bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune-related adverse effects: Recognition and initiation of appropriate treatment in cancer patients on immunotherapy
Authors: Mohr Riley , Howard Anna , Townsend Melanie
Published: April 2024

Purpose

Delayed or improper identification of immune-related adverse events (IRAEs) during cancer treatment can impact time to receive proper treatment. This study describes rates of IRAE recognition and appropriate treatment in adult patients with cancer at a community teaching hospital.

Methods

This single-center, retrospective, cohort study evaluated rates of proper IRAE treatment in conjunction with National Comprehensive Cancer Network (NCCN) guidelines. Secondary outcomes included time from presentation to IRAE diagnosis and hospital readmissions/repeat emergency department (ED) visits following initial admission for IRAE. Retrospective chart review assessed IRAE presentation including common terminology criteria for adverse event (CTCAE) grading and treatment choices.

Results

Fifteen subjects included in this study contributed to 21 encounters with noted IRAE. Over half (52.4%) of the encounters received proper IRAE treatment (e.g. correct drug, dose, route, frequency, or therapy duration). Nearly 22% of total actionable components were improper, occurring more often in patients with colitis, pneumonitis, and hepatitis. Median time to IRAE diagnosis was approximately 3.5 days, with the longest being 24 days. There were eight all-cause rehospitalizations one year after initial IRAE presentation, with four directly IRAE-related. Most (75%) IRAE-related rehospitalizations occurred with colitis. Seven ED return visits were also noted.

Conclusion

Many IRAEs were misdiagnosed and/or received improper treatment resulting in increased rehospitalization/return ED visit rates. The importance of medical oncology involvement (e.g. medical oncology consult at time of admission and/or notification of primary oncologist) in IRAE management in the hospital or ED was also stressed. Organizations may benefit from systematic improvements and staff education to improve patient outcomes and prevent readmissions.
Dose Range-Finding Toxicity Study in Rats With Recombinant Human Lactoferrin Produced in Komagataella phaffii
Authors: Peterson Ross , Crawford Robert B. , Blevins Lance K. , Kaminski Norbert E. , Sass June S. , Ferraro Bryce , Vishwanath-Deutsch Roma , Clark Anthony J. , Malinczak Carrie-Anne
Published: April 2024

The oral toxicity of recombinant human lactoferrin (rhLF, Helaina rhLF, Effera™) produced in Komagataella phaffii was investigated in adult Sprague Dawley rats by once daily oral gavage for 14 consecutive days. The study used groups of 3–6 rats/sex/dose. The vehicle control group received sodium citrate buffer, and the test groups received daily doses of 200, 1000, and 2000 mg of rhLF in sodium citrate buffer per kg body weight. Bovine LF at 2000 mg/kg body weight per day was used as a comparative control. Clinical observations, body weight, hematology, clinical chemistry, iron parameters, immunophenotyping, and gross examination at necropsy were used as criteria for detecting the effects of treatment in all groups and to help select dose levels for future toxicology studies. Quantitative LF levels were also analyzed as an indication of bioavailability. Overall, administration of Helaina rhLF by once daily oral gavage for 14 days was well tolerated in rats at levels up to 2000 mg/kg/day, or 57 × Helaina’s intended commercial use in adults, and indicating that a high dose of 2000 mg/kg/day is appropriate for future definitive toxicology studies.
Is there a dialogic teaching model in primary school classrooms? A qualitative study in the practicum / ¿Existe un modelo dialógico docente en las aulas de Educación Primaria? Un estudio cualitativo en el practicum
Authors: Iglesias-Martínez Marcos-Jesús , Lozano-Cabezas Inés , Fernández-Verdú Ceneida , Rovira-Collado José
Published: April 2024

This study inquires into how students in primary education teaching degrees professionally view teaching–learning situations during their practicum period at schools. In particular, it examines how they professionally view aspects of the teaching models they observe in the classroom. Using a qualitative approach, we analyse the narratives written by the teachers-in-training in which they had to identify and describe teaching–learning situations related to the mathematics competence and the linguistic communication competence. To focus the gaze of the teachers-in-training on the teaching models, they were given several guiding questions. The results show that in their narratives, the students highlight relevant aspects of the teaching models in the situations they observed. However, the changes they proposed show that they focus on the mathematics or language content without taking changes in the aspects of the teaching models observed into account. Therefore, they do not observe changes aimed at including new strategies or resources which resemble the characteristics of a more collaborative model common to learning communities. The main conclusions suggest taking decisions in pre-service teacher training towards a more collaborative model based on participative, dialogic and active collaboration in the educational process.
The role of inner speech in the effect of argumentation among peers on learning: a case analysis / El rol del habla interna en el efecto de la argumentación entre pares en el aprendizaje: un análisis de caso
Authors: Larrain Antonia , Freire Paulina , Salvat Ignacia , López Patricia , Moran Camila , Sánchez Álvaro , Silva Maximiliano , Villavicencio Constanza , Grau Valeska , Cerda Bárbara , Salinas Pedro
Published: April 2024

Different studies suggest that collaborative argumentation among peers promotes school learning, especially the comprehension of concepts. However, the available evidence shows that the relationship between argumentation and learning is not direct but instead mediated by development processes that, in turn, promote learning. The goal of this study is to understand the mediating role that the development of argumentative inner speech may play in the process of constructing knowledge through collaborative argumentation. A case study was conducted in which one child (fourth grade) was tracked throughout an entire unit in which he and his peers argued collaboratively class after class. We assessed the students individually before and after in their learning (oral and written) and written argumentation skills. The collaborative work from all the classes was videoed and analysed through discourse analysis. The student showed significant progress in both delayed learning and written argumentation compared to the group. Furthermore, the analysis of oral tests shows that the argumentative interactions that initially appeared in the discussions among peers were internalized so he could understand the concepts involved on an individual level. The article discusses the implications of these results in understanding the role of discursive interactions in school learning processes.
The multidimensional nature of students’ maturity: the Spanish case / La naturaleza multidimensional de la madurez de los estudiantes: el caso de España
Authors: Marcenaro-Gutierrez Oscar David , Lopez-Agudo Luis Alejandro
Published: April 2024

Many research works have claimed the relevance that students’ maturity may have in their academic achievement, but in spite of this importance, this maturity concept is not so easy to delimit and measure. Because of that, the current work proposes to measure students’ maturity by three different proxies: the ages when children begin to read and write, the bimester of birth and grade retention. To perform this analysis, a representative sample of primary (age 11–12) and secondary education (age 15–16) Andalusian students (the most populated region in Spain) was used. Our results have shown the unsuitability of the bimester of birth and the ages when children begin to read and write as instruments for grade retention, which supports that the three measure different dimensions of students’ maturity. In addition, results show that an early beginning in reading and writing positively associates with students’ academic achievement.
Cultural variability in finger representations / Variabilidad cultural en las representaciones con dedos
Authors: Sánchez Rosario , Muñez David , Matilla Laura , Orrantia Josetxu
Published: April 2024

Finger representations are used to count or show quantities. How fingers are lifted to count and the type of representation that we use to communicate quantities have been the focus of studies that have aimed at providing evidence of dominant patterns across cultures. In the current study, we go beyond those studies and investigate intracultural variability. Specifically, whether finger counting habits and finger montring patterns are similar in children and adults. To this aim, a total of 3,210 Spaniard participants took part in this study (637 children and 2,573 adults). All of them were assessed regarding handedness, the way in which they counted with their fingers from 1 to 10 (finger counting) and how they show quantities with their fingers (finger montring). The results showed certain consistency; however, there was substantial variability within each group. Findings are interpreted within the context of current theories reinforcing the relevance of finger patterns to support the understanding of the meaning of numbers.
Resilience of rural businesses in times of crisis: Firm survival during the COVID-19 pandemic in Finland
Authors: Mitze Timo , Makkonen Teemu
Published: April 2024

Little is known about the geography of firm survival during COVID-19. We investigated the effect heterogeneity of the pandemic itself and of business support funding by the Finnish government with respect to rural and urban business closures. To do so, we utilised regional data on firm survival, detailed business support funding data and a rural–urban typology for Finland. Results from panel regressions showed that the pandemic had an overall negative impact on businesses in terms of an increased closure rate of about 20–30% during the period 2020q2–2022q4, which was generally higher in urban than rural areas. While the bulk of business support funding from the Finnish government during the pandemic went to urban businesses, COVID-19 funding mitigated the effects of the pandemic on business closures equally across the different rural–urban categories. Counterfactual simulations show that the average closure rate would have been about 10–12% higher during the pandemic if no business support funding schemes would have been implemented.
The Theme Park as Simulation of American Rape Culture: #MeToo and the Problem of Justice in HBO’s Westworld
Authors: Thompson Zoë Brigley
Published: April 2024

Drawing on Jean Baudrillard’s theorizing of the theme park, this study recognizes the TV show Westworld (2016-2022) as a simulation of contemporary America with intriguing questions about rape culture and justice in a post-#MeToo moment? In seasons 1 and 2, android characters like Dolores (Evan Rachael Wood), Maeve (Thandiwe Newton), and Akecheta (Zahn McClarnon) are violated but rebel against sexist and racist programing, and the “Man in Black” represents the violating nature of the stereotypical, Western hero. The principles of the Old West, like benevolent violence, are reflected in a TV industry where the actors of Westworld document their own violation in #MeToo artifacts, such Wood’s documenting of abuse in Phoenix Rising (2022), and interviews with Newton. In thinking about justice, Westworld falters, because it frames redress only in terms of further violence and revenge. Wood and Newton, however, represent the prevention of future violence, offering a possibility of justice.
Luteolin Inhibits Lung Cancer Cell Migration by Negatively Regulating TWIST1 and MMP2 Through Upregulation of miR-106a-5p
Authors: Wang Qiang , Chen Mengyuan , Tang Xiaofang
Published: April 2024

Background:

Luteolin, a common dietary flavonoid found in plants, has been shown to have anti-cancer properties. However, its exact mechanisms of action in non-small cell lung cancer (NSCLC) are still not fully understood, particularly its role in regulating broader genomic networks and specific gene targets. In this study, we aimed to elucidate the role of microRNAs (miRNAs) in NSCLC treated with luteolin, using A549 cells as a model system.

Materials and Methods:

miRNA profiling was conducted on luteolin-treated A549 cells using Exiqon microarrays, with validation of selected miRNAs by qRT-PCR. Bioinformatic analysis identified the regulatory roles of miRNAs in biological processes and pathways following luteolin treatment. Computational algorithms were employed to identify potential target genes. A549 cells were transfected with miR-106a-5p mimic and inhibitor or their corresponding controls. The expression levels of 2 genes, twist basic helix-loop-helix transcription factor 1 (TWIST1) and matrix metallopeptidase 2 (MMP2), and cell migration were assessed.

Results:

miRNA profiling identified 341 miRNAs, with 18 exhibiting significantly altered expression ( P < 0.05). Subsequent qRT-PCR analysis confirmed altered expression of 6 selected miRNAs. KEGG and GO analyses revealed significant alterations in pathways and biological processes crucial for tumor biology. TWIST1 and MMP2, which both contain conserved miR-106a-5p binding sites, exhibited an inverse correlation with the expression levels of miR-106a-5p. Dual-luciferase reporter assays confirmed TWIST1 and MMP2 as direct targets of miR-106a-5p. Luteolin treatment led to a reduction in A549 cell migration, and this reduction was further amplified by the overexpression of miR-106a-5p.

Conclusion:

Luteolin inhibits A549 cell migration by modulating the miRNA landscape, shedding light on its mechanisms and laying the foundation for miRNA-based therapeutic approaches for NSCLC.
Limits of Automata—Then and Now: Challenges of Architecture, Brittleness, and Scale
Authors: Woods David D.
Published: April 2024

Two trajectories underway transform human systems. Processes of growth/complexification have accelerated as stakeholders seek advantage from advances in connectivity/autonomy/sensing. Surprising empirical patterns also arise—puzzling collapses of critical valued services occur against a background of growth. In parallel, new scientific foundations have arisen from diverse directions explaining the observed anomalies and breakdowns, highlighting basic weaknesses of automata regardless of technology. Conceptual growth provides laws, theorems, and comprehensive theories that encompass the interplay of autonomy/people and complexity/adaptation across scales. One danger for synchronizing the trajectories is conceptual lag as researchers remain stuck in stale frames unable to keep pace with transformative change. Any approach that does not either build on the new conceptual advances—or provide alternative foundations—is no longer credible to match the scale and stakes of modern distributed layered systems and overcome the limits of automata. The paper examines longstanding challenges by contrasting progress then as the trajectories gathered steam, to situation now as change has accelerated.
Analysis of coal mining accident risk factors based on text mining
Authors: He Yiman , Li Jizu
Published: April 2024

Frequently occurring coal mine safety accidents have caused great casualties and economic losses. Coal mine intelligence is the core technical support for the high-quality development of the coal industry. The deep integration of coal mining safety production management and Artificial Intelligence (AI) technology is practically significant to achieve accident prevention. To efficiently identify mining accident risk factors and explore mechanism of coupling between risk factors, this study mined 400 reported cases of mining accidents in Shanxi Province and identified 64 accident risk factors through custom, stopword, synonym dictionary construction, keyword extraction and keyword correlation analysis. Then, this study constructed association rules and a Bayesian causal network. The major risk factors are identified using a comprehensive high-frequency, sensitivity, strength and key path analysis of the Bayesian causal network. The following seven risk factors are found to play a major role in the occurrence of mine accidents: inadequate safety supervision, disordered safety management, illegal organization of production, inadequate staff safety education and training, operation against rules, command against rules and weak safety consciousness among the staff. Finally, a case study is conducted to validate the reliability of the results. This study solves the problem of incomplete extraction of key feature information in coal mine reports and the lack of analyses of coupling mechanisms between coal mine risk factors in traditional accident analysis methods, providing the methodological support for the effective use of unstructured coal mine safety production data for risk analysis.
Long-term real-world data of ustekinumab in Crohn’s disease: the Stockholm ustekinumab study
Authors: Bello Francesca , Muhsen Samer , Sabhan Haider , Borin Alexandra , Johansson Fredrik , Höög Charlotte , Forsberg Ole , Wennerström Christina , Söderman Charlotte , Lördal Mikael , Almer Sven
Published: April 2024

Background:

Ustekinumab is used to treat inflammatory bowel disease mainly in patients failing anti-tumour necrosis factor (TNF)-agents.

Objectives:

To provide real-world data in unselected patients with Crohn’s disease (CD), treated with ustekinumab.

Design:

Longitudinal retrospective study at four hospitals in Stockholm, Sweden.

Methods:

Disease activity (Harvey–Bradshaw index and physician global assessment), laboratory parameters, endoscopic findings and drug persistence were assessed. Follow-up data were obtained in patients that stopped ustekinumab.

Results:

In total, 322 patients (median age 38 years, 48% women) were included. All had luminal disease and 22% also fistulizing disease. A total of 271 (84%) had failed ⩾1 and 148 (46%) ⩾2 anti-TNF drugs; 34% failed vedolizumab. At inclusion, 93% had active disease; 28% were on oral corticosteroids and 18% on thiopurines. The median follow-up on treatment was 13.5 months; overall 67% were followed at least 24 months. By intention to treat analysis, response rate at 3 and 12 months was 43% and 42%, respectively. Among patients with ongoing ustekinumab, 19% were in steroid-free remission at 3 months and 64% at 12 months. The median faecal calprotectin level decreased from 460 µg/g at baseline to 156 µg/g at 3 months and was 182 µg/g at 12 months. C-reactive protein remained stable at 4 mg/L whereas serum albumin increased slightly. About 31% of patients were withdrawn during the first 12 months, mainly due to persisting disease activity 21%, adverse events 5%, bowel surgery 0.6% or malignancy 0.3%. The overall persistence on ustekinumab was 88%, 51%, 34% and 20% at 3, 12, 24 and 36 months, respectively. Within 12 months following withdrawal of ustekinumab in 121 patients, 64% had active disease most of the time, 68% needed another biologic and 24% underwent surgery.

Conclusion:

Among difficult-to-treat patients with CD, ustekinumab was effective in the majority, with high drug persistence at 12 and 24 months in combination with a favourable safety profile.
Politically Correct 4.0: Historical causes and cultural evaluation
Authors: Maddalena Giovanni
Published: April 2024

The current form of political correctness has many cultural roots; these explain why its underlying quest for social justice has become a dangerous ideology. This article addresses the political, religious and philosophical roots of this phenomenon. It also sets forth ways of avoiding dangerous extremism while holding onto the demands for justice often associated with political correctness.
Differentiated Instruction for Gifted Teaching Behavior in Classrooms: What Are the Levers of Change in the United Arab Emirates?
Authors: Opoku Maxwell Peprah , Elhoweris Hala , Anwahi Noora , Alsheikh Negmeldin , Mustafa Ashraf , Dhaheri Wadima Al
Published: April 2024

Differentiation is recommended as the best teaching strategy to nurture gifted and talented (GT) students. While numerous studies have explored teachers’ perceptions of differentiating instruction for GT students in Western countries, the body of literature on this phenomenon remains small in non-Western contexts. This study attempted to understand the differentiation of the curriculum for GT students among teachers in the United Arab Emirates (UAE). The Maker's model was used as a framework to guide development of the Gifted Teaching and Talent Development Scale (GTDS) and collect data from 239 teachers in the UAE. We assessed the structural validity of the GTDS using AMOS software to perform confirmatory factor analysis. Further, we used SPSS to compute multivariate analysis of variance, which revealed differences between background and latent variables (content, process, product, and environment). The findings support the use of multifaceted lenses to study gifted teaching behavior and its other implications.
Parental Stress Related to Caring for a Child With Autism Spectrum Disorder and the Benefit of Mindfulness-Based Interventions for Parental Stress: A Systematic Review
Authors: Yesilkaya Merve , Magallón-Neri Ernesto
Published: April 2024

Children with autism spectrum disorder (ASD) tend to exhibit more severe challenging behaviors than typically developing children and those with intellectual or other disabilities. This study aimed to review the stress levels of parents of individuals with ASD, and the use of mindfulness to decrease parental stress. The following variables of Autism, Stress, Parenting, Family, and Mindfulness were searched in PubMed and APA PsycNet databases. The studies between 2000 and 2023 with at least two of the mentioned keywords were included for further review. This review highlights the significance of further research on the severity of autism symptoms and how they are related to the level of parental stress, and it thoroughly examines the findings of pertinent studies on parental stress and autism. Furthermore, it aims to draw attention to the application of mindfulness-based interventions in reducing parental stress. Parents of children with ASD were found to have higher stress levels than those of typically developing children. Mindfulness-based interventions were found to be helpful in decreasing parents’ stress levels. Parenting a child with autism spectrum disorder is very challenging, which causes parents to experience higher stress levels than those of typically developing children.
The fuel of discontent? Transport poverty risks and equity concerns in French urban peripheries
Authors: Pons Armand , Finance Olivier , Conesa Alexis
Published: April 2024

A range of accessibility indicators has been developed in the past decade to evaluate equity in transportation within urban areas. Some studies have attempted to incorporate them in transport poverty metrics, focussing on insufficient access to general services and employment. While accessibility measures coupled with statistics have been effective in assessing immediate households’ vulnerability, we argue that an analysis of their adaptive capacity could contribute to a better information of local policies in the long term. This paper aims to develop a methodology for mapping transport poverty risks at the metropolitan scale, while studying the relation between urban segregation and the transport divide. We use the case study of Lyon to operationalise our method and find evidence of vulnerability patterns previously identified in the sociological literature. Beyond the sensitivity of households living in the first-crown neighbourhoods and the growing exposure of medium-income families settling in peripheral municipalities, we emphasise the importance of using mixed methodologies to better capture households’ needs and mobility choices within suburban environments. We conclude by discussing shortcomings and future developments of our research.
mTOR signaling pathway regulation HIF-1 α effects on LPS induced intestinal mucosal epithelial model damage
Authors: Huang Zeyong , Teng Wenbin , Yao Liuxu , Xie Kai , Hang Suqin , He Rui , Li Yuhong
Published: April 2024

Background

Sepsis-induced small-intestinal injury is associated with increased morbidity and mortality. Our previous study and other papers have shown that HIF-1α has a protective effect on intestinal mucosal injury in septic rats. The purpose of this study is to further verify the protective effect of HIF-1α on intestinal mucosa and its molecular mechanism in vitro experiments.

Methods

Caco-2 cells were selected and experiment was divided into 2 parts. Part I: HIF-1α activator and inhibitor were used to treat lipopolysacchrides (LPS)-stimulated Caco-2 cells respectively, to explore the effect of HIF-1α on LPS induced Caco-2 cell epithelial model; Part II: mTOR activator or inhibitor combined with or without HIF-1α activator, inhibitor to treat LPS-stimulated Caco-2 cells respectively, and then the molecular mechanism of HIF-1α reducing LPS induced Caco-2 cell epithelial model damage was detected.

Results

The results showed that HIF-1α activator decreased the permeability and up regulated tight junction (TJ) expression, while HIF-1α inhibitor had the opposite effect with the HIF-1α activator. mTOR activation increased, while mTOR inhibition decreased HIF-1α protein and expression of its downstream target molecules, which can be attenuated by HIF-1α activator or inhibitor.

Conclusion

This study once again confirmed that HIF-1α alleviates LPS-induced mucosal epithelial model damage through P70S6K signalling pathway. It is of great value to explore whether HIF-2α plays crucial roles in the regulation of mucosal epithelial model functions in the future.
Conserved DNA sequence analysis reveals the phylogeography and evolutionary events of Akebia trifoliata in the region across the eastern edge of the Tibetan Plateau and subtropical China
Authors: Dong Qing , Zhang Yongle , Zhong Shengfu , Zhang Qiuyi , Yang Hao , Yang Huai , Yi Xiaoxiao , Tan Feiquan , Chen Chen , Luo Peigao
Published: April 2024

Background

The eastern edge of the Qinghai‒Tibet Plateau (QTP) and subtropical China have various regions where plant species originate and thrive, but these regions have been the focus of very few integrative studies. Here, we elucidated the phylogeographic structure of a continuous and widespread Akebia trifoliata population across these two regions.

Results

Sixty-one populations consisting of 391 genotypes were examined to assess population diversity and structure via network distribution analysis, maximum likelihood phylogenetic tree reconstruction, divergence time estimation, demographic history inference, and ancestral area reconstruction of both conserved internal transcribed spacer (ITS) and chloroplast (rps16) DNA sequences. The results showed that the ITS region was more variable than the rps16 region and could be suitable for studying intraspecific phylogeography. The A. trifoliata population displayed high genetic diversity, genetic differentiation and obvious phylogeographical structure, possibly originating on the eastern QTP, expanding during the last glacial-interglacial cycle, diverging in the early Pleistocene and middle Pleistocene, and extensively migrating thereafter. The migration route from west to east along rivers could be largely responsible for the long-distance dispersal of this species, while three main refuges (Qinba Mountains, Nanling Mountains and Yunnan-Guizhou Plateau) with multiple ice shelters facilitated its wide distribution.

Conclusions

Our results suggested that the from west to east long migration accompanying with the minor short reciprocal migration in the south-north direction, and the three main refuges (the Qinba Mountains, Nanling Mountains and Yunnan-Guizhou Plateau) contributed to the extant geographical distribution of A. trifoliata. In addition, this finding also strongly reduced the discrepancy between glacial contraction and postglacial expansion and the in situ survival hypothesis by simultaneously considering the existence of many similar climate-related ecological niches and migration influences.
Optimizing nicardipine dosage for effective control of pituitrin-induced hypertension in laparoscopic myomectomy undergoing total intravenous anesthesia
Authors: Wang Chen , Zhao Xiaoli , Chen Yunyun , Xia Jianhua , Zhang Xixue , Wang Tingting
Published: April 2024

Background

This study aimed to determine the median effective dose (ED50) and 95% effective dose (ED95) of nicardipine for treating pituitrin-induced hypertension during laparoscopic myomectomy, providing guidance for the management of intraoperative blood pressure in such patients.

Methods

Among the initial 40 participants assessed, 24 underwent elective laparoscopic myomectomy. A sequential up-and-down method was employed to ascertain the ED50 of nicardipine based on its antihypertensive efficacy. Nicardipine was initially administered at 6 µg/kg following the diagnosis of pituitrin-induced hypertension in the first patient. Dosing adjustments were made to achieve the desired antihypertensive effect, restoring systolic blood pressure and heart rate to within ± 20% of baseline within 120 s. The dosing increment or reduction was set at 0.5 µg/kg for effective or ineffective responses, respectively. The ED50 and ED95 of nicardipine were calculated using Probit regression by Maximum Likelihood Estimation (MLE) to establish dose-response curves and confidence intervals.

Results

24 patients were included for analysis finally. The ED50 and ED95 of nicardipine for blood pressure control after pituitrin injection were determined. The study found that the ED50 of nicardipine for treating pituitrin-induced hypertension was 4.839 µg/kg (95% CI: 4.569–5.099 µg/kg), and the ED95 was estimated at 5.308 µg/kg (95% CI: 5.065–6.496 µg/kg). Nicardipine effectively mitigated the hypertensive response caused by pituitrin without inducing significant tachycardia or hypotension.

Conclusions

Nicardipine effectively controlled blood pressure after pituitrin injection during laparoscopic myomectomy, with ED50 and ED95 values established. This research highlights the potential utility of nicardipine in addressing hypertensive responses induced by pituitrin, particularly in clinical settings where pituitrin is routinely administered.
“They are saying it’s high, but I think it’s quite low”: exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients – a qualitative study
Authors: Cowap Lisa , Riley Victoria , Grogan Sarah , Ellis Naomi J. , Crone Diane , Cottrell Elizabeth , Chambers Ruth , Clark-Carter David , Gidlow Christopher J.
Published: April 2024

Background

NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators.

Methods

Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis.

Results

Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding.

Conclusions

Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes.

Trial registration

ISRCTN10443908. Registered 7th February 2017.
Understanding suboptimal insulin use in type 1 and 2 diabetes: a cross-sectional survey of healthcare providers who treat people with diabetes
Authors: Newson Rachel S. , Spaepen Erik , Liao Birong , Bower Julie , Bhattacharya Indranil , Artime Esther , Polonsky William
Published: April 2024

Background

The purpose of this study was to understand the healthcare provider (HCP) perspective on the extent of suboptimal insulin dosing in people with diabetes (PwD), as well as specific challenges and solutions to insulin management.

Methods

An online survey of general practitioners and specialists (N = 640) who treat PwD in Germany, Spain, the United Kingdom, and the United States was conducted. Responses regarding HCP background and their patients, HCP perceptions of suboptimal insulin use, and challenges associated with optimal insulin use were collected. Categorical summary statistics were presented.

Results

Overall, for type 1 diabetes (T1D) and type 2 diabetes (T2D), most physicians indicated < 30% of PwD missed or skipped a bolus insulin dose in the last 30 days (T1D: 83.0%; T2D: 74.1%). The top 3 reasons (other than skipping a meal) HCPs believed caused the PwD to miss or skip insulin doses included they “forgot,” (bolus: 75.0%; basal: 67.5%) “were too busy/distracted,” (bolus: 58.8%; basal: 48.3%), and “were out of their normal routine” (bolus: 57.8%; basal: 48.6%). HCPs reported similar reasons that they believed caused PwD to mistime insulin doses. Digital technology and improved HCP-PwD communication were potential solutions identified by HCPs to optimize insulin dosing in PwD.

Conclusions

Other studies have shown that PwD frequently experience suboptimal insulin dosing. Conversely, results from this study showed that HCPs believe suboptimal insulin dosing among PwD is limited in frequency. While no direct comparisons were made in this study, this apparent discrepancy could lead to difficulties in HCPs giving PwD the best advice on optimal insulin management. Approaches such as improving the objectivity of dose measurements for both PwD and HCPs may improve associated communications and help reduce suboptimal insulin dosing, thus enhancing treatment outcomes.
Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain
Authors: Sánchez-Moreno Esteban , Gallardo-Peralta Lorena , Barrón López de Roda Ana , Rivera Álvarez Joaquín M.
Published: April 2024

Background

The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness.

Methods

A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson’s r) and logistic regression analyses.

Results

The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced.

Conclusion

Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.
The clinical utility of cystatin C based eGFR in assessing renal function among HIV/AIDs patients on ART at Mildmay Uganda
Authors: Wekiya Enock , Mujuzi Godfrey P. , Nakiyingi Jane , Sanya Juliet , Matovu Moses , Guido Ocung , Nakaweesi Jane , Karamagi Charles , Nakayaga Joan K. , Mutebi Edrisa I. , Nakanjako Damalie
Published: April 2024

Background

In clinical practice, Measurement of estimated glomerular filtration rates (eGFR) is the gold standard assessing renal function the glomerular filtration rate often estimated from plasma creatinine. Several studies have shown Cystatin C based eGFR (Cys C) to be a better parameter for the diagnosis of impaired renal function. Cystatin C based eGFR has been proposed as a potential renal function marker but its use in HIV&AIDS patients has not been well evaluated.

Methods

A cross sectional study was carried out on 914 HIV&AIDS patients on antiretroviral therapy (ART) attending Mildmay Uganda for care and treatment between January to March 2015. Serum Cystatin C based eGFR was measured using the particle enhanced immunoturbidimetric assay. Creatinine was analyzed using enzymatic Creatinine PAP method and creatinine clearance was calculated according to C&G.

Results

The sensitivity of Cystatin C based eGFR was 15.1% (95% CI = 8.4, 24) with specificity 99.3% (95% CI = 98- 99.7). The positive and negative predictive values were 70.0% (95% CI 45.7–88.1) and 91.2% (95% CI 98.11–92.94) respectively. The positive likelihood ratio was 18.81 and negative likelihood ratio was 0.85. Cystatin C based eGFR had diagnostic accuracy of 90.7 and area under curve was 0.768.

Conclusion

Cystatin C based eGFR exhibited a high specificity and a high positive likelihood ratio in diagnosis of kidney disease among HIV&AIDS patients. Cystatin C based eGFR can be used as a confirmatory test.
Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study
Authors: Sanchez-Samaniego Giuliana , Mäusezahl Daniel , Hartinger-Peña Stella Maria , Hattendorf Jan , Verastegui Hector , Fink Günther , Probst-Hensch Nicole
Published: April 2024

Background

During the last two decades, Caesarean section rates (C-sections), overweight and obesity rates increased in rural Peru. We examined the association between pre-pregnancy body mass index (BMI) and C-section in the province of San Marcos, Northern Andes-Peru.

Methods

This is a prospective cohort study. Participants were women receiving antenatal care in public health establishments from February 2020 to January 2022, who were recruited and interviewed during pregnancy or shortly after childbirth. They answered a questionnaire, underwent a physical examination and gave access to their antenatal care card information. BMI was calculated using maternal height, measured by the study team and self-reported pre-pregnancy weight measured at the first antenatal care visit. For 348/965 (36%) women, weight information was completed using self-reported data collected during the cohort baseline. Information about birth was obtained from the health centre’s pregnancy surveillance system. Regression models were used to assess associations between C-section and BMI. Covariates that changed BMI estimates by at least 5% were included in the multivariable model.

Results

This study found that 121/965 (12.5%) women gave birth by C-section. Out of 495 women with pre-pregnancy normal weight, 46 (9.3%) had C-sections. Among the 335 women with pre-pregnancy overweight, 53 (15.5%) underwent C-sections, while 23 (18.5%) of the 124 with pre-pregnancy obesity had C-sections. After adjusting for age, parity, altitude, food and participation in a cash transfer programme pre-pregnancy overweight and obesity increased the odds of C-section by more than 80% (aOR 1.82; 95% CI 1.16–2.87 and aOR 1.85; 95% CI 1.02–3.38) compared to women with a normal BMI.

Conclusions

High pre-pregnancy BMI is associated with an increased odds of having a C-section. Furthermore, our results suggest that high BMI is a major risk factor for C-section in this population. The effect of obesity on C-section was partially mediated by the development of preeclampsia, suggesting that C-sections are being performed due to medical reasons.
Personalised exercise rehabilitation in cancer survivorship: the percs triage and referral system study protocol
Authors: Brennan Louise , Sheill Grainne , Collier Sonya , Browne Peter , Donohoe Claire L. , O’Neill Linda , Hussey Juliette , Guinan Emer M.
Published: April 2024

Background

To effectively embed exercise rehabilitation in cancer survivorship care, a co-ordinated system of acute and community exercise rehabilitation services, forming a stepped model of care, is recommended. Patients can be directed to the exercise rehabilitation service which best meets their needs through a system of assessment, triage and referral. Triage and referral systems are not yet widely applied in cancer survivorship practice and need to be evaluated in real-world contexts. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) study aims to evaluate the real-world application of an exercise rehabilitation triage and referral system in cancer survivors treated during the COVID-19 pandemic. Secondary aims are to evaluate change in physical and psychosocial outcomes, and to qualitatively evaluate the impact of the system and patient experiences, at three months after application of the triage and referral system.

Methods

This study will assess the implementation of an exercise rehabilitation triage and referral system within the context of a physiotherapy-led cancer rehabilitation clinic for cancer survivors who received cancer treatment during the COVID-19 pandemic. The PERCS triage and referral system supports decision making in exercise rehabilitation referral by recommending one of three pathways: independent exercise; fitness professional referral; or health professional referral. Up to 100 adult cancer survivors treated during the COVID-19 pandemic who have completed treatment and have no signs of active disease will be recruited. We will assess participants’ physical and psychosocial wellbeing and evaluate whether medical clearance for exercise is needed. Participants will then be triaged to a referral pathway and an exercise recommendation will be collaboratively decided. Reassessment will be after 12 weeks. Primary outcomes are implementation-related, guided by the RE-AIM framework. Secondary outcomes include physical function, psychosocial wellbeing and exercise levels. Qualitative analysis of semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) will provide insights on implementation and system impact.

Discussion

The PERCS study will investigate the real-world application of a cancer rehabilitation triage and referral system. This will provide proof of concept evidence for this triage approach and important insights on the implementation of a triage system in a specialist cancer centre.

Trial registration

This study is registered on ClinicalTrials.gov, registration number: NCT05615285, date registered: 21st October 2022.
When one door closes: a qualitative exploration of women’s experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria
Authors: Adelekan Babatunde , Ikuteyijo Lanre , Goldson Erika , Abubakar Zubaida , Adepoju Oluwatomi , Oyedun Olaitan , Adebayo Gbenga , Dasogot Andat , Mueller Ulla , Fatusi Adesegun O.
Published: April 2024

Background

COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.

Methods

The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.

Results

Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.

Conclusion

COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.