in ten mothers experiencing depression after childbirth. Perceived social support is associated with mental health. Yet empirical evidence regarding the causal effects of social support on postpartum mental health remains scarce. In this paper, we used a nationally representative panel data of women to examine causality between perceived social support and postpartum mental health. We used fixed-effect method and included dependent variable lags to account for past mental health condition before birth (i.e., the pre-pregnancy and prenatal periods). The study also used an instrumental variable approach to address endogeneity. We find a declining trend in postpartum mental health between 2002 to 2018. Our study also showed that past mental health (i.e., before childbirth) is positively correlated with postpartum mental health. A universal routine mental health screening for expectant and new mothers should remain a key priority to ensure mental wellbeing for the mothers and their infants.
Exploring red cell distribution width as a potential risk factor in emergency bowel surgery—A retrospective cohort study
Authors: Berry Michael , Gosling Jennifer Louise , Bartlett Rachel Elizabeth , Brett Stephen James
Published: May 2022

Increased preoperative red cell distribution width (RDW) is associated with higher mortality following non-cardiac surgery in patients older than 65 years. Little is known if this association holds for all adult emergency laparotomy patients and whether it affects 30-day or long-term mortality. Thus, we examined the relationship between increased RDW and postoperative mortality. Furthermore, we investigated the prognostic worth of anisocytosis and explored a possible association between increased RDW and frailty in this cohort. We conducted a retrospective, single centre National Emergency Laparotomy Audit (NELA) database study at St Mary’s Hospital Imperial NHS Trust between January 2014 and April 2018. A total of 356 patients were included. Survival models were developed using Cox regression analysis, whereas RDW and frailty were analysed using multivariable logistic regression. Underlying model assumptions were checked, including discrimination and calibration. We internally validated our models using bootstrap resampling. There were 33 (9.3%) deaths within 30-days and 72 (20.2%) overall. Median RDW values for 30-day mortality were 13.8% (IQR 13.1%-15%) in survivors and 14.9% (IQR 13.7%-16.1%) in non-survivors, p = 0.007. Similarly, median RDW values were lower in overall survivors (13.7% (IQR 13%-14.7%) versus 14.9% (IQR 13.9%-15.9%) (p<0.001)). Mortality increased across quartiles of RDW, as did the proportion of frail patients. Anisocytosis was not associated with 30-day mortality but demonstrated a link with overall death rates. Increasing RDW was associated with a higher probability of frailty for 30-day (Odds ratio (OR) 4.3, 95% CI 1.22–14.43, (p = 0.01)) and overall mortality (OR 4.9, 95% CI 1.68–14.09, (p = 0.001)). We were able to show that preoperative anisocytosis is associated with greater long-term mortality after emergency laparotomy. Increasing RDW demonstrates a relationship with frailty. Given that RDW is readily available at no additional cost, future studies should prospectively validate the role of RDW in the NELA cohort nationally.
Considering similarity and the rating conversion of neighbors on neural collaborative filtering
Authors: Neammanee Thitiporn , Maneeroj Saranya , Takasu Atsuhiro
Published: May 2022

One of the most popular recommender system techniques is collaborative filtering (CF). Nowadays, many researchers apply a neural network with CF, but few focus on the neighbors’ concept of CF. This work needs to consider two major issues: the similarity levels between the neighbors and the target user and the user’s rating pattern conversion. Because different neighbors have a different influence on the target user and different users usually have a different rating pattern, the ratings directly utilized by the neighbor’s preference pattern may be incorrect for the target user. Under two main issues, we try to accomplish three main ideas of CF’s prediction: the similarity between users’ levels, the neighbor’s rating, and the rating conversion. Thus, we propose three main modules, the rating conversion module, the similarity module, and the prediction module, to solve the two issues mentioned above. The rating conversion module projects the neighbor’s rating into the target user’s aspect. The similarity module uses the users’ attentions to compute similarity levels between users. Finally, these similarity levels and the converted ratings are integrated to perform the prediction. The proposed method is compared with the current CF with friends and latent factor model using two types of datasets: real-world and synthetic datasets. We evaluate N neighbors and all neighbors on real-world datasets to prove the number of neighbor is important. Moreover, the performance of the rating conversion module is also evaluated. The proposed method simulates the full rating datasets and the partial rating dataset to compare the effectiveness of using different types of distribution and dataset size. The experimental results demonstrate that the proposed method effectively outperformed the baselines using ranking evaluation and prediction accuracy on real-world and synthetic datasets. Besides, The effectiveness of using different the number of neighbors depends on the quality of neighbors.
Device-worn measures of sedentary time and physical activity in South Asian adults at high risk for type 2 diabetes in Metro-Vancouver, Canada
Authors: Mahmood Bushra , Nettlefold Lindsay , Ashe Maureen C. , Puyat Joseph H. , Tang Tricia S.
Published: May 2022

Background

South Asians have high incidence of chronic disease. Physical activity (PA) and sedentary time are modifiable risk factors for chronic disease but their assessment in South Asians has been primarily based on self-report. This study presents directly-measured PA and sedentary time in South Asian adults in Canada.

Methods

A subset of 100 South Asian participants from a larger study who were identified at being at a higher risk for type 2 diabetes wore Actical accelerometers for 7 days. Anthropometric measures were taken and socio-demographic factors including age, income, education level, years since immigration, presence of children under the age of 12 years in the household and employment status were self-reported.

Results

Ninety-one participants (mean age 65.6 years) provided valid accelerometer data. Participants accumulated mean 673.5 (95% CI: 656.6, 691.0) min/day sedentary time, 130.5 (95% CI: 117.3, 145.3) min/day light PA (LPA) and 2.3 (95% CI: 1.3, 4.2) min/day moderate-to-vigorous PA (MVPA). For sedentary time and LPA, sex and BMI explained 51% of variability. For MVPA, BMI, season of assessment and employment status explained 23% variability with those who were employed accumulating significantly higher mean min/day of MVPA compared to those who were unemployed; (5.8, 95% CI: 1.5, 21.7) vs (1.5, 95% CI: 5.3, 20.0) respectively.

Conclusion

High sedentary time, and low MVPA indicates the need to focus health promotion efforts on shifting sedentary time into LPA while trying to increase MVPA. Future studies need to be based on larger, representative samples of South Asians.
Notable paradoxical phenomena in associations between cardiovascular health score, subclinical and clinical cardiovascular disease in the community: The Framingham Heart Study
Authors: Bourdillon Maximillian T. , Gaye Bamba , Song Rebecca J. , Vasan Ramachandran S. , Xanthakis Vanessa
Published: May 2022

Importance

Cardiovascular Health (CVH) scores are inversely associated with prevalent subclinical (SubDz) and incident cardiovascular disease (CVD). However, the majority of people who develop CVD have intermediate or ideal CVH scores, while many with poor CVH profiles escape CVD development.

Objective

To describe the prevalence of paradoxical relations among CVH, SubDz, and CVD.

Design

Cohort study, Framingham Study data collected prospectively (1995–2016).

Setting

Population-based.

Participants

7,627 participants (mean age 49 years, 53% women) attending Offspring examinations 6/7 and Third Generation examinations 1/2.

Exposures

CVH score (range 0–14) constructed from poor, intermediate, or ideal status for each metric (smoking, diet, physical activity, blood pressure, body mass index, fasting glucose, total cholesterol); and prevalent SubDz (≥1 of: increased carotid intimal media thickness, CIMT; left ventricular hypertrophy, LVH; microalbuminuria, MA; elevated ankle brachial index, ABI; coronary artery calcium score ≥100,CAC).

Main outcome(s) and measure(s)

Ideal CVH (scores 12–14), intermediate CVH (scores 8–11), and poor CVH (0–7). We described three distinct paradoxical phenomena, involving combinations of CVH, SubDz, and CVD, and generated CVD incidence rates and predicted CVD probabilities for all combinations.

Results

We observed 842 CVD events (median follow-up 13.7 years); 1,663 participants had SubDz. Most individuals with poor CVH (78%) or SubDz (57% for CIMT to 77% for LVH) did not develop CVD on follow-up. Among participants with incident CVD, the majority had intermediate or ideal CVH (68%) or absent SubDz (46% for CAC to 96% for ABI) at baseline. We observed similar paradoxical results in relations between CVH and prevalent SubDz. Poor CVH and prevalent SubDz were each associated with higher CVD incidence rates compared to intermediate or ideal CVH and absent SubDz, respectively. The predicted CVD probability was nearly three-times greater among participants with poor (22%) versus intermediate or ideal CVH (8%). Mean CVD predicted probabilities were nearly three (26% vs. 10% for MA) to six-times (29% vs. 5% for CAC) greater among participants with SubDz versus without SubDz. Findings were consistent within age and sex strata.

Conclusions and relevance

Although poor CVH and SubDz presence are associated with CVD incidence, paradoxical phenomena involving CVH, SubDz, and CVD are frequently prevalent in the community. Further studies to elucidate biological mechanisms underlying these phenomena are warranted.
Effects of aerobic and resistance exercise on glycosylated hemoglobin (HbA1c) concentrations in non-diabetic Taiwanese individuals based on the waist-hip ratio
Authors: Chou Ying-Hsiang , Cheng Yung-Yin , Nfor Oswald Ndi , Chen Pei-Hsin , Chen Che‐Hong , Chen Hsin-Lin , Chang Bo-Jiun , Tantoh Disline Manli , Huang Chien-Ning , Liaw Yung-Po
Published: May 2022

Background

Glycosylated hemoglobin (HbA1c) reflects the average blood sugar over the past eight to twelve weeks. Several demographic and lifestyle factors are known to affect HbA1c levels. We evaluated the association of HbA1c with aerobic and resistance exercise in non-diabetic Taiwanese adults based on the waist-hip ratio (WHR).

Methods

We conducted this study based on TWB data collected from 90,958 individuals between 2008 and 2019. We estimated the Beta (β) coefficient and 95% confidence intervals (CI) for HbA1c using multivariate regression models.

Results

Based on the multivariate analysis, lower HbA1c levels were associated with both resistance exercise (β-coefficient = -0.027, 95% CI -0.037 to -0.017) and aerobic exercise (β-coefficient = 0.018, 95% CI, -0.023 to -0.013). Higher HbA1c levels were associated with abnormal WHR compared to normal WHR (β-coefficient = 0.091, 95% CI, 0.086 to 0.096). We detected an interaction between exercise and WHR (p for interaction = 0.0181). To determine the magnitude of the interaction, we performed additional analyses (with the reference group being ’abnormal WHR with no exercise’) and observed substantial decreases in HbA1c regardless of the WHR and exercise category. However, the largest reduction occurred in the ’normal WHR and resistance exercise’ group (β = -0.121, 95% CI, -0.132 to -0.109).

Conclusions

We found that normal resistance exercise, coupled with a normal WHR was significantly associated with lower HbA1c levels among non-diabetic individuals in Taiwan.
Design of PM2.5 monitoring and forecasting system for opencast coal mine road based on internet of things and ARIMA Mode
Authors: Wang Meng , Zhang Qiaofeng , Tai Caiwang , Li Jiazhen , Yang Zongwei , Shen Kejun , Guo Chengbin
Published: May 2022

The dust produced by transportation roads is the primary source of PM2.5 pollution in opencast coal mines. However, China’s opencast coal mines lack an efficient and straightforward construction scheme of monitoring and management systems and a short-term prediction model to support dust control. In this study, by establishing a PM2.5 and other real-time environmental information to monitor, manage, visualize and predict the Internet of things monitoring and prediction system to solve these problems. This study solves these problems by establishing an Internet of things monitoring and prediction system, which can monitor PM2.5 and other real-time environmental information for monitoring, management, visualization, and prediction. We use Lua language to write interface protocol code in the APRUS adapter, which can simplify the construction of environmental monitoring system. The Internet of things platform has a custom visualization scheme, which is convenient for managers without programming experience to manage sensors and real-time data. We analyze real-time data using a time series model in Python, and RMSE and MAPE evaluate cross-validation results. The evaluation results show that the average RMSE of the ARIMA (4,1,0) and Double Exponential Smoothing models are 12.68 and 8.34, respectively. Both models have good generalization ability. The average MAPE of the fitting results are 10.5% and 1.7%, respectively, and the relative error is small. Because the ARIMA model has a more flexible prediction range and strong expansibility, and ARIMA model shows good adaptability in cross-validation, the ARIMA model is more suitable as the short-term prediction model of the prediction system. The prediction system can continuously predict PM2.5 dust through the ARIMA model. The monitoring and prediction system is very suitable for managers of opencast coal mines to prevent and control road dust.
Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and relationship with mortality among United States Veterans after testing positive for COVID-19
Authors: Campbell Heather M. , Murata Allison E. , Conner Todd A. , Fotieo Greg
Published: May 2022

Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are among the most-frequently used medications. Although these medications have different mechanisms of action, they have similar indications and treatment duration has been positively correlated with cardiovascular risk although the degree of risk varies by medication. Our objective was to study treatment effects of chronic use of individual NSAID medications and acetaminophen on all-cause mortality among patients who tested positive for COVID-19 while accounting for adherence. We used the VA national datasets in this retrospective cohort study to differentiate between sporadic and chronic medication use: sporadic users filled an NSAID within the last year, but not recently or regularly. Using established and possible risk factors for severe COVID-19, we used propensity scores analysis to adjust for differences in baseline characteristics between treatment groups. Then, we used multivariate logistic regression incorporating inverse propensity score weighting to assess mortality. The cohort consisted of 28,856 patients. Chronic use of aspirin, ibuprofen, naproxen, meloxicam, celecoxib, diclofenac or acetaminophen was not associated with significant differences in mortality at 30 days (OR = 0.98, 95% CI: 0.95–1.00; OR = 0.99, 95% CI: 0.98–1.00; OR = 1.00, 95% CI: 0.98–1.01; OR = 0.99, 95% CI: 0.98–1.00; OR = 1.00, 95% CI: 0.98–1.01; OR = 0.99, 95% CI: 0.97–1.01; and OR = 1.00, 95% CI: 0.99–1.02, respectively) nor at 60 days (OR = 0.97, 95% CI: 0.95–1.00; OR = 1.00, 95% CI: 0.99–1.01; OR = 0.99, 95% CI: 0.98–1.01; OR = 0.99, 95% CI: 0.97–1.00; OR = 0.99, 95% CI: 0.97–1.01; OR = 0.99, 95% CI: 0.97–1.01; and OR = 1.01, 95% CI: 0.99–1.02, respectively). Although the study design cannot determine causality, the study should assure patients as it finds no association between mortality and chronic use of these medications compared with sporadic NSAID use among those infected with COVID-19.
Blood mRNA biomarkers distinguish variable systemic and sputum inflammation at treatment initiation of inhaled antibiotics in cystic fibrosis: A prospective non-randomized trial
Authors: Caceres Silvia M. , Sanders Linda A. , Rysavy Noel M. , Poch Katie R. , Jones Caroline R. , Pickard Kyle , Fingerlin Tasha E. , Marcus Roland A. , Malcolm Kenneth C. , Taylor-Cousar Jennifer L. , Nichols David P. , Nick Jerry A. , Strand Matthew , Saavedra Milene T.
Published: May 2022

Inhaled antibiotics control chronic airway infection and maintain respiratory health in cystic fibrosis (CF). Given variation in patient responses to inhaled antibiotics, the ability to identify distinct responder phenotypes would facilitate the delivery of personalized care. Previously, a 10-gene panel was identified, measured directly from blood leukocytes, which predicted host response to intravenous antibiotic treatment during pulmonary exacerbations. In the current study, we tested whether the same panel predicted clinical response in subjects receiving a month of inhaled antibiotic therapy with aztreonam lysine (AZLI; Cayston®). A small cohort of CF subjects infected with Pseudomonas aeruginosa were enrolled at baseline health, prior to initiating one month’s treatment with AZLI using the Altera® nebulizer system. Eighteen CF subjects underwent blood leukocyte gene panel measurements, sputum quantitative microbiology, spirometry, and C-reactive protein (CRP) measurement prior to onset and at completion of 4 weeks of AZLI therapy. Mean absolute improvement in percent predicted Forced Expiratory Volume in one second (ppFEV1) was 3%. Significant reductions in sputum bacterial colony counts were detected with treatment. CRP increased following treatment. While single genes within the panel did not change significantly following treatment, the analysis of multigene panel data demonstrated that HCA112 gene predicted ppFEV1 improvement. Hierarchical clustering based on gene expression yielded two distinctive molecular clusters before and after AZLI therapy. In conclusion, peripheral blood leukocyte genes quantifying inflammation are associated with responses to inhaled antibiotic therapy. Molecular quantification of systemic inflammation may indicate subgroups of CF subjects with variations in underlying inflammation and with variable clinical responses to inhaled antibiotics. Given the size limitation of the study, larger studies are needed in order to evaluate whether molecular measures may add precision to the determination of infectious and inflammatory outcomes following courses of inhaled antimicrobial therapies. Clinical Trials.gov Identifier: NCT01736839.
Factors related to the suppression of the antitumour immune response in female dogs with inflammatory mammary carcinoma
Authors: Damasceno Karine Araújo , Santos-Conceição Aline Michelle dos , Silva Laís Pereira , Cardoso Thiago Marconi de Souza , Vieira-Filho Carlos Humberto da Costa , Figuerêdo Samantha Hellen Santos , Martins-Filho Emanoel , Faria Barbra Gabriela Oliveira de , Costa-Neto João Moreira da , Cassali Geovanni Dantas , Estrela-Lima Alessandra
Published: May 2022

Inflammatory mammary carcinoma (IMC), a neoplasia affecting women and female dogs, is considered an aggressive cancer with high metastatic potential and a low survival rate. Studies focused on the tumour microenvironment indicate that the aggressive behaviour of this tumour is primarily correlated with immunological factors as well as inflammation. The objective of this study was to analyse the possible strategies used by the tumour cells to suppress the immune response in female dogs with IMC. Forty-six female dogs were divided into three groups: control (C, n = 10), IMC (n = 14) and mammary carcinoma (MC, n = 22). Clinical-pathological evaluations, survival at follow-up, immunophenotyping of leukocytes in peripheral blood and tumours, and immunohistochemical evaluation of CD4+, granzyme B, perforin and FAS-L were performed. Clinical and pathological results showed a higher frequency of the primary form of neoplasia, solid arrays of tumor cells and a lower survival rate in the IMC group (30 days). Morphometric analysis of inflammatory infiltrate revealed more lymphocytes and macrophages in the IMC group. Immunophenotyping analysis of peripheral blood revealed a higher frequency of CD8+T-cells (p = 0.0017), a lower frequency of CD4+T-cells (p <0.0001), and significantly higher mean MHCI and MHCII CD14+fluorescence intensity in the IMC group (p = 0.038 and p = 0.0117, respectively). The immunohistochemical evaluation of tumour sections showed fewer FAS-L-positive inflammatory cells in the IMC group. These results suggest the important contribution of CD8+T-cells, macrophages and FAS-L in the aggressiveness of IMC.
Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties
Authors: Awuviry-Newton Kofi , Tavener Meredith , Wales Kylie , Byles Julie
Published: May 2022

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers.
Evaluation of blood cell count parameters as predictors of treatment failure of malaria in Angola: An observational study
Authors: Sacomboio Euclides Nenga Manuel , dos Santos Sebastião Cruz , Salvador Silvana Teresa da Costa , João Joaquim António , Bapolo Daisy Viviana Sebastião , Francisco Ngiambudulu M. , Morais Joana , Valentim Eduardo Ekundi
Published: May 2022

Background

Despite the guidelines provided by the World Health Organization for the treatment of malaria, treatment failure occurs in many hospitalized patients.

Objective

Evaluate whether blood cell count parameters may serve as predictors for malaria treatment.

Methodology

A cross-sectional study with a quantitative approach.

Results

Of the 219 patients, 21.5% showed failure to antimalarial treatment, Patient with 21 and 40 years (72.6%), male (53.4%), from peri-urban area (47.5%), with high parasitemia (59.8%), treated with Arthemeter (90.9%) and the mortality were 5.9%. Significant associations were observed between occupation, level of parasitemia and outcome with resistance to antimalarial treatment (p<0.05). Patients with normal Hb [OR: 0.75 (95% CI: 0.39–1.44), p = 0.393], RBC [OR: 0.83 (95% CI: 0.40–1.72), p = 0.632], RDW [OR: 0.54 (95% CI: 0.27–1.09), p = 0.088], MCV [OR: 0.61 (95% CI: 0.28–1.31), p = 0.204] were less likely to have malaria treatment failures after artemisinin-based therapy failure. In contrast, those with normal values of segmented neutrophils [OR: 0.32 (95% CI: 0.11–0.96), p = 0.042] and lymphocyte counts [OR: 0.24 (95% CI: 0.05–1.04), p = 0.055]. We also found that patients with significant low levels of Hct [OR: 0.31 (95% CI: 0.15–0.64) p = 0.002], and high leukocytes [OR: 8.88 (95% CI: 2.02–37.2), p = 0.004] and normal platelet values [OR: 1.42 (95% CI: 0.73–2.95), p = 0.280] demonstrated high probability of treatment failure.

Conclusion

The importance of blood cell count parameters in monitoring malaria therapy necessitates the urgent need to re-evaluate Artemether-based therapy. Future studies involving more participants in different settings are needed to provide further evidence.
Two pathways are required for ultrasound-evoked behavioral changes in Caenorhabditis elegans
Authors: Magaram Uri , Weiss Connor , Vasan Aditya , Reddy Kirthi C. , Friend James , Chalasani Sreekanth H.
Published: May 2022

Ultrasound has been shown to affect the function of both neurons and non-neuronal cells, but, the underlying molecular machinery has been poorly understood. Here, we show that at least two mechanosensitive proteins act together to generate C. elegans behavioral responses to ultrasound stimuli. We first show that these animals generate reversals in response to a single 10 msec pulse from a 2.25 MHz ultrasound transducer. Next, we show that the pore-forming subunit of the mechanosensitive channel TRP-4, and a DEG/ENaC/ASIC ion channel MEC-4, are both required for this ultrasound-evoked reversal response. Further, the trp-4;mec-4 double mutant shows a stronger behavioral deficit compared to either single mutant. Finally, overexpressing TRP-4 in specific chemosensory neurons can rescue the ultrasound-triggered behavioral deficit in the mec-4 null mutant, suggesting that both TRP-4 and MEC-4 act together in affecting behavior. Together, we demonstrate that multiple mechanosensitive proteins likely cooperate to transform ultrasound stimuli into behavioral changes.
Socio-economic and proximate determinants of under-five mortality in Guinea
Authors: Ahinkorah Bright Opoku , Budu Eugene , Seidu Abdul-Aziz , Agbaglo Ebenezer , Adu Collins , Osei Dorothy , Banke-Thomas Aduragbemi , Yaya Sanni
Published: May 2022

Background

The death of children under-five years is one of the critical issues in public health and improving child survival continues to be a matter of urgent concern. In this paper, we assessed the proximate and socio-economics determinants of child mortality in Guinea.

Methods

Using the 2018 Guinea Demographic and Health Survey (GDHS), we extracted demographic and mortality data of 4,400 children under-five years. Both descriptive and multivariable logistic regression analyses were conducted.

Results

Under-five mortality was 111 deaths per 1,000 live births in Guinea. The likelihood of death was higher among children born to mothers who belong to other religions compared to Christians (aOR = 2.86, 95% CI: 1.10–7.41), smaller than average children compared to larger than average children (aOR = 1.97, 95% CI: 1.28–3.04) and those whose mothers had no postnatal check-up visits after delivery (aOR = 1.72, 95% CI: 1.13–2.63). Conversely, the odds of death in children with 2–3 birth rank & >2 years of birth interval compared to ≥4 birth rank and ≤2 years of birth interval were low (aOR = 0.53, 95% CI: 0.34–0.83).

Conclusion

We found that household/individual-level socioeconomic and proximate factors predict under-five mortality in Guinea. With just about a decade left to the 2030 deadline of the Sustainable Development Goals (SDGs), concerted efforts across all key stakeholders, including government and development partners, need to be geared towards implementing interventions that target these predictors.
The subjective experience of time during the pandemic in Germany: The big slowdown
Authors: Kosak Ferdinand , Schelhorn Iris , Wittmann Marc
Published: May 2022

Several COVID-19 studies on the felt passage of time have been conducted due to the strong feeling of time distortion many people have experienced during the pandemic. Overall, a relative decelaration of time passage was generally associated with negative affect and social isolation; a relative acceleration was associated with an increase in routine in daily life. There is some variability in results depending on the country of study and COVID-19 restrictions introduced, participants’ demographics, and questionnaire items applied. Here we present a study conducted in May 2021 in Germany including n = 500 participants to assess time perception, emotional reactions, and attitudes towards the countermeasures. The passage of time judgments (POTJ) for the preceding 12 months during the pandemic were compared to data addressing the same question posed in previous studies conducted before the outbreak of COVID-19. The previous year was rated as having passed relatively slower during the pandemic compared to the ratings from before the pandemic. The duration judgments (DJ) of the 14 months since the start of the pandemic showed a bimodal distribution with both relatively shorter and relatively longer DJs. Higher levels of several negative emotions, as well as less social satisfaction, were associated with prolonged DJs and partially slower POTJs. Fear for health was not linked with the subjective experience of time, but exploratory analyses suggested that higher levels of fear were linked to more positive evaluations and approval of the governmental countermeasures. Those who reported higher levels of negative, agitated-aggressive emotions showed lower levels of consent with these measures.
Comparison of conventional versus customised Eurosil-4 Pink bolus for radiotherapy of the chest wall
Authors: Gill Ashlesha , Smith Warwick , Hirst Andrew , Sabet Mahsheed , Alkhatib Zaid , Gill Suki , Rowshanfarzad Pejman
Published: May 2022

Introduction

In radiotherapy,the presence ofair gaps near a tumour can lead to underdose to the tumour. In this study, the impact of air gaps on dose to the surface was evaluated. 3D-printing was used to construct a Eurosil-4 Pink bolus customised to the patient and its dosimetric properties were compared with that of Paraffin wax bolus.

Methods

Surface dose was measured for flat sheets of Eurosil-4 Pink bolus with different thicknesses. Different air gap thicknesses were inserted between the bolus and the surface, and dose was measured for each air gap using 10 cm × 10 cm fields. This was repeated with the effective field size calculated from the patient plan. Surface dose was measured for varying angles of incidence. A customised chest phantom was used to compare dose for two customised Eurosil-4 Pink boluses, and commonly used Paraffin wax bolus.

Results

The surface dose was found to be highest for 1.1 cm thick bolus. The decrease in surface dose for the Eurosil-4 Pink bolus was minimal for the 10 cm × 10 cm field, but higher for the effective field size and larger angles of incidence. For instance, the dose was reduced by 6.2% as a result of 1 cm air gap for the effective field size and 60 degree angle of incidence. The doses measured using Gafchromic film under the customised Eurosil-4 Pink boluses were similar to that of the Paraffin wax bolus, and higher than prescribed dose.

Conclusions

The impact of air gaps can be significant for small field sizes and oblique beams. A customised Eurosil-4 Pink bolus has promising physical and dosimetric properties to ensure sufficient dose to the tumour, even for treatments where larger impact of air gaps is suspected.
Perceived symptoms as the primary indicators for 30-day heart failure readmission
Authors: Anderson Kelley M. , Murphy Dottie , Groninger Hunter , Kolm Paul , Wang Haijun , Barton-Maxwel Vera
Published: May 2022

Background

To identify 30-day rehospitalizations in patients discharged with heart failure (HF) based on clinical indications, physiologic measures and symptoms.

Methods

Fifty-six patients with heart failure participated. After discharge to home, clinical indicators of dyspnea, fatigue, orthopnea, dyspnea with exertion, daily weight, edema, heart rate, blood pressure, mental condition, medication adherence, and overall well-being were reported by participants daily for up to 30 days.

Results

Joint modeling of longitudinal and time-to-event approach was applied to assess the association of readmission with longitudinal measurements. There was no association between demographic, physiological, or laboratory variables and re-hospitalization within 30 days post discharge. Perceptions of dyspnea (p = .012) and feeling unwell (p < .001) were associated with rehospitalization. Patients struggling to breath were 10.7 times more likely to be readmitted than those not struggling to breath.

Conclusion

Perceived measures, particularly dyspnea and feeling unwell were more important factors than demographic, physiological, or laboratory parameters in predicting 30-day rehospitalizations in this racially diverse cohort. The symptomatic experience of heart failure is an important indicator of rehospitalization.
Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke
Authors: Khan Adnan , De Boever Patrick , Gerrits Nele , Akhtar Naveed , Saqqur Maher , Ponirakis Georgios , Gad Hoda , Petropoulos Ioannis N. , Shuaib Ashfaq , Faber James E. , Kamran Saadat , Malik Rayaz A.
Published: May 2022

Objectives

Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients.

Methods

Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images.

Results

The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8,p= 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3,p= 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0(1.673±0.028vs1.652±0.025,p= 0.028), D1(1.609±0.027vs1.590±0.025,p= 0.044) and f(α)max (1.674±0.027vs1.652±0.024,p= 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p= 0.702), BMI (p= 0.422), total cholesterol (p= 0.842), triglycerides (p= 0.673), LDL (p= 0.952), HDL (p= 0.366), systolic blood pressure (p= 0.727), HbA1c(p= 0.261) and standard retinal metrics including CRAE (p= 0.084), CRVE (p= 0.946), AVR (p= 0.148), tortuosity index (p= 0.790), monofractal Df(p= 0.576), lacunarity (p= 0.531), curve asymmetry (p= 0.679) and singularity length (p= 0.937) did not differ between patients with poor compared to good pial collaterals.

Conclusions

This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
A comparison of psychological characteristics in people with knee osteoarthritis from Japan and Australia: A cross-sectional study
Authors: Uritani Daisuke , Campbell Penny K. , Metcalf Ben , Egerton Thorlene
Published: May 2022

The aim of this study was to investigate differences in psychological characteristics between people with knee osteoarthritis (OA) from Japan and Australia. Sixty-two adults from Japan and 168 adults from Australia aged over 50 years with knee pain were included. Japanese data were collected from patients with knee OA diagnosed by medical doctors. Australian data were baseline data from a randomized controlled trial. Participants were not exercising regularly or receiving physiotherapy at the time. Psychological characteristics evaluated were depressive symptoms, fear of movement, and pain catastrophizing. These psychological characteristics were compared between the Japanese and Australian cohorts by calculating 95% confidence intervals (CIs) for difference of the mean. To test for equivalence, an equivalence margin was set at 0.5 standard deviations (SD) of the mean, where these SDs were based on the Australian data. When the 95%CI for the difference of the mean value lay entirely within the range of equivalence margin (i.e. between -0.5 and 0.5 times the Australian SD), the outcome was considered equivalent. There were no differences between the groups from Japan and Australia for depressive symptoms and the two groups were considered equivalent. There was no difference between groups for fear of movement, however the criteria for equivalence was not met. People from Japan with knee OA had higher scores for pain catastrophizing than people from Australia. The findings should be confirmed in other samples of people with knee OA from Japan and Australia due to the limitations of the participant recruitment strategy in this study. However, our findings suggest there may be a greater need to consider pain catastrophizing and build pain self-efficacy when managing Japanese people with knee OA. Implementation of international clinical practice guidelines for OA management may require different strategies in different countries due to different psychological profiles.
Advancing data to care strategies for persons with HIV using an innovative reconciliation process
Authors: Villanueva Merceditas , Miceli Janet , Speers Suzanne , Nichols Lisa , Carroll Constance , Jenkins Heidi , Altice Frederick
Published: May 2022

Background

UN AIDS has set ambitious 95-95-95 HIV care continuum targets for global HIV elimination by 2030. The U.S. HIV Care Continuum in 2018 showed that 65% of persons with HIV(PWH) are virally suppressed and 58% retained in care. Incomplete care-engagement not only affects individual health but drives ongoing HIV transmission. Data to Care (D2C) is a strategy using public health surveillance data to identify and re-engage out-of-care (OOC) PWH. Optimization of this strategy is needed.

Setting

Statewide partnership with Connecticut Department of Public Health (CT DPH), 23 HIV clinics and Yale University School of Medicine (YSM). Our site was one of 3 participants in the CDC-sponsored RCT evaluating the efficacy of DPH-employed Disease Intervention Specialists (DIS) for re-engagement in care.

Methods

From 11/2016-7/2018, a data reconciliation process using public health surveillance and clinic visit data was used to identify patients eligible for randomization (defined as in-Care for 12 months and OOC for subsequent 6-months) to receive DIS intervention. Clinic staff further reviewed this list and designated those who would not be randomized based on established criteria.

Results

2958 patients were eligible for randomization; 655 (22.1%) were randomized. Reasons for non-randomizing included: well patient [499 (16.9%)]; recent visit [946 (32.0%)]; upcoming visit [398 (13.5%)]. Compared to non-randomized patients, those who were randomized were likely to be younger (mean age 46.1 vs. 51.6, p < .001), Black (40% vs 35%)/Hispanic (37% vs 32.8%) [(p < .001)], have CD4<200 cells/ul (15.9% vs 8.5%, p < .001) and viral load >20 copies/ml (43.8% vs. 24.1%, 0<0.001). Extrapolating these estimates to a statewide HIV care continuum suggests that only 8.3% of prevalent PWH are truly OOC.

Conclusions

A D2C process that integrated DPH surveillance and clinic data successfully refined the selection of newly OOC PWH eligible for DIS intervention. This approach more accurately reflects real world care engagement and can help prioritize DPH resources.
Warfarin sensitivity is associated with increased hospital mortality in critically Ill patients
Authors: Ma Zhiyuan , Wang Ping , Mahesh Milan , Elmi Cyrus P. , Atashpanjeh Saeid , Khalighi Bahar , Cheng Gang , Krishnamurthy Mahesh , Khalighi Koroush
Published: May 2022

Background

Warfarin is a widely used anticoagulant with a narrow therapeutic index and large interpatient variability in the therapeutic dose. Warfarin sensitivity has been reported to be associated with increased incidence of international normalized ratio (INR) > 5. However, whether warfarin sensitivity is a risk factor for adverse outcomes in critically ill patients remains unknown. In the present study, we aimed to evaluate the utility of different machine learning algorithms for the prediction of warfarin sensitivity and to determine the impact of warfarin sensitivity on outcomes in critically ill patients.

Methods

Nine different machine learning algorithms for the prediction of warfarin sensitivity were tested in the International Warfarin Pharmacogenetic Consortium cohort and Easton cohort. Furthermore, a total of 7,647 critically ill patients was analyzed for warfarin sensitivity on in-hospital mortality by multivariable regression. Covariates that potentially confound the association were further adjusted using propensity score matching or inverse probability of treatment weighting.

Results

We found that logistic regression (AUC = 0.879, 95% CI: 0.834–0.924) was indistinguishable from support vector machine with a linear kernel, neural network, AdaBoost and light gradient boosting trees, and significantly outperformed all the other machine learning algorithms. Furthermore, we found that warfarin sensitivity predicted by the logistic regression model was significantly associated with worse in-hospital mortality in critically ill patients with an odds ratio (OR) of 1.33 (95% CI, 1.01–1.77).

Conclusions

Our data suggest that the logistic regression model is the best model for the prediction of warfarin sensitivity clinically and that warfarin sensitivity is likely to be a risk factor for adverse outcomes in critically ill patients.