bluuebunny/crossref_metadata_2025 huggingface dataset:
Communicable Illness Mitigation Strategies for Traveling Elite Sporting Organizations
Authors: McElheny Kathryn D. , Little Dean , Taylor David , Manzi Joseph E.
Published: July 2021

Context:

Transmission of communicable diseases observed in sporting organizations is often preventable. Early detection, isolation, and treatment can significantly diminish time lost. Until recently, there has been a paucity of standardized guidelines outlining feasible, preventable measures to protect both athletes and staff from contagious illnesses. Therefore, the purpose of this narrative was to highlight optimal prevention practices for transmission mitigation, with a particular focus on hygiene activity and travel considerations in professional sporting organizations.

Evidence Acquisition:

Current recommendations from the Centers for Disease Control and Prevention and peer-reviewed journals.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Communicable illness prevention strategies begin at the level of sufficient personal hygiene practices. Common area surface cleaning recommendations, including shared equipment sanitization between usage as well as designated equipment use to specific athletes, should be considered to minimize cross-contamination, in particular, for liked-position players. Intelligent design for shared areas can include redistributing the layout of communal spaces, most feasibly, spreading locker designation a minimum distance of 6 ft from one another. Travel considerations can include placing most susceptible passengers closest to window seating, boarding last and exiting first. Team physicians should have knowledge of essential personnel medical histories in an effort to risk stratify staff members and players in the setting of communicable disease.

Conclusion:

Providing a framework for illness management and prevention is important when considering the effects on player health, missed time, performance, and overall cost. Containment of commonly observed communicable illnesses can be optimized with sufficient personal hygiene practices, common area surface cleaning recommendations, intelligent design for shared areas, travel and hotel considerations, as well as appropriate screening tools and isolation techniques.

Strength of Recommendation Taxonomy (SORT):

B.
Thrombosed Urethral Prolapse: a case series and review of the literature
Authors: Oliyide Abisola , Chibuzo Ijeoma , Kujawa Magda
Published: July 2021

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature.

Level of Evidence: Level 4
Current Issues and Challenges for Legal Education in a Globalized Context: A Case Study from Hanoi Law University, Vietnam
Authors: Huong Phan Thi Lan , Thuy Nguyen Thi
Published: July 2021

Laws inevitably reflect political, social, and economic histories and more recent developments regardless of jurisdiction. Recent years have brought significant and rapid change in legal context and practice. Legal education must respond to this, if necessary with new methods and approaches to enable lawyers, judges, prosecutors, and law enforcement officers to meet the requirements of what is now a global market and to further serve the interests of society. Many lawyers are now expected to perform their work in a domestic and wider context. The education system of Vietnam in general, and legal education in particular, has raised many issues and challenges and the question remains—how to reform legal education to meet relevant needs. This article describes and analyses current legal education provision and identifies potential solutions for reform.
Quadriceps and Hamstring Strength in Adolescents 6 Months After ACL Reconstruction With Femoral Nerve Block, Adductor Canal Block, or No Nerve Block
Authors: Frazer Abigail R. , Chaussé Marie-Eve , Held Marlee , St-Pierre Catherine , Tsai Cheng Yi , Preuss Richard , Descoteaux Nancy , Chan Monica , Martineau Paul A. , Veilleux Louis-Nicolas
Published: July 2021

Background:

Femoral nerve block (FNB) and adductor canal block (ACB) have been used increasingly for pain control during anterior cruciate ligament (ACL) reconstruction in adolescent patients. However, recent evidence suggests that the use of FNB may affect quadriceps strength recovery 6 months after surgery.

Purpose/Hypothesis:

To compare postoperative isokinetic strength in adolescents who received FNB, ACB, or no block for perioperative analgesia during ACL reconstruction. We anticipated lower postoperative quadriceps and hamstring isokinetic deficits in adolescents who received FNB as compared with ACB.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients were included in the study if they had undergone hamstring tendon autograft ACL reconstruction by a single surgeon from July 2008 to January 2018 and if they underwent isokinetic muscle testing at 4 to 8 months postoperatively. The participants were divided into 3 groups (no block, FNB, and ACB), and we compared the deficit in percentages between the affected and unaffected limbs as calculated from the isokinetic quadriceps and hamstring strength testing at 60 and 180 deg/s. Between-group analysis was performed using analysis of variance, with an alpha of .05.

Results:

A total of 98 participants were included in the analysis (31 no block, 36 FNB, and 31 ACB). The mean ± SD age of the patients was 15.26 ± 1.15, 15.50 ± 1.42, and 15.71 ± 1.44, for no block, FNB, and ACB, respectively. At 5.61 months postoperatively, there was no significant difference across the 3 groups in isokinetic quadriceps deficits ( P ≥ .99), and the only significant difference in isokinetic hamstring deficit was observed for peak flexion at 180 deg/s, in which the ACB group had lower peak torque than the FNB group (–9.80% ± 3.48% vs 2.37% ± 3.23%; P = .035). The ratio of participants with a deficit exceeding 15% did not differ significantly among the 3 groups.

Conclusion:

Contrary to previous research, our findings indicate only minimal difference in quadriceps strength among the 3 types of perioperative analgesia in adolescents approximately 6 months after ACL reconstruction. The only significant strength deficit was seen in the hamstrings of patients receiving ACB at peak flexion as compared with those receiving FNB.
“Corporate Sustainability” or “Corporate Social Responsibility”? A Comparative Study of Spanish and Latin American Companies’ Websites
Authors: Pérez Cañizares Pilar
Published: July 2021

This study aims to compare how leading companies in Spain and in Spanish-speaking Latin America communicate corporate social responsibility or sustainability on their web pages. For this purpose, the pages of 68 companies were examined to establish the accessibility of such topics and to trace how their prominence and wording had evolved over time. The results show a trend toward greater uniformity in both Spain and Latin America, with corporate social responsibility/sustainability discourse gaining in prominence and “responsibility”-related terms being gradually replaced by those related to “sustainability.” Various cases hint that changes in terminology may be unrelated to any clear distinction between both terms.
Becoming a Family Caregiver to a Person With Dementia: A Literature Review on the Needs of Family Caregivers
Authors: Steenfeldt Vibeke Østergaard , Aagerup Lars Christian , Jacobsen Anna Holm , Skjødt Ulla
Published: July 2021

Introduction

The dementia disease affects both the family caregivers’ health and social and psychological well-being. The aim of this review was to identify and describe the needs of family caregivers living with a person with dementia at home.

Method

The literature review, conducted using the matrix method, was also inspired by Thomas and Harden’s thematic synthesis.

Results

Three themes were identified: (1) the family caregiver’s new roles and relationships; (2) caregiver burdens; and (3) the caregiver’s need for information and support.

Conclusion

When family caregivers gradually lose their reciprocal relationship with the person with dementia, and sometimes also with family and friends, the need for other kinds of social contact arises e.g. with others in a similar situation. They also need to have some respite to provide room to pursue their own interests and take care of their own health. Also, a high level of individually tailored information is needed.
Resistance is in the air: From post-politics to the politics of expertise
Authors: da Schio Nicola , van Heur Bas
Published: July 2021

Knowledge about air pollution is key, both to contest the status quo and to propose a different environmental imaginary as to how urban reality should be. Empirically, this paper focuses on Brussels and its history of air pollution contestation over the last fifty years, in order to trace how knowledge dynamics shape the politics of air. Theoretically, the paper offers a critical reading of the ‘post-political city’ literature that has been omnipresent in urban studies, human geography and political ecology over the last decades, in order to offer a more sophisticated theorization of expertise and knowledge. The paper offers at least three key insights. First, lay as well as public knowledge is of key importance in making air pollution manifest as a matter of concern. Making a perceived problem visible to a wider public in itself can be transformative and can pressure governments to respond, albeit rarely adequately. Second, the use of scientific knowledge by social movements and civil society plays a central role in contesting established priorities and in developing counter strategies, often alternating lay knowledge and more formal scientific knowledge in the process. At the same time, scientific knowledge and other forms of specialized expertise also play an important role in solidifying existing hierarchies of authority. Third, our analysis points to the centrality of the state as an arena for political action and to the importance of a politics of shifting blame and responsibility onto other layers of government or other societal actors.
Metabolomic analyses reveal new stage-specific features of COVID-19
Authors: Jia Hongling , Liu Chaowu , Li Dantong , Huang Qingsheng , Liu Dong , Zhang Ying , Ye Chang , Zhou Di , Wang Yang , Tan Yanlian , Li Kuibiao , Lin Fangqin , Zhang Haiqing , Lin Jingchao , Xu Yang , Liu Jingwen , Zeng Qing , Hong Jian , Chen Guobing , Zhang Hao , Zheng Lingling , Deng Xilong , Ke Changwen , Gao Yunfei , Fan Jun , Di Biao , Liang Huiying
Published: July 2021

The current pandemic of coronavirus disease 2019 (COVID-19) has affected >160 million individuals to date, and has caused millions of deaths worldwide, at least in part due to the unclarified pathophysiology of this disease. Identifying the underlying molecular mechanisms of COVID-19 is critical to overcome this pandemic. Metabolites mirror the disease progression of an individual and can provide extensive insights into their pathophysiological significance at each stage of disease. We provide a comprehensive view of metabolic characterisation of sera from COVID-19 patients at all stages using untargeted and targeted metabolomic analysis. As compared with the healthy controls, we observed different alteration patterns of circulating metabolites from the mild, severe and recovery stages, in both the discovery cohort and the validation cohort, which suggests that metabolic reprogramming of glucose metabolism and the urea cycle are potential pathological mechanisms for COVID-19 progression. Our findings suggest that targeting glucose metabolism and the urea cycle may be a viable approach to fight COVID-19 at various stages along the disease course.
Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice � ABC
versus
5As
Authors: Kastaun Sabrina , Viechtbauer Wolfgang , Leve Verena , Hildebrandt Jaqueline , Funke Christian , Klosterhalfen Stephanie , Lubisch Diana , Reddemann Olaf , Raupach Tobias , Wilm Stefan , Kotz Daniel
Published: July 2021

We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC
versus
5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation.

Follow-up data were collected in 1937 smoking patients � independently of the receipt of GP advice � recruited before or after the training of 69 GPs. At week 26, ~70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed.

Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC
versus
the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26.

We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients� loss to follow-up or to contextual factors,
e.g.
access to free evidence-based cessation treatment, which can hamper the transfer of GPs� advice into patients� behaviour change.
Anxiety and depression in Dutch patients with primary ciliary dyskinesia and their caregivers: associations with health-related quality of life
Authors: Verkleij Marieke , Appelman Iris , Altenburg Josje , Twisk Jos , Quittner Alexandra L. , Haarman Eric
Published: July 2021

Background

Primary ciliary dyskinesia (PCD) might be a risk factor for the development of anxiety and depression. This study investigated the associations between anxiety, depression and health-related quality of life (HRQoL) in individuals with PCD and their caregivers.

Methods

Children, adolescents and adults with PCD and their caregivers were invited to participate in a mental health screening programme. During regular yearly outpatient visits, measures of anxiety (GAD-7), depression (PHQ-9), HRQoL (QOL-PCD), lung function (forced expiratory volume in 1 s (FEV1)) and body mass index (BMI)) were collected and associations of anxiety, depression and HRQoL were estimated.

Results

A total of 103 individuals participated in the mental health screening programme. Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 6% of adults (n=33), 14% of children (n=7), 6% of adolescents (n=17) and 20% of caregivers (n=46, 52% of mothers). Elevated depression levels (scores ≥10 on PHQ-9) were found in 18% of adults, 14% of children, 6% of adolescents and 11% of caregivers. Anxiety and depression were associated with scales on the QOL-PCD. Mothers reported higher anxiety scores than fathers (30%versus9%, p=0.03). A strong negative relationship was found between depression in caregivers and physical functioning (QOL-PCD) of the child. Anxiety and depression were not significantly associated with anxiety/depression in their child.

Conclusion

This is the first study investigating anxiety and depression in individuals with PCD and their caregivers. Our results revealed elevated levels of anxiety and depression, which were associated with worse HRQoL. These results suggest the need for psychological support in PCD.
A CREB1-miR-181a-5p loop regulates the pathophysiologic features of bone marrow stromal cells in fibrous dysplasia of bone
Authors: Fu Yu , Xin Zhili , Ling Ziji , Xie Hanyu , Xiao Tao , Shen Xin , Lin Jialin , Xu Ling , Jiang Hongbing
Published: July 2021

Background

Fibrous dysplasia (FD) is a bone marrow stromal cell (BMSC) disease caused by activating mutations of guanine nucleotide-binding protein alpha-stimulating activity polypeptide (GNAS) and is characterized by increased proliferative activity and disrupted osteogenesis of BMSCs. However, the molecular mechanisms regulating the pathophysiologic features of BMSCs in FD remain unknown. This study aimed to identify and verify the roles of the CREB1-miR-181a-5p regulatory loop in FD pathophysiology.

Methods

MicroRNA (miRNA) sequencing analysis was used to identify the possible miRNAs implicated in FD. The proliferation, apoptosis, and osteogenic differentiation of BMSCs, as well as the osteoclast-induced phenotype, were measured and compared after exogenous miR-181a-5p transfection into FD BMSCs or miR-181a-5p inhibitor transfection into normal BMSCs. Chromatin immunoprecipitation and luciferase reporter assays were performed to verify the interactions between CREB1 and miR-181a-5p and their effects on the FD pathological phenotype.

Results

Compared to normal BMSCs, FD BMSCs showed decreased miR-181a-5p levels and exhibited increased proliferative activity, decreased apoptotic capacity, and impaired osteogenesis. FD BMSCs also showed a stronger osteoclast activation effect. miR-181a-5p overexpression reversed the pathophysiologic features of FD BMSCs, whereas miR-181a-5p suppression induced an FD-like phenotype in normal BMSCs. Mechanistically, miR-181a-5p was the downstream target of CREB1, and CREB1 was posttranscriptionally regulated by miR-181a-5p.

Conclusions

Our study identifies that the interaction loop between CREB1 and miR-181a-5p plays a crucial role in regulating the pathophysiologic features of FD BMSCs. MiR-181a-5p may be a potential therapeutic target for the treatment of FD.
Malignant peripheral nerve sheath tumour in an unusual location of the urinary bladder: case report and review of literature
Authors: Ajani Mustapha A. , Awosusi Babatope L. , Nwanji Ifeanyichukwu D.
Published: July 2021

Background

Malignant peripheral nerve sheath tumour (MPNST) is a rare malignant soft tissue neoplasm of ectomesenchymal origin. They usually arise from a major or minor peripheral nerve branch or its sheath and also from somatic soft tissues. The most common sites of origin include the extremities and trunk but can sometimes arise an unusual site resulting in the demise of the patient before any intervention.

Case presentation

We report a case of 58-year-old male who presented with complaints of weight loss of a year duration, abdominal swelling of 10 months duration and easy fatigability of 3 weeks duration. Digital rectal examination revealed a huge firm mass 6 cm from the anal verge which was non-tender. Abdomino-pelvic ultrasound scan revealed an irregular heterogeneous mass in the posterior wall of the urinary bladder measuring 15.1cmx 14.0 cm with bilateral dilatation of the renal pelvi-calyceal system and ureters. His clinical condition continued to deteriorate while on hospital admission, and he died on the12th day of admission. Post-mortem examination showed a rough ovoid tumour mass firmly adherent to the posterior wall of the bladder with compression of both ureters. Histological and immunohistochemical analysis of the tumour revealed the diagnosis of a MPNST. The final anatomical diagnosis and cause of death was that of a malignant peripheral nerve sheath tumour of the urinary bladder with obstructive uropathy and severe sepsis.

Conclusion

MPNST can arise at unusual sites other than its common location in the extremities and the existence of neurofibromatosis may not be present. High index of suspicion of MPNST should be raised in rapidly growing painless tumour in and around a nerve tissue. Prompt radio-imaging with biopsy and expert immunohistochemical analysis of lesions will lead to early diagnosis and intervention. Molecular targeted therapies following surgery for MPNST should be developed to improve prognosis and patient outcomes.
Oceanic long-range transport of organic additives present in plastic products: an overview
Authors: Andrade Helena , Glüge Juliane , Herzke Dorte , Ashta Narain Maharaj , Nayagar Shwetha Manohar , Scheringer Martin
Published: July 2021

Most plastics are made of persistent synthetic polymer matrices that contain chemical additives in significant amounts. Millions of tonnes of plastics are produced every year and a significant amount of this plastic enters the marine environment, either as macro- or microplastics. In this article, an overview is given of the presence of marine plastic debris globally and its potential to reach remote locations in combination with an analysis of the oceanic long-range transport potential of organic additives present in plastic debris. The information gathered shows that leaching of hydrophobic substances from plastic is slow in the ocean, whereas more polar substances leach faster but mostly from the surface layers of the particle. Their high content used in plastic of several percent by weight allows also these chemicals to be transported over long distances without being completely depleted along the way. It is therefore likely that various types of additives reach remote locations with plastic debris. As a consequence, birds or other wildlife that ingest plastic debris are exposed to these substances, as leaching is accelerated in warm-blooded organisms and in hydrophobic fluids such as stomach oil, compared to leaching in water. Our estimates show that approximately 8100–18,900 t of various organic additives are transported with buoyant plastic matrices globally with a significant portion also transported to the Arctic. For many of these chemicals, long-range transport (LRT) by plastic as a carrier is their only means of travelling over long distances without degrading, resulting in plastic debris enabling the LRT of chemicals which otherwise would not reach polar environments with unknown consequences. The transport of organic additives via plastic debris is an additional long-range transport route that should also be considered under the Stockholm Convention.
Correction to: Detecting differentially methylated regions using a fast wavelet-based approach to functional association analysis
Authors: Denault William R. P. , Jugessur Astanand
Published: July 2021

A Correction to this paper has been published: https://doi.org/10.1186/s12859-021-03979-y
Organizational attributes of interprofessional primary care for adults with intellectual and developmental disabilities in ontario, Canada: a multiple case study
Authors: Bobbette Nicole , Lysaght Rosemary , Ouellette-Kuntz Hélène , Tranmer Joan , Donnelly Catherine
Published: July 2021

Background

Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context.

Methods

A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis.

Results

Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population.

Conclusions

This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population.
Retroperitoneum ganglioneuroma: imaging features and surgical outcomes of 35 cases at a Chinese Institution
Authors: Zhang Qian-Wen , Song Tao , Yang Pan-Pan , Hao Qiang
Published: July 2021

Background

The preoperative evaluation is crucial for diagnosis and surgical plan of retroperitoneum ganglioneuroma (GN). In this study, we reviewed a relatively large series of histopathological proved retroperitoneum GN cases, summarized the imaging features and further depicted risk factors of increased surgical blood loss.

Methods

A total of 35 (18 male, 17 female) patients were retrospectively enrolled from January 2012 to June 2019 at our institution. Among them, 24 patients had undergone CT scans and 19 patients had undergone MR examination before treatment. The clinical and radiological features were analyzed and the relationships between image features and surgical blood loss were evaluated.

Results

The media age of the involved 35 patients was 40 years (range, 14–66 years). The histological tumor size was 10.12 ± 4.56 cm for average. Retroperitoneum GN was relatively low density on unenhanced CT images and showed delayed progressive enhancement on enhanced CT and MR images. The whorled sign could be seen in 14 patients. The vessel encasement sign could be found in 17 patients. Univariate analysis revealed maximal tumor size measured on axial image, maximal tumor size measured on coronal image, encasing one or both renal pedicles, encasing the aorta and/or vena cava and whorled sign on MRI showed significant difference between the blood loss ≥ 400 ml and blood loss < 400 ml group. Logistic regression further detected that maximal tumor size measured on axial images (OR: 1.12; 95% CI: 1.02–1.24; P = 0.023) and encasing one or both renal pedicles (OR: 22.39; 95% CI: 1.35–372.99; P = 0.030) were independently correlated with surgical blood loss.

Conclusions

Preoperative CT and MR imaging analysis was valuable for both diagnosis and surgical risk prediction of retroperitoneum GN.
Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia A successfully managed with rituximab – case report and review of the literature
Authors: Meyer Nicholas , Cooper Wendy , Kirwan Paul , Garsia Roger , Dunkley Scott , Gracey David M.
Published: July 2021

Background

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) cause a wide range of glomerular pathologies. In people with haemophilia, transfusion-associated infections with these viruses are common and definitive pathological diagnosis in this population is complicated by the difficulty of safely obtaining a renal biopsy. Membranous nephropathy (MN) is a common cause of adult onset nephrotic syndrome occurring in both primary and secondary forms. Primary MN is associated with podocyte autoantibodies, predominantly against phospholipase A2 receptor (PLA2R). Secondary disease is often associated with viral infection; however, infrequently with HIV or HCV. Distinguishing these entities from each other and other viral glomerular disease is vital as treatment strategies are disparate.

Case presentation

We present the case of a 48-year-old man with moderate haemophilia A and well-controlled transfusion-associated HCV and HIV coinfection who presented with sudden onset nephrotic range proteinuria. Renal biopsy demonstrated grade two membranous nephropathy with associated negative serum PLA2R testing. Light and electron microscopic appearances were indeterminant of a primary or secondary cause. Given his extremely stable co-morbidities, treatment with rituximab and subsequent angiotensin receptor blockade was initiated for suspected primary MN and the patient had sustained resolution in proteinuria over the following 18 months. Subsequent testing demonstrated PLA2R positive glomerular immunohistochemistry despite multiple negative serum results.

Conclusions

Pursuing histological diagnosis is important in complex cases of MN as the treatment strategies between primary and secondary vary significantly. Serum PLA2R testing alone may be insufficient in the presence of multiple potential causes of secondary MN.
Nomogram predict relapse-free survival of patients with thymic epithelial tumors after surgery
Authors: Huang Yang-Yu , Wu Lei-Lei , Liu Xuan , Liang Shen-Hua , Ma Guo-Wei
Published: July 2021

Background

Hematological indicators and clinical characteristics play an important role in the evaluation of the progression and prognosis of thymic epithelial tumors. Therefore, we aimed to combine these potential indicators to establish a prognostic nomogram to determine the relapse-free survival (RFS) of patients with thymic epithelial tumors undergoing thymectomy.

Methods

This retrospective study was conducted on 156 patients who underwent thymectomy between May 2004 and August 2015. Cox regression analysis were performed to determine the potential indicators related to prognosis and combine these indicators to create a nomogram for visual prediction. The prognostic predictive ability of the nomogram was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, and risk stratification. Decision curve analysis was used to evaluate the net benefits of the model.

Results

Preoperative albumin levels, neutrophil-to-lymphocyte ratio (NLR), T stage, and WHO histologic types were included in the nomogram. In the training cohort, the nomogram showed well prognostic ability (C index: 0.902). Calibration curves for the relapse-free survival (RFS) were in good agreement with the standard lines in training and validation cohorts.

Conclusions

Combining clinical and hematologic factors, the nomogram performed well in predicting the prognosis and the relapse-free survival of this patient population. And it has potential to identify high-risk patients at an early stage. This is a relatively novel approach for the prediction of RFS in this patient population.
Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study
Authors: Jennings Hannah Maria , Morrison Joanna , Akter Kohenour , Haghparast-Bidgoli Hassan , King Carina , Ahmed Naveed , Kuddus Abdul , Shaha Sanjit Kumar , Nahar Tasmin , Azad Kishwar , Fottrell Edward
Published: July 2021

Background

Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered.

Methods

Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient.

Results

People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence.

Conclusion

People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care.

Trial registration

ISRCTN41083256. Registered on 30/03/2016.
Women’s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso
Authors: Beaujoin Camille , Bila Alice , Bicaba Frank , Plouffe Véronique , Bicaba Abel , Druetz Thomas
Published: July 2021

Background

In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso.

Methods

A descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis.

Results

A conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power.

Conclusion

In light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.
Health professionals and students’ experiences of reflective writing in learning: A qualitative meta-synthesis
Authors: Artioli Giovanna , Deiana Laura , De Vincenzo Francesco , Raucci Margherita , Amaducci Giovanna , Bassi Maria Chiara , Di Leo Silvia , Hayter Mark , Ghirotto Luca
Published: July 2021

Background

Reflective writing provides an opportunity for health professionals and students to learn from their mistakes, successes, anxieties, and worries that otherwise would remain disjointed and worthless. This systematic review addresses the following question: “What are the experiences of health professionals and students in applying reflective writing during their education and training?”

Methods

We performed a systematic review and meta-synthesis of qualitative studies. Our search comprised six electronic databases: MedLine, Embase, Cinahl, PsycINFO, Eric, and Scopus. Our initial search produced 1237 titles, excluding duplicates that we removed. After title and abstract screening, 17 articles met the inclusion criteria. We identified descriptive themes and the conceptual elements explaining the health professionals’ and students’ experience using reflective writing during their academic and in-service training by performing a meta-synthesis.

Results

We identified four main categories (and related sub-categories) through the meta-synthesis: reflection and reflexivity, accomplishing learning potential, building a philosophical and empathic approach, and identifying reflective writing feasibility. We placed the main categories into an interpretative model which explains the users’ experiences of reflective writing during their education and training. Reflective writing triggered reflection and reflexivity that allows, on the one hand, skills development, professional growth, and the ability to act on change; on the other hand, the acquisition of empathic attitudes and sensitivity towards one’s own and others’ emotions. Perceived barriers and impeding factors and facilitating ones, like timing and strategies for using reflective writing, were also identified.

Conclusions

The use of this learning methodology is crucial today because of the recognition of the increasing complexity of healthcare contexts requiring professionals to learn advanced skills beyond their clinical ones. Implementing reflective writing-based courses and training in university curricula and clinical contexts can benefit human and professional development.
A systematic review of the applications of Expert Systems (ES) and machine learning (ML) in clinical urology
Authors: Salem Hesham , Soria Daniele , Lund Jonathan N. , Awwad Amir
Published: July 2021

Background

Testing a hypothesis for ‘factors-outcome effect’ is a common quest, but standard statistical regression analysis tools are rendered ineffective by data contaminated with too many noisy variables. Expert Systems (ES) can provide an alternative methodology in analysing data to identify variables with the highest correlation to the outcome. By applying their effective machine learning (ML) abilities, significant research time and costs can be saved. The study aims to systematically review the applications of ES in urological research and their methodological models for effective multi-variate analysis. Their domains, development and validity will be identified.

Methods

The PRISMA methodology was applied to formulate an effective method for data gathering and analysis. This study search included seven most relevant information sources: WEB OF SCIENCE, EMBASE, BIOSIS CITATION INDEX, SCOPUS, PUBMED, Google Scholar and MEDLINE. Eligible articles were included if they applied one of the known ML models for a clear urological research question involving multivariate analysis. Only articles with pertinent research methods in ES models were included. The analysed data included the system model, applications, input/output variables, target user, validation, and outcomes. Both ML models and the variable analysis were comparatively reported for each system.

Results

The search identified n = 1087 articles from all databases and n = 712 were eligible for examination against inclusion criteria. A total of 168 systems were finally included and systematically analysed demonstrating a recent increase in uptake of ES in academic urology in particular artificial neural networks with 31 systems. Most of the systems were applied in urological oncology (prostate cancer = 15, bladder cancer = 13) where diagnostic, prognostic and survival predictor markers were investigated. Due to the heterogeneity of models and their statistical tests, a meta-analysis was not feasible.

Conclusion

ES utility offers an effective ML potential and their applications in research have demonstrated a valid model for multi-variate analysis. The complexity of their development can challenge their uptake in urological clinics whilst the limitation of the statistical tools in this domain has created a gap for further research studies. Integration of computer scientists in academic units has promoted the use of ES in clinical urological research.
The influential factors for achieving universal health coverage in Iran: a multimethod study
Authors: Derakhshani Naser , Maleki Mohammadreza , Pourasghari Hamid , Azami-Aghdash Saber
Published: July 2021

Background

The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran.

Methods

This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system’s control knobs framework during three expert panel sessions.

Results

Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts’ panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the “regulation and supervision” dimension, whilst the “payment system” entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC.

Conclusion

Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries’ experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.
Patients satisfaction with healthcare delivery in Ghana
Authors: Amporfro Daniel Adjei , Boah Michael , Yingqi Shao , Cheteu Wabo Therese Martin , Zhao Miaomiao , Ngo Nkondjock Victorine Raissa , Wu Qunhong
Published: July 2021

Background

The service industry has been an evolving sector and a great concern to providers ensuring continuously that clients’ satisfaction is met. Hence, the importance of patient satisfaction in the healthcare sector. This study focused on the satisfaction of women with the delivery of health services in Ghana and aims to be different from other studies which has focused on patient satisfaction with urban and rural health services, regional health services and health insurance. Our study examines the percentages of satisfaction with the multiple outcomes defined and identifies the key health system and demographic related factors associated with women satisfaction.

Methods

This study used data from the 2014 Ghana Demographic and Health Survey and a total of 12,831 households were systematically selected with reproductive women aged 15–49 years eligible for interview. Data for this study was analysed quantitatively using descriptive statistics, chi square and regression analysis. A total of 3648 women were included in this study and the final analysis thus involved a weighted sample of 3507 women. Satisfaction indicators were put together into SERVQUAL dimensions in the study and reliability test run using Cronbach Alpha (α). All data analyses were carried out in STATA 13.0. The adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI) were calculated.

Results

Analysis showed that independently, education and religion were significantly associated with service reliability, overall satisfaction and responsiveness. Payment option was also associated with responsiveness and tangibility dimensions. Furthermore, place of residence was independently associated with responsiveness, tangibility and overall satisfaction. Finally, maternal age, region, provider friendly, ease of getting care and opening hours were all independently associated with reliability, responsiveness, tangibility and overall service satisfaction at the multivariable level.

Conclusions

Dimensions of service quality which focus on patient-centered atmosphere and efficient service delivery system should be integrated and strengthened by hospital management in order to increase patient satisfaction. Key maternal characteristics and health system related factors were revealed to have positive association with patient satisfaction with health services delivery and this cannot be ignored by health care managers in ensuring that systems are improved for better health care.