bluuebunny/crossref_metadata_2025 huggingface dataset:
State-of-the-Art Opinion Article on Ventilator-Induced Diaphragm Dysfunction: Update on Diagnosis, Clinical Course, and Future Treatment Options
Authors: Spiesshoefer Jens , Kersten Alexander , Enriquez Geppert Jonathan , Regmi Binaya , Senol Mehdi , Kabitz Hans Joachim , Dreher Michael
Published: December 2022

Evidence from both animal and human studies now supports the development of ventilator-induced diaphragm dysfunction (VIDD) starting as early as 24 h after initiation of mechanical ventilation in the intensive care unit (ICU). However, although the concept of VIDD is now widely accepted, there remain several unanswered questions regarding its pathophysiology, rate of development, and (potentially) recovery after mechanical ventilation.This state-of-the-art opinion article briefly explains VIDD and provides an update on its clinical and prognostic relevance. It then focusses on state-of-the-art diagnostic approaches to determine diaphragm function, strength, and control (neural and peripheral), highlights knowledge gaps relevant to VIDD, and discusses the use of diaphragm pacing for VIDD prevention. It is suggested that future research projects in mechanically ventilated patients would ideally use both cortical and cervical phrenic nerve stimulation studies over time (including also diaphragm electromyography) as the gold standard techniques. This approach has not yet been utilized in a longitudinally designed study in the ICU. Application of these gold standard techniques would allow better understanding of the true pathophysiology and rate of development of VIDD. Notably, these techniques would be superior to diaphragm ultrasound, which yields surrogate markers of diaphragm function only without any direct measure of diaphragm strength or control. It is also suggested that such translational research would further advance understanding of diaphragm pacing as a very promising treatment option for VIDD.
Sujeitos de sorte: narrativas de esperança em produções artísticas no Brasil recente
Authors: Facina Adriana
Published: December 2022

Este artigo busca identificar narrativas de esperança produzidas por artistas e grupos culturais que desenvolvem suas atividades tendo como referência cultural as periferias brasileiras. Tais sujeitos periféricos se encontram em um “momento de perigo”, na expressão de Walter Benjamin, ameaçados pelo recrudescimento da violência armada contra a população negra e favelada, pelo aprofundamento da desigualdade econômica, pela destruição das políticas públicas de cultura e pela pandemia de COVID-19. Em tal contexto, esses sujeitos buscam se reinventar para seguir realizando seus trabalhos artísticos e culturais. Essas narrativas de esperança são compreendidas aqui como prática, em diálogo com a linguística aplicada e a antropologia linguística, bem como com a ótica bakhtiniana da linguagem como interação. Este artigo se filia ainda às reflexões antropológicas propostas por Vincent Crapanzano, Arjun Appadurai e outros que vêm se dedicando a configurar uma Antropologia do Futuro e uma Antropologia da Esperança.
Nordeste, contracultura e Cultura Popular: lugares cognitivos e ficções persistentes na poética de João do Crato
Authors: Marques Roberto
Published: December 2022

Ao longo dos quarenta anos de percurso como cantor e ativista, João do Crato valeu-se inúmeras vezes do fato de estar fora do lugar: foi cantor de rock no interior do Ceará nas décadas de 1970 e 1980; sustenta uma performatividade de gênero excessivamente sinuosa para os bairros periféricos onde se apresenta e milita; consegue transitar livremente entre grupos diversos de cultura popular e manifestações próximas às culturas de matrizes africanas na região do Cariri (CE). Apoiados em narrativas do cantor e companheiros(as) de militância, refletiremos sobre deslocamentos efetuados em torno da recepção de marcadores sociais expressos pelo artista. A ação contínua empreendida a partir dos palcos notabiliza a trajetória de João como forma expressiva das vivências no interior do Ceará, ao tempo que modula estereótipos sobre a imobilidade de uma cultura popular autêntica e fixidez das oposições entre masculino e feminino em áreas rurais e periféricas. Ao tratar mundo rural e cultura popular como cenários de diferenças, João potencializa o reconhecimento de um lugar para si e para seu público a partir dos deslocamentos que provoca.
Inovação ativa em jovens negros universitários: o trabalho crítico emancipatório na construção de identidades
Authors: Silva Thainá Rocha da , Perazzo Priscila Ferreira
Published: December 2022

Este artigo apresenta dados de uma pesquisa sobre como os jovens universitários negros e negras constituem suas noções de identidade e cidadania na sociedade midiatizada. Nesse sentido, lança um olhar para o potencial das Oficinas de Trabalho Crítico Emancipatórias como instrumento metodológico promotor do empoderamento e inovação nas pesquisas do campo da Comunicação, apresentando roteiro estruturado para aplicação das oficinas e o percurso metodológico utilizado na pesquisa, bem como possibilidades de avaliação de resultados. Apresenta os participantes e as oficinas realizadas que operam como um guia do passo a passo que pode auxiliar outros pesquisadores a adotarem essa proposta.
Imagem Institucional de uma Universidade Comunitária : arquétipos no inconsciente coletivo da comunidade
Authors: Behling Hans Peder , Hostins Regina Celia Linhares , Ramos Mayara Bonin , Bazzanello Vagner Luis
Published: December 2022

Este estudo foi motivado pela indagação sobre a possível (in)coerência entre a forma como as Universidades Comunitárias comunicam seus atributos comunitários e a imagem percebida pelos seus respectivos públicos. O objetivo geral é analisar a imagem institucional de uma Universidade Comunitária na visão da comunidade interna e externa. O método adotado é de natureza qualitativa, apoiado na Teoria dos Arquétipos de Jung sobre a construção do inconsciente coletivo e sua expressão na percepção da imagem institucional. Os dados empíricos foram coletados por meio de entrevista de grupos focal, organizados por diferentes públicos com vinculação de direta e/ou indireta à instituição. Entre os resultados da pesquisa destaca-se a expressiva e convergente percepção dos entrevistados em torno dos arquétipos do Homem Comum e do Cuidador, os quais sintetizam como principais atributos percebidos da instituição: responsável, simples, adaptável, coletiva, amiga, trabalhadora, modesta, protetora, confiável, solidária e prestativa, com importante vinculação ao conceito de universidade comunitária.
Articulações da luta político-pedagógico-comunicativa do MST com o trabalhador urbano e a cidade na construção da hegemonia popular
Authors: Engelmann Solange Ines
Published: December 2022

Marcha dialética do MST: formação e comunicação política entre campo e cidade é o título da obra de Pablo Nabarrete Bastos, que discute a articulação política desenvolvida nos últimos anos entre o Movimento dos Trabalhadores Rurais Sem Terra (MST) e os/as trabalhadores/as urbanos/as na luta pela hegemonia popular da classe trabalhadora brasileira, com ênfase no período histórico de formação do MST, a partir da sua gênese no início dos anos 1980 até o seu 6º Congresso Nacional, em 2014. A partir da proposta da resenha em estudar as relações entre comunicação e educação, propomos uma leitura da obra com a intenção de perceber alguns aspectos político-pedagógico-comunicativos, que perpassam a articulação do MST no processo de luta política pela hegemonia popular entre os trabalhadores do campo e da cidade na obra.
Beneficial Effects of Moderate Hepatic Activin A Expression on Metabolic Pathways, Inflammation, and Atherosclerosis
Authors: Liu Huan , Hallauer Hastings Margaret , Kitchen Robert , Xiao Chunyang , Baldovino Guerra Justin Ralph , Kuznetsov Alexandra , Rosenzweig Anthony
Published: December 2022

Background:

Atherosclerosis is an inflammatory vascular disease marked by hyperlipidemia and hematopoietic stem cell expansion. Activin A, a member of the Activin/GDF/TGFβ/BMP (growth/differentiation factor/transforming growth factor beta/bone morphogenetic protein) family is broadly expressed and increases in human atherosclerosis, but its functional effects in vivo in this context remain unclear.

Methods:

We studied LDLR
−
/−
mice on a Western diet for 12 weeks and used adeno-associated viral vectors with a liver-specific TBG (thyroxine-binding globulin) promoter to express Activin A or GFP (control). Atherosclerotic lesions were analyzed by oil red staining. Blood lipid profiling was performed by high-performance liquid chromatography, and immune cells were evaluated by flow cytometry. Liver RNA-sequencing was performed to explore the underlying mechanisms.

Results:

Activin A expression decreased in both livers and aortae from LDLR
−
/−
mice fed a Western diet compared with standard laboratory diet. Adenoassociated virus-TBG-Activin A increased Activin A hepatic expression ≈10-fold at 12 weeks;
P
<0.001) and circulating Activin A levels ≈2000 pg/ml versus ≈50 pg/ml;
P
<0.001, compared with controls). Hepatic Activin A expression decreased plasma total and LDL (low-density lipoprotein) cholesterol ≈60% and ≈40%, respectively), reduced inflammatory cells in aortae and proliferating hematopoietic stem cells in bone marrow, and reduced atherosclerotic lesion and necrotic core area in aortae. Activin A also attenuated liver steatosis and expression of the lipogenesis genes, Srebp1 and Srebp2. RNA sequencing revealed Activin A not only blocked expression of genes involved in hepatic de novo lipogenesis but also fatty acid uptake and liver inflammation. In addition, Activin A expressed in the liver also reduced white fat tissue accumulation, decreased adipocyte size, and improved glucose tolerance.

Conclusions:

Our studies reveal hepatic Activin A expression reduces inflammation, hematopoietic stem cell expansion, liver steatosis, circulating cholesterol, and fat accumulation, which likely all contribute to the observed protection against atherosclerosis. The reduced Activin A observed in LDLR
−/−
mice on a Western diet seems maladaptive and deleterious for atherogenesis.
Promoting Lymphangiogenesis and Lymphatic Growth and Remodeling to Treat Cardiovascular and Metabolic Diseases
Authors: Liu Xiaolei , Cui Kui , Wu Hao , Li Kathryn S. , Peng Qianman , Wang Donghai , Cowan Douglas B. , Dixon J. Brandon , Sathish Srinivasan R. , Bielenberg Diane R. , Chen Kaifu , Wang Da-Zhi , Chen Yabing , Chen Hong
Published: December 2022

Lymphatic vessels are low-pressure, blind-ended tubular structures that play a crucial role in the maintenance of tissue fluid homeostasis, immune cell trafficking, and dietary lipid uptake and transport. Emerging research has indicated that the promotion of lymphatic vascular growth, remodeling, and function can reduce inflammation and diminish disease severity in several pathophysiologic conditions. In particular, recent groundbreaking studies have shown that lymphangiogenesis, which describes the formation of new lymphatic vessels from the existing lymphatic vasculature, can be beneficial for the alleviation and resolution of metabolic and cardiovascular diseases. Therefore, promoting lymphangiogenesis represents a promising therapeutic approach. This brief review summarizes the most recent findings related to the modulation of lymphatic function to treat metabolic and cardiovascular diseases such as obesity, myocardial infarction, atherosclerosis, and hypertension. We also discuss experimental and therapeutic approaches to enforce lymphatic growth and remodeling as well as efforts to define the molecular and cellular mechanisms underlying these processes.
Can 10 000 Healthy Steps a Day Slow Aortic Root Dilation in Pediatric Patients With Marfan Syndrome?
Authors: Selamet Tierney Elif Seda , Chung Sukyung , Stauffer Katie Jo , Brabender Jerrid , Collins Ronnie Thomad , Folk Robert , Li Weidang , Murthy Ashlesh K. , Murphy Daniel Jerome , Esfandiarei Mitra
Published: December 2022

Background

Stiffer aortas are associated with a faster rate of aortic root (AoR) dilation and higher risk of aortic dissection in patients with Marfan syndrome. We have previously shown that mild aerobic exercise reduces aortic stiffness and rate of AoR dilation in a Marfan mouse model. In this study, we investigated if these results could be translated to pediatric patients with Marfan syndrome.

Methods and Results

We enrolled 24 patients with Marfan syndrome aged 8 to 19 years to participate in a 6‐month physical activity intervention, excluding those with ventricular dysfunction or prior history of aortic surgery. We instructed patients to take 10 000 steps per day, tracked by an activity tracker. At baseline and 6 months, we measured AoR dimension, arterial stiffness, endothelial function, physical activity indices, inflammatory biomarkers, and coping scores. Controls consisted of 15 age‐matched patients with Marfan syndrome. Twenty‐four patients with Marfan syndrome (median age, 14.4 years [interquartile range {IQR}, 12.2–16.8], 14 male patients) were enrolled. Baseline assessment demonstrated that the majority of these patients were sedentary and had abnormal arterial health. Twenty‐two patients completed the intervention and took an average of 7709±2177 steps per day (median, 7627 [IQR, 6344–9671]). Patients wore their Garmin trackers at a median of 92.8% (IQR, 84%–97%) of their intervention days. AoR
Z
score in the intervention group had a significantly lower rate of change per year compared with the controls (rate of change, −0.24 versus +0.008;
P
=0.01).

Conclusions

In this clinical intervention in pediatric patients with Marfan syndrome, we demonstrated that a simple physical activity intervention was feasible in this population and has the potential to decrease the AoR dilation rate.

REGISTRATION

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03567460.
Teachers’ Perceptions of Heritage Language Learners: A Large-scale Survey Study on Dialect Variation, Expectations, and Assessment Needs
Authors: Chi John , Donovan Anne E. , Malone Margaret E.
Published: December 2022

Many case studies of heritage language learners (HLL s) have documented learners’ perceptions and experiences, including experiences of stigmatization in the classroom for use of a non-standard variation or for not meeting teachers’ expectations of an HLL. However, few have investigated teachers’ perceptions of their HLL s, and how these could address or illuminate documented negative learning experiences. The current study uses survey methodology to investigate language teachers’ language ideologies of heritage languages and perceptions of HLL s on a larger scale than previous efforts. The study is inclusive of teachers of different grade levels, types of classrooms, and, perhaps most importantly, different languages. By looking at a wide array of participants (N = 325), this study addresses the overarching question: How do language teachers perceive their HLL s in the classroom? The findings provide insight on teachers’ views of HLL s’ dialects, their expectations of learners, and the practical needs of teachers.
Chronicle of a Death Foretold in Flanders
Authors: Abrahams Naasiha
Published: December 2022

Many years ago, my master thesis advisor told me that if I wanted to understand the history of a country, I should read novels. His statement caused me to reflect seriously on what it is that novels do, the truths (and untruths) they yield. This creative piece is inspired primarily by literature and is an attempt to understand how the needless death of a black university student could occur in a society that doggedly continues to view racism as something other societies do. It is simultaneously an attempt to explore how silences in the telling of history have been challenged by authors of colour, how the past reverberates into the present, and the implications for those living in the (African) diaspora. I draw on research that I conducted in two Flemish primary schools, which explored how doxic conceptions of education and belonging, equally racialized, are both reproduced and contested.
Participatory architecture workshops with asylum seekers and local people: Experiences from the Crossing Cultures project in Southern Italy
Authors: Calissano Federica , Denicke-Polcher Sandra , Giacco Domenico , Haenschel Corinna
Published: December 2022

Background:

Participatory architecture can promote dialogue across cultures while working together to create physical outputs. A team of academics with a background in architecture, psychology and health sciences evaluated a participatory architecture workshop in Southern Italy as part of the Crossing Cultures project. The goal was to explore participants’ experiences and perceived benefits. In the context of situated learning, the workshop brought together architecture students, local citizens and asylum seekers, who by working together and learning from each other formed a community of practice (CoP).

Objective:

The aim of this study was to explore the experiences of members of the CoP, their beliefs about the benefits of the project and ways to improve it.

Setting:

Data collection took place in 2019 during a participatory architecture workshop in Belmonte, Italy.

Method:

Twenty-five asylum seekers, locals and students took part in in-depth interviews, which were later subjected to thematic analysis.

Results:

Participants reported experiences relating to ‘living together’, ‘working together’, ‘making home’, ‘making locals comfortable to be involved’ and ‘understanding and respecting differences’. Perceived benefits were ‘creating a space for connection’, ‘revitalising local communities’, ‘promoting development of towns’, ‘broadening horizons’, ‘gaining or practising skills’, ‘having your ideas heard’ and ‘creating lasting things’.

Conclusion:

Findings suggest that creating a CoP not only fulfils individual goals but also addresses common concerns. Participatory architecture workshops in an area with high immigration can create connections between asylum seekers and local people, and promote intercultural dialogue while helping to reactivate an economically and socially deprived area.
Music self-efficacy predicted by self-esteem, grit, and (in)formal learning preferences among amateur musicians who use online music tutorials
Authors: Harpaz Gal , Vaizman Tal
Published: December 2022

The present study explores the relationship between music self-efficacy (MSE) and self-esteem, grit, and learning and playing habits of amateur musicians who use online music tutorials (OMTs) while learning to play new pieces. Amateur musicians ( N = 409) from 30 countries answered research questionnaires, including preferences of autonomy OMTs (foster independent learners and incorporate knowledge) versus dependent OMTs (based mainly on imitation and provide little further knowledge). Ordinary least squares regression indicated that the independent variables accounted for 50% of the variance in the dependent variable (MSE) and that the model was significant. The results indicated that self-esteem, grit, preferences of autonomy OMTs, playing with others and weekly hours of playing were positive predictors of MSE. In addition, dependent OMTs were negatively correlated with MSE. The findings highlight the need to examine any possible causality in the relationship between learning and playing habits, and MSE of amateur musicians. In addition, data were collected in the midst of the Covid-19 worldwide impact and should be further explored post-Covid-19.
Support structures for healthcare professionals involved in medical assistance in dying: Quebec, Canada, and the international landscape
Authors: Perron Catherine , Bouthillier Marie-Eve , Racine Eric
Published: December 2022

When the Act Respecting End-of-Life Care came into effect in Quebec in 2015, nearly 30 Interdisciplinary Support Groups (ISGs) were formed to accompany practitioners and managers in the clinical, administrative, legal, and ethical practice of Medical Assistance in Dying (MAiD). Today, significant variability is observed in the constitution, role and functioning of ISGs. Based on an overview of national and international support structures, we highlight the strengths and challenges of ISGs. This article presents the results of the first phase of research conducted with 245 people involved in the practice of MAiD in Quebec. The objective is to survey current ISG practices in order to contrast them with those of equivalent structures in Canada and around the world. The intention is to guide leaders in the development of support structures for their institutions. In summary, ISGs are distinguished by their interdisciplinary constitution, their decentralized nature, and their proximity to the teams in the field. However, their service offer remains largely unknown to caregivers and the general population. This can be explained by the undefined and unlimited nature of their mandate, but also by the gap between the scope of their mandate and the lack of funding they receive.
Going Public: Performing Dying in the Second Decade of the 21st Century
Authors: Brennan Michael
Published: December 2022

It is now more than a decade since the death of celebrity television personality Jade Goody – a high water mark in public dying comparable to the watershed moment in public mourning marked by the death of Diana, Princess of Wales, a decade or so earlier. As Walter has noted in this journal, Goody’s very public and highly mediated dying will not be the last. With that in mind, this article analyses the sociological significance of public dying in the decade following Goody’s death – the ‘tens’ of the 21st century. It does so chiefly by focusing on a number of high-profile instances which gained significant media traction, using these to examine the ways in which dying is both performed and made meaningful in contemporary 21st century culture. The argument presented operates on the assumption, following Goffman, of life – and by extension, dying – as performance.
The Evolving Portrayal of Hispanic-Serving Institutions? A Systematic Review of More Than 20 Years of Research
Authors: Marin Patricia , Aguilar-Smith Stephanie
Published: December 2022

Hispanic-Serving Institutions (HSIs) play a pivotal role in the higher education of Latina/o/xs. Considering the growth and diversification of these institutions over time, we systematically reviewed more than 20 years of literature on HSIs. Specifically, we explored the nature of the HIS scholarship and the ways it reflects these institutions’ evolution, finding that while literature has grown in the last decade, it has not kept pace with HSIs’ growth, spread, and overall evolution over time.
Generalisation of value-based attentional priority is category-specific
Authors: Clement Andrew , Grégoire Laurent , Anderson Brian A
Published: December 2022

A large body of research suggests that previously reward-associated stimuli can capture attention. Recent evidence also suggests that value-driven attentional biases can occur for a particular category of objects. However, it is unclear how broadly these category-level attentional biases can generalise. In the present study, we examined whether value-driven attentional biases can generalise to new exemplars of a category or semantically related categories using a modified version of the value-driven attentional capture paradigm. In an initial training phase, participants searched for two categories of objects and were rewarded for correctly fixating members of one target category. In a subsequent test phase, participants searched for two new categories of objects. A new exemplar of one of the previous target categories or a member of a semantically related category could appear as a critical distractor in this phase. Participants were more likely to initially fixate the critical distractor and fixated the distractor longer when it was a new exemplar of the previously rewarded category. However, similar findings were not observed for members of semantically related categories. Together, these findings suggest that the generalisation of value-based attentional priority is category-specific.
3D Numerical Investigation of Heat Transfer of Infants in the Indoor Environment
Authors: Jiang Shu , Li Jun
Published: December 2022

This study aimed to investigate the heat transfer around the infant surface in the indoor environment based on computational fluid dynamics analysis. A three-dimensional numerical model containing a virtual infant manikin was developed in COMSOL software. The high-quality geometry model of the infant was obtained using three-dimensional body scanning technology. Governing fluid flow and energy equations were solved along with the low Re k–ε turbulence model. Real-scale measurements were carried out to determine the accuracy of the developed numerical model. Good agreement was found between the simulation results and the experimental data. The results showed that, at room temperature of 21oC, the convective heat transfer coefficient was 64.2% greater than the radiative heat transfer coefficient, which demonstrated that the convective heat transfer was the main approach for heat exchange between the infant and its surrounding environment. Moreover, the largest convective heat transfer coefficients were observed at the forearm and calf, indicating the importance of the additional thermal protection at these regions. The findings will be beneficial to provide some instructions on infant thermal care for caregivers.
Influence of pneumoperitoneum and head-down maneuver on the cerebral microvasculature in rabbits
Authors: Kobayashi Hiroki , Asano Nobumasa , Kondo Daisuke , Shintani Noriyuki , Kotoda Masakazu , Matsuoka Toru , Ishiyama Tadahiko , Matsukawa Takashi
Published: December 2022

Background

With recent advances in robot-assisted techniques, an increasing number of surgeries are being performed with pneumoperitoneum and head-down maneuver (HDM) that may affect the cerebral microcirculation. For the first time, this study investigated the direct influence of pneumoperitoneum and HDM on the cerebral microvasculature in rabbits.

Methods

Adult male rabbits were randomly allocated to the following groups (n = 7 each): control, pneumoperitoneum alone (P), and pneumoperitoneum with HDM (P + HDM) for 120 min. A closed cranial window was installed above the parietal bone to visualize the pial microvasculature. Pial arteriolar diameter and hemodynamic and blood gas parameters were measured during the 140-min observation period. Brain edema was assessed by evaluation of the brain water content at the end of the experiment.

Results

Rabbits in the P and P + HDM groups exhibited a similar degree of immediate pial arteriolar dilation following the initiation of both P and P + HDM (P: 1.11 ± 0.03, p = 0.0044 and P + HDM: 1.07 ± 0.02, p = 0.0004, relative changes from the baseline value by defining the baseline as one). In the P + HDM group, pial arteriole diameter returned to the baseline level following the discontinuation of pneumoperitoneum and HDM (1.05 ± 0.03, p = 0.0906, vs. baseline). In contrast, the pial arterioles remained dilated as compared to the baseline level in the P group after discontinuation of pneumoperitoneum. There were no changes in pial arteriole diameter in the animals in the control group. Heart rate, blood gas parameters, and brain water content were not significantly different between the groups.

Conclusion

The pial arterioles dilated immediately after pneumoperitoneum with or without HDM. The pial arterioles remained dilated 20 min after discontinuation of pneumoperitoneum alone but constricted upon discontinuation of pneumoperitoneum plus HDM. Pneumoperitoneum and HDM for 2 h did not cause brain edema.
Development and validation of retrospective electronic frailty index using operational data of aged care homes
Authors: Sarwar Tabinda , Jimeno Yepes Antonio Jose , Zhang Xiuzhen , Chan Jeffrey , Hudson Irene , Evans Sarah , Cavedon Lawrence
Published: December 2022

Background

Although elderly population is generally frail, it is important to closely monitor their health deterioration to improve the care and support in residential aged care homes (RACs). Currently, the best identification approach is through time-consuming regular geriatric assessments. This study aimed to develop and validate a retrospective electronic frailty index (reFI) to track the health status of people staying at RACs using the daily routine operational data records.

Methods

We have access to patient records from the Royal Freemasons Benevolent Institution RACs (Australia) over the age of 65, spanning 2010 to 2021. The reFI was developed using the cumulative deficit frailty model whose value was calculated as the ratio of number of present frailty deficits to the total possible frailty indicators (32). Frailty categories were defined using population quartiles. 1, 3 and 5-year mortality were used for validation. Survival analysis was performed using Kaplan-Meier estimate. Hazard ratios (HRs) were estimated using Cox regression analyses and the association was assessed using receiver operating characteristic (ROC) curves.

Results

Two thousand five hundred eighty-eight residents were assessed, with an average length of stay of 1.2 ± 2.2 years. The RAC cohort was generally frail with an average reFI of 0.21 ± 0.11. According to the Kaplan-Meier estimate, survival varied significantly across different frailty categories (p < 0.01). The estimated hazard ratios (HRs) were 1.12 (95% CI 1.09–1.15), 1.11 (95% CI 1.07–1.14), and 1.1 (95% CI 1.04–1.17) at 1, 3 and 5 years. The ROC analysis of the reFI for mortality outcome showed an area under the curve (AUC) of ≥0.60 for 1, 3 and 5-year mortality.

Conclusion

A novel reFI was developed using the routine data recorded at RACs. reFI can identify changes in the frailty index over time for elderly people, that could potentially help in creating personalised care plans for addressing their health deterioration.
Lower body muscle strength, dynapenic obesity and risk of type 2 diabetes –longitudinal results on the chair-stand test from the Survey of Health, Ageing and Retirement in Europe (SHARE)
Authors: Kowall Bernd
Published: December 2022

Background

The chair-stand test is a measure of lower body muscle strength. In a longitudinal study with older adults, we investigated whether results of the five-repetition chair-stand test (CST-5) are associated with incident type 2 diabetes, and whether diabetes risk in obese persons is modified by dynapenia (age-related loss of muscle strength) in the lower limbs.

Methods

We used data of the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study with eight waves carried out between 2004 and 2020 in 28 European countries and Israel mainly in persons aged 50 years or older. Forty-six thousand one hundred nineteen persons (mean age 63.5 years, 44.1% men) with CST-5 data and follow-up data for diabetes were included from wave 2 and waves 4 to 7. The mean follow-up time was 5.3 years (standard deviation 2.9 years). Relative risks with 95% confidence intervals (CI) were estimated from log-linear models with a Poisson working likelihood and robust standard errors.

Results

In the crude model, increased risks of diabetes were found for persons who considered the CST-5 as not safe, or whose times for the test were in the highest or second highest quartiles (relative risks 2.18 (95% CI: 1.95–2.43), 1.71 (1.54–1.91), 1.44 (95% CI: 1.29–1.61), reference: lowest quartile). These associations were attenuated in the fully adjusted regression model (relative risks 1.32 (95% CI: 1.17–1.48), 1.23 (1.10–1.37), 1.19 (1.06–1.33)). Furthermore, in fully adjusted models, the risk of diabetes in obese persons did not depend on whether they had low muscle strength or not. In obese persons with times for 5 sits and stands > 15 seconds, the adjusted risk of diabetes was 2.56 (95% CI: 2.22–2.95) times higher than in non-obese persons with times ≤15 seconds. The corresponding relative risk in obese persons with times ≤15 seconds was 2.45 (2.25–2.67).

Conclusions

Poor results in the CST-5 were associated with an increased risk of diabetes. Among obese persons, the risk of diabetes was not modified by results of the CST-5.
Efficacy of extended focused assessment with sonography for trauma using a portable handheld device for detecting hemothorax in a low resource setting; a multicenter longitudinal study
Authors: Kithinji Stephen Mbae , Lule Herman , Acan Moses , Kyomukama Lauben , Muhumuza Joshua , Kyamanywa Patrick
Published: December 2022

Introduction

Chest trauma is one of the most important and commonest injuries that require timely diagnosis, accounting for 25–50% of trauma related deaths globally. Although CT scan is the gold standard for detection of haemothorax, it is only useful in stable patients, and remains unavailable in most hospitals in low income countries. Where available, it is very expensive. Sonography has been reported to have high accuracy and sensitivity in trauma diagnosis but is rarely used in trauma patients in low income settings in part due to lack of the sonography machines and lack of expertise among trauma care providers. Chest X-ray is the most available investigation for chest injuries in low income countries. However it is not often safe to wheel seriously injured, unstable trauma patients to X-ray rooms. This study aimed at determining the efficacy of extended focused assessment with sonography for trauma (eFAST) in detection of haemothorax using thoracostomy findings as surrogate gold standard in a low resource setting.

Methods

This was an observational longitudinal study that enrolled 104 study participants with chest trauma. Informed consent was obtained from all participants. A questionnaire was administered and eFAST, chest X-ray and tube thoracotomy were done as indicated. Data were analysed using SPSS version 22. The sensitivity, specificity, predictive values, accuracy and area under the curve were determined using thoracostomy findings as the gold standard. Ethical approval for the study was obtained from the Research and Ethics Committee of Kampala International University Western Campus REC number KIU-2021-53.

Results

eFAST was found to be superior to chest X-ray with sensitivity of 96.1% versus 45.1% respectively. The accuracy was also higher for eFAST (96.4% versus 49.1%) but the specificity was the same at 100.0%. The area under the curve was higher for eFAST (0.980, P = 0.001 versus 0.725, P = 0.136). Combining eFAST and X-ray increased both sensitivity and accuracy.

Conclusion

This study revealed that eFAST was more sensitive at detecting haemothorax among chest trauma patients compared to chest X-ray. All patients presenting with chest trauma should have bedside eFAST for diagnosis of haemothorax.
Surveillance Strategy after Curative Resection for Oesophageal Squamous Cell Cancer Using the Hazard Function
Authors: Kanematsu Kyohei , Kudose Yozo , Utsunomiya Daichi , Kubo Kentaro , Fujii Yusuke , Kurita Daisuke , Ishiyama Koshiro , Oguma Junya , Daiko Hiroyuki
Published: December 2022

Background

The optimal surveillance period and frequency after curative resection for oesophageal squamous cell carcinoma (OSCC) remain unclear, and current guidelines are mainly based on traditional Kaplan–Meier analyses of cumulative incidence rather than risk analysis. The aim of this study was to determine a suitable follow-up surveillance program following oesophagectomy for OSCC using the hazard function.

Methods

A total of 1187 patients who underwent curative resection for OSCC between 2000 and 2014 were retrospectively analyzed. The changes in the estimated hazard rates (HRs) of recurrence over time were analyzed according to tumour-node-metastasis stage.

Results

Four hundred seventy-eight (40.2%) patients experienced recurrence during the follow-up period (median, 116.5 months). The risk of recurrence peaked at 9.2 months after treatment (HR = 0.0219) and then decreased to half the peak value at 24 months post-surgery. The HRs for Stage I and II patients were low (< 0.007) post-treatment. The HR for Stage III patients peaked at 9.9 months (HR = 0.031) and the hazard curve declined to a plateau at 30 months. Furthermore, the HR peaked at 10.8 months (HR = 0.052) in Stage IV patients and then gradually declined from 50 months.

Conclusions

According to tumour-node-metastasis stage, changes in the HRs of postoperative recurrence in OSCC varied significantly. Intensive surveillance should be undertaken for 3 years in Stage III patients and for 4 years in Stage IV patients, followed by annual screening. For Stage I OSCC patients, a reduction in the surveillance intensity could be taken into consideration.
Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach
Authors: Metwally Ammal M. , Sallam Sara F. , Mawla Mohamed A. Abdel , Alian Khadija M. , Abdel-Latif Ghada A. , Hasanin Hasanin M. , Kamal Ayat N. , Hanna Carine , Shebini Salwa M. El , Ahmed Nihad H. , Mabrok Hoda B. , Mahmoud Maha H. , Ismail Ahmed S. , Boseila Samia A. W. , El-Alameey Inas R. , Mahfouz Nermine N. , Shaaban Fatma A. , Ibrahim Nihad A. , Hassan Nayera E. , El-Masry Sahar A. , Naga Maie M. , Khalil Aya
Published: December 2022

Background

Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents’ beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.

Methods

An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan “ enjoy meals like a baby”. The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.

Results

There was marked and significant improvement in the awareness and of the majority of the weaning practices’ indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3–5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the “Minimum Dietary Diversity” (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).

Conclusion

Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
Is equity considered in systematic reviews of interventions for mitigating social isolation and loneliness in older adults?
Authors: Madani Mohamad Tarek , Madani Leen , Ghogomu Elizabeth Tanjong , Dahrouge Simone , Hébert Paul C. , Juando-Prats Clara , Mulligan Kate , Welch Vivian
Published: December 2022

Background

Social isolation and loneliness affect one in four older adults in many regions around the world. Social isolation and loneliness are shown to be associated with declines in physical and mental health. Intersecting social determinants of health influence both the risk of being socially isolated and lonely as well as the access and uptake of interventions. Our objective is to evaluate what evidence is available within systematic reviews on how to mitigate inequities in access to and effectiveness of interventions.

Methods

We performed an overview of reviews following methods of the Cochrane Handbook for Overviews of Reviews. We selected systematic reviews of effectiveness of interventions aimed at mitigating social isolation and loneliness in older adults (aged 60 or above) published in the last 10 years. In addition, we assessed all primary studies from the most recent systematic review with a broad intervention focus. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus in collaboration with a librarian scientist. We used a structured framework called PROGRESS-Plus to assess the reporting and consideration of equity. PROGRESS-Plus stands for place of residence, race/ethnicity/culture/language, occupation, gender or sex, religion, education, socioeconomic status (SES), social capital, while “plus” stands for additional factors associated with discrimination and exclusion such as age, disability, and sexual orientation. We assessed whether PROGRESS-Plus factors were reported in description of the population, examination of differential effects, or discussion of applicability or limitations.

Results

We identified and assessed 17 eligible systematic reviews. We assessed all 23 primary studies from the most recent systematic review with a broad intervention focus. All systematic reviews and primary studies described the population by one or more PROGRESS-Plus factor, most commonly across place of residence and age, respectively. None of the reviews and five primary studies examined differential effects across one or more PROGRESS-Plus dimension. Nine reviews and four primary studies discussed applicability or limitations of their findings by at least one PROGRESS-Plus factor.

Conclusions

Although we know that social isolation and loneliness are worse for the poorest and most socially disadvantaged older adults, the existing evidence base lacks details on how to tailor interventions for these socially disadvantaged older people.
Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures
Authors: Lan Ching-Yu , Lien Po-Hao , Lin Yu-Te , Lin Cheng-Hung , Hsu Chung-Cheng , Lin Chih-Hung , Chen Shih-Heng , Yu Yi-Hsun
Published: December 2022

Background

Gustilo type III tibial fractures commonly involve extensive soft tissue and bony defects, requiring complex reconstructive operations. Although several methods have been proposed, no research has elucidated the efficacies and differences between vascular bone graft (VBG) and the Masquelet technique (MT) to date. We aimed to evaluate and compare the clinical effectiveness of VBG and the MT for the reconstruction of Gustilo type III tibial fractures.

Methods

This retrospective cohort study enrolled patients who underwent reconstruction for Gustilo type III tibial fractures using VBG or the MT in a single center from January 2000 to December 2020. The patients’ demographics, injury characteristics, and surgical interventions were documented for analysis. The clinical outcomes including union status, time to union, postoperative infections, and the causes of union failure were compared between the two groups.

Results

We enrolled 44 patients: 27 patients underwent VBG, and 17 underwent MT. The average union time was 20.5 ± 15.4 and 15.1 ± 9.0 months in the VBG and MT groups, respectively (p = 0.232). The postoperative deep infection rates were 70.4% and 47.1% in the VBG and MT groups (p = 0.122), respectively. Though not statistically significant, the VBG group had a shorter union time than did the MT group when the bone defect length was > 60 mm (21.0 ± 17.0 versus 23.8 ± 9.4 months, p = 0.729), while the MT group had a shorter union time than did the VBG group when the bone defect was length < 60 mm (17.2 ± 5.6 versus 10.7 ± 4.7 months, p = 0.067).

Conclusions

VBG and MT are both promising reconstruction methods for Gustilo type III tibial fractures. VBG appears to have more potential in reconstructing larger bone defects, while MT may play an important role in smaller bone defects, severe surgical site infections, and osteomyelitis. Therefore, flexible treatment strategies are required for good outcomes in Gustilo type III open tibial fractures.
Mandibular morphometric analysis in open bite early treatment relapse subjects: a retrospective observational pilot study
Authors: Paoloni Valeria , Lugli Letizia , Danesi Carlotta , Cozza Paola
Published: December 2022

Background

The purpose of this retrospective study was to evaluate the mandibular shape differences between a group of success and a group of failure Anterior Open Bite (AOB) malocclusion early orthodontic treatment in growing subjects, in order to identify mandibular features of relapse.

Methods

Twenty three patients (7 males, 16 females, 9.3 years ±1,5 years) were enrolled from the Department of Orthodontics at the University of Rome Tor Vergata. Inclusion criteria were: white ancestry, overbite < 0 mm, mixed dentition phase, end-to-end or Class I molar relationship, first skeletal class assessed on lateral cephalograms (0° < ANB < 4°), cervical skeletal maturation CS1-CS2, no previous orthodontic treatment, no congenital diseases. Pre-treatment (T1) lateral cephalograms were acquired. Each patient underwent early orthodontic treatment with Rapid Maxillary Expander (RME) and Bite Block (BB) or Quad-Helix Crib (QHC) until open bite correction. Radiographic records were recollected at T2 (permanent dentition, skeletal cervical maturation CS3-CS4). Mean interval time T2-T1 was 4.2 years ±6 months. According to treatment stability, a Relapse Group (RG 11 patients, 3 M, 8F; 13.7 years ±8 months, 7 subjects treated with RME/BB, 4 with QH/C) and a Success Group (SG, 12 patients, 4 M, 8F; 13.4 ± 10 months, 7 subjects treated with QH/C, 5 with RME/BB) were identified. On the lateral radiographs the mandibular length (Co-Gn), the inferior gonial angle (NGo^GoMe) and the antegonial notch depth (AND) were analyzed. Then the mandibular Geometric Morphometric analysis (GMM) was applied. Intergroup statistically significant differences were found using student’s t-tests. Procrustes analysis and principal component analysis (PCA) were performed for the GMM.

Results

At T1 no statistically significant differences were found between RG and SG, however higher values of antegonial notch depth were found in RG. T2-T1 comparison showed in RG statistically significant increases in Co-Gn (p = 0.04), NGo^GoMe angle (p = 0.01) and antegonial notch depth (p = 0,04). PC1 confirmed the increase in the antegonial notch depth in RG when compared to SG at T2.

Conclusions

The increased antegonial notch depth associated with the increased mandibular length and the increased gonial angle could be responsible of relapse of early orthodontic treatment in open bite growing subjects.