bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence based opioid weaning with behavioral support – Forum for Behavioral Science Edition
Authors: Hayes John , Johnston Bryan , Barenboim Hernan , Tempe Mario
Published: July 2022

Nationally published guidelines state that many patients prescribed chronic opioids would benefit from gradually reducing and/or eliminating their use of these medications. This is easier said than done. Patients are often resistant or fearful, physicians are often uncomfortable prescribing an opioid taper, and patients often do not get the needed behavioral health support in this process. It is critical to develop a comprehensive behavioral and medical plan, however the field lacks practical approaches to guide physicians (and patients) through this challenge. In this manuscript our team of primary care providers and behaviorists walk through a case involving complex opioid weaning in a Family Medicine residency clinic environment. Through the lens of our patient’s case, we will discuss best practices for getting patient buy-in, opioid weaning strategies, behavioral support during the wean, identifying co-morbid opioid use disorders, and deciding on acceptable end points for the taper.
Psychometric Evaluation of Three Translated Measures of Functional Health Literacy among Jordanians
Authors: Abed Mona A. , Khalifeh Anas H. , Hall Lynne A.
Published: July 2022

Assessment of functional health literacy (FHL) is not integrated into clinical settings in Jordan possibly because relevant psychometric studies are lacking. The aim of this secondary analysis of data on family caregivers ( N = 115) was to evaluate the internal consistency reliability and construct validity of three measures of FHL among Jordanians: the Short Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), and the Single Item Literacy Screener (SILS). Cronbach’s alpha was excellent for the S-TOFHLA (.92), but suboptimal for the REALM-R (.67). In bivariate analysis, FHL measured by the S-TOFHLA and the REALM-R, but not the SILS, was positively associated with educational attainment ( p < .05) and negatively related to self-reported anxiety ( p < .05). Among Jordanians, psychometric rigor was fully demonstrated for the S-TOFHLA and partially for the REALM-R, but not for the SILS.
Raising children: Discussing and practicing modern/colonial family education in Colombia
Authors: Pedraza-Gómez Zandra , Aristizábal-García Diana Marcela
Published: July 2022

This paper focuses on how a colonial logic shaped ideas and practices about childhood in the modern/colonial interplay between family members, knowledge, activities, and goods that combined difference, structural subordination, and modern adult-child relations in Colombia. Based on a local magazine directed by elite women, it refers to the cultural mechanism that merged northern and central perspectives with the regional and national modern/colonial horizon of family, public and private sex roles, children, and the broader framework of modernization between 1926 and 1940.
Changes in the Prevalence of Thin Bodies Bias Young Women’s Judgments About Body Size
Authors: Devine Sean , Germain Nathalie , Ehrlich Stefan , Eppinger Ben
Published: July 2022

Body dissatisfaction is pervasive among young women in Western countries. Among the many forces that contribute to body dissatisfaction, the overrepresentation of thin bodies in visual media has received notable attention. In this study, we proposed that prevalence-induced concept change may be one of the cognitive mechanisms that explain how beauty standards shift. We conducted a preregistered online experiment with young women ( N = 419) and found that when the prevalence of thin bodies in the environment increased, the concept of being overweight expanded to include bodies that would otherwise be judged as “normal.” Exploratory analyses revealed significant individual differences in sensitivity to this effect, in terms of women’s judgments about other bodies as well as their own. These results suggest that women’s judgments about other women’s bodies are biased by an overrepresentation of thinness and lend initial support to policies designed to increase size-inclusive representation in the media.
A novel presentation of childhood systemic lupus erythematosus in a 6-year-old child
Authors: Wurster Alena , Bauler Laura , Howing Colleen , McGlinchey Ford Maureen
Published: July 2022

Childhood systemic lupus erythematosus (cSLE) is an autoimmune disorder, characterized by the formation of autoantibodies, that most often presents in children around the age of 12. Antiphospholipid antibody syndrome (APS) is a condition in which antiphospholipid antibodies produced by the patient cause the formation of thromboses. While reports estimate that 30%–40% of cSLE patients have antiphospholipid antibodies, only 4% develop symptomatic APS, with venous thromboses being more common than arterial. Overall, thrombosis has an incidence of about 0.1/10,000 in the pediatric population and usually only occurs in the setting of underlying disease or in relation to medical procedures. Here, we report a case of a 6-year-old female who presented with abdominal pain, arthralgia, fever, and right popliteal artery thrombus. Further testing revealed an abundance of autoantibodies including antinuclear, lupus anticoagulant, and anticardiolipin which resulted in a diagnosis of cSLE with associated APS. This presentation is novel due to both the young age of the patient at disease onset and the presence of concurrent cSLE and APS at initial diagnosis. Childhood systemic lupus erythematosus can be difficult for providers to recognize as it can present with varied nonspecific symptoms but being aware of the potential for onset in children significantly younger than the average will allow for early detection and potentially better outcomes.
Media Attention and Deliberation on the Supreme Court
Authors: Badas Alex , Justus Billy
Published: July 2022

The news media acts as a “watchdog” over political institutions by holding them accountable for their actions through critical commentary. Being that the Supreme Court rarely interacts directly with the public, the news media is the primary mechanism through which individuals become aware of the Supreme Court’s actions and decisions. Thus, for the Supreme Court, the news media’s role as a “watchdog” takes greater meaning than it does for institutions that often speak directly to the public. Considering this, along with the Supreme Court’s use of strategic presentation, we argue that news media attention to particular cases will influence the extent to which the Supreme Court deliberates on argued cases. We find support for our hypothesis in four contexts. First, cases with more news media attention take longer to produce a published opinion. Second, cases with greater media attention are more likely to be reargued. Third, cases with more news media attention produce a higher number of draft opinions before being published. Fourth, cases with more news media attention produce opinions with a greater share of cognitive mechanisms included in them. Our results have implications for the Justice’s use of strategic behavior and the potential constraints faced by the Court in its decision-making.
Treatment of preschool children with obsessive compulsive disorder
Authors: Inci Izmir Sevim Berrin , Ercan Eyüp Sabri
Published: July 2022

The aim was to examine the clinical features of Obsessive-Compulsive Disorder (OCD) in preschool and the effectiveness of aripiprazole with a standardized Cognitive-Behavioral Family Therapy (CBFT) in the treatment of preschoolers with OCD. Twelve preschool children, 36–72 months of age were diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders, the Fifth Edition criteria by a fellowship-trained child and adolescent psychiatrist. They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version and Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS) at baseline, at the end of the 12th and 24th weeks of treatment. The baseline mean of total CY-BOCS score decreased from 33.67 to 13.83 at the 12th week and 5.58 at the end of the 24th week of treatment. Also, 66.7% of them had at least one psychiatric comorbidity. Overall, this study revealed the effect of aripiprazole with CBFT in preschool-aged children with OCD. Also, the presence of comorbidity that is seen frequently in preschoolers with OCD may complicate the treatment. Therefore, there is a need to increase awareness of OCD and its comorbidities in preschoolers to supply treatment at an early age.
Changing characteristics over time of individuals receiving COVID-19 vaccines in Denmark: A population-based descriptive study of vaccine uptake
Authors: Reilev Mette , Olesen Morten , Kildegaard Helene , Støvring Henrik , Andersen Jacob H. , Hallas Jesper , Lund Lars Christian , Ladebo Louise , Ernst Martin T. , Damkier Per , Jensen Peter B. , Pottegård Anton , Rasmussen Lotte
Published: July 2022

Aims:

The Danish authorities implemented a differential rollout of the COVID-19 vaccines where individuals at high risk of COVID-19 were prioritized. We describe the temporal uptake and characteristics of COVID-19 vaccine recipients in Denmark.

Methods:

Using nationwide healthcare registries, we identified all Danish residents ⩾5 years of age who received at least one dose of a COVID-19 vaccine from 27 December 2020–29 January 2022. We charted the daily number of newly vaccinated individuals and the cumulative vaccine coverage over time, stratified by vaccine type, age groups and vaccination priority groups, and described characteristics of vaccine recipients during two-month-intervals and in vaccination priority groups.

Results:

By 29 January 2022, 88%, 86% and 64% of Danish residents ⩾5 years ( n=5,562,008) had received a first, second and third dose, respectively, of a COVID-19 vaccine, most commonly the BNT162b2 vaccine (84%). Uptake ranged from 48% in 5–11-year-olds to 98% in 65–74-year-olds. Individuals vaccinated before June 2021 were older (median age 61–70 years vs 10–35 years in later periods) and had more comorbidities such as hypertension (22–28% vs 0.77–2.8% in later periods), chronic lung disease (9.4–15% vs 3.7–4.6% in later periods) and diabetes (9.3–12% vs 0.91–2.4% in later periods).

Conclusions:

We document substantial changes over time in, for example, age, sex and medical history of COVID-19 vaccine recipients. Though these results are related to the differential vaccine rollout in Denmark, similar findings are probable in other countries and should be considered when designing and interpreting studies on the effectiveness and safety of COVID-19 vaccines.
Mapping enchanted landscapes in Philip Weller’s The Dartmoor of The Hound of the Baskervilles
Authors: McLaughlin David
Published: July 2022

Literary mapping has developed in fascinating ways in recent years, both as a field of study and as a practical tool to pursue those studies. However, one area of literary mapping as a subject remains under explored – the use and production of literary mappings by lay readers. Recent research into non-scholarly use and production of literary mappings has suggested that they are expressive, creative and affective practices. In the hands of lay readers, literary mappings have affective agency, they can tell stories, they can be catalysts of personal and worldly change. In this article I will show how we might see and feel these expressive, creative properties of literary mapping in action; to offer these affective properties as an answer to the question ‘what can literary mappings do?’. I explore this question here through a reading of a literary mapping of Dartmoor produced by Sherlockian fan Philip Weller, made within the context of the Sherlockian ‘Game’ to align actual and fictional times and places. By framing my reading through the lens of enchantment, I will focus on the role of Weller’s mapping as both a catalyst for, and a representation of, Thurgill and Lovell’s (2016) theory of the ‘spatial hinge’, that affective, creative moment when fictional and actual worlds bleed into each other. I suggest we can see Weller’s experience of the ‘spatial hinge’ and feel his mappings role in inciting his affective encounters with landscape and story, in action.
Against settler sustainability: California’s groundwater as a vertical frontier
Authors: Underhill Vivian , Sabati Sheeva , Beckett Linnea
Published: July 2022

California has been heralded as a beacon of agricultural production and productivity, yet its groundwater crisis is a warning of its impending collapse. In this paper, we argue that policies like California’s Sustainable Groundwater Management Act reinscribe the settler state, even as they aim toward environmental sustainability. Drawing from Indigenous feminist scholarship on water and frontier processes, our methodology traces settler colonialism materially and discursively through the movement of water. First, we analyze hydraulic engineering discourses at the turn of the 20th century to illustrate how racial logics were key to producing irrigation—and the broader project of white settlement—as ostensibly benevolent processes of improvement. We then highlight how turn-of-the-century legislation was central to producing agriculture as a site of accumulation by dispossession through the production of settler forms of property and relations with land and water. Finally, we consider groundwater overdraft as a vertical frontier. Thinking with water as an analytic, we study the nexus of relationships that inscribe settler water infrastructures as normative, demonstrating their role as frontier processes within a settler colonial present. Our analysis shows the necessity of dismantling settler modes of sustainability and centering and supporting Indigenous sovereignty.
The returns to school-quality-adjusted education of immigrants in Germany
Authors: Le-Quang Huy , Vallizadeh Ehsan
Published: July 2022

This paper explores the role of school quality in immigrants’ home countries on their earnings in Germany, using native Germans as a benchmark. We propose an empirical analysis that highlights two important insights. First, there is a substantial gap in the returns to education between natives and immigrants in Germany, especially when we consider the quality of schooling in the source country where education was obtained. In particular, lower school quality reduces the endowment advantage that immigrants possess from their education. Second, quality-adjusted education helps us to better understand the potential driving force behind the native–immigrant wage gap. We show that this measure accounts for a substantial fraction of the unexplained part in the Oaxaca–Blinder decomposition. These findings emphasize the role of the school quality in explaining the imperfect transferability of human capital of immigrants in Germany.
J-SPACE: a Julia package for the simulation of spatial models of cancer evolution and of sequencing experiments
Authors: Angaroni Fabrizio , Guidi Alessandro , Ascolani Gianluca , d’Onofrio Alberto , Antoniotti Marco , Graudenzi Alex
Published: July 2022

Background

The combined effects of biological variability and measurement-related errors on cancer sequencing data remain largely unexplored. However, the spatio-temporal simulation of multi-cellular systems provides a powerful instrument to address this issue. In particular, efficient algorithmic frameworks are needed to overcome the harsh trade-off between scalability and expressivity, so to allow one to simulate both realistic cancer evolution scenarios and the related sequencing experiments, which can then be used to benchmark downstream bioinformatics methods.

Result

We introduce a Julia package for SPAtial Cancer Evolution (J-SPACE), which allows one to model and simulate a broad set of experimental scenarios, phenomenological rules and sequencing settings.Specifically, J-SPACE simulates the spatial dynamics of cells as a continuous-time multi-type birth-death stochastic process on a arbitrary graph, employing different rules of interaction and an optimised Gillespie algorithm. The evolutionary dynamics of genomic alterations (single-nucleotide variants and indels) is simulated either under the Infinite Sites Assumption or several different substitution models, including one based on mutational signatures. After mimicking the spatial sampling of tumour cells, J-SPACE returns the related phylogenetic model, and allows one to generate synthetic reads from several Next-Generation Sequencing (NGS) platforms, via the ART read simulator. The results are finally returned in standard FASTA, FASTQ, SAM, ALN and Newick file formats.

Conclusion

J-SPACE is designed to efficiently simulate the heterogeneous behaviour of a large number of cancer cells and produces a rich set of outputs. Our framework is useful to investigate the emergent spatial dynamics of cancer subpopulations, as well as to assess the impact of incomplete sampling and of experiment-specific errors. Importantly, the output of J-SPACE is designed to allow the performance assessment of downstream bioinformatics pipelines processing NGS data. J-SPACE is freely available at: https://github.com/BIMIB-DISCo/J-Space.jl.
A detailed workflow to develop QIIME2-formatted reference databases for taxonomic analysis of DNA metabarcoding data
Authors: Dubois Benjamin , Debode Frédéric , Hautier Louis , Hulin Julie , Martin Gilles San , Delvaux Alain , Janssen Eric , Mingeot Dominique
Published: July 2022

Background

The DNA metabarcoding approach has become one of the most used techniques to study the taxa composition of various sample types. To deal with the high amount of data generated by the high-throughput sequencing process, a bioinformatics workflow is required and the QIIME2 platform has emerged as one of the most reliable and commonly used. However, only some pre-formatted reference databases dedicated to a few barcode sequences are available to assign taxonomy. If users want to develop a new custom reference database, several bottlenecks still need to be addressed and a detailed procedure explaining how to develop and format such a database is currently missing. In consequence, this work is aimed at presenting a detailed workflow explaining from start to finish how to develop such a curated reference database for any barcode sequence.

Results

We developed DB4Q2, a detailed workflow that allowed development of plant reference databases dedicated to ITS2 and rbcL, two commonly used barcode sequences in plant metabarcoding studies. This workflow addresses several of the main bottlenecks connected with the development of a curated reference database. The detailed and commented structure of DB4Q2 offers the possibility of developing reference databases even without extensive bioinformatics skills, and avoids ‘black box’ systems that are sometimes encountered. Some filtering steps have been included to discard presumably fungal and misidentified sequences. The flexible character of DB4Q2 allows several key sequence processing steps to be included or not, and downloading issues can be avoided. Benchmarking the databases developed using DB4Q2 revealed that they performed well compared to previously published reference datasets.

Conclusion

This study presents DB4Q2, a detailed procedure to develop custom reference databases in order to carry out taxonomic analyses with QIIME2, but also with other bioinformatics platforms if desired. This work also provides ready-to-use plant ITS2 and rbcL databases for which the prediction accuracy has been assessed and compared to that of other published databases.
Assessment of label-free quantification and missing value imputation for proteomics in non-human primates
Authors: Hamid Zeeshan , Zimmerman Kip D. , Guillen-Ahlers Hector , Li Cun , Nathanielsz Peter , Cox Laura A. , Olivier Michael
Published: July 2022

Background

Reliable and effective label-free quantification (LFQ) analyses are dependent not only on the method of data acquisition in the mass spectrometer, but also on the downstream data processing, including software tools, query database, data normalization and imputation. In non-human primates (NHP), LFQ is challenging because the query databases for NHP are limited since the genomes of these species are not comprehensively annotated. This invariably results in limited discovery of proteins and associated Post Translational Modifications (PTMs) and a higher fraction of missing data points. While identification of fewer proteins and PTMs due to database limitations can negatively impact uncovering important and meaningful biological information, missing data also limits downstream analyses (e.g., multivariate analyses), decreases statistical power, biases statistical inference, and makes biological interpretation of the data more challenging. In this study we attempted to address both issues: first, we used the MetaMorphues proteomics search engine to counter the limits of NHP query databases and maximize the discovery of proteins and associated PTMs, and second, we evaluated different imputation methods for accurate data inference. We used a generic approach for missing data imputation analysis without distinguising the potential source of missing data (either non-assigned m/z or missing values across runs).

Results

Using the MetaMorpheus proteomics search engine we obtained quantitative data for 1622 proteins and 10,634 peptides including 58 different PTMs (biological, metal and artifacts) across a diverse age range of NHP brain frontal cortex. However, among the 1622 proteins identified, only 293 proteins were quantified across all samples with no missing values, emphasizing the importance of implementing an accurate and statiscaly valid imputation method to fill in missing data. In our imputation analysis we demonstrate that Single Imputation methods that borrow information from correlated proteins such as Generalized Ridge Regression (GRR), Random Forest (RF), local least squares (LLS), and a Bayesian Principal Component Analysis methods (BPCA), are able to estimate missing protein abundance values with great accuracy.

Conclusions

Overall, this study offers a detailed comparative analysis of LFQ data generated in NHP and proposes strategies for improved LFQ in NHP proteomics data.
In vitro assessment of 17 antimicrobial agents against clinical Mycobacterium avium complex isolates
Authors: Lin Siran , Hua Wenya , Wang Shiyong , Zhang Yu , Chen Xinchang , Liu Hong , Shao Lingyun , Chen Jiazhen , Zhang Wenhong
Published: July 2022

Background

Recently, Mycobacterium avium complex (MAC) infections have been increasing, especially in immunocompromised and older adults. The rapid increase has triggered a global health concern due to limited therapeutic strategies and adverse effects caused by long-term medication. To provide more evidence for the treatment of MAC, we studied the in vitro inhibitory activities of 17 antimicrobial agents against clinical MAC isolates.

Results

A total of 111 clinical MAC isolates were enrolled in the study and they were identified as M. intracellulare, M. avium, M. marseillense, M. colombiense, M. yongonense, and two isolates could not be identified at the species level. MAC strains had relatively low (0–21.6%) resistance to clarithromycin, amikacin, bedaquiline, rifabutin, streptomycin, and clofazimine, and the resistant rates to isoniazid, rifampin, linezolid, doxycycline, and ethionamide were very high (72.1–100%). In addition, M. avium had a significantly higher resistance rate than that of M. intracellulare for ethambutol (92.3% vs 40.7%, P < 0.001), amikacin (15.4% vs 1.2%, P = 0.049), and cycloserine (69.2% vs 25.9%, P = 0.004).

Conclusions

Our results supported the current usage of macrolides, rifabutin, and aminoglycosides in the regimens for MAC infection, and also demonstrated the low resistance rate against new drugs, such as clofazimine, tedizolid, and bedaquiline, suggesting the possible implementation of these drugs in MAC treatment.
Floral morphology and phenology of Sassafras tzumu (Lauraceae)
Authors: Yang Zhi , Tan Chao , Wei Yi-Min , Rohwer Jens G , Liu Bing , Yang Yong
Published: July 2022

Background

Sassafrashas been considered to belong to trib. Laureae of Lauraceae and has been assumed to have unisexual flowers. However, recent molecular phylogenetic studies have consistently suggested thatSassafrasdoes not belong to the trib. Laureae but to Cinnamomeae and that it is nested withinCinnamomum. A recent morphological study revealed that one of the Asian species,S. randaiense, possesses bisexual flowers that are plesiomorphic in the family Lauraceae. As reports on the flower structure of the second Asian species,S. tzumu, have been contradictory, we wanted to ascertain if it has bisexual flowers or not. If the flowers were bisexual, could earlier reports that they were unisexual have been based on dichogamous flowering?

Results

In this study, we investigated two populations ofS. tzumu. We found that this species has determinate botryoid racemes, and possesses bisexual flowers. Among the three extant species,S. tzumuis more similar to its sister speciesS. randaiensebut markedly different from the AmericanS. albidum: the two Asian species possess bisexual flowers while the American species has unisexual flowers. The bisexual flower ofS. tzumuis protogynous, and shows two phenological phases typical of Lauraceae: 1) in a flower, the pistil functions first, the stigma is fresh and white, stamens of the outer two whorls are spreading, anthers do not open, and the staminodes secrete nectar at this stage; 2) in the second phase, the stigma becomes brown, staminodes are withered, stamens of the third whorl stand up and surround the pistil, glands of the third whorl of stamens secrete nectar, and the anthers open and release pollen.

Conclusions

The similarity of racemose inflorescences betweenSassafrasand some members of Laureae were caused by parallel evolution; the racemose inflorescence of ancestralSassafrasoriginated from the thyrsoid-cymose inflorescence inCinnamomum. The Asian speciesS. tzumuandS. randaiensepossess bisexual flowers with two phenological phases, the AmericanS. albidumevolved unisexual flowers independently from other clades with unisexual flowers in the Lauraceae, i.e., the Laureae,Alseodaphnopsisin the Perseeae and the unisexual clade in theOcoteacomplex of the Cinnamomeae.
Transporter NRT1.5/NPF7.3 suppresses primary root growth under low K+ stress by regulating the degradation of PIN-FORMED2
Authors: Wang Youyou , Wang Ran , Zhao Shuang , Lu Changmei , Zhu Ziqiang , Li Hong
Published: July 2022

Background

The availability of potassium is one of the main environmental factors for modifying the plasticity of root architecture. Many potassium channels and transporters are involved in regulating primary root growth in response to low potassium stress. NRT1.5/NPF7.3 transporter is a NO3−/H+ and K+/H+ cotransporter, and participates in NO3− and K+ translocation from the roots to the shoots. However, the underlying mechanism of NRT1.5-regulated primary root growth under low potassium stress is unclear.

Results

We show that NRT1.5/NPF7.3 inhibited primary root growth under low potassium conditions by regulating the accumulation of PIN2 protein and auxin levels. Under low potassium conditions, the mutants nrt1.5 and lks2 exhibited longer primary roots, longer meristem regions and elongation zones of primary roots, and more cell activity in the meristem region compared to WT plants, revealing the involvement of NRT1.5 in LK (low potassium)-inhibition primary root growth. In addition, exogenous auxin (IAA), auxin analogue (NAA, 2.4-D) or auxin precursor (IBA) promoted the primary root growth of WT and the complementation line NRT1.5 COM plants. In addition, the application of NPA inhibited the primary root growth of the nrt1.5 and lks2 mutants. Auxin accumulation was higher in the root tip of nrt1.5 plants than in WT plants, indicating that NRT1.5 regulates root growth inhibition by regulating auxin distribution. Furthermore, PIN2 was degraded more quickly in nrt1.5 plants under LK stress.

Conclusions

Our findings reveal that NRT1.5 inhibits primary root growth by modulating the auxin level in the root tip via the degradation of PIN2.
Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts
Authors: Shrestha Prakriti , Van Pilsum Rasmussen Sarah E. , King Elizabeth A. , Gordon Elisa J. , Faden Ruth R. , Segev Dorry L. , Humbyrd Casey Jo , McAdams-DeMarco Mara
Published: July 2022

Background

Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function during transplant evaluation to help identify appropriate candidate. Yet, there are no ethical guidelines regarding the use of frailty and cognitive function during this evaluation. We seek to develop a clinical consensus on balancing utility and justice in access to KT for frail and cognitively impaired patients.

Methods

Twenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement).

Results

Experts believed that denying patients transplantation based solely on expected patient survival was inequitable to frail or cognitively impaired candidates; 100% agreed that frailty and cognitive impairment are important factors to consider during KT evaluation. There was consensus that health related quality of life and social support are important to consider before waitlisting frail or cognitively impaired patients. Experts identified important factors to consider before waitlisting frail (likely to benefit from KT, frailty reversibility, age, and medical contraindications) and cognitively impaired (degree of impairment and medication adherence) patients.

Conclusions

Clinical experts believed it was ethically unacceptable to allocate organs solely based on patients’ expected survival; frailty and cognitive impairment should be measured at evaluation when weighed against other clinical factors. Ethical guidelines regarding the use of frailty and cognitive function during KT evaluation ought to be developed.
Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations
Authors: Bircher Charles , Wilkes Matt , Zahradka Nicole , Wells Emily , Prosser-Snelling Ed
Published: July 2022

Background

During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom.

Methods

Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions.

Results

Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology.

Conclusions

The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.
Determinants of place birth: a multinomial logistic regression and spatial analysis of the Ethiopian mini demographic and health survey data, 2019
Authors: Gudayu Temesgen Worku
Published: July 2022

Background

Maternal and neonatal health significantly improves when birth is attended at health institutions where there are quality services and skilled attendants. In contrary, home birth results in high rates of maternal and neonatal mortality. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia based on the recent national survey.

Methods

Ethiopian mini-DHS-2019 data was used in this analysis. A weighted sample of 5423 mothers were included. While health facility was a reference, home and health post were used as comparison categories to identify determinants of place of birth in a survey multinomial logistic regression model. An adjusted relative risk ratio, marginal effect, and a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The prevalence of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth.

Result

Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low coverage of cluster level 4 + antenatal visits were predictors of home birth. Also, home birth was clustered across enumeration areas and it was over 40% in most parts of the country with > 75% in the Somali region. SaTScan analysis detected most likely primary clusters in the Somali region and secondary clusters in the rest five regions of the country.

Conclusion

Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally, implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities by qualified providers and back-up systems in place could be supportive.
Women’s view on shared decision making and autonomy in childbirth: cohort study of Belgian women
Authors: Deherder Elke , Delbaere Ilse , Macedo Adriana , Nieuwenhuijze Marianne J. , Van Laere Sven , Beeckman Katrien
Published: July 2022

Background

Health care providers have an important role to share evidence based information and empower patients to make informed choices. Previous studies indicate that shared decision making in pregnancy and childbirth may have an important impact on a woman’s birth experience. In Flemish social media, a large number of women expressed their concern about their birth experience, where they felt loss of control and limited possibilities to make their own choices. The aim of this study is to explore autonomy and shared decision making in the Flemish population.

Methods

This is a cross-sectional, non-interventional study to explore the birth experience of Flemish women. A self-assembled questionnaire was used to collect data, including the Pregnancy and Childbirth Questionnaire (PCQ), the Labor Agentry Scale (LAS), the Mothers Autonomy Decision Making Scale (MADM), the 9-item Shared Decision Making Questionnaire (SDM–Q9) and four questions on preparation for childbirth. Women who gave birth two to 12 months ago were recruited by means of social media in the Flemish area (Northern part of Belgium).

Linear mixed-effect modelling with backwards variable selection was applied to examine relations with autonomy in decision making.

Results

In total, 1029 mothers participated in this study of which 617 filled out the survey completely. In general, mothers experienced moderate autonomy in decision-making, both with an obstetrician and with a midwife with an average on the MADM score of respectively 18.5 (± 7.2) and 29.4 (±10.4) out of 42. The linear mixed-effects model showed a relationship between autonomy in decision-making (MADM) for the type of healthcare provider (p < 0.001), the level of self-control during labour and birth (LAS) (p = 0.003), the level of perceived quality of care (PCQ) (p < 0.001), having epidural analgesia during childbirth (p = 0.026) and feeling to have received sufficient information about the normal course of childbirth (p < 0.001).

Conclusions

Childbearing women in Flanders experience moderate levels of autonomy in decision- making with their health care providers, where lower autonomy was observed for obstetricians compared to midwives. Future research should focus more on why differences occur between obstetrics and midwives in terms of autonomy and shared decision-making as perceived by the mother.
Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis research consortium of Canada scoring system
Authors: Zhang Yimeng , Guo Zikang , Zhan Ying , Qu Jin , Lei Xinwei
Published: July 2022

Background

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting the spine and sacroiliac joints. To investigate whether there are differences in inflammatory and chronic structural damages, as assessed by a semiquantitative MRI scoring method, between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) patients with active inflammation at baseline, and to evaluate the treatment response in these patients after 3 months of tumor necrosis factor-alpha (TNF-α) inhibitor treatment.

Methods

Fifty-eight axSpA patients with active inflammation were included in the study. The patients were divided into nr-axSpA group and AS group. MRI examinations of the sacroiliac joints were performed before and after treatment. Inflammatory and structural damages in these patients were assessed using the established Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation and sacroiliac joint structural (SSS) scoring methods, which are two MRI-based scoring methods. The SPARCC score, SSS score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were compared between the two groups.

Results

At baseline, SPARCC scores for patients in the nr-axSpA and AS groups did not differ significantly (P > 0.05); however, SSS scores for fat metaplasia, erosion, and backfill for patients in the AS group were significantly higher (P < 0.001). Compared with baseline, SPARCC scores were significantly decreased in both groups after treatment (P < 0.001); however, after treatment, no statistically significant difference was found regarding SPARCC scores between the AS and nr-axSpA groups. Compared with baseline, a significant increase in the SSS scores for fat metaplasia and backfill (P < 0.001) and a significant decrease in the SSS scores for erosion (P < 0.001) were observed in all axSpA patients. Changes in the SPARCC score was inversely correlated with the changes in the SSS score for fat metaplasia (r = − 0.634, P < 0.001). Changes in the SSS score for backfill were positively correlated with the changes in the SSS score for fat metaplasia (r = 0.277, P < 0.05) and inversely correlated with those for erosion (r = − 0.443, P < 0.001).

Conclusion

The SPARCC and SSS scoring systems can be used to assess inflammatory and chronic structural damages as well as treatment responses in patients with axSpA. More severe structural damages were seen in AS patients. TNF-α inhibitor treatment for 3 months could effectively reduce inflammation in axSpA patients.
Tumor-induced osteomalacia characterized by “painful knee joint with difficulty in moving”: a case report
Authors: Jiang Lan , Tan Qing-Qing , Gao Chen-Lin , Xu Ling , Zhu Jian-Hua , Yan Pi-Jun , Miao Ying , Wan Qin , Xu Yong
Published: July 2022

Background

Tumor-related osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by severe hypophosphatemia and osteomalacia. The diagnosis of TIO can be very difficult because of its nonspecific nature of clinical manifestations. Here we reported a case of young TIO patient with “painful knee joint with difficulty in moving” to improve the clinical diagnosis and treatment levels.

Case presentation

The patient’s clinical features were consistent with TIO. A tumor was successfully located in left tibial by 68Ga-DOTATATE PET/CT, and then was surgically resected. Upon pathologic assessment, the tumor was diagnosed as phosphaturia stromal tumor (PMT) with positive Vim staining. After the surgery, serum phosphate level rapidly recovered and symptoms significantly improved.

Conclusion

TIO should be considered in patients with chronically hypophosphorus osteomalacia in the setting of no family history. Early removal of the responsible tumors is clinically essential for the treatment, and imaging examination is of great significance for tumor localization.
Analysis of risk factors for the development of type 2 diabetes mellitus complicated with Hashimoto’s thyroiditis
Authors: Han Meng , Wu Haoneng , Yang Weiming , Chen Juanjuan
Published: July 2022

Aims

The purpose of this study is to elucidate the correlation between thyroid hormone, glycosylated hemoglobin (HbA1c), vitamin D and type 2 diabetes mellitus (T2DM) with Hashimoto’s thyroiditis (HT), and to seek the independent predictors affecting disease development.

Methods

The study included 44 T2DM with HT, 94 T2DM, and 112 healthy subjects. We investigated some laboratory factors like thyroid hormone and compared the levels. Independent predictors determination by logistic univariate regression analysis were analyzed. The diagnostic value of thyroid-stimulating hormone (TSH) and threshold concentration were determined by ROC curve.

Results

In T2DM with HT group, levels of PTH, HbA1c were lower and levels of TSH were significantly higher, when compared with T2DM group. But there was no significant difference in vitamin D between these two groups. In both logistic univariate regression analysis and multiple logistic regression analysis, TSH, HbA1c were independent predictors for T2DM with HT. Based on the ROC curve, the best cut-off value of the TSH was 4 mIU/L (sensitivity 72.7%, specificity 94.6%, AUC = 0.832) for predicting T2DM with HT in T2DM patients.

Conclusions

TSH has increased risk for T2DM evolving into T2DM complicated with HT, so it is important to monitor the concentrations of TSH in patients with T2DM. Although vitamin D was not the independent predictor in T2DM with HT development, effect of vitamin D deficiency on the progress of diabetes and its complications should be taken into consideration.
How do I deal with breast cancer: a qualitative inquiry into the coping strategies of Iranian women survivors
Authors: Manouchehri E. , Taghipour A. , Ebadi A. , Homaei Shandiz F. , Latifnejad Roudsari R.
Published: July 2022

Background

Breast cancer is the most frequent cancer in Iran. Understanding the coping strategies employed by cancer survivors can provide valuable information for designing interventions to help them adapt to the problems produced by cancer and its treatment. This study aimed to explore the coping strategies of BC survivors in Iran.

Methods

This qualitative study was conducted in Mashhad, Northeast Iran, between April and December 2021. Fourteen BC survivors were selected through purposive sampling. The data were collected using semi-structured interviews. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman. MAXQDA 12 software was used for data organization. Components of trustworthiness, including credibility, dependability, confirmability, and transferability, were considered.

Results

The main categories that emerged from the participants' data analysis were “behavioral coping strategies” and “emotional coping strategies.” Behavioral coping strategies included efforts to adopt healthy nutrition, attempts to improve a healthy lifestyle, maintenance of everyday activities, use of specialized cancer support consultation services, and seeking to increase health literacy about BC. The emotional coping strategies consisted of denial as a temporary escape route, positive thinking and focusing on the positive aspects of life, reinforcement of spirituality, and seeking the support of relatives.

Conclusion

Our findings provide an in-depth understanding of Iranian women’s strategies for coping with BC. A trained team of oncologists, psychiatrists, mental health professionals, and reproductive health specialists needs to contribute significantly to improving the coping ability of patients with cancer, which could lead to enhanced health promotion and a higher quality of life.
Ways to unravel the clinical potential of carbon ions for head and neck cancer reirradiation: dosimetric comparison and local failure pattern analysis as part of the prospective randomized CARE trial
Authors: Held Thomas , Tessonnier Thomas , Franke Henrik , Regnery Sebastian , Bauer Lukas , Weusthof Katharina , Harrabi Semi , Herfarth Klaus , Mairani Andrea , Debus Jürgen , Adeberg Sebastian
Published: July 2022

Background

Carbon ion radiotherapy (CIRT) yields biophysical advantages compared to photons but randomized studies for the reirradiation setting are pending. The aim of the current project was to evaluate potential clinical benefits and drawbacks of CIRT compared to volumetric modulated arc therapy (VMAT) in recurrent head and neck cancer.

Methods

Dose-volume parameters and local failure patterns of CIRT compared to VMAT were evaluate in 16 patients from the randomized CARE trial on head and neck cancer reirradiation.

Results

Despite an increased target dose, CIRT resulted in significantly reduced organ at risk (OAR) dose across all patients (− 8.7% Dmean). The dose-volume benefits were most pronounced in the brainstem (− 20.7% Dmax) and the optic chiasma (− 13.0% Dmax). The most frequent local failure was type E (extraneous; 50%), followed type B (peripheral; 33%) and type A (central; 17%). In one patient with type A biological and/or dosimetric failure after CIRT, mMKM dose recalculation revealed reduced target coverage.

Conclusions

CIRT resulted in highly improved critical OAR sparing compared to VMAT across all head and neck cancer reirradiation scenarios despite an increased prescription dose. Local failure pattern analysis revealed further potential CIRT specific clinical benefits and potential pitfalls with regard to image-guidance and biological dose-optimization.