bluuebunny/crossref_metadata_2025 huggingface dataset:
Motivation of Lithuanian Saturday school heritage language teachers
Authors: Jakaitė-Bulbukienė Kristina , Matulionytė Akvilė
Published: August 2024

Working (or volunteering) in a Lithuanian Saturday (or Sunday) school abroad is difficult. Teachers must balance work, family, and teaching in those schools, give up their free time to prepare for classes, and spend Saturdays working. Some of them need to find not only teaching materials, but also a place for teaching. Moreover, some parents often have very high expectations for the school—they do not speak enough Lithuanian at home, or not even at all, but they expect that the school will teach their child to speak it fluently in a half of a day. In addition, the Lithuanian language is a quite rare, non-international language for teaching and learning of which another motivation needs to be found rather than size, usefulness, and prestige. However, the number of schools abroad not only do not decrease in number, but every year more and more are established, and in more distant countries. The fact that this number of schools is growing tells us that teachers who want to take on the challenge can in fact be found. This article aims to find out why people choose to work or volunteer in these schools, what brings them there, and what keeps them there—what is their motivation. This article is based on the data of a quantitative survey about Lithuanian Saturday school teachers’ attitudes and motivation (2021–2022).
Exploring Bioactive Constituents and Pharmacological Effects of Scutellaria baicalensis Georgi: A Review
Authors: Liu Yan , Gao Zhixu , Zhao Yintao , Kong Lingjuan , Ji Xiaoqing , Wu Jinyang , Gao Zhanhua
Published: August 2024

Scutellaria baicalensis, commonly known as Chinese Skullcap, is a traditional herb with a long history of cultural use in Chinese medicines. This review focuses on a comprehensive summary of the morphological description, bioactive compounds, drug-herb interactions, and pharmacological activities of Scutellaria baicalensis, as well as its therapeutic applications. A wide-ranging search using databases such as PubMed, Scopus, Google Scholar, and advanced search on the Web was conducted for data collection from prior studies. The plant root contains major active constituents including flavonoids and flavo-glycosides such as wogonin, baicalein, baicalin, oroxylin A, scutellarein, and norwogonin. These compounds have demonstrated a variety of pharmacological activities, combating inflammation, oxidative stress, cancer, neuronal disorders, and liver disorders. Chinese Skullcap represents a promising avenue for potential pharmacotherapeutic formulation advancement, emphasizing the need for further scientific exploration and clinical trials.
There are Other Ways to Know: The Role of Spirituality in Theological Research for Gaining Understanding and Attaining Personal Transformation
Authors: Aždajić Dejan
Published: August 2024

Theological research typically pursues knowledge acquisition without the explicit integration of spirituality as a legitimate source and process of gaining understanding. This historically evolved assumption tacitly presupposes that spirituality may impede rational objectivity and thereby delegitimize some of the research findings. There is also a resolute presumption that cognitive forms of appropriating knowledge are inherently superior to all other forms of procuring comprehension. This paper argues that such a bifurcation is unwarranted, and that lived spirituality does indeed have an important epistemological function. Aspects of practiced spirituality, which are here explored through a Christian lens, offer multiple possibilities for knowledge augmentation. Motivated by love for God and neighbour, researchers can employ various epistemic methodologies for gaining greater discernment, which include embodiment, spiritual practices, religious experiences, and pneumatological insights. A deliberately spiritual approach to research provides new avenues for understanding, while at the same time inviting the researcher on a holistic journey of personal transformation.
Assessing the Incidence of Head Trauma in Australian Mixed Martial Arts: A Retrospective Analysis of Fight Outcomes
Authors: Brown Daniel A. , Gross Garret
Published: August 2024

Background:

Mixed martial arts (MMA) is experiencing a surge in popularity in Australia. Previous research has suggested knockout (KO) and technical knockout (TKO) are frequent outcomes during competition, raising concern about the brain health of athletes. This study aims to describe fight outcomes in Australian MMA and to explore differences in fight-ending outcomes between male and female athletes, amateur and professional competition, and different weight classes.

Hypothesis:

There is no difference in the incidence of KO/TKO between level of competition, sex, and weight class.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 3.

Methods:

Retrospective analysis of 143 Australian MMA events from 2020 to 2023 was conducted using video replay to assess fight outcomes between sex and level of competition. Binary logistic regression analysis was used to determine relationships between weight class and KO/TKO fight outcomes.

Results:

Male competition (34%) had a significantly greater number of KO/TKO secondary to head strikes fight outcomes compared with female competition (23%) ( P = 0.01). The KO/TKO rate secondary to head strikes for amateur and professional male competition was 16.6 and 18.7 per 100 athlete-exposures (AEs), respectively. The amateur and professional female rate was 12.6 and 7.4 per 100 AEs, respectively. Amateur male light heavyweight and heavyweight, and professional male heavyweight were at greater odds of a KO or TKO compared with other weight classes in their equivalent level of competition.

Conclusion:

There is a sex and professional level disparity in the incidence of fight-ending head trauma in Australian MMA. The study findings highlight the urgent need for targeted safety protocols and medical oversight, particularly for men in heavier weight classes.

Clinical Relevance:

This study highlights the need for enhanced safety protocols and medical oversight in Australian MMA, particularly for male athletes in heavier weight divisions.
Privacy resignation, apathy, and cynicism: Introduction to a special theme
Authors: Draper Nora A , Pieter Hoffmann Christian , Lutz Christoph , Ranzini Giulia , Turow Joseph
Published: August 2024

The growing trend of collecting data about individuals to track past actions and infer future attitudes and behaviors has fueled popular and scholarly interest in the erosion of privacy. Recent shifts in technologies around machine learning and artificial intelligence have intensified these concerns. This editorial introduces the articles in the special theme on digital resignation and privacy cynicism: concepts developed in the past decade to explain the growing powerlessness individuals feel in relation to their digital privacy even as they continue to experience consternation over the collection and use of their personal information. The papers in this special theme engage and extend existing research on these topics. The original articles and commentaries pose theoretical and practical questions related to the ways people confront the powerful institutional forces that increasingly shape many aspects of the information environment. They employ several methodologies and theoretical perspectives and extend the range of geographic, political, cultural, and institutional contexts in which privacy cynicism and digital resignation can be identified and examined. In addition to contextualizing these contributions, this editorial maps a range of related concepts including digital resignation, privacy cynicism, privacy apathy, surveillance realism, privacy fatigue, and privacy helplessness. It concludes by identifying key themes across the papers in this collection and provides directions for future research.
Osteochondritis Dissecans of the Knee: A Case Report
Authors: Johnson Benjamin L. , Schultz Cassidy M. , Wyatt Charles W. , Wilson Philip L.
Published: August 2024

Osteochondritis dissecans (OCD) is a focal, idiopathic alteration of subchondral bone with the potential for instability and disruption of adjacent articular cartilage causing pain or discomfort in the knee and, if left untreated, may cause increasing disability and progressive arthritic change of the joint. This article presents a case study of a 16-year-old female who presented with intermittent right lateral knee pain for several years with no acute traumatic injury. Diagnostic imaging demonstrated subchondral changes of the lateral femoral condyle consistent with osteochondritis dissecans. The patient was diagnosed with an unstable OCD of the right knee and underwent surgical treatment. Following treatment, the patient attended formal physical therapy two times per week and began a gradual return to sport protocol at 4 months post-operatively. This case study will demonstrate the complexities surrounding the clinical presentation, diagnostic workup, and treatment options for this challenging diagnosis. The importance of accurate imaging and aggressive treatment of unstable OCD lesions will be highlighted.
Pneumonia, Depression, and Mortality are Impacted by Feeding Route in Patients With Dysphagia
Authors: Hanners Gutierrez Jennifer , Lazarus Cathy , Corwin Melinda , Leslie Paula
Published: August 2024

Background: Liquid nutrition delivered through a tube is often used amid difficulty swallowing. Tube feeding has been shown to have a relationship to pneumonia and mortality. Aim: Researchers investigated the relationship of feeding route (oral or tube) to patient outcomes. Design: Data were collected on outcomes (pneumonia, depression, mortality), feeding route, presence/absence of dysphagia, and covariates (chronic obstructive pulmonary disease [COPD], stroke, mortality risk, illness severity, sex, age). Researchers collected data over a 45-month period to ensure an adequate sample size for matching. The method of sampling was retrospective, archival data analysis. Propensity score analysis resulted in 94 matched, balanced pairs. Covariates were isolated from the treatment effect. Participants: The records of 2,180 inpatients treated by Palliative Medicine were considered, and 292 met the inclusion criteria. Results: Results revealed 10.14 times greater odds of pneumonia (OR = 10.14; p < .001) with tube feeding compared to oral feeding in patients with dysphagia and end-stage COPD or end-stage stroke. Results also revealed increased odds of depression (OR = 2.79; p = .01) and mortality (OR = 3.02; p < .01) with tube feeding compared to oral feeding. Conclusion: Study findings should encourage consideration of oral nutrition at the end of life.
Growing Curiosity: Three Strategies to Foster Engagement in Large Classroom Settings Among Generation Z Public Health Undergraduate Students
Authors: Drnach-Bonaventura Grace M. , Hoffman Beth L. , Koperwas Mara L.
Published: August 2024

As undergraduate public health programs continue to grow across the United States, it is important to tailor public health pedagogy in large classroom settings to meet the learning styles of diverse Generation Z students. Generation Z students are unique as they have grown up in an uncertain economic and political environment, tend to be more open minded and open to engagement and feedback, and have a unique set of technology skills and expectations for in classroom learning. We present a case study of a three-pronged approach to effectively scale up introductory public health courses in large classroom settings to meet the learning styles for Generation Z through: (1) Integrating Technology, (2) Emphasizing Real World Skills, and (3) Providing Clear and Defined Rubrics. This combination of student digital prowess and connectedness presents unique opportunities for instructors to adopt unique teaching tools and assessment modalities to appeal to a diverse student population.
African Pastors’ Virtual Ministry from South Korea
Authors: Hirome David , Kim Hansung
Published: August 2024

The massive shift of ministry from physical to virtual spaces as occasioned by the Covid-19 pandemic led to an explosion in virtual ministry. The proliferation of social media within diverse areas of human life continues to present important ramifications for present and future church ministry. This article presents the findings of a qualitative research study into the virtual ministry of thirteen African pastors in Korea to their people back home and in so doing highlights the importance of Christian mission from an African diasporic view. The purpose of this study was to understand the experiences of African pastors in Korea who conducted virtual ministry to their congregation back home in the time of Covid-19. The grounded theory of this study was that African virtual pastoring from Korea during Covid-19 was driven by a search for community, used the prevalent and yet unreliable or problematic social media platforms, as a means to carry out interactive ministries and often extended beyond their home audiences. It is also revealed that the African pastors forged a mediated space through their virtual ministry even as they negotiated their distance and belonging in South Korean society.
Dynamic changes of food environment: In and out of COVID-19 pandemic
Authors: Lu Zhiying , Yang Yang , Ou Danlin , Gu Dazhi
Published: August 2024

The outbreak of the COVID-19 pandemic has precipitated food crises worldwide, prompting a re-examination of the resilience of the urban food environment. While previous research on the urban food environment has predominantly focused on Western contexts, scant attention has been given to China. This study takes Shenzhen, China as an example to establish a food environment evaluation framework centered on accessibility, diversity, and healthiness factors, aiming to analyze the dynamic changes of the food environment during normal and pandemic periods. By using the GA optimization algorithm, some convenience stores are transformed into self-pickup points (SPPs), which is expected to eliminate the deserts risk areas (DRAs) with low cost and high efficiency. The findings reveal a distinctive “center-periphery” spatial structure characterizing the food environment in Shenzhen, and the improvement of healthiness plays a crucial role in sustaining food oases and ameliorating food swamps. This research provides methods for improving the resilience of the food environment during the pandemic across diverse nations, bolstering the security of urban lifeline systems.
Politics in the Name of Women’s Reservation
Authors: Dehalwar Kavita , Sharma Shashikant Nishant
Published: August 2024

The discussion highlights concerns regarding gender-based reservations in India, particularly the potential for these policies to disproportionately benefit wealthier and upper-class women, sidelining women from lower socio-economic strata and disadvantaged castes. It proposes solutions such as ‘reservation within reservation’ for Scheduled Castes and Scheduled Tribes to ensure equitable distribution of benefits and advocates for a shift towards economic-based reservations, considering financial need rather than gender alone. The importance of education, awareness campaigns and transparent criteria for reservation is emphasized, promoting equal access to opportunities. An intersectional approach that addresses both gender and caste factors is deemed essential to bridge existing disparities. The discussion concludes by emphasizing the need for regular reviews and data-driven policy adjustments to create an inclusive reservation system that empowers individuals from all backgrounds, aligning with the broader goal of fostering a just and balanced society.
How does it feel? Space and text as affective affordances in the multimodal museum
Authors: Johnstone Eilidh , Liao Min-Hsiu , Strani Katerina
Published: August 2024

Museums are multimodal environments where semiotic resources including objects, space, sound, light, movement, language and the body converge. Our case study of a Taiwanese ceramics exhibition draws on the concept of ‘affective affordances’, meaning the socially and contextually informed ways that semiotic resources invite felt and embodied responses. We use this concept to investigate the ways in which texts and space co-construct affective meanings. We discuss texts and space as physical entities within the affective exhibition, each possessing intrinsic properties which can potentially stimulate certain embodied responses from visitors. Specifically, the case study addresses two questions: (1) how written texts within an exhibition interact with space to afford affective meaning potential; and (2) how museum visitors as active participants respond to space and text as affective stimuli. The study adopts a novel composite theoretical framework that combines spatial discourse analysis using the Binding framework, linguistic analysis using the Appraisal framework, and walking interviews. Our analysis provides rich empirical evidence of how space and written texts interact to create a felt sense of place for visitors.
Talking across worlds: The ontological turn and communication in natural resource co-management with Indigenous communities
Authors: Chew Suzanne
Published: August 2024

The ontological turn in critical social theory provokes emerging calls for new approaches to natural resource management where Indigenous perspectives, worldview, knowledges, and values are prioritized in the stewardship of Indigenous lands. Yet, scant literature focuses on the ontological implications for communication within environmental decision-making, where Habermas’ communicative action theory, with its norms of privileging argumentation, formality, expertise, institutional authority, rationality, and language, continues to shape spaces of public participation since the communicative turn in the 1990s. Growing calls for participatory decision-making, as well as the mounting failures of scientific management approaches espoused by conventional natural resource management, have fuelled the rise of co-management since the 1980s. The emerging emphasis in co-management approaches on community collaboration and meaningful communication was strengthened with the emergence of adaptive co-management and adaptive governance in the early 2000s. Yet, the ontological turn unveils communicative tensions which continue to persist, rooted in ontological difference and onto-epistemic violence. Rethinking communication under the ontological turn in co-management with Indigenous communities, this paper reviews the literature and further proposes the idea of ethical equivocation as a communicative tool and starting point toward learning to talk across worlds.
Avoiding future surprises after acute shocks: long-term flood risk lessons catalysed by the 2021 summer flood in the Netherlands
Authors: Pot Wieke , de Ridder Yza , Dewulf Art
Published: August 2024

In summer 2021, the Dutch Province of Limburg faced an acute high-water event caused by two days of heavy rainfall, resulting in €383 million worth of damage. Afterwards, various policy actors organised a number of evaluations. This study analyses these evaluations and the long-term lessons drawn from this flood event. Dealing with climate change requires insights into how lessons from acute shocks such as floods can stimulate the anticipation of climate change and solutions that can cope with future extremes. This study therefore applies policy learning theory—single, double and triple loop learning—to different layers of flood safety to analyse the extent to which governments prepare for future events and how.

The results show that pre-2021 water and flood risk management policies—our point of comparison to derive what lessons emerge after the 2021 flood—focused mostly on flood prevention (layer 1) and from 1996 onwards with the start of the Room for the River programme also on spatial planning (layer 2), without paying much attention to crisis management (layer 3). Based on the 2021 flood, the official evaluation committee recommends adding two more layers to the multilayer flood safety approach: increasing water awareness (layer 0 as a base layer for the other layers) and focusing on climate-robust recovery after floods (layer 4) to improve long-term robustness. Based on our research, triple-loop learning as the deepest type of learning appeared in the form of applying the Room for the River approach to the tributary brooks systems. To prepare for the future, policy evaluations recommend improving stress tests to better deal with climate change. Futures scenarios and visions for the future are also recommended. Creating future visions can help to steer changes in existing land use and re-think areas to build or to use for water retention, for example. Governments are advised to strengthen their anticipatory capacities as part of their crisis management response and recovery systems. Furthermore, governments will need to apply the different layers for multilayer safety in an integrated way to ensure that regions are able to prepare for future floods.
Distribution and functional perspective analysis of epiphytic and endophytic bacterial communities associated with marine seaweeds, Alexandria shores, Egypt
Authors: Abdelrazek Hanan M. , Shams El-Din Nihal G. , Ghozlan Hanan A. , Sabry Soraya A. , Abouelkheir Samia S.
Published: August 2024

There is an enormous diversity of life forms present in the extremely intricate marine environment. The growth and development of seaweeds in this particular environment are controlled by the bacteria that settle on their surfaces and generate a diverse range of inorganic and organic chemicals. The purpose of this work was to identify epiphytic and endophytic bacterial populations associated with ten common marine macroalgae from various areas along the Mediterranean Sea coast in Alexandria. This was done to target their distribution and possible functional aspects. Examine the effects of the algal habitat on the counting and phenotypic characterization of bacteria, which involves grouping bacteria based on characteristics such as shape, colour, mucoid nature, type of Gram stain, and their ability to generate spores. Furthermore, studying the physiological traits of the isolates under exploration provides insight into the optimum environmental circumstances for bacteria associated with the formation of algae. The majority of the bacterial isolates exhibited a wide range of enzyme activities, with cellulase, alginase, and caseinase being the most prevalent, according to the data. Nevertheless, 26% of the isolates displayed amylolytic activity, while certain isolates from Miami, Eastern Harbor, and Montaza lacked catalase activity. Geographical variations with the addition of algal extract may impact on the enumeration of the bacterial population, and this might have a relationship with host phylogeny. The most significant observation was that endophytic bacteria associated with green algae increased in all sites, while those associated with red algae increased in Abu Qir and Miami sites and decreased in Eastern Harbor. At the species level, the addition of algal extract led to a ninefold increase in the estimated number of epiphytic bacteria for Cladophora pellucida in Montaza. Notably, after adding algal extract, the number of presented endophytic bacteria associated with Codium sp. increased in Abu Qir while decreasing with the same species in Montaza. In addition to having the most different varieties of algae, Abu Qir has the most different bacterial isolates.
Ultrasound-guided superior laryngeal nerve block: a randomized comparison between parasagittal and transverse approach
Authors: Shan Tao , Tan Qilian , Wu Dan , Bao Hongguang , Ge Degao , Han Liu , Su Chuan , Ju Yu
Published: August 2024

Background

Different approach ultrasound-guided superior laryngeal nerve block was used to aid awake intubation, but little is known which approach was superior. We aimed to compare the parasagittal and transverse approaches for ultrasound-guided superior laryngeal nerve block in adult patients undergoing awake intubation.

Methods

Fifty patients with awake orotracheal intubation were randomized to receive either a parasagittal or transverse ultrasound-guided superior laryngeal nerve block. The primary outcome was patient’s quality of airway anesthesia grade during insertion of the tube into the trachea. The patients’ tube tolerance score after intubation, total procedure time, mean arterial pressure, heart rate, Ramsay sedation score at each time point, incidence of sore throat both 1 h and 24 h after extubation, and hoarseness before intubation, 1 h and 24 h after extubation were documented.

Results

Patients’ quality of airway anesthesia was significantly better in the parasagittal group than in the transverse group (median grade[IQR], 0 [0–1] vs. 1 [0–1], P = 0.036). Patients in the parasagittal approach group had better tube tolerance scores (median score [IQR],1[1–1] vs. 1 [1–1.5], P = 0.042) and shorter total procedure time (median time [IQR], 113 s [98.5–125.5] vs. 188 s [149.5–260], P < 0.001) than those in the transverse approach group. The incidence of sore throat 24 h after extubation was lower in the parasagittal group (8% vs. 36%, P = 0.041). Hoarseness occurred in more than half of the patients in parasagittal group before intubation (72% vs. 40%, P = 0.023).

Conclusions

Compared to the transverse approach, the ultrasound-guided parasagittal approach showed improved efficacy in terms of the quality of airway topical anesthesia and shorter total procedure time for superior laryngeal nerve block.

Trial registration

This prospective, randomized controlled trial was approved by the Ethics Committee of Nanjing First Hospital (KY20220425-014) and registered in the Chinese Clinical Trial Registry (19/6/2022, ChiCTR2200061287) prior to patient enrollment. Written informed consent was obtained from all participants in this trial.
Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care
Authors: Sideman Alissa Bernstein , Nguyen Huong Q. , Langer-Gould Annette , Lee Eric A. , Borson Soo , Shen Ernest , Tsoy Elena , Macias Mayra , Goode Collette , Rankin Katherine , Kramer Joel , Possin Katherine L.
Published: August 2024

Background

Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia.

Methods

This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity.

Results

We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027.

Conclusions

Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention’s effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system.

Trial Registation

Clinicaltrials.gov: NCT06090578 (registered 10/24/23).
Do behavioral drivers matter for healthcare decision-making during crises? A study of low-income women in El Salvador during the COVID-19 pandemic
Authors: Lara Pedro Bernal , Daga Giuliana , Kossuth Lajos , Boo Florencia Lopez
Published: August 2024

Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors—internal locus of control, impatience, optimism bias, and aspirations—and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women’s use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers’ influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks.

JEL Codes

I12, D10, D91, I30.
How women living with HIV in the UK manage infant-feeding decisions and vertical transmission risk – a qualitative study
Authors: Kasadha Bakita , Hinton Lisa , Tariq Shema , Nyatsanza Farai , Namiba Angelina , Freeman-Romilly Nell , Rai Tanvi
Published: August 2024

Background

The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, across high-income countries, HIV and infant-feeding guidelines recommend exclusive formula feeding if parents want to avoid all risk of postpartum transmission. However, recently these guidelines (including in the United Kingdom (UK)) increasingly state that individuals with HIV should be supported to breast/chest feed if they meet certain criteria; such as an undetectable maternal HIV viral load and consent to additional clinical monitoring. Between 600 and 800 pregnancies are reported annually in women with HIV in the UK, with low rates of vertical transmission (0.22%). Informed infant-feeding decision-making requires clinical support. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with their clinical teams and familial and social networks, and the resources needed to reach an informed decision.

Methods

Semi-structured remote interviews were conducted between April 2021 – January 2022 with UK-based individuals with a confirmed HIV diagnosis who were pregnant or one-year postpartum. Using purposive sampling, pregnant and postpartum participants were recruited through NHS HIV clinics, community-based organisations and snowballing. Data were analysed thematically and organised using NVivo 12.

Results

Of the 36 cisgender women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The majority of postpartum women had chosen to formula feed. Women’s decision-making regarding infant-feeding was determined by (1) information and support; (2) practicalities of implementing medical guidance; (3) social implications of infant-feeding decisions.

Conclusion

The evolution of UK HIV and infant-feeding guidelines are not reflected in the experiences of women living with HIV. Clinicians’ emphasis on reducing the risk of vertical transmission, without adequately considering personal, social and financial concerns, prevents women from making fully informed infant-feeding decisions. For some, seeking advice beyond their immediate clinical team was key to feeling empowered in their decision. The significant informational and support need among women with HIV around their infant-feeding options must be addressed. Furthermore, training for and communication by healthcare professionals supporting women with HIV is essential if women are to make fully informed decisions.
MSI2 regulates NLK-mediated EMT and PI3K/AKT/mTOR pathway to promote pancreatic cancer progression
Authors: Huang Longping , Sun Jian , Ma Yuteng , Chen He , Tian Chen , Dong Ming
Published: August 2024

Background

The incidence of pancreatic cancer is increasing by years, and the 5-year survival rate is very low. Our team have revealed that Musashi2 (MSI2) could promote aggressive behaviors in pancreatic cancer by downregulating Numb and p53. MSI2 also facilitates EMT in pancreatic cancer induced by EGF through the ZEB1-ERK/MAPK signaling pathway. This study aims to further explore the molecular mechanisms of MSI2-regulated downstream pathways in pancreatic cancer.

Methods

In vitro and in vivo experiments were conducted to investigate the role and mechanism of MSI2 in promoting malignant behaviors of pancreatic cancer through regulation of NLK.

Results

Genes closely related to MSI2 were screened from the GEPIA and TCGA databases. We found that NLK showed the most significant changes in mRNA levels with consistent changes following MSI2 interference and overexpression. The high correlation between MSI2 and NLK was also observed at the protein level. Multivariate analysis revealed that both MSI2 and NLK were independent adverse indicators of survival in pancreatic cancer patients, as well as join together. In vitro, silencing or overexpressing NLK altered cell invasion and migration, by regulating EMT and the PI3K-AKT-mTOR pathway. Silencing MSI2 reduced protein expression in the EMT and PI3K-AKT-mTOR pathways, leading to decreased cell invasion and migration abilities, while these effects could be reversed by overexpression of NLK. In vivo, MSI2 silencing inhibited liver metastasis, which could be reversed by overexpressing NLK. Mechanistically, MSI2 directly binds to the translation regulatory region of NLK mRNA at positions 79–87 nt, enhancing its transcriptional activity and exerting post-transcriptional regulatory roles. The analysis of molecular docking showed the close relationship between MSI2 and NLK in pancreatic cancer patients.

Conclusions

Our findings elucidate the regulatory mechanisms of the MSI2-NLK axis in modulating aggressive behaviors of pancreatic cancer cells, which providing new evidence for therapeutic strategies in pancreatic cancer.
Investigation of pulmonary inflammatory responses following intratracheal instillation of and inhalation exposure to polypropylene microplastics
Authors: Tomonaga Taisuke , Higashi Hidenori , Izumi Hiroto , Nishida Chinatsu , Kawai Naoki , Sato Kazuma , Morimoto Toshiki , Higashi Yasuyuki , Yatera Kazuhiro , Morimoto Yasuo
Published: August 2024

Background

Microplastics have been detected in the atmosphere as well as in the ocean, and there is concern about their biological effects in the lungs. We conducted a short-term inhalation exposure and intratracheal instillation using rats to evaluate lung disorders related to microplastics. We conducted an inhalation exposure of polypropylene fine powder at a low concentration of 2 mg/m3 and a high concentration of 10 mg/m3 on 8-week-old male Fischer 344 rats for 6 h a day, 5 days a week for 4 weeks. We also conducted an intratracheal instillation of polypropylene at a low dose of 0.2 mg/rat and a high dose of 1.0 mg/rat on 12-week-old male Fischer 344 rats. Rats were dissected from 3 days to 6 months after both exposures, and bronchoalveolar lavage fluid (BALF) and lung tissue were collected to analyze lung inflammation and lung injury.

Results

Both exposures to polypropylene induced a persistent influx of inflammatory cells and expression of CINC-1, CINC-2, and MPO in BALF from 1 month after exposure. Genetic analysis showed a significant increase in inflammation-related factors for up to 6 months. The low concentration in the inhalation exposure of polypropylene also induced mild lung inflammation.

Conclusion

These findings suggest that inhaled polypropylene, which is a microplastic, induces persistent lung inflammation and has the potential for lung disorder. Exposure to 2 mg/m3 induced inflammatory changes and was thought to be the Lowest Observed Adverse Effect Level (LOAEL) for acute effects of polypropylene. However, considering the concentration of microplastics in a real general environment, the risk of environmental hazards to humans may be low.
Utilization of integrated community-based case management of childhood illness and associated factors in Ethiopia: a systematic review and meta-analysis
Authors: Mekie Maru , Belachew Yismaw Yimam , Fenta Setegn Muche , Ferede Wassie Yazie , Yehuala Enyew Dagnew , Taklual Wubet , Mekonen Demewoz Kefale , Addisu Dagne
Published: August 2024

Background

Despite significant progress being made in reducing under-five mortality, three-fourths of under-five deaths are still caused by preventable conditions such as pneumonia, diarrhea, malaria, and newborn issues. Integrated community case management of childhood illnesses (ICCM) could serve as a means to reduce preventable child mortality in Low- and Middle-Income countries. Our aim was to assess the overall level of ICCM utilization and its associated factors in Ethiopia.

Methods

Candidate studies for inclusion in this review were identified through searches across various databases, including PubMed, EMBASE, Google Scholar, and university repositories online databases, spanning from February 1, 2024, to March 18, 2024. The quality assessment of the studies included in this systematic review and meta-analysis was conducted using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data extraction and analysis were carried out using Microsoft Excel and Stata 17 software, respectively. Heterogeneity among the studies was assessed using Cochran’s Q test and I2 statistics, while the presence of publication bias was evaluated through funnel plots and Egger’s regression asymmetry test. Subgroup analysis was performed based on sample size and study site.

Results

In this study, the pooled level of ICCM utilization was found to be 42.73 (95%, CI 27.65%, 57.80%) based on the evidence obtained from ten primary studies. In this review, parents’ awareness about illness (OR = 2.77, 95%, CI 2.06, 3.74), awareness about ICCM service (OR = 3.64, 95%, CI 2.16, 6.14), perceived severity of the disease (OR = 3.14, 95%, CI 2.33, 4.23), secondary/above level of education (OR = 2.57, 95%, CI 1.39, 4.77), and live within 30 min distance to the health post (OR = 3.93, 95%, CI 2.30, 6.74) were variables significantly associated with utilization of ICCM in Ethiopia.

Conclusion

The utilization of ICCM was found to be low in Ethiopia. Factors such as parents’ awareness about the illness, knowledge of ICCM services, perceived severity of the disease, attending a secondary or more level of education, and living within 30 min distance to the health post were significantly associated with the utilization of ICCM. Therefore, it is crucial to focus on creating awareness and improving access to high-quality ICCM services to reduce child morbidity and mortality from preventable causes.
DNA-binding factor footprints and enhancer RNAs identify functional non-coding genetic variants
Authors: Biddie Simon C. , Weykopf Giovanna , Hird Elizabeth F. , Friman Elias T. , Bickmore Wendy A.
Published: August 2024

Background

Genome-wide association studies (GWAS) have revealed a multitude of candidate genetic variants affecting the risk of developing complex traits and diseases. However, the highlighted regions are typically in the non-coding genome, and uncovering the functional causative single nucleotide variants (SNVs) is challenging. Prioritization of variants is commonly based on genomic annotation with markers of active regulatory elements, but current approaches still poorly predict functional variants. To address this, we systematically analyze six markers of active regulatory elements for their ability to identify functional variants.

Results

We benchmark against molecular quantitative trait loci (molQTL) from assays of regulatory element activity that identify allelic effects on DNA-binding factor occupancy, reporter assay expression, and chromatin accessibility. We identify the combination of DNase footprints and divergent enhancer RNA (eRNA) as markers for functional variants. This signature provides high precision, but with a trade-off of low recall, thus substantially reducing candidate variant sets to prioritize variants for functional validation. We present this as a framework called FINDER—Functional SNV IdeNtification using DNase footprints and eRNA.

Conclusions

We demonstrate the utility to prioritize variants using leukocyte count trait and analyze variants in linkage disequilibrium with a lead variant to predict a functional variant in asthma. Our findings have implications for prioritizing variants from GWAS, in development of predictive scoring algorithms, and for functionally informed fine mapping approaches.
Study protocol: perinatal mood treatment study
Authors: Wolitzky-Taylor Kate , Richards Misty C. , Welborn Amelia , McDonald Vanessa , Arnaudova Inna , Fears Scott , O’Mahen Heather , Newby Jill M. , Millard Mike , Metts Allison V. , Stein Alan , Freimer Nelson , Craske Michelle G.
Published: August 2024

Perinatal depression (PND) affects up to 20% of women and is associated with significant impairment and disability in affected women. In addition, perinatal depression is associated with broader public health and multigenerational consequences. Innovative approaches are needed to reduce the burden of perinatal depression through identification, tracking, and treatment of depressive symptoms during the perinatal period. This study is a randomized clinical trial comparing the relative efficacy of a multi-tiered system of care, Screening and Treatment of Anxiety and Depression (STAND) to perinatal care delivered by a reproductive psychiatrist in reducing symptoms of depression and anxiety. A sample of 167 individuals was randomized between week 28 of pregnancy and 6 months postpartum. A secondary aim compares the original online therapy intervention used in the first half of the study to a newer online therapy program used in the second half of the study for individuals assigned to the STAND treatment. The study measures, intervention groups, and analysis methods are described, as well as expected implications. The findings from this study may improve the methods for tracking symptom changes over time, monitoring treatment response, and providing personalized care for individuals with PND. As such, this study may improve the lives of patients with PND and their families and lower the related health care costs to society.

Trial registration NCT: 9/24/2021

NCT direct link: https://www.clinicaltrials.gov/study/NCT05056454?term=NCT05056454&rank=1&a=1.
Clinical trials with mechanism evaluation of intervention(s): mind the power and sample size calculation
Authors: Lee Kim May , Hellier Jennifer , Emsley Richard
Published: August 2024

Background

Mediation analysis, often completed as secondary analysis to estimating the main treatment effect, investigates situations where an exposure may affect an outcome both directly and indirectly through intervening mediator variables. Although there has been much research on power in mediation analyses, most of this has focused on the power to detect indirect effects. Little consideration has been given to the extent to which the strength of the mediation pathways, i.e., the intervention-mediator path and the mediator-outcome path respectively, may affect the power to detect the total effect, which would correspond to the intention-to-treat effect in a randomized trial.

Methods

We conduct a simulation study to evaluate the relation between the mediation pathways and the power of testing the total treatment effect, i.e., the intention-to-treat effect. Consider a sample size that is computed based on the usual formula for testing the total effect in a two-arm trial. We generate data for a continuous mediator and a normal outcome using the conventional mediation models. We estimate the total effect using simple linear regression and evaluate the power of a two-sided test. We explore multiple data generating scenarios by varying the magnitude of the mediation paths whilst keeping the total effect constant.

Results

Simulations show the estimated total effect is unbiased across the considered scenarios as expected, but the mean of its standard error increases with the magnitude of the mediator-outcome path and the variability in the residual error of the mediator, respectively. Consequently, this affects the power of testing the total effect, which is always lower than planned when the mediator-outcome path is non-trivial and a naive sample size was employed. Analytical explanation confirms that the intervention-mediator path does not affect the power of testing the total effect but the mediator-outcome path. The usual effect size consideration can be adjusted to account for the magnitude of the mediator-outcome path and its residual error.

Conclusions

The sample size calculation for studies with efficacy and mechanism evaluation should account for the mediator-outcome association or risk the power to detect the total effect/intention-to-treat effect being lower than planned.
Acute abducens nerve palsy following coronavirus disease 2019 vaccination: a case report
Authors: Wang Chen-Ting , Li Jie-Yuan
Published: August 2024

Background

Abducens nerve palsy is the most common isolated ocular cranial nerve palsy. In adults, nontraumatic etiologies of isolated sixth cranial nerve palsy can include vascular disease, inflammation, tumors, and a prior history of infection.

Case presentation

We present a case of a 52-year-old Asian male who developed acute abducens nerve palsy after vaccination with the AstraZeneca coronavirus disease 2019 vaccine. A complete workup including magnetic resonance imaging of the brain and orbits revealed no abnormalities. The patient experienced a gradual recovery over 10 weeks through alternative eye patching. The abducens nerve palsy is postulated to be correlated with the coronavirus disease 2019 vaccine.

Conclusion

Despite the recognized efficacy and cost benefits of coronavirus disease 2019 vaccines, clinicians should be aware of the possible association between cranial nerve palsies and coronavirus disease 2019 vaccines.