bluuebunny/crossref_metadata_2025 huggingface dataset:
Space of basis functions to retrieve road surface reflection tables from luminance maps
Authors: Boucher V , Greffier F
Published: July 2022

Road surface reflection tables ( r-tables) relate scene illuminance to luminance seen by a car driver. They are important for many road lighting tasks accounting for road optical properties, such as new illumination design, new pavement texture or lighting design software, to reduce energy consumption without losses on safety and visibility. This paper aims first at finding a space of basis functions to describe r-tables. From a database of 34 r-tables covering a large variety of pavements, a principal component analysis allows to construct a 33-dimensional space, basis for r-table representations. From that statistical model, a method is exposed to retrieve r-table from a luminance map. The estimated r-table is then used to calculate a reconstructed luminance map. Road lighting quality criteria are also derived and they demonstrate the relevancy of the estimated r-table. Finally the model is tested with noisy input data and it remains stable and reliable, making it applicable with experimental luminance maps.
Prospective comparison of volumetric post-contrast T1-Sampling Perfection with Application optimized Contrasts by using different flip angle Evolutions and Magnetization-Prepared Rapid Acquisition with Gradient Echo in patients with metastatic melanoma
Authors: Lasocki Arian , Caspersz Lauren , McArthur Grant A
Published: July 2022

Introduction

Volumetric turbo spin echo (3D-TSE) T1-weighted imaging techniques such as T1-SPACE (Sampling Perfection with Application optimized Contrasts by using different flip angle Evolutions) improve detection of intracranial metastases (IM) compared to volumetric magnetisation-prepared gradient recalled echo techniques such as MPRAGE (Magnetization-Prepared Rapid Acquisition with Gradient Echo). However, incomplete vascular suppression can produce false positives when using 3D-TSE. Research into 3D-TSE has generally targeted patients with known or suspected IM, but the clinical implications of false positives are greater in patients with lower likelihood of IM. This study examined additional findings identified by T1-SPACE in patients with metastatic melanoma, targeting patients with a lower incidence of IM.

Methods

Patients with metastatic melanoma and an upcoming brain MRI booking were identified prospectively. Consent for adding post-contrast T1-SPACE to the MRI protocol (which included MPRAGE) was obtained. Imaging was initially assessed without T1-SPACE. Subsequently, T1-SPACE images were examined and additional findings identified were recorded, including their correlation with MPRAGE.

Results

One hundred examinations were performed, 24 having evidence of active IM. T1-SPACE allowed identification of additional lesions in five patients, including two with small solitary IM not identified when first assessing MPRAGE. In 18 examinations, T1-SPACE identified additional equivocal findings, confidently attributed to artefact (most commonly normal vessels) following correlation with MPRAGE.

Conclusion

T1-SPACE improves detection of small lesions in patients without known IM, changing patient management. False positives are common but can be clarified with MPRAGE. Combining T1-SPACE and MPRAGE allows both sensitivity and specificity to be optimised.
Use of social media for COVID-19-related information and associated factors among health professionals in Northwest Ethiopia: A cross-sectional study
Authors: Tegegne Masresha Derese , Endehabtu Berhanu Fikadie , Klein Jorn , Gullslett Monika Knudsen , Yilma Tesfahun Melese
Published: July 2022

Background

Social media has become an alternative platform for communication during medical crises like the COVID-19 pandemic. This study aimed to assess social media usage for COVID-19-related information among health professionals.

Method

A quantitative cross-sectional study design was conducted among 370 health professionals. The data were analyzed using SPSS version 25 software. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and binary logistic regression analysis techniques were used to describe respondents’ social media usage for COVID-19 information and identify its associated factors.

Results

About 54% (95% CI: 48–58%) of the participants had good social media usage for COVID-19-related information. Age≤30 (AOR = 2.02, 95% CI: 1.14–3.58), Wi-Fi/broadband Internet access (AOR = 2.45, 95% CI: 1.38–4.33), taking computer training (AOR = 2.58, 95% CI: 1.37–4.85), basic computer skill (AOR = 3.28, 95% CI: 1.71–6.29), and usefulness of social media (AOR = 3.56, 95% CI: 1.57–8.04) were found to be the significant factors associated with usage of social media for COVID-19-related information.

Conclusion

The present study confirms that more than half of health professionals had good social media usage for COVID-19-related information. This shows that social media platforms can be used as a source of COVID-19-related information for health professionals if basic computer training is offered, internet connection is available in the workplace, and the usefulness of social media is emphasized.
Bayesian network meta-analysis methods for combining individual participant data and aggregate data from single arm trials and randomised controlled trials
Authors: Singh Janharpreet , Gsteiger Sandro , Wheaton Lorna , Riley Richard D. , Abrams Keith R. , Gillies Clare L. , Bujkiewicz Sylwia
Published: July 2022

Background

Increasingly in network meta-analysis (NMA), there is a need to incorporate non-randomised evidence to estimate relative treatment effects, and in particular in cases with limited randomised evidence, sometimes resulting in disconnected networks of treatments. When combining different sources of data, complex NMA methods are required to address issues associated with participant selection bias, incorporating single-arm trials (SATs), and synthesising a mixture of individual participant data (IPD) and aggregate data (AD). We develop NMA methods which synthesise data from SATs and randomised controlled trials (RCTs), using a mixture of IPD and AD, for a dichotomous outcome.

Methods

We propose methods under both contrast-based (CB) and arm-based (AB) parametrisations, and extend the methods to allow for both within- and across-trial adjustments for covariate effects. To illustrate the methods, we use an applied example investigating the effectiveness of biologic disease-modifying anti-rheumatic drugs for rheumatoid arthritis (RA). We applied the methods to a dataset obtained from a literature review consisting of 14 RCTs and an artificial dataset consisting of IPD from two SATs and AD from 12 RCTs, where the artificial dataset was created by removing the control arms from the only two trials assessing tocilizumab in the original dataset.

Results

Without adjustment for covariates, the CB method with independent baseline response parameters (CBunadjInd) underestimated the effectiveness of tocilizumab when applied to the artificial dataset compared to the original dataset, albeit with significant overlap in posterior distributions for treatment effect parameters. The CB method with exchangeable baseline response parameters produced effectiveness estimates in agreement withCBunadjInd, when the predicted baseline response estimates were similar to the observed baseline response. After adjustment for RA duration, there was a reduction in across-trial heterogeneity in baseline response but little change in treatment effect estimates.

Conclusions

Our findings suggest incorporating SATs in NMA may be useful in some situations where a treatment is disconnected from a network of comparator treatments, due to a lack of comparative evidence, to estimate relative treatment effects. The reliability of effect estimates based on data from SATs may depend on adjustment for covariate effects, although further research is required to understand this in more detail.
Incidentalomas are associated with an increase in liver transplantation in patients with cirrhosis: a single-center retrospective study
Authors: Cortés Pedro , Ghoz Hassan M. , Stancampiano Fernando , Omer Mohamed , Malviya Balkishan , Bowman Andrew W. , Palmer William C.
Published: July 2022

Background

Incidentalomas, defined as incidental findings on imaging, are a growing concern. Our aim was to determine the impact and outcomes of extrahepatic incidentalomas on liver transplantation.

Methods

Patients at a large liver transplant center, who had an initial MRI for hepatocellular carcinoma screening between January 2004 and March 2020 were identified. Clinical data were collected retrospectively. Survival analysis, utilizing Kaplan Meier estimates and Cox proportional hazards regression analysis, was utilized to determine factors associated with liver transplantation.

Results

720 patients were included. NASH (24.9%), HCV (22.1%) and alcohol (20.6%) were the most common causes of cirrhosis. 79.7% of patients had an extrahepatic incidentaloma. Older age and having received a liver transplant by the end of the study were associated with an incidentaloma. MELD was not associated with the presence of an incidentaloma. On univariate Cox proportional hazards regression, male sex, history of moderate alcohol use, smoking history, MELD, and incidentalomas were predictors of liver transplantation. On multivariate analysis, only MELD and the presence of an incidentaloma were found to be significant. Discovery of an incidentaloma was associated with a 30% increase in the risk of liver transplantation. Median time to transplantation did not differ based on the presence on an incidentaloma. Patients with cirrhosis from alcohol or HCV had a significantly shorter median time to transplantation than those with NASH. Renal and pancreatic lesions comprised 91% of all incidentalomas.

Conclusions

In this single-center retrospective study, extrahepatic incidentalomas were common in patients with cirrhosis. The finding of an incidentaloma was associated with a higher risk of liver transplantation despite a similar median time to transplantation if no incidentaloma was discovered.
Resilience is associated with frailty and older age in hospitalised patients
Authors: Lenti Marco Vincenzo , Brera Alice Silvia , Ballesio Alessia , Croce Gabriele , Padovini Lucia , Bertolino Giampiera , Di Sabatino Antonio , Klersy Catherine , Corazza Gino Roberto
Published: July 2022

Background

Little is known about resilience in an internal medicine setting. We aimed to assess the relationship between resilience and frailty and other clinical and sociodemographic characteristics in a cohort of prospectively enrolled hospitalised patients.

Methods

In 2017–2019, we consecutively enrolled patients in our internal medicine wards. We selected all patients who filled in the 25-item Connor-Davidson resilience scale (CD-RISC). Mean resilience was evaluated according to baseline demographic (i.e., age, sex, marital and socioeconomic status) and clinical (i.e., Cumulative Illness Rating Scale [CIRS], Edmonton Frail Scale [EFS], Barthel index, Short Blessed test, length of stay [LOS]) data. A multivariable analysis for assessing factors affecting resilience was fitted.

Results

Overall, 143 patients (median age 69 years, interquartile range 52–79, 74 females) were included. Resilience was significantly lower in frail (p = 0.010), elderly (p = 0.021), dependent (p = 0.032), and more clinically (p = 0.028) and cognitively compromised patients (p = 0.028), and in those with a low educational status (p = 0.032). No relation between resilience and LOS was noticed (p = 0.597). Frail patients were significantly older (p < 0.001), had a greater disease burden as measured by CIRS comorbidity (p < 0.001) and severity indexes (p < 0.001), were more dependent (p < 0.001), more cognitively impaired (p < 0.001), and displayed a lower educational level (p = 0.011) compared to non-frail patients. At multivariable analysis, frailty (p = 0.022) and dependency (p = 0.031; according to the Barthel index) were associated with lower resilience in the age groups 18–64 and ≥ 65 years, respectively.

Conclusions

Low resilience was associated with frailty and dependency with an age-dependent fashion. Studies assessing the impact of this finding on important health outcomes are needed.

Trial registration

Clinical Complexity in Internal Medicine Wards. San MAtteo Complexity Study (SMAC); NCT03439410. Registered 01/11/2017.
Favorable outcome in PLA2R positive HBV-associated membranous nephropathy
Authors: Chen Ruiying , Wang Jia , Xie Qionghong , Zheng Jianming , Liu Shaojun , Xue Jun , Hao Chuanming
Published: July 2022

Introduction

Over half of the patients with hepatitis B virus associated membranous nephropathy (HBV-MN) were found to be phospholipase A2 receptor (PLA2R) positive. Whether MN is really secondary to hepatitis B or just coincidence of hepatitis and PLA2R positive idiopathic MN (IMN) remains controversial.

Methods

We retrospectively studied seven PLA2R positive HBV-MN patients with complete data in Huashan Hospital from 2009 to 2016 and compared them with PLA2R positive idiopathic MN patients.

Results

Proteinuria and renal function of these 7 HBV-MN patients were similar to that of IMN patients. However, 5 of them were female and half showed hypocomplementemia, while in IMN group only 32.4% were female and 20% had hypocomplementemia, and the level of hematuria was 94.5/μL in HBV-MN patients and 64.9 /μL in IMN patients, though there was no statistically significant difference. Renal biopsies revealed significantly increased mesangial eletron-deposits in HBV-MN patients. All 7 patients received antiviral therapy, and one patient received immunosuppresants due to severe nephrotic syndrome with acute myocardial infarction and elevated serum creatinine. Compared with IMN group, the prevalence of remission without immunosuppressive therapy of HBV-MN patients was higher (85.7% vs. 43.7%), while the percentage of patients receiving immunosuppresants was lower (14.3% vs. 47.9%) (P=0.048).

Conclusion

Compared with IMN patients, PLA2R positive HBV-MN patients had a more favorable prognosis after antiviral therapy, indicating a secondary form of MN. For these patients, antiviral treatment is recommended and long observation time should be provided before use of immunosuppressive treatment.
Understanding perinatal patient’s health preferences and patient-provider relationships to prevent congenital syphilis in California and Louisiana
Authors: Wagman Jennifer A. , Park Eunhee , Giarratano Gloria P. , Buekens Pierre M. , Harville Emily W.
Published: July 2022

Background

Congenital syphilis (CS) has reemerged as a global maternal and child health crisis. Kern County, California and East Baton Rouge Parish, Louisiana are among the highest CS morbidity regions in the United States. We previously reported on social-ecological and structural barriers to prenatal care and maternal syphilis testing and treatment in these two regions. The aim of this study was to examine perinatal patient’s health preferences and perceptions of patient-provider relationships in the prenatal care clinic setting.

Methods

Between May 2018 and January 2019 we conducted 20 in-depth qualitative interviews with prenatal providers and 8 focus group discussions with pregnant and postpartum individuals in Kern County and East Baton Rouge Parish. We applied an adapted health services framework to analyze participants’ understanding of health disparities and vulnerable populations; perinatal patient’s health and prenatal care preferences; and participants’ perspectives of clinical encounters in the context of prenatal care and maternal syphilis testing and treatment.

Results

Site-specific determinants of syphilis infection emerged but participants from both locations felt CS prevention efforts should be prioritized among youth, racial/ethnic minority populations, people experiencing socioeconomic limitations and people with other commonly occurring health conditions. Although perinatal patients expressed clear health preferences, they reported inconsistent receipt of respectful, patient-centered care. Inconsistencies were connected with limited ethnic and cultural competence among providers, and implicit, negative attitudes toward patients using substances, experiencing homelessness, or engaging in sex work. Providers clearly aimed to offer high quality prenatal care. However, some clinic and health systems level factors were thought to reduce positive and communicative patient-provider relationships, contributing to gaps in use of prenatal care and syphilis testing and treatment.

Conclusions

Our findings suggest that interventions tailored to address setting-specific determinants (including clinic and health system factors) of disparities in CS risk could improve pregnant people’s access to prenatal care and ensure they and their sex partners receive timely syphilis screening and treatment. We recommend all prenatal care providers receive training on how to identify and mitigate implicit biases and provide competent and compassionate patient-centered care.
Can two multimodal psychomotor exercise programs improve attention, affordance perception, and balance in community dwellings at risk of falling? A randomized controlled trial
Authors: Rosado Hugo , Bravo Jorge , Raimundo Armando , Carvalho Joana , Almeida Gabriela , Pereira Catarina
Published: July 2022

Background

Falls are associated with cognitive and physical function deterioration. Attention decline, inaccurate affordance perception, and balance impairment are considered to be risk factors for falls. Furthermore, few studies have reported psychomotor intervention as a fall prevention program. This study aimed to investigate the effects of two multimodal programs on attention, perceptual and stepping-forward boundaries, and balance in community-dwelling older adults at risk of falling.

Methods

Fifty-one community-dwelling older adults were recruited to participate in a 24-week randomized controlled trial. Participants (75.4 ± 5.6 years) were randomly assigned to one of three groups: the 1) multimodal psychomotor program [EG1], 2) combined program (multimodal psychomotor program + whole-body vibration program) [EG2], and 3) control group. Participants were assessed at baseline, at post-intervention, and after a 12-week no-intervention follow-up period.

Results

The within-group comparisons showed significant improvements in attention and balance in EG1 and EG2 after the intervention (p <  0.05). The magnitudes of the treatment effects were similar in both EGs, ranging from medium to large. Decreases in the fall rate were also observed in EG1 (− 44.2%) and EG2 (− 63.0%) (p <  0.05). During the follow-up period, these improvements in attention were maintained, while those in balance were reversed in both EGs. No significant differences between groups were found.

Conclusions

These study results suggest that both multimodal exercise programs were effective for fall prevention and were well tolerated by the participants. Specifically, EG1 and EG2 showed identical improvements in attention, and EG2 presented a slightly larger enhancement in balance and a larger decrease in the fall rate. Our findings demonstrate the benefits of maintaining the psychomotor intervention program by itself or in combination with the whole-body vibration program to prevent cognitive and physical function deterioration.

Trial registration

ClinicalTrials.gov Identifier:NCT03446352. Date of registration: February 26, 2018.
Reduced forced vital capacity is independently associated with, aging, height and a poor socioeconomic status: a report from the Tunisian population-based BOLD study
Authors: Hsan Safa , Lakhdar Nadia , Harrabi Imed , Zaouali Monia , Burney Peter , Denguezli Meriam
Published: July 2022

Background

Reduced forced vital capacity (FVC) is a risk factor of all-cause mortality; however, the prevalence and determinants of reduced FVC are not available for the Tunisian population. This study investigated the association of reduced FVC with risk factors and health variables in an urban population of subjects aged ≥ 40 years and living in the city of Sousse in Tunisia.

Methods

A cross-sectional survey was performed using data from the Tunisian Burden of Obstructive Lung Disease (BOLD) study. We defined reduced FVC as a post-bronchodilator FVC below the lower limit of normal using National Health and Nutrition Examination Survey (NHANES) values and Global Lung Function Initiative 2012 equations (GLI 2012) and determined the relation between this finding and the potential risk factors (demographic and socioeconomic factors and the presence of chronic diseases), using multivariable regression analysis.

Results

The prevalence of reduced FVC was 26.6% (176/661) when using NHANES values for white Americans and 14.2% (94/661) using the GLI 2012 equations. Compared to people with normal FVC, those with a reduced FVC were significantly older, taller, had a lower body mass index (BMI), more respiratory symptoms and a higher prevalence of heart disease and hypertension. Multivariable analysis showed that reduced FVC was essentially driven by exposure to biomass smoke for heating, a number of schooling years lower than or equal to 6 years, a childhood history of hunger for a lack of money, aging and height.

Conclusions

The prevalence of reduced FVC is associated with a poor socioeconomic status aging and height.
GENESISS 2—Generating Standards for In-Situ Simulation project: a systematic mapping review
Authors: Evans Kerry , Woodruff Jenny , Cowley Alison , Bramley Louise , Miles Giulia , Ross Alastair , Cooper Joanne , Baxendale Bryn
Published: July 2022

Background

In-situ simulation is increasingly employed in healthcare settings to support learning and improve patient, staff and organisational outcomes. It can help participants to problem solve within real, dynamic and familiar clinical settings, develop effective multidisciplinary team working and facilitates learning into practice. There is nevertheless a reported lack of a standardised and cohesive approach across healthcare organisations. The aim of this systematic mapping review was to explore and map the current evidence base for in-situ interventions, identify gaps in the literature and inform future research and evaluation questions.

Methods

A systematic mapping review of published in-situ simulation literature was conducted. Searches were conducted on MEDLINE, EMBASE, AMED, PsycINFO, CINAHL, MIDIRS and ProQuest databases to identify all relevant literature from inception to October 2020. Relevant papers were retrieved, reviewed and extracted data were organised into broad themes.

Results

Sixty-nine papers were included in the mapping review. In-situ simulation is used 1) as an assessment tool; 2) to assess and promote system readiness and safety cultures; 3) to improve clinical skills and patient outcomes; 4) to improve non-technical skills (NTS), knowledge and confidence. Most studies included were observational and assessed individual, team or departmental performance against clinical standards. There was considerable variation in assessment methods, length of study and the frequency of interventions.

Conclusions

This mapping highlights various in-situ simulation approaches designed to address a range of objectives in healthcare settings; most studies report in-situ simulation to be feasible and beneficial in addressing various learning and improvement objectives. There is a lack of consensus for implementing and evaluating in-situ simulation and further studies are required to identify potential benefits and impacts on patient outcomes. In-situ simulation studies need to include detailed demographic and contextual data to consider transferability across care settings and teams and to assess possible confounding factors. Valid and reliable data collection tools should be developed to capture the complexity of team and individual performance in real settings. Research should focus on identifying the optimal frequency and length of in-situ simulations to improve outcomes and maximize participant experience.
Hospital variation in admissions for low back pain following an emergency department presentation: a retrospective study
Authors: Ferreira Giovanni , Lobo Marina , Richards Bethan , Dinh Michael , Maher Chris
Published: July 2022

Background

One in 6 patients with low back pain (LBP) presenting to emergency departments (EDs) are subsequently admitted to hospital each year, making LBP the ninth most common reason for hospital admission in Australia. No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP.

Methods

We used routinely collected ED data from public hospitals within the state of New South Wales, Australia, to identify presentations of patients aged between 18 and 111 with a discharge diagnosis of LBP. We fitted a series of random effects multilevel logistic regression models adjusted by case-mix and hospital variables. The main outcome was the hospital-adjusted admission rate (HAAR). Data were presented as funnel plots with 95% and 99.8% confidence limits. Hospitals with a HAAR outside the 95% confidence limit were considered to have a HAAR significantly different to the state average.

Results

We identified 176,729 LBP presentations across 177 public hospital EDs and 44,549 hospital admissions (25.2%). The mean (SD) age was 51.8 (19.5) and 52% were female. Hospital factors explained 10% of the variation (ICC = 0.10), and the median odds ratio (MOR) was 2.03. We identified marked variation across hospitals, with HAAR ranging from 6.9 to 65.9%. After adjusting for hospital variables, there was still marked variation between hospitals with similar characteristics.

Conclusion

We found substantial variation in hospital admissions following a presentation to the ED due to LBP even after controlling by case-mix and hospital characteristics. Given the substantial costs associated with these admissions, our findings indicate the need to investigate sources of variation and to determine instances where the observed variation is warranted or unwarranted.
Factors influencing the implementation of TB screening among PLHIV in selected HIV clinics in Ghana: a qualitative study
Authors: Narh-Bana Solomon A. , Kawonga Mary , Odopey Selase Adjoa , Bonsu Frank , Ibisomi Latifat , Chirwa Tobias F.
Published: July 2022

Background

Decreasing the burden of Tuberculosis (TB) among PLHIV through TB screening is an effective intervention recommended by the World Health Organization (WHO). However, after over a decade of implementation in Ghana, the intervention does not realize the expected outcomes. It is also not well understood whether this lack of success is due to implementation barriers. Our study, therefore, sought to examine the factors influencing the implementation of the intervention among people living with HIV (PLHIV) attending HIV clinics at district hospitals in Ghana.

Methods

This was a qualitative study conducted from 6th to 31 May 2019 in three regions of Ghana. We conducted 17 in-depth interviews (IDIs – comprising two regional, six districts and nine facility TB/HIV coordinators) and eight focus group discussions (FGD – consisting of a total of 65 participants) with HIV care providers. The Consolidated Framework for Implementation Research (CFIR) guided the design of interview guides, data collection and analysis. All responses were digitally audio-recorded and transcribed verbatim for coding and analysis using the Framework Approach. Participants consented to the interview and recording.

Results

The main barriers to TB screening relate to the low commitment of the implementers to screen for TB and limited facility infrastructure for the screening activities. Facilitators of TB screening include (1) ease in TB screening, (2) good communication and referral channels, (3) effective goals and feedback mechanisms, (4) health workers recognizing the need for the intervention and (5) the role of chemical sellers.

Conclusions

Key barriers and facilitators to the intervention are revealed. The study has shown that there is a need to increase HIV care providers and institutional commitment towards TB screening interventions. In addition, cost issues need to be assessed as they are drivers of sustainability. Our study also advances the field of implementation science through CFIR to better understand the factors influencing the implementation.
Multiplex immunohistochemistry defines the tumor immune microenvironment and immunotherapeutic outcome in CLDN18.2-positive gastric cancer
Authors: Jia Keren , Chen Yang , Sun Yu , Hu Yajie , Jiao Lei , Ma Jie , Yuan Jiajia , Qi Changsong , Li Yanyan , Gong Jifang , Gao Jing , Zhang Xiaotian , Li Jian , Zhang Cheng , Shen Lin
Published: July 2022

Background

The FAST study identified claudin-18 (CLDN18.2) as a promising novel therapeutic target for gastric cancer (GC). However, the tumor immune microenvironment and clinicopathological features of CLDN18.2-positive GC are unclear, making it difficult to develop and optimize CLDN18.2-targeted treatments.

Methods

This study included 80 GC patients, 60 of whom received anti-PD-1/PD-L1 treatment. CD4/CD8/CD20/CD66b/CD68/CD163/PD-1/PD-L1/TIM-3/LAG-3/FoxP3/CTLA-4/HLA-DR/STING, and CLDN18.2 were labeled using multiplex immunohistochemistry (m-IHC) to decipher the rate and spatial distribution of T cells, B cells, macrophages, and neutrophils in formalin-fixed, paraffin-embedded tumor tissues isolated from these patients. Tumor immune-microenvironmental features and patient survival stratified by CLDN18.2 expression were analyzed using two independent-sample t-tests and log-rank tests, respectively.

Results

We considered moderate-to-strong CLDN18.2 expression ≥ 40% of tumor cells as the cut-off for positivity. The proportion of CD8+PD-1−, CD8+LAG-3−, and CD8+TIM-3− T cells was significantly higher in CLDN18.2-positive tumors than in negative tumors (0.039 vs. 0.026, P = 0.009; 0.050 vs.0.035, P = 0.024; 0.045 vs. 0.032, P = 0.038, respectively). In addition, the number of neutrophils (CD66b+) was higher in the CLDN18.2-positive group than in the negative group (0.081 vs. 0.055, P = 0.031, respectively), while the rates of M1 (CD68+CD163−HLA-DR+), M2 macrophages (CD68+CD163+HLA-DR−), and B cells (CD20+) were comparable between the CLDN18.2-positive and negative groups. The average numbers of CD8+PD-1−, CD8+LAG-3−, and CD8+TIM-3−T cells surrounding tumor cells within a 20-μm range were higher in CLDN18.2-positive tumors than in the CLDN18.2-negative tumors (0.16 vs. 0.09, P = 0.011; 0.20 vs. 0.12, P = 0.029; 0.18 vs. 0.12, P = 0.047, respectively). In addition, in the CLDN18.2-positive group, tumor cells surrounded by CD8+PD-1−, CD8+LAG-3− T cells, or M1 macrophages within a 20-μm range accounted for a higher proportion of all tumor cells than those in the CLDN18.2-negative group (10.79% vs. 6.60%, P = 0.015; 12.68% vs. 8.70%, P = 0.049; 9.08% vs. 6.56%, P = 0.033, respectively). These findings suggest that CLDN18.2-positive GC harbors complex immune-microenvironmental features. Additionally, CLDN18.2-positive group had shorter OS and irOS than CLDN18.2-negative group (median OS: 23.33 vs.36.6 months, P < 0.001; median irOS: 10.03 vs. 20.13 months, P = 0.044, respectively).

Conclusions

CLDN18.2-positive GC displayed unique immune-microenvironmental characteristics, which is of great significance for the development of CLDN18.2-targeted therapies. However, the impact of CLDN18.2-related microenvironmental features on prognosis requires further investigation.
Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system
Authors: Khan Mustafa Ali , Shahbaz Hamna , Noorali Ali Aahil , Ehsan Anam Noor , Zaki Mareeha , Asghar Fahham , Hassan Mohammed Moizul , Arshad Haroon Muhammad , Sohaib Muhammad , Asghar Muhammad Ali , Khan Muhammad Faisal , Sabeen Amber , Aqeel Masooma , Khan Muhammad Haroon , Munir Tahir , Amin Syed Kashif , Atiq Huba , Haider Adil Hussain , Samad Zainab , Latif Asad
Published: July 2022

Background

In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.

Methods

To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.

Results

A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.

Conclusion

Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.
Review and statistical analysis of clinical management of feline leishmaniosis caused by Leishmania infantum
Authors: Garcia-Torres Maria , López María Cristina , Tasker Séverine , Lappin Michael Rex , Blasi-Brugué Carles , Roura Xavier
Published: July 2022

Background

There is limited information about feline leishmaniosis (FeL) management in clinical practice. Leishmania infantum is the species of Leishmania most frequently reported in both dogs and cats in countries of the Mediterranean region (henceforth ‘Mediterranean countries’), Central and South America, and Iran. This study was conducted to provide veterinary clinicians with an updated overview of evidence-based information on leishmaniosis in cats.

Methods

A review was performed using PubMed, Science Direct, Google Scholar and Web of Science. Case reports of FeL caused by L. infantum were sought for the period 1912 to 1 June 2021.

Results

Sixty-three case reports are included in this review. Fifty-nine out of the 63 cats were from Europe, mostly from Mediterranean countries (88.9%). Most of them were domestic short-haired cats (90%) with a mean age of 7.9 years, and had access to the outdoors (77.3%). Sixty-six percent of the cats had comorbidities, of which feline immunodeficiency virus infection was the most frequent (37.7%). Dermatological lesions (69.8%) was the most frequent clinical sign, and hyperproteinemia (46.3%) the most frequent clinicopathological abnormality. Serology was the most performed diagnostic method (76.2%) and was positive for 93.7% of cats. Medical treatment was applied in 71.4% of cats, and allopurinol was the most used drug (74.4%). Survival time was greater for treated cats (520 days; 71.4% of cats) than non-treated cats (210 days; 25.4%).

Conclusions

The majority of the cats had comorbidities, of which feline immunodeficiency virus was the most frequent. Dermatological lesions were frequently reported, and systemic clinical signs and clinicopathological abnormalities were also common. Serology may be useful for the diagnosis of FeL in clinical practice, and a positive titer of ≥ 1/40 may be a useful cut-off for sick cats. The reported treatments and dosages varied, but there was a good clinical response and longer survival in most of the cats treated with allopurinol monotherapy.

Graphical abstract
Proof-of-concept for intervention to prevent post-operative ileus in patients undergoing ileostomy formation
Authors: Greenberg Anya L. , Kelly Yvonne M. , Sarin Ankit , Varma Madhulika G.
Published: July 2022

Background

Preventing post-operative ileus (POI) is important given its associated morbidity and increased cost of care. The authors’ prior work showed that POI in patients with newly created ileostomies is associated with a post-operative day (POD) 2 net fluid balance of > + 800 mL. The purpose of this study was to conduct an initial assessment of the efficacy of a pilot intervention.

Methods

This is a single-institution, pre–post-intervention, proof-of-concept study conducted on the Colorectal Surgery service at the University of California, San Francisco. The study included 58 procedures with ileostomy formation by board-certified colorectal surgeons between August 13, 2020 and June 1, 2021. The intervention included three adjustments to the standard Enhanced Recovery After Surgery protocol: addition of diuresis, delay in advancement to solid food, and earlier stoma intubation. Demographics, intraoperative factors, post-operative fluid balance, and outcomes (POI, post-procedure length of stay [LOS], hospitalization cost, and re-admissions) were compared between patients pre- and post-intervention.

Results

Eight (13.8%) of the 58 procedures in the intervention period were associated with POI vs. a baseline POI rate of 32.6% (p = 0.004). Compared to patients without intervention, those with intervention had 67% less odds of POI (OR 0.33, 95% CI 0.15–0.73, p = 0.01). This difference remained significant when adjusted for age, gender, body mass index, procedure duration, and operative approach (adjusted OR 0.32, 95% CI 0.14–0.72, p = 0.01). Average POD2 stoma output was 0.3 L greater (1.1 L vs. 0.8L; p < 0.001) and net fluid balance was 1.8 L lower (+ 0.3 L vs. + 2.1 L; p < 0.00001) for these 58 cases. Average post-procedure LOS was 1.9 days lower (5.3 vs. 7.2 days, p < 0.001) and direct cost was $5561 lower ($21,652 vs. $27,213, p = 0.004), with no difference in 30-day readmissions (p = 0.43).

Conclusions

This pilot intervention shows promise for reduction in POI in patients with newly created ileostomies. Additional assessment is needed to confirm these initial findings.
Tumor response to radiotherapy and expression of epidermal growth factor receptor mutation and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase rearrangement in patients with non-small cell lung cancer
Authors: Nagi Nadeem M. S. , Khair Yasir A. M. , Bakari Khamis H. , Nagi Mohamed N. , Mghanga Fabian P.
Published: July 2022

Background

One of the main limitations of radiation therapy is the resistance of tumor cells. This study aimed at evaluating the relationship between the expression of epidermal growth factor receptor (EGFR) and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) and tumor radiosensitivity in patients with non-small cell lung cancer.

Methods

Medical case files, pathological results for EGFR and EML4-ALK, and computerized tomography scans of patients with NSCLC treated with thoracic radiation therapy were analyzed.

Results

The sample size was 101 patients with mean age 58.43 ± 9.89 years. Statistically significant differences were observed in the mean reduction of long tumor diameter during the early treatment phase in EGFR-positive versus EGFR-negative patients (p value = 0.04) and in short tumor diameter during the late treatment phase in EGFR-positive versus EGFR-negative patients (p value = 0.04).

Conclusion

Patients with overexpression of EGFR mutations are more radiosensitive during the early treatment phase, and EML4-ALK mutations were less radiosensitive regardless of phases.
Telepsychiatry: what clinicians need to know about digital mental healthcare
Authors: Brunt Thomas J. , Gale-Grant Oliver
Published: July 2022

The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.
Martha S. Braun: A Neglected Austrian School Economist and Her Theoretical Contribution to Economics
Authors: Becchio Giandomenica
Published: July 2022

During the interwar period, Austrian school economists played a fundamental role in establishing marginalism as a central principle of economics. In those years, the role of Mises in Vienna was especially pivotal in building up economics as a science based on the notion of subjective utility within a free institutional framework. As is well known, Mises was surrounded by several colleagues and students who were members of his intellectual circle (Mises's Kreis). This paper sheds some light on the theoretical contribution of Martha Stephanie (Steffy) Braun (Browne), a neglected Austrian economist in Mises's circle. Embedded in the Viennese cultural milieu of the time and trained as an Austrian school economist, Braun originally helped develop, and sometimes anticipated, some pivotal aspects of the economic theory of the Austrian school. Her focus was mainly on monetary issues, the nature of economic policy, and economic education, especially for women.
Reading Practices in Political Economy: The Case of Adam Smith
Authors: Hickey Jocelyn
Published: July 2022

The main references of the social sciences and humanities are texts. Texts are the means by which social scientists communicate their ideas and the means through which we, as readers, access those same ideas. Consequently, reading can be regarded as one of the main tools in the social sciences and ultimately the cornerstone of academia. This minisymposium takes the idea of reading and reading practices as its central focus. More specifically, the minisymposium demonstrates a variety of ways in which the reading process is complex, varied, and subject to many influences. In addition to this shared consideration of reading practices, articles in this minisymposium are united in their discussions of Adam Smith. It is through the means of interrogating readings and receptions of Smith that each article brings to the fore a different aspect of the reading process. The four articles contained within the minisymposium were first presented in May 2020 at an Adam Smith workshop funded by Newcastle University's Political Philosophy Cluster, and they each represent a continuation of the contemporary revisionist discussions on Smith—put forward by the likes of Glory Liu, Warren Samuels, and Amartya Sen—that criticize and revise dominant interpretations of Smith's works. The articles offer a diverse range of thoughts on the complex and multifaceted nature of the reading process, on how we might interrogate our own reading practices and those of others, and, ultimately, why doing so is beneficial and worthwhile.
Reading the Invisible Hand: An Epistemological Consideration
Authors: Hickey Jocelyn
Published: July 2022

Within the discipline of economics, as within all academic disciplines, scholars produce texts in which they examine, discuss, and sometimes invoke their intellectual predecessors. As historians of economic thought, we are faced with the task of evaluating the readings put forward by these scholars. This article argues that to adequately evaluate such readings one must understand the inalienable role that a scholar's epistemological framework plays in the conditioning of their reading of historical texts and concepts. To do so, the author examines two divergent readings of Adam Smith: Jacob Viner's reading of Smith's invisible hand as God and Paul Samuelson's reading of the same three words as an allocative mechanism that translates an individual's “selfish” actions into the public good or “the best good of all” within a state of perfect competition. These distinct readings from two North American economists with remarkably similar historical, geographical, and academic contexts provide the ideal case for exploring the manner in which readers' differing epistemological commitments shape their different readings of historical concepts and texts. The exploration of these readings and the manner in which they are epistemologically conditioned are embedded within the wider discussion around an interpretation put forward by Quentin Skinner. Thus, this article offers an account of the variance in readings of the invisible hand and contributes toward the contemporary revisionist Smithian literature that explores, criticizes, and revises dominant readings of Smith.
The Place of Glasgow in The Wealth of Nations: Caught between Biography and Text, Philosophical and Commercial History
Authors: Watson Matthew
Published: July 2022

Adam Smith's biographers have been in no doubt how important his experiences of living and working among Glasgow's merchant community were to the content of The Wealth of Nations. Many Smith scholars who themselves have been based in the city go further. They insist on the essential Scottishness of the text, seeing Glasgow as the indispensable intermediary between lowland Scotland's town-and-country dynamics and its insertion into global trading routes. However, Glasgow plays no explicit part in the way Smith chose to construct his arguments. This juxtaposition between the fundamental feeling that a work can elicit for a particular reading community and the words that actually appear on the page prompts the methodological question of how to proceed when encountering an apparent absence in a text. The reader does not possess a privileged access point from which to offer correctives by way of asserting that certain knowledge should have been present even though it is not. An absence from the text does not equate to missing text in the form of an obviously anomalous omission. Studies of the historical backdrop against which Smith was writing cannot be given the same authority when interpreting The Wealth of Nations as his direct communication to the reader of his views on the relationship between text and context. We may know more than he chose to reveal about his social and cultural embeddedness within the Glaswegian merchant community, but at most this knowledge can only provide an extra perspective when the matter at hand is textual interpretation. It is not a direct substitute for what Smith chose not to say.