bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrition Status Plays a Partial Mediation Role in the Relationship between Number of Teeth and Frailty: A Cross-Sectional Multicenter Study
Authors: Xia Xin , Yang Zhongli , Xu Zhigang , Tang Jingyi , Zhang Gongchang , Dong Birong , Liu Xiaolei
Published: April 2024

Introduction: Although the relationship between the number of teeth and frailty has been extensively studied, the mediating role of nutrition status in the association between the number of teeth and frailty remains to be clarified. Methods: A number of 6,664 participants lived in the communities of West China were analyzed in our study. Physical frailty was determined based on the phenotype established by Fried. Nutrition status was evaluated using the Mini Nutrition Assessment-Short Form (MNA-SF) scale. Multiple linear regression was employed to evaluate the direct relationships between the number of teeth, nutrition, and frailty. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of nutrition status in the relationship between the number of teeth and frailty. Results: Among the 6,664 participants aged over 50 years old, the prevalence of frailty was 6.2%. Multiple linear regression analysis showed a significant total relationship between the number of teeth (β = −0.359, 95% CI: −0.473 to −0.244, p < 0.001) and frailty. After adjusting for MNA-SF scores, the relationship between the number of teeth and frailty remained significant (β = −0.327, 95% CI: −0.443 to −0.211, p < 0.001), indicating a partial mediating effect of nutrition. Mediation analysis verified that nutrition partially mediated the relationship between the number of teeth and frailty (indirect effect estimate = −0.0121, bootstrap 95% CI: −0.0151 to −0.0092; direct effect estimate = −0.0874, bootstrap 95% CI: −0.1086 to −0.0678) in the fully adjusted model. This mediating effect occurred through influencing weight loss, low level of physical activity, and debility. SEM framework pathway analysis confirmed the association between the number of teeth, nutrition, and frailty. Conclusions: Our findings demonstrated that frailty was correlated with the number of teeth and poorer nutritional status, with nutrition partially mediating the correlation between the number of teeth and frailty. Our results supported early nutritional evaluation and intervention in oral health to decrease the risk of frailty.
Higher In-Hospital Mortality among Asian Americans Undergoing Transjugular Intrahepatic Portosystemic Shunt Procedure
Authors: Li Renxi , Sarin Shawn
Published: April 2024

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to alleviate portal hypertension in patients with decompensated liver cirrhosis. While prior research highlighted racial disparities in TIPS, Asian Americans were not included in the investigation. This study aimed to investigate disparities in the immediate postprocedural outcomes among Asian American patients who underwent TIPS. Methods: The study identified Asian American and Caucasian patients who underwent TIPS in the National Inpatient Sample from Q4 2015–2020. Preprocedural factors, including demographics, comorbidities, primary payer status, and hospital characteristics, were matched by 1:2 propensity-score matching between the groups. In-hospital outcomes after TIPS were examined. Results: There were 6,658 patients who underwent TIPS with 128 (1.92%) Asian Americans and 4,574 (68.70%) Caucasians, where 218 Caucasians were matched to all Asian Americans. Asian Americans had higher in-hospital mortality (14.06% vs. 7.34%, p = 0.04) and higher total hospital charge (253,756 ± 37,867 vs. 163,391 ± 10,265 US dollars, p = 0.02). The occurrence of hepatic encephalopathy, acute kidney injury, transfers out to other hospital facilities, and length of stay did not differ between cohorts. Conclusion: Despite their heightened risk for cirrhosis, Asian Americans are significantly underrepresented in TIPS and had higher in-hospital mortality after TIPS. This highlights the need for enhanced access to diagnosis and treatment care of liver cirrhosis for Asian Americans.
Primary versus Revisional One Anastomosis Gastric Bypass: Outcomes of Patients with at Least 8-Year Follow-Up
Authors: Abu-Abeid Adam , Bendayan Anat , Yuval Jonathan B. , Eldar Shai Meron , Lahat Guy , Lessing Yonatan
Published: April 2024

Introduction: One anastomosis gastric bypass (OAGB) prevalence is increasing worldwide and shows good mid- to long-term results. Data on long-term outcomes of revisional OAGB (rOAGB) is limited. This study’s objective was to evaluate the long-term outcomes of patients undergoing primary OAGB (pOAGB) and rOAGB. Methods: A retrospective analysis of a prospectively maintained patient registry at a single-tertiary center. Patients undergoing OAGB from January 2015 to May 2016 were included and grouped into pOAGB and rOAGB. Results: There were 424 patients, of which 363 underwent pOAGB, and 61 underwent rOAGB. Baseline characteristics were insignificantly different between groups except for the type 2 diabetes (T2D) rate which was higher in pOAGB (26% vs. 11.5%, p = 0.01). The mean follow-up time was 98.5 ± 3.9 months, and long-term follow-up data were available for 52.5% of patients. The mean total weight loss (TWL) was higher in the pOAGB group (31.3 ± 14 vs. 24.1 ± 17.6, p = 0.006); however, TWL was comparable when relating to the weight at primary surgery for rOAGB. The rate of T2D and hypertension resolution was 79% and 72.7% with no difference between groups. Thirteen patients (5.9%) underwent OAGB revision during follow-up, with no difference between groups. Two deaths occurred during follow-up, both non-related to OAGB. Conclusion: OAGB is effective as a primary and as a revisional procedure for severe obesity with good long-term results in terms of weight loss and resolution of associated diseases. In addition, the revisional surgery rates and chronic complications are acceptable. Further large prospective studies are required to clarify these data.
A new species of the extant genus Bulasconotus from mid-Cretaceous Kachin amber (Coleoptera: Zopheridae: Colydiinae)
Authors: Li Yan-Da , Jin Zhen-Yu , Ślipiński Adam , Huang Di-Ying , Cai Chen-Yang
Published: April 2024

A fossil species of the extant colydiine genus Bulasconotus Ślipiński & Lawrence, B. carinisternus Li, Ślipiński & Cai sp. nov., is reported from mid-Cretaceous Kachin amber of northern Myanmar. The new species shares with extant Bulasconotus the 3-segmented antennal club, externally open procoxal cavities, and similar sculpture on the pronotum and elytra, but could be recognized by the medially carinated prosternal process. The present discovery provides a valuable example of morphological stasis in the cylindrical bark beetles.
Processos de criação do livro para a infância: imagem, palavra e construção poética
Authors: Araújo Hanna , Gama Mônica , Silva Natasha Castro
Published: April 2024

Editorial n. 37. Dossiê: Processos de criação do livro para a infância: imagem, palavra e construção poética.
Criação e violência em Edgardo Cozarinsky
Authors: Olivo Júnior Valdir
Published: April 2024

O objetivo deste trabalho é problematizar as relações entre criação e violência em Edgardo Cozarinsky (1939). A proposta consiste em pensar os textos do escritor sob a luz dos principais dispositivos de poder que atravessaram a Argentina durante o século passado, e refletir sobre como esses dispositivos se imprimem em seus textos e em seu processo criativo. Para pensar a violência e o poder em Cozarinsky se faz necessário entender as formas como esses problemas se manifestam. Não se trata apenas de pensá-los como temáticas abordadas pelo escritor durante sua trajetória intelectual (ainda que esse também seja um dos eixos deste trabalho), mas sim entender como seu trabalho criativo se constrói como contestação de uma violência implícita (a violência da disciplina em nome do controle). Desde seus primeiros trabalhos, Cozarinsky busca pensar a arte como inanição da ordem autotélica do poder como violência. Neste trabalho, pretendo demonstrar os bastidores dessa sua concepção de arte e também refletir sobre como ela se configura enquanto estratégia textual.
A história do conceito de "scriptor"
Authors: Willemart Philippe Marie
Published: April 2024

O artigo reúne os elementos que permitem definir o conceito de scriptor, uma das instancias que agem na construção da escritura de todo manuscrito.
Global, Regional, and National Burdens of Stroke in Children and Adolescents From 1990 to 2019: A Population-Based Study
Authors: Sun Hao , Ma Bing , Jin Chenye , Li Zhenning , Song Xinying , Bu Yifan , Liu Tingting , Han Xu , Yang Xue , Yang Kaijie , Xu Dongchu , Zhang Jing , Li Yongze
Published: April 2024

BACKGROUND:

Stroke is one of the leading causes of death among children, yet evidence on stroke incidence and prognosis in this population is largely neglected worldwide. The aim of this study was to estimate the latest burden of childhood stroke, as well as trends, risk factors, and inequalities from 1990 to 2019, at the global, regional, and national levels.

METHODS:

The Global Burden of Disease 2019 study was utilized to evaluate the prevalence, incidence, years lived with disability, years of life lost (YLLs), and average annual percentage changes in stroke among populations aged 0 to 19 years from 1990 to 2019.

RESULTS:

The global age–standardized incidence of stroke increased (average annual percentage change, 0.15% [95% uncertainty interval, 0.09%–0.21%]), while YLLs decreased substantially (average annual percentage change, −3.33% [95% uncertainty interval, −3.38% to −3.28%]) among children and adolescents between 1990 and 2019. Ischemic stroke accounted for 70% of incident cases, and intracerebral hemorrhage accounted for 63% of YLLs. Children under 5 years of age had the highest incidence of ischemic stroke, while adolescents aged 15 to 19 years had the highest incidence of hemorrhagic stroke. In 2019, low-income and middle-income countries were responsible for 84% of incident cases and 93% of YLLs due to childhood stroke. High-sociodemographic index countries had a reduction in YLLs due to stroke that was more than twice as fast as that of low-income and middle-income.

CONCLUSIONS:

Globally, the burden of childhood stroke continues to increase, especially among females, children aged <5 years, and low-sociodemographic index countries, such as sub-Saharan Africa. The burden of childhood stroke is likely undergoing a significant transition from being fatal to causing disability. Global public health policies and the deployment of health resources need to respond rapidly and actively to this shift.
Heat Transfer in Magnetohydrodynamic Convective Flow of Hybrid Nanofluid Over a Revolving Cone with Heat Generation/Absorption
Authors: Abdul Hakeem A. K. , Kirusakthika S. , Ganga B. , Renuka P.
Published: April 2024

The contemporary study’s goal is to investigate the role of the Casson hybrid nanofluid on boundary layer flow and heat transfer over a vertical rotating cone using various base fluids. The dynamic effects of the magnetic field and heat generation/absorption are taken into account
in the modeling of hybrid nanofluids. Flow-related PDEs are remodeled to ODEs through use of similarity transmutations. Furthermore, the numerical results are explained using the fourth order Runge-Kutta scheme in conjunction with the shooting technique. The solution depends on a Lorentz force,
Casson parameter, heat generation/absorption and spin parameter. The dependency of the skin friction coefficient and local Nusselt number on these four parameters is numerically explored. To the best of the author’s knowledge, the presence of three types of hybrid nanoparticles (Al2O3–
TiO2, TiO2–Cu and Al2O3–Cu) with Newtonian/non-Newtonian base fluids has not yet been examined. The findings of the study reveal that increasing the magnetic parameter values reduces flow velocities (tangential and swirl) and increases
the tangential velocity profile of Newtonian based hybrid nanofluid. Additionally, the thermal profile and non-Newtonian based hybrid nanofluid indicate a rising trend in heat generation/absorption parameter. Furthermore, the thermal transfer rate of water-based hybrid nanofluid is increased,
while the skin friction coefficient reverses.
Local Thermal Non-Equilibrium and Internal Heating Impact on Thermal Instability of Jeffrey Nanofluid Saturated Porous Media Under Different Gravity Modulations
Authors: Shilpee  , Bhadauria B. S.
Published: April 2024

In the present study, we have implied internal heating and different types of gravity modulation on a Jeffrey nanofluid saturating porous media under three field temperature models i.e., fluid, solid-matrix, and particle phases. Normal mode technique is applied for linear analysis and
the truncated Fourier series method is used for non-linear analysis. Numerical values are obtained to compare the convection rate between LTNE and LTE models. Jeffrey parameter and internal heating enhance the stationary rate of convection. Analytically the effect of internal heating and the
Jeffrey parameter is obtained and compared with graphical results. Effect of rate of convection at ɛp = 0.1 is observed more earlier than convection at ɛp = 0.4. Opposite impact of the Jeffrey parameter is obtained in the graph of interface heat
transfer for particle phase (NHS) and critical wave number (ac). Three types of gravity modulation (day-night, saw-tooth, sinusoidal) are applied to investigate the earlier influence of modulation on the system for Nusselt number for concentration, fluid,
solid-matrix, and particle phase and we obtain day-night profile has an earlier rate of heat and mass transfer than the other two profiles. No effect of frequency of modulation is observed for steady-state analysis. Comparison of heat transfer rate for Nusselt number was obtained using RKF-45
method and NDSolve Mathematica.
Micropolar Nanofluid Wedged Between Permeable Fluid Saturated with Nanoparticles
Authors: Umavathi J. C. , Sutkar P. S.
Published: April 2024

This paper aim to discuss micropolar nanofluid stuffed between permeable nanofluids in a horizontal channel. Single phase Tiwari-Das model is used to define nanofluid and Brinkman model to define permeable fluid. Using appropriate boundary and interface conditions, closed form elucidation
are evaluated with the help of perturbation method. The response of governing parameters like porous parameter, solid volume fraction, material parameter, Eckert number, and cell rotational viscosity on linear velocity, microrotation velocity and temperature are presented in graphical and
tabular form. It is dissipated that the material parameter, solid volume fraction and porous parameter reduces velocity and temperature, whereas Eckert number promotes the temperature. The Nusselt numbers are not much varied for any of the nanoparticles. Combinations of immiscible micropolar
fluids and nanofluids provide excellent advantages in the fields of renewable energy, biomedicine, plasma physics, geophysics, and petroleum industry.
Study of Thermal-Instability in Nanoliquid (Walter-B Viscoelastic) within the Hele-Shaw Cell Under Thermal-Modulation Using Cubic Ginzburg-Landau (GBL) Equation
Authors: Rai S. N. , Bhadauria B. S. , Srivastava Anurag
Published: April 2024

This paper includes both linear and local nonlinear exploration to estimate the onset of instability and heat/mass transportation in nanoliquid (Walter-B viscoelastic) within the Hele-Shaw (HS) cell under the impact of thermalmodulation. The stability exploration uses Nusselt numbers
based on the cubic Ginzburg-Landau (GBL) equation. We have considered three types of thermal-modulation viz symmetric thermal-modulation, asymmetric thermal-modulation, and lower-boundary thermal-modulation. In the sequel, the impact of the non-dimensional parameters is discussed graphically
in detail. It is described that elastic-parameter (H), nanoliquid Prandtl number (Pr), and amplitude of the thermal-modulation (δ) destabilize the system, that is, the heat/mass transportation increases. On the other hand, HS-number (Hs), nanoliquid Lewis-number
(Le), redefined diffusivity-ratio (NA), concentration Rayleigh-number (Rn), and modulating-frequency (Ω) stabilize the system. Moreover, it is found that in all three types of thermal-modulation, maximun heat/mass transportation can be observed in the
case of asymmetric modulation. Walter-B nanoliquid can be used to enhance the heat/mass transportation as compared to a normal nanoliquid.
Analysis of Nanofluid Heat Transfer and Entropy Generation in a Novel Metal Foam Heat Sink
Authors: Bouacida T. , Bessaïh R. , Bouziane B.
Published: April 2024

This study investigated the impact of key parameters, including Re (300 ≤ Re ≤ 1800), Φ (0% ≤ Φ ≤ 2.5%), ɛ (0.2 ≤ ɛ ≤ 0.9), and Da (10−4 ≤ Da ≤ 10−1), on heat transfer and entropy
generation in a novel metal foam heat sink. Results show that increasing the Darcy number to 10−1 can enhance the average Nusselt number by approximately 18.05% while placing Al.Cu foam in the middle of the heat sink can significantly reduce the CPU surface temperature by
up to 15 .C. Additionally, increasing the Reynolds number from 300 to 1800 can lower the thermal entropy generation by up to 51.55%. The metal foam’s effectiveness was evaluated using performance evaluation criteria (PEC).
Energy and economic performance optimization of a window with variable transparency shape-stabilized PCM in hot summer and cold winter climate zone
Authors: Zhang Hangming , Zhang Ling , Zheng Yue , Liu Zhongbing
Published: April 2024

Improving the thermal performance of windows is important for building energy efficiency. Filling windows with variable transparency shape-stabilized phase change materials (VTSS-PCM) improves the thermal inertia of windows while avoiding the leakage of PCM. In this paper, a new type of VTSS-PCM window was proposed, tested, simulated and optimized in hot summer and cold winter climate zone. A numerical model of the VTSS-PCM window was built, and the model was validated using experimental tests. On this basis, three key parameters of VTSS-PCM were investigated and optimized. Finally, the energy and economic performance of the optimized VTSS-PCM window were compared with a typical hollow glass window. The results showed that the total annual unfavourable heat transfer (TAHT) and the annual investment cost (AIC) of the VTSS-PCM window obtained from the optimization were 118.16 kWh/m2 and 8.53 CNY/m2, respectively. Compared with the hollow glass window, the VTSS-PCM window reduced the TAHT by 30.14% and the total annual cost by 28.39%. The VTSS-PCM window produced a better development potential in terms of energy performance and economic performance. This study provided a reference for the application of the VTSS-PCM window in hot summer and cold winter regions of China.
Single-cell characterisation of tissue homing CD4 + and CD8 + T cell clones in immune-mediated refractory arthritis
Authors: Bhattacharya Dipabarna , Theodoropoulos Jason , Nurmi Katariina , Juutilainen Timo , Eklund Kari K. , Koivuniemi Riitta , Kelkka Tiina , Mustjoki Satu , Lönnberg Tapio
Published: April 2024

Background

Immune-mediated arthritis is a group of autoinflammatory diseases, where the patient’s own immune system attacks and destroys synovial joints. Sustained remission is not always achieved with available immunosuppressive treatments, warranting more detailed studies of T cell responses that perpetuate synovial inflammation in treatment-refractory patients.

Methods

In this study, we investigated CD4 + and CD8 + T lymphocytes from the synovial tissue and peripheral blood of patients with treatment-resistant immune-mediated arthritis using paired single-cell RNA and TCR-sequencing. To gain insights into the trafficking of clonal families, we compared the phenotypes of clones with the exact same TCRß amino acid sequence between the two tissues.

Results

Our results show that both CD4 + and CD8 + T cells display a more activated and inflamed phenotype in the synovial tissue compared to peripheral blood both at the population level and within individual T cell families. Furthermore, we found that both cell subtypes exhibited clonal expansion in the synovial tissue.

Conclusions

Our findings suggest that the local environment in the synovium drives the proliferation of activated cytotoxic T cells, and both CD4 + and CD8 + T cells may contribute to tissue destruction and disease pathogenesis.
Proteomics study of primary and recurrent adamantinomatous craniopharyngiomas
Authors: Deng Haidong , Lei Ting , Liu Siqi , Hao Wenzhe , Hu Mengqing , Xiang Xin , Ye Ling , Chen Dongting , Li Yan , Liu Fangjun
Published: April 2024

Background

Adamantinomatous craniopharyngiomas (ACPs) are rare benign epithelial tumours with high recurrence and poor prognosis. Biological differences between recurrent and primary ACPs that may be associated with disease recurrence and treatment have yet to be evaluated at the proteomic level. In this study, we aimed to determine the proteomic profiles of paired recurrent and primary ACP, gain biological insight into ACP recurrence, and identify potential targets for ACP treatment.

Method

Patients with ACP (n = 15) or Rathke’s cleft cyst (RCC; n = 7) who underwent surgery at Sanbo Brain Hospital, Capital Medical University, Beijing, China and received pathological confirmation of ACP or RCC were enrolled in this study. We conducted a proteomic analysis to investigate the characteristics of primary ACP, paired recurrent ACP, and RCC. Western blotting was used to validate our proteomic results and assess the expression of key tumour-associated proteins in recurrent and primary ACPs. Flow cytometry was performed to evaluate the exhaustion of tumour-infiltrating lymphocytes (TILs) in primary and recurrent ACP tissue samples. Immunohistochemical staining for CD3 and PD-L1 was conducted to determine differences in T-cell infiltration and the expression of immunosuppressive molecules between paired primary and recurrent ACP samples.

Results

The bioinformatics analysis showed that proteins differentially expressed between recurrent and primary ACPs were significantly associated with extracellular matrix organisation and interleukin signalling. Cathepsin K, which was upregulated in recurrent ACP compared with that in primary ACP, may play a role in ACP recurrence. High infiltration of T cells and exhaustion of TILs were revealed by the flow cytometry analysis of ACP.

Conclusions

This study provides a preliminary description of the proteomic differences between primary ACP, recurrent ACP, and RCC. Our findings serve as a resource for craniopharyngioma researchers and may ultimately expand existing knowledge of recurrent ACP and benefit clinical practice.
A chromosome-level genome assembly of the soybean pod borer: insights into larval transcriptional response to transgenic soybean expressing the pesticidal Cry1Ac protein
Authors: Wang Yangzhou , Yao Yao , Zhang Yunyue , Qian Xueyan , Guo Dongquan , Coates Brad S.
Published: April 2024

Background

Genetically modified (GM) crop plants with transgenic expression ofBacillus thuringiensis(Bt) pesticidal proteins are used to manage feeding damage by pest insects. The durability of this technology is threatened by the selection for resistance in pest populations. The molecular mechanism(s) involved in insect physiological response or evolution of resistance to Bt is not fully understood.

Results

To investigate the response of a susceptible target insect to Bt, the soybean pod borer,Leguminivora glycinivorella(Lepidoptera: Tortricidae), was exposed to soybean,Glycine max, expressing Cry1Ac pesticidal protein or the non-transgenic parental cultivar. Assessment of larval changes in gene expression was facilitated by a third-generation sequenced and scaffolded chromosome-level assembly of theL. glycinivorellagenome (657.4 Mb; 27 autosomes + Z chromosome), and subsequent structural annotation of 18,197 RefSeq gene models encoding 23,735 putative mRNA transcripts. Exposure ofL. glycinivorellalarvae to transgenic Cry1AcG. maxresulted in prediction of significant differential gene expression for 204 gene models (64 up- and 140 down-regulated) and differential splicing among isoforms for 10 genes compared to unexposed cohorts. Differentially expressed genes (DEGs) included putative peritrophic membrane constituents, orthologs of Bt receptor-encoding genes previously linked or associated with Bt resistance, and those involved in stress responses. Putative functional Gene Ontology (GO) annotations assigned to DEGs were significantly enriched for 36 categories at GO level 2, respectively. Most significantly enriched cellular component (CC), biological process (BP), and molecular function (MF) categories corresponded to vacuolar and microbody, transport and metabolic processes, and binding and reductase activities. The DEGs in enriched GO categories were biased for those that were down-regulated (≥ 0.783), with only MF categories GTPase and iron binding activities were bias for up-regulation genes.

Conclusions

This study provides insights into pathways and processes involved larval response to Bt intoxication, which may inform future unbiased investigations into mechanisms of resistance that show no evidence of alteration in midgut receptors.
Timing of early water intake post-general anaesthesia: a systematic review and meta-analysis
Authors: Dai Suwan , Chen Lingyan , Wu Min , Guo Liangyou , Wang Rong
Published: April 2024

Background

Early water intake has gained widespread attention considering enhanced recovery after surgery (ERAS). In the present systematic evaluation and meta-analysis, we assessed the effects of early water intake on the incidence of vomiting and aspiration in adult patients who received general anaesthesia on regaining consciousness during the resuscitation period.

Objective

To systematically analyse the results of randomised controlled trials on early postoperative water intake in patients who underwent different types of surgery under general anaesthesia, both at home and abroad, to further explore the safety and application of early water intake and provide an evidence-based foundation for clinical application.

Design

Systematic review and meta-analysis.

Methods

To perform the systematic evaluation and meta-analysis, we searched the Web of Science, CINAHL, Embase, PubMed, Cochrane Library, Sinomed, China National Knowledge Infrastructure (CNKI), Wanfang, and Vipshop databases to identify randomised controlled trial studies on early water intake in adult patients who received general anaesthesia.

Results

Herein, we included 10 publications with a total sample size of 5131 patients. Based on statistical analysis, there was no statistically significant difference in the incidence of vomiting (odds ratio [OR] = 0.81; 95% confidence interval [CI] [0.58–1.12]; p = 0.20; I-squared [I2] = 0%) and aspiration (OR = 0.78; 95%CI [0.45–1.37]; p = 0.40; I2 = 0%) between the two groups of patients on regaining consciousness post-general anaesthesia.

Conclusion

Based on the available evidence, early water intake after regaining consciousness post-anaesthesia did not increase the incidence of adverse complications when compared with traditional postoperative water abstinence. Early water intake could effectively improve patient thirst and facilitate the recovery of gastrointestinal function.
How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study
Authors: Johnsgård Tine , Elenjord Renate , Holis Renata Vesela , Waaseth Marit , Zahl-Holmstad Birgitte , Fagerli Marie , Svendsen Kristian , Lehnbom Elin Christina , Ofstad Eirik Hugaas , Risør Torsten , Garcia Beate Hennie
Published: April 2024

Background

Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician’s responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs.

Methods

An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021.

Results

In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians’ work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks.

Conclusion

In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.
An ecological resilience model for adolescents with type 1 diabetes: a cross-sectional study
Authors: Luo Dan , Cai Xue , Wang Hong , Xu Jingjing , Wang Yubing , Li Mingzi
Published: April 2024

Background

Highly resilient adolescents with type 1 diabetes have been proved to achieve within-target glycemic outcomes and experience high quality of life. The ecological resilience model for adolescents with type 1 diabetes was developed in this study. It aims to increase our understanding of how resilience is both positively and negatively affected by internal and environmental ecological factors.

Methods

This cross-sectional study surveyed 460 adolescents with type 1 diabetes from 36 cities in 11 provinces, China. Participants completed self-report questionnaires on resilience, family functioning, peer support, peer stress, coping style, and demographics. Standard glycated hemoglobin tests were performed on the adolescents. Structural equation modeling was applied to analyze the data.

Results

The ecological resilience model for adolescents with type 1 diabetes was a good model with a high level of variance in resilience (62%). Family functioning was the most important predictor of resilience, followed by peer support, positive coping, and peer stress. Moreover, positive coping was the mediator of the relationship between family functioning and resilience. Positive coping and peer stress co-mediated the association between peer support and resilience.

Conclusions

Family functioning, peer relationships, and positive coping are interrelated, which may jointly influence resilience. The findings provide a theoretical basis for developing resilience-promotion interventions for adolescents with type 1 diabetes, which may lead to health improvements during a vulnerable developmental period.
Survival among children under-five in India: a parametric multilevel survival approach
Authors: Jaiswal Ajit Kumar , Alagarajan Manoj , Meitei Wahengbam Bigyananda
Published: April 2024

Background

Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective.

Method

The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015–16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that ‘individuals’ (i.e., level-1) are nested within ‘districts’ (i.e., level-2), and districts are enclosed within ‘states’ (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics.

Results

Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17 and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady.

Conclusion

This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics.
Action researchers as “orchestrators” of co-innovation: a theoretical and methodological framework
Authors: Eliassen Marianne , Arntzen Cathrine , Forslund Lina , Nikolaisen Morten , Alexandersson Patrik , Gramstad Astrid , Hellström Andreas
Published: April 2024

Background

With the increasing complexity of health care services, more comprehensive and integrated services need to be designed. Action researchers are encouraged to facilitate multiactor participation and user-centered approaches to initiate service development. However, “orchestrating” co-innovation, in which actors have diverse attitudes, agendas, positions of power, and horizons of understanding, is challenging, and a framework that supports action researchers in co-innovation studies lack. The purpose of this article was to explore how action researchers can facilitate multiactor engagement and handle possible challenges and stimulate creativity among diverse stakeholders.

Methods

We have studied and discussed two Scandinavian cases of rehabilitation innovation (for cancer patients and persons with acquired brain injury) where two research teams with action research approaches have acted in an orchestrating role to create co-innovation.

Results

We identified four themes that are essential for action researchers to facilitate collaborative and creative co-innovation processes: (1) relational power reflexibility, (2) resource integration, (3) joint understanding, and (4) the facilitation of creativity. These mutually dependent themes constitute a theoretical and methodological framework for of co-innovation.

Conclusions

This paper offers a contribution that supports action researchers in orchestrating diverse actors and their contributions in co-innovation processes.
Socioeconomic factors associated with use of telehealth services in outpatient care settings during the COVID-19
Authors: Kim Pearl C. , Tan Lo-Fu , Kreston Jillian , Shariatmadari Haniyeh , Keyoung Estella Sky , Shen Jay J. , Wang Bing-Long
Published: April 2024

Background

To examine potential changes and socioeconomic disparities in utilization of telemedicine in non-urgent outpatient care in Nevada since the COVID-19 pandemic.

Methods

This retrospective cross-sectional analysis of telemedicine used the first nine months of 2019 and 2020 electronic health record data from regular non-urgent outpatient care in a large healthcare provider in Nevada. The dependent variables were the use of telemedicine among all outpatient visits and using telemedicine more than once among those patients who did use telemedicine. The independent variables were race/ethnicity, insurance status, and language preference.

Results

Telemedicine services increased from virtually zero (16 visits out of 237,997 visits) in 2019 to 10.8% (24,159 visits out of 222,750 visits) in 2020. Asians (odds ratio [OR] = 0.85; 95% confidence interval [CI] = 0.85,0.94) and Latinos/Hispanics (OR = 0.89; 95% CI = 0.85, 0.94) were less likely to use telehealth; Spanish-speaking patients (OR = 0.68; 95% CI = 0.63, 0.73) and other non-English-speaking patients (OR = 0.93; 95% CI = 0.88, 0.97) were less likely to use telehealth; and both Medicare (OR = 0.94; 95% CI = 0.89, 0.99) and Medicaid patients (OR = 0.91; 95% CI = 0.87, 0.97) were less likely to use telehealth than their privately insured counterparts. Patients treated in pediatric (OR = 0.76; 95% CI = 0.60, 0.96) and specialty care (OR = 0.67; 95% CI = 0.65, 0.70) were less likely to use telemedicine as compared with patients who were treated in adult medicine.

Conclusions

Racial/ethnic and linguistic factors were significantly associated with the utilization of telemedicine in non-urgent outpatient care during COVID-19, with a dramatic increase in telemedicine utilization during the onset of the pandemic. Reducing barriers related to socioeconomic factors can be improved via policy and program interventions.
Withdrawal during outpatient low dose buprenorphine initiation in people who use fentanyl: a retrospective cohort study
Authors: Jones Benjamin L. H. , Geier Michelle , Neuhaus John , Coffin Phillip O. , Snyder Hannah R. , Soran Christine S. , Knight Kelly R. , Suen Leslie W.
Published: April 2024

Background

Buprenorphine is an effective treatment for opioid use disorder (OUD); however, buprenorphine initiation can be complicated by withdrawal symptoms including precipitated withdrawal. There has been increasing interest in using low dose initiation (LDI) strategies to reduce this withdrawal risk. As there are limited data on withdrawal symptoms during LDI, we characterize withdrawal symptoms in people with daily fentanyl use who underwent initiation using these strategies as outpatients.

Methods

We conducted a retrospective chart review of patients with OUD using daily fentanyl who were prescribed 7-day or 4-day LDI at 2 substance use disorder treatment clinics in San Francisco. Two addiction medicine experts assessed extracted chart documentation for withdrawal severity and precipitated withdrawal, defined as acute worsening of withdrawal symptoms immediately after taking buprenorphine. A third expert adjudicated disagreements. Data were analyzed using descriptive statistics.

Results

There were 175 initiations in 126 patients. The mean age was 37 (SD 10 years). 71% were men, 26% women, and 2% non-binary. 21% identified as Black, 16% Latine, and 52% white. 60% were unstably housed and 75% had Medicaid insurance. Substance co-use included 74% who used amphetamines, 29% cocaine, 22% benzodiazepines, and 19% alcohol. Follow up was available for 118 (67%) initiations. There was deviation from protocol instructions in 22% of these initiations with follow up. 31% had any withdrawal, including 21% with mild symptoms, 8% moderate and 2% severe. Precipitated withdrawal occurred in 10 cases, or 8% of initiations with follow up. Of these, 7 had deviation from protocol instructions; thus, there were 3 cases with follow up (3%) in which precipitated withdrawal occurred without protocol deviation.

Conclusions

Withdrawal was relatively common in our cohort but was mostly mild, and precipitated withdrawal was rare. Deviation from instructions, structural barriers, and varying fentanyl use characteristics may contribute to withdrawal. Clinicians should counsel patients who use fentanyl that mild withdrawal symptoms are likely during LDI, and there is still a low risk for precipitated withdrawal. Future studies should compare withdrawal across initiation types, seek ways to support patients in initiating buprenorphine, and qualitatively elicit patients’ withdrawal experiences.
Trends in prevalence of unmet need for family planning in India: patterns of change across 36 States and Union Territories, 1993–2021
Authors: Devaraj Kirtana , Gausman Jewel , Mishra Raman , Kumar Akhil , Kim Rockli , Subramanian S. V.
Published: April 2024

Background

Eliminating unmet need for family planning by 2030 is a global priority for ensuring healthy lives and promoting well-being for all at all ages. We estimate the sub-national trends in prevalence of unmet need for family planning over 30 years in India and study differences based on socio-economic and demographic factors.

Methods

We used data from five National Family Health Surveys (NFHS) conducted between 1993 to 2021 for the 36 states/Union Territories (UTs) of India. The study population included women of ages 15–49 years who were married or in a union at the time of the survey. The outcome was unmet need for family planning which captures the prevalence of fecund and sexually active women not using contraception, who want to delay or limit childbearing. We calculated the standardized absolute change to estimate the change in prevalence on an annual basis across all states/UTs. We examined the patterning of prevalence of across demographic and socioeconomic characteristics and estimated the headcount of women with unmet need in 2021.

Results

The prevalence of unmet need in India decreased from 20·6% (95% CI: 20·1– 21·2%) in 1993, to 9·4% (95% CI: 9·3–9·6%) in 2021. Median unmet need prevalence across states/UTs decreased from 17·80% in 1993 to 8·95% in 2021. The north-eastern states of Meghalaya (26·9%, 95% CI: 25·3–28·6%) and Mizoram (18·9%, 95% CI: 17·2–20·6%), followed by the northern states of Bihar (13·6%, 95% CI: 13·1–14·1%) and Uttar Pradesh (12·9%, 95% CI: 12·5–13·2%), had the highest unmet need prevalence in 2021. As of 2021, the estimated number of women with an unmet need for family planning was 24,194,428. Uttar Pradesh, Bihar, Maharashtra, and West Bengal accounted for half of this headcount. Women of ages 15–19 and those belonging the poorest wealth quintile had a relatively high prevalence of unmet need in 2021.

Conclusions

The existing initiatives under the National Family Planning Programme should be strengthened, and new policies should be developed with a focus on states/UTs with high prevalence, to ensure unmet need for family planning is eliminated by 2030.
Validation of the predictive value of BDNF -87 methylation for antidepressant treatment success in severely depressed patients—a randomized rater-blinded trial
Authors: Maier Hannah Benedictine , Neyazi Alexandra , Bundies Gabriel L. , Meyer-Bockenkamp Fiona , Bleich Stefan , Pathak Hansi , Ziert Yvonne , Neuhaus Barbara , Müller Franz-Josef , Pollmann Iris , Illig Thomas , Mücke Stefanie , Müller Meike , Möller Brinja Kira , Oeltze-Jafra Steffen , Kacprowski Tim , Voges Jan , Müntefering Fabian , Scheiber Josef , Reif Andreas , Aichholzer Mareike , Reif-Leonhard Christine , Schmidt-Kassow Maren , Hegerl Ulrich , Reich Hanna , Unterecker Stefan , Weber Heike , Deckert Jürgen , Bössel-Debbert Nicole , Grabe Hans J. , Lucht Michael , Frieling Helge
Published: April 2024

Background

Brain-derived neurotrophic factor (BDNF) is essential for antidepressant treatment of major depressive disorder (MDD). Our repeated studies suggest that DNA methylation of a specific CpG site in the promoter region of exon IV of the BDNF gene (CpG -87) might be predictive of the efficacy of monoaminergic antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and others. This trial aims to evaluate whether knowing the biomarker is non-inferior to treatment-as-usual (TAU) regarding remission rates while exhibiting significantly fewer adverse events (AE).

Methods

The BDNF trial is a prospective, randomized, rater-blinded diagnostic study conducted at five university hospitals in Germany. The study’s main hypothesis is that {1} knowing the methylation status of CpG -87 is non-inferior to not knowing it with respect to the remission rate while it significantly reduces the AE rate in patients experiencing at least one AE. The baseline assessment will occur upon hospitalization and a follow-up assessment on day 49 (± 3). A telephone follow-up will be conducted on day 70 (± 3). A total of 256 patients will be recruited, and methylation will be evaluated in all participants. They will be randomly assigned to either the marker or the TAU group. In the marker group, the methylation results will be shared with both the patient and their treating physician. In the TAU group, neither the patients nor their treating physicians will receive the marker status. The primary endpoints include the rate of patients achieving remission on day 49 (± 3), defined as a score of ≤ 10 on the Hamilton Depression Rating Scale (HDRS-24), and the occurrence of AE.

Ethics and dissemination

The trial protocol has received approval from the Institutional Review Boards at the five participating universities. This trial holds significance in generating valuable data on a predictive biomarker for antidepressant treatment in patients with MDD. The findings will be shared with study participants, disseminated through professional society meetings, and published in peer-reviewed journals.

Trial registration

German Clinical Trial Register DRKS00032503. Registered on 17 August 2023.
Occludin and collagen IV degradation mediated by the T9SS effector SspA contributes to blood–brain barrier damage in ducks during Riemerella anatipestifer infection
Authors: Chen Zongchao , Zhu Min , Liu Dan , Wu Mengsi , Niu Pengfei , Yu Yang , Ding Chan , Yu Shengqing
Published: April 2024

Riemerella anatipestifer infection is characterized by meningitis with neurological symptoms in ducklings and has adversely affected the poultry industry. R. anatipestifer strains can invade the duck brain to cause meningitis and neurological symptoms, but the underlying mechanism remains unknown. In this study, we showed that obvious clinical symptoms, an increase in blood‒brain barrier (BBB) permeability, and the accumulation of inflammatory cytokines occurred after intravenous infection with the Yb2 strain but not the mutant strain Yb2ΔsspA, indicating that Yb2 infection can lead to cerebrovascular dysfunction and that the type IX secretion system (T9SS) effector SspA plays a critical role in this pathological process. In addition, we showed that Yb2 infection led to rapid degradation of occludin (a tight junction protein) and collagen IV (a basement membrane protein), which contributed to endothelial barrier disruption. The interaction between SspA and occludin was confirmed by coimmunoprecipitation. Furthermore, we found that SspA was the main enzyme mediating occludin and collagen IV degradation. These data indicate that R. anatipestifer SspA mediates occludin and collagen IV degradation, which functions in BBB disruption in R. anatipestifer-infected ducks. These findings establish the molecular mechanisms by which R. anatipestifer targets duckling endothelial cell junctions and provide new perspectives for the treatment and prevention of R. anatipestifer infection.