bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal Indigeneities: Identity, Authenticity, and Power in Taiwan’s Indigenous Courts
Authors: Upton J. Christopher
Published: November 2022

In this article I examine performances of Indigeneity in encounters between Indigenous people and the Taiwan legal system. Studying displays of Indigenous identities reveals the processes through which individuals and communities draw upon histories and practices to fashion themselves as Indigenous and engage with wider publics through performances and performative acts. Focusing on three encounters between Indigenous people and the Taiwan legal system, displays of Indigeneity in these encounters were multivalent and involved a repertoire of creative performative acts as Indigenous actors used court spaces, like the new ad hoc Chamber of Indigenous Courts, to perform identities that confounded essentialist conceptions of Indigeneity, introduced alternative ontological parameters, and assumed state governance responsibilities. These performances suggest a contextually situated engagement with the postcolonial state where Indigenous identities are anchored in the past and forward-looking, reinforce or challenge the category of Indigeneity, and themselves operate as techniques of power.
Validation of the Revised Multicultural Ideology Scale (MCI-r) in the UK
Authors: Lefringhausen Katharina , Berry John W. , Grigoryev Dmitry , Stogianni Maria
Published: November 2022

As worldwide migration continues to grow, valid and reliable instruments are needed to assess the psychological processes that influence the successful management of intercultural relations in different sociopolitical contexts. In this study, we test whether the original Multicultural Ideology Scale (MCI) required a revision to remain ‘fit for purpose’ in the current culturally plural context of the UK (MCI-r). Specifically, six subscales are proposed to underlie the construct of a multicultural ideology: Cultural Maintenance, Equity/Inclusion, Social interaction, Essentialistic Boundaries, Extent of Differences, and Consequences of Diversity. With data from 300 UK nationals, we tested the psychometric properties of the MCI-r using various confirmatory factor analysis techniques to estimate the scale’s factor structure followed by convergent and discriminant validity tests. The results indicated that a 4-factor solution (Cultural Maintenance, Equity/Inclusion, Social interaction, and Consequences of Diversity) fitted the data best. All four subscales demonstrated adequate internal consistency as well as convergent and discriminant validity. All four subscales were also negatively correlated with a right-wing political orientation, whilst especially Social Interaction and Consequences of Diversity were positively associated with intergroup contact frequency across domains (work, family and friends and/or acquaintances). Finally, UK participants with personal migratory experiences reported a stronger belief in positive consequences of multiculturalism and more support for Social Interactions between members of different ethnic groups. Overall, findings provide first insights into the applicability of the MCI-r as a reliable and valid tool for the assessment of multiculturalism within the present UK context.
The Association Between Neuroticism and Problematic Social Networking Sites Use: The Role of Fear of Missing out and Self-Control
Authors: Gugushvili Nino , Täht Karin , Schruff-Lim Eva Maria , Ruiter Robert AC , Verduyn Philippe
Published: November 2022

Problematic use of social networking sites (SNS) has a negative impact on mental health. It has been found that people who score high on neuroticism are especially vulnerable towards engaging with SNS in a problematic way but it is not clear which psychological mechanisms explain this relationship. We addressed this issue by examining the mediating role of fear of missing out and self-control in the relationship between neuroticism and problematic SNS use. For this purpose, we conducted a cross-sectional study ( n = 151, 69.5% female, Mage = 26.23, SD = 7.52) and tested for parallel mediation using structural equation modelling. Neuroticism was found to be predictive of increased levels of problematic SNS use. Moreover, neuroticism was associated with both increased levels of fear of missing out and decreased levels of self-control. However, only fear of missing out was found to robustly mediate the relationship between neuroticism and problematic use of SNS. These findings suggest that fear of missing out could be an intervention target to prevent people scoring high on neuroticism from engaging in problematic SNS use.
Introduction: Science and connoisseurship in the European Enlightenment
Authors: Bycroft Michael , Wragge-Morley Alexander
Published: November 2022

A major theme of the European Enlightenment was the rationalization of value, the use of reason to determine the value of things, from diamonds to civilizations. This view of the Enlightenment is well-established in the human sciences. It is ripe for extension to the natural sciences, given the rich recent literature on affect, evaluation, and subjectivity in early modern science. Meanwhile, in art history, the new history of connoisseurship provides a model for the historical study of the evaluation of material things. Historians of natural history have already noted the connections between science, Enlightenment, and connoisseurship. The time has come to extend their insights to other areas of Enlightenment science. This means recognizing the breadth of connoisseurship – the social, linguistic, and disciplinary diversity of the practice – as understood in Europe in the eighteenth century and the latter part of the seventeenth century. An outline of the three papers in this special section gives an indication of how this historiographical project might be carried out.
Deriving suitable models for model-based control design of a parallel manipulator with flexible components
Authors: Colombo Fernanda Thaís , da Silva Maíra Martins
Published: November 2022

Parallel manipulators are more energy-efficient and present higher speed/acceleration ratios when compared with serial manipulators. Moreover, reducing their components’ inertia can further improve these performance criteria. However, this design alternative could induce vibrations due to its lighter components. In this case, model-based control design strategies can help the designer to meet high-performance requirements. These strategies require limited-sized models, while the methods for modeling system’s flexibilities usually yield large-sized models. Therefore, strategies for reducing the size of these large-sized models should be employed. In this manuscript, a two-step model reduction strategy is proposed to derive suitable models for control design. This proposal preserves all rigid modes and selects the most relevant flexible ones. An Linear Quadratic Gaussian is designed for a flexible 3RRR parallel manipulator using a limited-sized model. This model-based control strategy is evaluated in a flexible multibody environment demonstrating the proposal’s viability.
Implementation of a machine learning algorithm for automated thematic annotations in avatar: A linear support vector classifier approach
Authors: Hudon Alexandre , Beaudoin Mélissa , Phraxayavong Kingsada , Dellazizzo Laura , Potvin Stéphane , Dumais Alexandre
Published: November 2022

Avatar Therapy (AT) is a modern therapeutic alternative for patients with schizophrenia suffering from persistent auditory verbal hallucinations. Its intrinsic therapeutical process is currently qualitatively analyzed via human coders that annotate session transcripts. This process is time and resource demanding. This creates a need to find potential algorithms that can operate on small datasets and perform such annotations. The first objective of this study is to conduct the automated text classification of interactions in AT and the second objective is to assess if this classification is comparable to the classification done by human coders. A Linear Support Vector Classifier was implemented to perform automated theme classifications on Avatar Therapy session transcripts with the use of a limited dataset with an accuracy of 66.02% and substantial classification agreement of 0.647. These results open the door to additional research such as predicting the outcome of a therapy.
Telemedicine Satisfaction and Preferences in an Orthopaedic Spine Clinic
Authors: Holbert S. Elliott , Brennan Jane , Turcotte Justin , Patton Chad
Published: November 2022

The use of telemedicine has expanded amid the COVID-19 pandemic and office closures and cancellation of elective surgeries early in the pandemic helped propagated its use. Previous studies have described the feasibility of telemedicine, however, little has been reported on patient perception and preferences within orthopaedics. The objective of this study was to evaluate satisfaction and preferences of telemedicine from the perspective of patients within an orthopaedic spine clinic. A cross-sectional, anonymous survey was implemented as a prospective quality improvement initiative. The survey was sent to patients who had an in-office or telemedicine visit with a provider in our orthopaedic spine clinic. Statistical analysis was performed on the results of the survey. The survey was sent to 1129 patients and a total of 316 patients responded. Twenty-one percent of respondents had a telemedicine appointment. There was no difference in satisfaction among groups ( P = .288) and those with telemedicine appointments were more likely to have had a previous experience with this type of visit ( P = .004) and were more inclined to use it in the future ( P < .001). Patients preferred telemedicine because of the ability to get earlier appointments ( P < .001) and the convenience of the visits ( P < .001). Patients preferred in-office visits because they received hands-on physical exams ( P = .003) or imaging ( P = .041). Telemedicine is a viable alternative to in-office appointments for spine patients, as evidenced by similar levels of patient satisfaction. Sooner appointments and convenience are attractive elements of telemedicine visits, while the desire for physical examination remains a barrier to adoption in this population.
Research Methods Used in Evidence-Based Design: An Analysis of Five Years of Research Articles From the HERD Journal
Authors: Battisto Dina , Li Xiaowei , Dong Jiaying , Hall Luke , Blouin Julia
Published: November 2022

Objective:

This study aims to analyze research methodologies from 157 research articles published in this journal in the last five years (2016–2020).

Background:

Health environments research is comprised of research covering many topics and from various disciplines worldwide. No systematic study exists to uncover themes in evidence-based design (EBD) research concerning the types of research published, people engaged in research, and the research methods employed. Understanding the nature of health environment research performed can help researchers, practitioners, and students situate their work within an EBD research structure.

Methods:

Case study research was used to analyze 157 articles published in the Health Environments Research & Design Journal devoted to EBD and research. Secondary data were extracted to capture research methods from health environments studies and then analyzed to identify themes. The design and outcome categories were structured around and the Center for Health Design’s (CHD) Knowledge Repository with origins to Ulrich et al.’s Evidence-Based Design Framework.

Results:

Findings are reported on categories commonly found in empirical research articles: (i) key words, (ii) disciplines from authors, (iii) settings studied, (iv) populations studied or sampled, (v) research approach and study design, (vi) research strategies, (vii) data collection methods, (viii) data analysis procedures, (ix) design categories and variables, and (x) outcome categories and variables.

Conclusions:

The analyses highlighted the research methods most frequently used in health environments research. Findings revealed several inconsistencies across articles on key words and the framing of research methodologies. Results suggest that there should be a consistent and overarching research taxonomy with a set of acceptable terms for effective literature searches.
Bringing History back into Media Systems Theory: Multiple Modernities and Institutional Legacies in Latin America
Authors: Echeverria Martin , González Rubén Arnoldo , Reyna Vıctor Hugo
Published: November 2022

Since Hallin and Mancini's (2004) seminal work, many scholars from around the world have proposed different models of media systems for countries and regions outside the Western world. Particular challenges have arisen when conceptualizing the systems in Latin America, where shifting liberal and polarized pluralist models have been proposed, and where media traits like clientelism and collusion remain in spite of political, economic and social changes. We contend that one obstacle to the characterization of the resilience of certain structures and practices in this region is the lack of a historical perspective to account for specific processes of media modernization. Drawing on the multiple modernization paradigm, as well as on post-colonial theories, system differentiation theories of the Global South, and theories of uneven regional development, we understand Latin American modernization processes as the appropriation, adaptation, or rejection of certain elements of Western institutions, ideals and values. In media systems, this might produce: (a) centralization of power, (b) a struggle between elites, (c) state-driven differentiation, and (d) regional or local subsystems. Our historical perspective aims to explain the prevalence of several media structures, and show how institutional legacies yield core media traits, in order to pave the way for further model inference.
Declining opportunities for speaking out: The impact of Vietnam's new leadership on grassroots collective action
Authors: Truong Mai
Published: November 2022

This article examines how Vietnam's 13th Politburo elected in 2021 affects citizens’ willingness to raise their voices about policy issues through extra-institutional channels such as protests, petitions, and social media. I argue that an exceptionally high number of public security figures in the Politburo reflected the concerns of the Communist Party's Central Committee over regime-destabilizing grassroots activism. Using an online survey experiment administered to 1500 Vietnamese citizens, which manipulates the information on the repressive nature of the public security institution and police representatives’ backgrounds, I find that a heavy police representation in the 13th Politburo makes respondents less likely to sign petitions, share their concerns on social media, and take to the streets to voice their discontent with the government. My findings suggest that single-party regimes can reverse democratic development, particularly the participation dimension, through strategic leadership arrangements.
Acute effects of regional heat stimulation by indirect moxibustion on cardiovascular responses
Authors: Nakahara Hidehiro , Kawai Eriko , Miyamoto Tadayoshi
Published: November 2022

Moxibustion is a traditional East Asian medicine treatment that involves burning moxa directly or indirectly on or near the skin at a specific site of the body, called an acupoint. However, whether moxibustion induces cardiovascular responses by modulating autonomic nervous activity remains unknown. The purpose of this study was to elucidate the effects of indirect moxibustion on cardiovascular responses and autonomic nervous activity. Fifteen healthy volunteers participated in the study. Each subject received regional heat stimulation by indirect moxibustion at the lower leg acupoint. Heart rate, RR intervals, blood pressure and skin temperature were measured continuously for 3 min at rest and 5 min during indirect moxibustion. Local skin temperature increased reaching a peak (45.3 ± 3.3 °C) at 2 min after moxibustion was started, and was accompanied by a significant decrease in heart rate (63.0 ± 7.8 to 60.8 ± 7.8 bpm, p < 0.05) together with a significant increase in root mean square difference of successive RR intervals. Regional heat stimulation by indirect moxibustion induced bradycardic response, which was modulated by autonomic nervous system.
Trajectories of mobility difficulty and falls in community-dwelling adults aged 50 + in Taiwan from 2003 to 2015
Authors: Kuo Fang-Lin , Yen Chia-Ming , Chen Hung-Ju , Liao Zih-Yong , Lee Yen
Published: November 2022

Background

A decline in mobility leads to fall occurrence and poorer performance in instrumental activities of daily living, which are widely proved to be associated with older adults' health-related quality of life. To inform potential predicaments faced by older adults at different age levels, predictors of this mobility change and falls along with the ageing process need to be further evaluated. Therefore, this study examined the risk factors associated with the longitudinal course of mobility difficulty and falls among community-dwelling middle-aged and older adults in the Taiwanese community.

Methods

We evaluated data for the period between 2003 and 2015 from the Taiwan Longitudinal Study on Aging; the data cover 5267 community-based middle-aged and older adults with approximately 12 years of follow-up. In terms of mobility, the participants self-reported difficulties in mobility tasks (eg, ambulation) and whether they used a walking device. We employed linear mixed-effects regression models and cumulative logit models to examine whether personal characteristics are associated with mobility difficulty and falls.

Results

Mobility difficulty significantly increased over time for the participants aged ≥ 60 years. Perceived difficulties in standing, walking, squatting, and running became apparent from a younger age than limitations with hand function. The probability of repeated falls increased significantly with older age at 70 (p = .002), higher level of mobility difficulty (p < .0001), lower cognitive status (p = .001), living alone (p = .001), higher number of comorbid illnesses (p < .001), walking device use (p = .003), longer time in physical activities (p < .011), and elevated depressive symptoms (p = .006). Although walking aid use increased the probability of falls, individuals with mobility difficulty had a reduced probability of repeated falls when using a walking device (p = .02).

Conclusion

Community-dwelling Taiwanese adults face an earlier mobility difficulty starting in 60 years old. Individuals with more leisure and physical activities in daily life were more likely to maintain mobility and walking safety. Long-term, regular, social, and physical activity could be a referral option for falls prevention program. The use of a walking device and safety precautions are warranted, particularly for individuals with walking difficulties.
Prognostic markers in patients with chronic lymphocytic leukaemia on targeted therapy, chemoimmunotherapy with anti-CD20 monoclonal antibody: a systematic review and meta-analysis of prognostic factors
Authors: Mkhwanazi Zekhethelo A. , Nyambuya Tawanda M. , Mfusi Snenhlanhla A. , Nkambule Bongani B.
Published: November 2022

Combination chemoimmunotherapy (CIT) consisting of anti-CD20 has improved the progression-free survival (PFS) and overall survival (OS) of patients with chronic lymphocytic leukaemia (CLL). We performed a comprehensive synthesis of prognostic factors in patients with CLL on combined CIT with anti-CD20 antibodies compared with standard chemotherapy alone or targeted therapy.

We searched the MEDLINE and academic search complete electronic databases as well as clinicaltrials.gov (from inception up to 01 August 2022) for randomised controlled trials examining chemoimmunotherapy and targeted therapy in patients with CLL. The risk of bias and the quality of evidence was assessed using the quality in prognostic studies tool (QUIPS).

A total of 10 prognostic factors were identified and evaluated in patients with CLL on anti-CD20 antibody-containing CIT. The predictive value of the following prognostic factors was confirmed and associated with poor patient outcomes; deletion 17p (HR = 3.39), Immunoglobulin heavy chain variable region gene mutation status (HR = 0.96) and β2-microglobulin (HR = 1.41).

Conventional predictive factors may have retained prognostic value and could be useful in the stratification of patients who may be non-responsive to CIT.

Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) registry (CRD42021218997).
Anticancer traits of chimeric antigen receptors (CARs)-Natural Killer (NK) cells as novel approaches for melanoma treatment
Authors: Bahmanyar Maryam , Vakil Mohammad Kazem , Al-Awsi Ghaidaa Raheem Lateef , Kouhpayeh Seyed Amin , Mansoori Yaser , Mansoori Behnam , Moravej Ali , Mazarzaei Abdulbaset , Ghasemian Abdolmajid
Published: November 2022

Owing to non-responsiveness of a high number of patients to the common melanoma therapies, seeking novel approaches seem as an unmet requirement. Chimeric antigen receptor (CAR) T cells were initially employed against recurrent or refractory B cell malignancies. However, advanced stages or pretreated patients have insufficient T cells (lymphopenia) amount for collection and clinical application. Additionally, this process is time-consuming and logistically cumbersome. Another limitation of this approach is toxicity and cytokine release syndrome (CRS) progress and neurotoxicity syndrome (NS). Natural killer (NK) cells are a versatile component of the innate immunity and have several advantages over T cells in the application for therapies such as availability, unique biological features, safety profile, cost effectiveness and higher tissue residence. Additionally, CAR NK cells do not develop Graft-versus-host disease (GvHD) and are independent of host HLA genotype. Notably, the NK cells number and activity is affected in the tumor microenvironment (TME), paving the way for developing novel approaches by enhancing their maturation and functionality. The CAR NK cells short lifespan is a double edge sword declining toxicity and reducing their persistence. Bispecific and Trispecific Killer Cell Engagers (BiKE and Trike, respectively) are emerging and promising immunotherapies for efficient antibody dependent cell cytotoxicity (ADCC). CAR NK cells have some limitations in terms of expanding and transducing NK cells from donors to achieve clinical response. Clinical trials are in scarcity regarding the CAR NK cell-based cancer therapies. The CAR NK cells short life span following irradiation before infusion limits their efficiency inhibiting their in vivo expansion. The CAR NK cells efficacy enhancement in terms of lifespan TME preparation and stability is a goal for melanoma treatment. Combination therapies using CAR NK cells and chemotherapy can also overcome therapy limitations.
Self-reported medication information needs among medication users in a general population aged 40 years and above – the Tromsø study
Authors: Walquist Mari J. , Svendsen Kristian , Garcia Beate H. , Bergmo Trine S. , Eggen Anne Elise , Halvorsen Kjell H. , Småbrekke Lars , Ringberg Unni , Lehnbom Elin C. , Waaseth Marit
Published: November 2022

Purpose

To determine the prevalence and associated factors of self-reported medication information needs among medication users in a general population aged 40 years and above – The Tromsø Study.

Methods

Cross-sectional study of medication users (n = 10,231) among participants in the Tromsø Study, a descriptive analysis of questionnaire data and multivariable logistic regression (n = 9,194).

Results

Sixteen percent of medication users expressed a need for more information about own medications. Overall, medication users agreed to a higher degree to have received information from the GP compared to the pharmacy. Concerned medication users and those disagreeing to have received information about side effects had the highest odds for needing more information (OR 5.07, 95% CI 4.43–5.81) and (OR 2.21, 95% CI 1.83–2.68), respectively. Medication users who used heart medications (e.g., nitroglycerin, antiarrhythmics, anticoagulants) (OR 1.71, 95% CI 1.46–2.01), medication for hypothyroidism (OR 1.36, 95% CI 1.13–1.64) or had moderately health anxiety had expressed need for medication information. Whereas medication users with lower education, those that never used internet to search for health advice, and medication users who disagreed to have received information about reason-for-use were associated with lower odds (OR 0.75, 95% CI 0.62–0.91), (OR 0.85, 95% CI 0.74–0.98) and (OR 0.68, 95% CI 0.53–0.88), respectively.

Conclusion

This study demonstrated that there is need for more information about own medications in a general population aged 40 years and above and shed light on several characteristics of medication users with expressed information need which is important when tailoring the right information to the right person.
Which style of duodenojejunostomy is better after resection of distal duodenum
Authors: Liu Wenshuai , Wang Jiongyuan , Ma Lijie , Zhuang Aobo , Xu Jing , He Junyi , Yang Hua , Fang Yuan , Lu Weiqi , Zhang Yong , Tong Hanxing
Published: November 2022

Background

Distal duodenal resections are sometimes necessary for radical surgery, but how to restore duodenal continuity is still unclear. This study aimed at determining which style of anastomosis was more suitable for the duodenojejunostomy after resection of distal duodenum.

Patients and methods

We retrospectively identified 34 patients who underwent distal duodenum resection at our center between January 2014 and December 2021. According to whether the end or the side of the proximal duodenum was involved in reconstruction, duodenojejunostomy were classified as End style (E-style) and Side style (S-style). Demographic data, clinicopathological details, and postoperative complications were analyzed between two groups.

Results

Thirteen patients (38.2%) received E-style duodenojejunostomy, and 21 patients (62.8%) received S-style duodenojejunostomy. Comparative analysis showed that in group of E-style, patients had a lower rate of multivisceral resection(5/13 vs 18/21; P = 0.008), delayed gastric emptying (DGE) (1/13 vs 11/21; P = 0.011) and intraperitoneal infection (2/13 vs 12/21; P = 0.03). In this study, the incidence of major complications was up to 35.3% (12/34) and no patient died of complication in perioperative period. In two group, there was no difference in the incidence of major complications (E-style vs S-style: 3/13 vs 9/21; P = 0.292).

Conclusions

The E-style duodenojejunostomy for the reconstruction of distal duodenum resection is safe and feasible. The E-style anastomosis may have potential value in decreasing the occurrence of complications such as DGE and intraperitoneal infection, and the definitive advantages still need to be verified.
A novel method of lateral closing wedge osteotomy for cubitus varus deformity in children
Authors: Su Yuxi , Xie Yan , Nan Guoxin
Published: November 2022

Background

Humeral osteotomy is the best method for treatment of severe cubitus varus in children. Many osteotomy methods have been developed in the past. In this study, we describe a novel corrective technique by applying the principles described by Paley involving lateral osteotomy using Kirschner wires (K-wires). Vertices of the osteotomy should be located at the center of rotation of angulation. The anatomical and mechanical axes can be corrected with precision.

Patients and methods

In this retrospective study, 21 patients (17 male, 4 female) who fulfilled the study criteria and underwent lateral closing osteotomy for cubitus varus deformity from July 2015 to October 2017 were included into the study. The osteotomy line of all patients was designed according to Paley’s principles. An isosceles triangle template was made according to the design preoperatively. The lateral osteotomy was made with the assistance of C-arm radiographs. The osteotomy was fixed by K-wires laterally. Patients were followed up, and elbows were evaluated by radiography and using the Mayo Elbow Performance Index (MEPI) score.

Results

The mean correction angle obtained was 32.33°±2.83°. According to the MEPI score assessment, 19 of the 21 patients had an excellent outcome and two had a good outcome. Two patients complained of conspicuous scars; however, no further cosmetic surgery was performed. The range of motion was 135.0° preoperatively and 133.7° postoperatively, showing no significant difference (p = 0.326). None showed evidence of neurovascular injury or complained of prominence of the lateral humerus.

Conclusion

Paley’s principles for correcting cubitus varus deformity in children are effective and reliable for treating such a condition.

Level of evidence

Therapeutic IV.
A study on initiation of postpartum family planning in India based on NFHS-4: does urban poor differ significantly from rural?
Authors: Srivastava Ujjaval , Pandey Arvind , Singh Pragya , Singh Kaushalendra Kumar
Published: November 2022

Objective

To explore the differentials of postpartum contraceptive adoption between rural and urban poor after adjusting for utilization of MCH services and other selected socioeconomic and demographic covariates.

Methods

The data for this study is taken from the 4th round of NFHS survey conducted in India during 2015–16. The analysis is limited to 125,340 currently married women whose menses had returned at the time of survey. Discrete time complementary log–log multilevel model was applied. 

Results

The results clearly indicate that women from rural areas had a lower chance of early initiation of modern spacing methods after having recent birth as compare to that of Urban Poor and Urban non-poor areas. The contributions of several socioeconomic and demographic characteristics that were important for family planning practice were also highlighted in this study.

Conclusion

There is an urgent need of designing an intervention that will result in effective delivery of services to achieve the greatest impact. Policy planners must focus on targeted interventions for family planning use in the postpartum period than simply focusing on family planning.
Preliminary verification of the anti-hypoxia mechanism of Gentiana straminea maxim based on UPLC-triple TOF MS/MS and network pharmacology
Authors: Kong Xiu mei , Song Dan , Li Jie , Jiang Yi , Zhang Xiao ying , Wu Xiao Jun , Ge Ming juan , Xu Jiao jiao , Gao Xiao min , Zhao Qin
Published: November 2022

Background

Anoxia is characterized by changes in the morphology, metabolism, and function of tissues and organs due to insufficient oxygen supply or oxygen dysfunction.Gentiana stramineaMaxim (G.s Maxim) is a traditional Tibetan medicine. Our previous work found that G.s Maxim mediates resistance to hypoxia, and we found that the ethyl acetate extract had the best effect. Nevertheless, the primary anti-hypoxia components and mechanisms of action remain unclear.

Methods

Compounds from the ethyl acetate extraction of G.s Maxim were identified using UPLC-Triple TOF MS/MS. Then Traditional Chinese Medicine Systematic Pharmacology Database was used to filtrate them. Network pharmacology was used to forecast the mechanisms of these compounds. Male specific pathogen-free Sprague Dawley rats were randomly divided into six groups: (1) Control; (2) Model; (3) 228 mg/kg body weight Rhodiola capsules; (4) 6.66 g/kg body weight the G.s Maxim’s ethyl acetate extraction; (5) 3.33 g/kg body weight the G.s Maxim’s ethyl acetate extraction; (6) 1.67 g/kg body weight the G.s Maxim’s ethyl acetate extraction. After administering intragastric ally for 15 consecutive days, an anoxia model was established using a hypobaric oxygen chamber (7000 m, 24 h). Then Histology, enzyme-linked immunosorbent assays, and western blots were performed to determine these compounds’ anti-hypoxic effects and mechanisms. Finally, we performed a molecular docking test to test these compounds using Auto Dock.

Results

Eight drug-like compounds in G.s Maxim were confirmed using UPLC-Triple TOF MS/MS and Lipinski’s rule. The tumor necrosis factor (TNF) signaling pathway, the hypoxia-inducible factor 1 (HIF-1) signaling pathway, and the nuclear factor kappa-B (NF-κB) signaling pathway was signaling pathways that G.s Maxim mediated anti-anoxia effects. The critical targets were TNF, Jun proto-oncogene (JUN), tumor protein p53 (TP53), and threonine kinase 1 (AKT1). Animal experiments showed that the ethyl acetate extraction of G.s Maxim ameliorated the hypoxia-induced damage of hippocampal nerve cells in the CA1 region and reversed elevated serum expression of TNF-α, IL-6, and NF-κ B in hypoxic rats. The compound also reduced the expression of HIF-1α and p65 and increased the Bcl-2/Bax ratio in brain tissue. These findings suggest that G.s Maxim significantly protects against brain tissue damage in hypoxic rats by suppressing hypoxia-induced apoptosis and inflammation. Ccorosolic acid, oleanolic acid, and ursolic acid had a strong affinity with core targets.

Conclusions

The ethyl acetate extraction of G.s Maxim mediates anti-hypoxic effects, possibly related to inhibiting apoptosis and inflammatory responses through the HIF-1/NF-κB pathway. The primary active components might be corosolic, oleanolic, and ursolic acids.
Healthcare cost consciousness among physicians and their attitudes towards controlling costs in Jordan: a cross sectional study
Authors: Yasin Mohmmed Hasan , Naser Abdallah Y.
Published: November 2022

Background

One of the most significant factors influencing medication adherence and, ultimately, therapeutic outcomes for patients is the cost. The aim of this study was to examine the cost-containment strategies used by physicians in Jordan while focusing on the importance of cost consciousness in addressing healthcare costs and its consequences.

Method

A quantitative study was conducted between June 19 and November 15, 2021, through a cross-sectional survey using a self-administered questionnaire.

Results

A total of 389 physicians participated in this study. Governments (65.6%), health insurance companies (60.2%), and pharmaceutical and device manufacturers (57.9%) were the most frequently mentioned entities as being primarily responsible for reducing healthcare costs. Participating physicians showed a high level of enthusiasm towards all domains of reducing healthcare costs with a mean percentage of 88.3% (standard deviation (SD): 0.04). When discussing physicians’ roles in containing healthcare costs and the effects of cost-conscious practice, most respondents agreed that there is currently too much emphasis on test and procedure costs (83.0%), that decision support tools that show costs would be helpful in their practice (84.5%), and that physicians need to take a more prominent role in limiting the use of unnecessary tests (86.0%). Around 70.0% of physicians agreed that they requested more tests when they did not know the patient well, and 80.0% of them stated that they considered the uncertainty involved in patient care to be disconcerting.

Conclusion

Participating physicians showed a moderate level of cost consciousness in Jordan. However, this must be higher because it will eventually lead to cost-related nonadherence, which will have a negative impact on the patient’s health.
Prevalence and trend of smokeless tobacco use and its associated factors among adolescents aged 12–16 years in 138 countries/territories, 1999–2019
Authors: Yang Hui , Ma Chuanwei , Zhao Min , Magnussen Costan G. , Xi Bo
Published: November 2022

Background

Smokeless tobacco use is popular in some regions worldwide, but it receives less attention compared to cigarette smoking. We aimed to estimate the recent prevalence of, and trends in, smokeless tobacco use and to examine its associated factors among adolescents aged 12–16 years in 138 countries/territories (hereafter “countries”) from 1999 to 2019.

Methods

Data from the Global Youth Tobacco Survey conducted in 138 countries in 2010–2019 and the National Youth Tobacco Survey conducted in the United States in 2019 were used to calculate the prevalence of current smokeless tobacco use and investigate its associated factors among adolescents aged 12–16 years. We also assessed the trend in the prevalence of smokeless tobacco use in 100 countries that had conducted more than one survey from 1999 to 2019.

Results

The overall prevalence of current smokeless tobacco use was 4.4% (95% confidence interval [CI] 4.0–4.9), with 5.7% (5.1–6.3) for boys, 3.1% (2.6–3.5) for girls, 3.9% (3.5–4.4) for adolescents aged 12–14 years and 5.4% (4.8–5.9) for those aged 15–16 years. The prevalence was highest in the South-East Asian region (6.1%, 4.4–7.7) and lowest in the Western Pacific region (2.0%, 1.7–2.4). The prevalence of smokeless tobacco use decreased in 57 of 100 countries, increased in 32 countries, and remained unchanged in 11 countries. Current cigarette smoking (odds ratio [OR]=2.00, 95% CI=1.68–2.39), other tobacco product use (OR=6.03, 95% CI=4.92–7.40), tobacco advertisement exposure (OR=1.44, 95% CI=1.19–1.74), being offered free tobacco products (OR=2.01, 95% CI=1.66–2.42), and not being taught about dangers of smoking (OR=1.28, 95% CI=1.09–1.50) were all positively associated with current smokeless tobacco use.

Conclusions

Smokeless tobacco use among adolescents remains a public health concern worldwide. Although the prevalence among adolescents decreased in most countries, it remains high especially in the South-East Asian region. More strict and effective strategies and measures are needed to further curb the smokeless tobacco use among adolescents.
Understanding lifestyle self-management regimens that improve the life quality of people living with multiple sclerosis: a systematic review and meta-analysis
Authors: Wills Olivia C. , Probst Yasmine C.
Published: November 2022

Background

Lifestyle self-management as an intervention for people living with multiple sclerosis (plwMS) is an emerging area of research. Previous reviews have highlighted a need to systematically identify effective self-management regimens that influence the health and well-being of plwMS using a common metric of success.

Objectives

To examine the effectiveness of lifestyle self-management strategies and interventions aimed at improving the quality of life (QOL), and/or disability of plwMS. The review also aimed to narratively explore common elements of self-management interventions that were effective at improving the outcomes of interest.

Methods

A systematic search was performed using five scientific databases. The review process followed the Cochrane Handbook for Systematic Reviews of Interventions  and was registered with PROSPERO (Ref: CRD42021235982).

Results

A total of 57 studies including 5830 individuals diagnosed with MS, met the inclusion criteria. Self-management interventions included physical activity, fatigue, dietary, stress/coping, emotional, symptom and medical management, and lifestyle and wellbeing programs. Self-reported QOL improved in 35 of 47 studies. Dietary intervention had no statistically significant overall effect on reducing MS disability, (P = 0.18). Heterogeneity limited the ability to pool the effects from a large number of eligible studies of the same design.

Conclusion

Multicomponent self-management interventions, multimodal delivery methods, and cognitive behavioural theory principles were common elements of self-management interventions that improved the QOL of plwMS. However, these results should be interpreted with caution and care should be taken in its clinical application. This review has the potential to inform future management practices for plwMS and has revealed a significant gap in the literature, warranting high-quality, large-scale experimental, and observational studies that address lifestyle management.
Chinese cross-culturally adapted patient-reported outcome measures (PROMs) for knee disorders: a systematic review and assessment using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) instrument
Authors: Ngwayi James Reeves Mbori , Obie Kenedy Uzoma , Tan Jie , Xu JianBiao , Alizada Mujahid , Porter Daniel Edward
Published: November 2022

Background

Knee patient-reported outcome measures (PROMs) are widely used in research in China, but there is limited evidence on the quality of cross-culturally adapted and original Chinese PROMs. We investigated Chinese language knee PROMs to provide evidence for clinicians on their quality and to guide PROM choices.

Method

A systematic literature search of databases: PUBMED, CINAHL, EMBASE, and CNKI, using adequate search strings and a three-step screen process identified relevant studies. An independent standardized assessment of the selected studies based on the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool was performed. Inter-rater reliability was assessed using intraclass coefficients (ICC).

Results

Thirty-three articles corresponding to 23 knee PROMs were evaluated with EMPRO global scores (100) ranging from 11.11 to 55.42. The attributes ‘reliability,’ ‘validity,’ and ‘cultural and language adaptation’ were significantly better evaluated compared to the attributes ‘responsiveness,’ ‘interpretability,’ and ‘burden’ (for all comparisons p < 0.0001). Moderate-to-excellent inter-rater agreement was observed with ICC values ranging from 0.538 to 0.934.

Conclusion

We identified six PROMs with a minimum acceptable threshold (> 50/100). The osteoarthritis of knee and hip quality of life, the lower extremity function scale, and the Western Ontario Meniscal Evaluation tool ranked highest. Nevertheless, no single PROM had evidence encompassing all EMPRO attributes, necessitating further studies, especially on responsiveness, interpretability, and burden. We identified duplication of effort as shown by repeated translations of the same PROM; this inefficiency could be ameliorated by rapid approval of Chinese language PROMs documented on original PROM developers’ platforms.
Identification of potential immunomodulators from Pulsatilla decoction that act on therapeutic targets for ulcerative colitis based on pharmacological activity, absorbed ingredients, and in-silico molecular docking
Authors: Deng Li-rong , Han Qian , Zou Min , Chen Fang-jun , Huang Chang-yin , Zhong Yi-ming , Wu Qian-yan , Tomlinson Brian , Li Yan-hong
Published: November 2022

Background

Pulsatilla decoction (Bai-Tou-Weng-Tang, BTWT) is a classic formula prescription of a traditional Chinese medicine that is used to treat ulcerative colitis (UC). However, its active components and underlying mechanism of action remain unclear. In the present study, we aimed to identify potential immunomodulators from BTWT that act at therapeutic targets for UC.

Methods

The protective effects of BTWT granules were examined in mice with colitis induced by dextran sulfate sodium. The absorbed components of BTWT were identified using LC-MS, and selected protein targets of these components in UC were investigated using molecular docking.

Results

Oral administration of BTWT granules significantly alleviated disease severity and colon shortening, and inhibited the inflammatory response in mice with chronic colitis. In these mice, 11 compounds from the BTWT granules were detected in the serum and/or colon. The molecular docking study demonstrated that compounds from Radix pulsatillae, such as anemoside A3, interacted with STAT3 and S1PR1; compounds from Rhizoma coptidis and/or Cortex phellodendri, such as palmatine, interacted with JAK3, PD-1, and PD-L1; and components of Cortex fraxini such as aesculin interacted with S1PR1, JAK3, STAT3 and PD-L1. Further in-vitro experiments showing that the compounds inhibited TNF-α and IL-6 production and STAT3 activation in RAW 264.7 cells suggested that these compounds have immunomodulatory activities.

Conclusion

We revealed for the first time that 11 absorbed ingredients from BTWT were immunomodulators against therapeutic targets for UC. These findings suggest that the identified compounds are the active components of BTWT, and the identified protein targets underlie the mechanism of action of BTWT against UC.
Feasibility, effectiveness and costs of a decision support intervention for consultees and legal representatives of adults lacking capacity to consent (CONSULT): protocol for a randomised Study Within a Trial
Authors: Shepherd Victoria , Wood Fiona , Gillies Katie , Martin Adam , O’Connell Abby , Hood Kerenza
Published: November 2022

Background

Randomised trials play a vital role in underpinning evidence-based care. However, trials involving adults with impaired capacity to consent raise a number of ethical and methodological challenges, leading to the frequent exclusion of this group from trials. This includes challenges around involving family members as alternative ‘proxy’ decision-makers. Family members are often given little information about their role as a consultee or legal representative. Some family members find making a decision about trial participation difficult and may experience an emotional and decisional burden as a result. Families have reported a need for greater support and guidance when making such decisions, leading to the development of a decision aid (‘Making decisions about research for others’) for family members acting as consultee/legal representative. The decision aid now requires evaluation to determine its effectiveness in supporting families to make more informed decisions.

Methods

This protocol describes a prospective, multi-centre, randomised-controlled Study Within a Trial (SWAT) to evaluate the effectiveness of the decision aid. The SWAT will initially be embedded in approximately five host trials. SWAT participants will be randomised in a 1:1 ratio to either the intervention (decision aid alongside standard information about the host trial provided to consultees/legal representatives) or control (standard information alone). The primary outcome is the quality of proxy consent decision, assessed by the Combined Scale for Proxy Informed Consent Decisions (CONCORD). The SWAT design is informed by previous qualitative research. Initial feasibility will be explored in one host trial, followed by the main SWAT. An embedded process evaluation and economic evaluation will enable the SWAT findings to be contextualised and identify factors likely to affect implementation.

Discussion

This SWAT will generate the first evidence for recruitment interventions for trials involving adults lacking capacity to consent and add to knowledge about the use of decision support interventions in trial participation decisions. The SWAT will be embedded in a range of trials, and the heterogenous nature of the host trials, settings and populations involved will enable the intervention to be evaluated in a wide range of contexts. However, a pragmatic and flexible approach to conducting the SWAT is needed.

Trial registration

The SWAT is registered as SWAT #159 with the Northern Ireland Hub for Trials Methodology Research SWAT repository (registered 09.08.2020). Each host trial will be registered on a clinical trials registry.