bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a calculation model to estimate the impact of the COVID-19 pandemic lockdown on visual acuity in neovascular AMD
Authors: Stattin Martin , Haas Anna-Maria , Ahmed Daniel , Graf Alexandra , Krepler Katharina , Ansari-Shahrezaei Siamak
Published: November 2021

Purpose

A model was calculated during the first Austrian coronavirus disease-2019 (COVID-19) pandemic lockdown to estimate the effect of a short-term treatment interruption due to healthcare restrictions on visual acuity (VA) in neovascular age-related macular degeneration (nAMD). The model was compared to the real-life outcomes before treatment re-started.

Methods

Retrospective data-collection of 142 eyes in 142 patients receiving repeated intravitreal injections with anti-VEGF at a retina unit in Vienna in a personalized pro-re-nata regimen prior to the COVID-19 associated lockdown, when treatment was deferred between March 16 and May 4, 2020. During the lockdown, the preliminary data was integrated into pre-existing formulae based on the natural course of the disease in untreated eyes in the long term. Patients were re-scheduled and treated after gradually opening operating rooms. The calculation model was compared to the effective VA change.

Results

The model calculated an overall VA loss of 3.5 ± 0.8 letters early treatment diabetes retinopathy study (ETDRS) ( p < 0.001 [95% CI:3.3;3.6]) on average compared to 2.5 ± 6 letters ETDRS ( p < 0.001 [95% CI:1.5;3.5]) as measured with a mean treatment delay of 61 ± 14 days after previously scheduled appointments. The total difference between the model exercise and the real-life outcomes accounted for 1 ± 5.9 letters ETDRS ( p = 0.051 [95% CI: 0.1;1.9]).

Conclusion

The herein presented calculation model might not be suitable to estimate the effective VA loss correctly over time, although untreated eyes and eyes under therapy show similarities after short-term treatment interruption. However, this study demonstrated the potentially negative impact of the COVID-19 pandemic lockdown on patients compromised by nAMD.
Ultrasound-guided access to the axillary vein for implantation of cardiac implantable electronic devices: A systematic review and meta-analysis
Authors: D’Arrigo Sonia , Perna Francesco , Annetta Maria Giuseppina , Pittiruti Mauro
Published: November 2021

The aims of our systematic review were to quantify the expected rate of procedural success, early and late complications during CIED implantation using US-guided puncture of the axillary vein and to perform a meta-analysis of those studies that compared the US technique (intervention) versus conventional techniques (control) in terms of complication rates. MEDLINE, ISI Web of Science, and EMBASE were searched for eligible studies. Pooled Odds Ratio (OR) and Pooled Mean Difference (PMD) for each predictor were calculated. The quality of evidence (QOE) was evaluated according to the GRADE guidelines. Thirteen studies were included a total of 2073 patients. The overall success of US-guided venipuncture for CIED implantation was 96.8%. As regards early complications, pneumothorax occurred in 0.19%, arterial puncture in 0.63%, and severe hematoma/bleeding requiring intervention in 1.1%. No cases of hemothorax, brachial plexus, or phrenic nerve injury were reported. As regards late complications, the incidence of pocket infection, venous thromboembolism, and leads dislodgement was respectively 0.4%, 0.8%, and 1.2%. In the meta-analysis (five studies), the intervention group (US-guided venipuncture) had a trend versus a lower likelihood of having a pneumothorax (0.19% vs 0.75%, p = 0.21), pocket hematoma (0.8% vs 1.7%, p = 0.32), infection (0.28% vs 1.05%, p = 0.29) than the control group, but this did not reach statistical significance. The overall QOE was low or very low. In conclusions we found that the US-guided axillary venipuncture for CIEDs implantation was associated with a low incidence of early and late complications and a steep learning curve.
Optimising specialist geriatric medicine services by telehealth
Authors: Haydon Helen M , Caffery Liam J , Snoswell Centaine L , Thomas Emma E , Taylor Monica , Budge Marc , Probert Jacinta , Smith Anthony C
Published: November 2021

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.
Fighting an Armed Doctrine: The Struggle to Modernize German Propaganda During World War I (1914–1918)
Authors: Fondren Elisabeth
Published: November 2021

During the First World War (1914–1918), all belligerent governments realized that propaganda proficiency was critical to selling their causes and stirring up support for the war. Yet German propagandists in particular struggled to master mass media, manage their messages, and build audience trust during the Great War in their goal to control domestic and foreign public opinion. Although previous scholarship has agreed that the German propaganda machine failed, little has been said about how Germany recognized these failures early on and sought to remedy them through increasingly modern propaganda strategies—even if those strategies were ultimately no match for the public’s growing distrust of official information. This monograph examines how it was that more institutions, more manpower, new publicity initiatives, copying tactics from enemies, crowdsourcing ideas, and eventually focusing on visuals and film did little to boost morale at home or improve Germany’s reputation abroad. The findings rest on a historical analysis of military dispatches, federal policy documents, letters, news stories, propaganda materials, and memoirs located in German and U.S. archives. Although many of the methods and tactics these early propagandists used would fail, others would become part of the universal toolbox governments still rely on to influence people’s views and spread information.
“China Virus” and “Kung-Flu”: A Critical Race Case Study of Asian American Journalists’ Experiences During COVID-19
Authors: Walker Denetra , Daniel Anders Allison
Published: November 2021

The researchers designed a critical race case study to represent media coverage by and experiences of Asian American1 journalists during the first months of COVID-19 pandemic in the United States. After analyzing data inductively, the researchers drew upon critical race theory scholarship to apply the theoretical concepts of race consciousness, whiteness as property, and the hegemony of racial hierarchy to analyze Asian American journalists’ experience during the first year of the COVID-19 pandemic. The researchers used the Asian American Journalists Association’s repository of news coverage, webinars, and panels written and presented by Asian American journalists; in-depth interviews with Asian American journalists; and their social media posts about Asian American experience and the pandemic as data sources. Triangulated across the data sources, the following themes are represented: (a) Asian American Journalists: Living and Reporting Multiple, Intersecting Crises; (b) Anti-Asian American Discrimination and Racism; and (c) The Paradox of Asian American hypervisibility and invisibility; the subtheme is “Calling for Diversity, Equity, and Transformation in the Newsroom.”
Better late than never: initial experience of intra-arterial pulsed-urokinase-injection as a salvage therapy for refractory sudden sensorineural hearing loss
Authors: Cui Yang , Liang Wenzhao , Li Mengxue , Zhao Zhongyu , Jiang Xinzhao , Zhao Bingyang , Xu Zhongxin , Mang Jing
Published: November 2021

Background and Purpose

Cochlear vascular micro-thrombosis has been hypothesized as one of the pathogenic mechanisms for sudden sensorineural hearing loss (SSNHL) refractory to regular management. This study aimed to evaluate the feasibility and safety of intra-arterial pulsed-injection urokinase (IAPU) as a salvage therapy for SSNHL after the failure of conventional therapy.

Methods

We retrospectively reviewed our patient database to identify refractory SSNHL patients between November 2017 and July 2020. Study outcomes before and after the IAPU therapy were compared between IAPU and conventional therapy groups.

Results

Sixty-seven moderate-profound SSNHL patients (29 in IAUP group, 38 in control group) were included in this study. Compared to the control group, patients in the IAPU group showed more significant improvement in pure tone average (PTA) (34.2 ± 23.5 vs. 10.7 ± 13.1, p < 0.001) and degree of hearing recovery (total: 20.7% vs. 5.3%, partial: 24.1% vs. 10.5%, mild: 27.6% vs. 13.2% and non: 27.6% vs. 71.1%) 2 weeks after admission. In the IAPU group, a significant improvement of PTA (86.6 ± 11.5 vs. 54.6 ± 20.1 dB, p < 0.005) was observed on the first day after IAPU treatment.

Conclusion

In carefully selected SSNHL cases with a highly suspected vascular origin, IAPU is a safe and effective therapy when conventional treatments have failed. Despite the encouraging findings of our work, large studies are needed to better investigate the strengths and limitations of this salvage therapy.
COVID-19 critical illness in pregnancy
Authors: Lapinsky Stephen E , Al Mandhari Maha
Published: November 2021

Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.
Bröstrom Repair Review
Authors: Chiou Daniel , Morris Brandon , Waryasz Gregory
Published: November 2021

Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play.

Level of Evidence: Level V
Datafied mobile markets: Measuring control over apps, data accesses, and third-party services
Authors: Flensburg Sofie , Lai Signe S.
Published: November 2021

The increasing use of mobile applications (apps) has turned data harvesting, mining, and distribution into commercial as well as functional backbones of mobile communication. Acknowledging that contemporary markets for mobile communication are increasingly datafied, this article maps and discusses how infrastructures for mobile datafication are controlled. It combines perspectives from critical data studies, political economy of communication, and app studies in an empirical analysis of the 500 most downloaded apps in the Google Play store (November 2020). Focusing on control over and ownership in the three interdependent markets for apps, data accesses, and third-party services, the analysis documents, confirms, and explains established power structures and sheds light on the mobile datafication processes that frame the use of apps and commodification of users. As such, it provides an empirical baseline for future monitoring, and ultimately regulation, of mobile app ecosystems.
Preparedness toward COVID-19 pandemics and associated factors among health care workers in Dire Dawa Hospitals, Eastern Ethiopia: A facility-based cross-sectional study
Authors: Menberu Tameru , Mekonnen Robel , Manaye Yibekal , Kebede Mesfin , Solomon Yonatan , Sema Alekaw , Yazie Bekele , Ayalew Agumas Fentahun
Published: November 2021

Introduction:

Health care workers are at the frontline of the response against the COVID-19 outbreak. Poor preparedness and infection prevention practices among health care workers compound the hazard and occurrence of COVID-19 hospital transmission. Thus, the study aimed to assess preparedness toward COVID-19 pandemics and associated factors among health care workers in Hospitals of Eastern Ethiopia.

Methods:

Facility-based cross-sectional study was conducted from 20 June to July 10 2020. A simple random sampling technique was used to select 423 health care workers. Data were collected using a structured self-administered questionnaire and analyzed using SPSS Version 23. Bivariate and multivariable logistic regression was conducted to identify factors associated with the outcome variable, and statistical significance was declared at a p-value less than 0.05.

Results:

This study revealed that the proportion of health care workers’ preparedness toward the COVID-19 pandemic was 40.9% (95% CI: 36.2–45.9). Working in a public hospital (AOR = 2.7, 95% CI: 1.6–4.3), being unafraid of transmitting COVID-19 to patients (Adjusted odds ratio/AOR = 4.6, 95% CI: 2.2–10.0), feeling safe at the workplace (AOR = 3.3, 95% CI: 1.7–6.4)), satisfied with the infection control policy (AOR = 6.0, 95% CI: 2.3–15.0), and not feeling anxious about the likelihood of COVID-19 spread (AOR = 2.1, 95% CI: 1.3–3.4) were significantly associated with COVID-19 preparedness.

Conclusion:

The majority of the health care workers were not prepared for COVID-19 pandemics. Feeling safe at the workplace scared of transmitting COVID-19 to patients, satisfied with the infection control policy, and feeling anxious concerning the likelihood of COVID-19 were factors associated with health care workers’ preparedness to COVID-19. The current awareness creation training, including motivational and psychological preparation for all health care workers, is mandatory, regardless of their profession or working place.
Benefits of prescribing low-dose digoxin in atrial fibrillation
Authors: Rosca Ciprian Ilie , Kundnani Nilima Rajpal , Tudor Anca , Rosca Maria-Silvia , Nicoras Violeta-Ariana , Otiman Gabriela , Ciurariu Elena , Ionescu Alin , Stelian Morariu , Sharma Abhinav , Borza Claudia , Lighezan Daniel Florin
Published: November 2021

Introduction

The role of digoxin (cardiac glycoside) in controlling the heart rate (HR) for the treatment of atrial fibrillation (AF) patients has not been explored in depth.

Methods

To contribute to the limited data, our team conducted retrospective analysis of the clinical records of 1444 AF patients. We divided the AF patients into two groups, wherein group 1 patients were treated with beta-blockers (BB), low-dose digoxin, and an anticoagulant (vitamin K antagonist/factor-IIa inhibitor/factor-Xa inhibitor), and group 2 patients were treated with just BB and an anticoagulant. Our objectives were to compare the impact of combination therapy of BB and digoxin on the resting HR in patients with permanent AF and the patients’ quality of life (QOL) at periodic intervals.

Results

The findings of our study showed a better control of the resting HR rate (<110bpm) and an improved QOL among the group 1 patients when compared with group 2 patients.

Conclusion

Our findings are indicative of the favorable clinical outcomes that resulted from the addition of a low-dose of digoxin to the AF treatment regimen. However, larger studies/trials elucidating the outcomes of AF patients treated with the dual rate control therapy are required, to clarify the role of digoxin, guide the choice of agents, and standardize the AF treatment protocol.
Making a Difference with Music Psychology Research: Strategy, Serendipity, and Surviving a Global Pandemic
Authors: Lamont Alexandra
Published: November 2021

The COVID-19 pandemic has forced researchers around the globe in every discipline imaginable into a position, where they have to provide justification for the relevance of their work. This represents a sharp acceleration in an underlying trend toward demonstrating greater impact for research, as evidenced in the UK by assessments such as Pathways to Impact statements in grant applications and Research Excellence Framework (REF) Impact Case Studies. Music psychology is ideally positioned at the nexus of a number of different larger fields to afford strategic relevance of some kind, and some work is more obviously placed to do so, such as the many intervention projects harnessing instrumental benefits of music which are explicitly designed to improve people’s lives. However, I argue that the fundamental power of music (in and of itself as well as in other areas) provides everyone in the field with inherent potential impact. Using the case study of a recent project, I am leading on people’s favorite music choices, which turned into something of value to many of its participants almost overnight, I illustrate how serendipity can be developed into strategy. Drawing on insights from analysis of people’s accounts of their favorite music, I show how the fundamental premise that music matters to people gives music psychology research a head start in its quest for relevance, placing this in wider debates about the relevance of music, the arts, and culture to post-COVID-19 life.
First-Year University Students’ Mental Health Trajectories Were Disrupted at the Onset of COVID-19, but Disruptions Were Not Linked to Housing and Financial Vulnerabilities: A Registered Report
Authors: Howard Andrea L. , Carnrite Kendra D. , Barker Erin T.
Published: November 2021

This study modeled disruptions in first-year undergraduates’ trajectories of mental health associated with the COVID-19 pandemic, testing whether disruptions were worse for students who moved residences, reported low family income, or were food insecure. Participants ( n = 510) at a large Canadian university reported depression, anxiety, and stress in September, November, January, and March. In March 2020, in tandem with COVID-related campus closures, students also reported for each mental health measure whether their responses were influenced by personal experiences surrounding the pandemic. As hypothesized, students who reported feeling more COVID-related disruption reported poorer mental health in March. Contrary to hypotheses, mental health disruptions were not more pronounced for students who moved, had low income, or were food insecure. Survey administration at an early stage of COVID-19 combined with supports afforded by moving in with parents and near-universal government income assistance may have mitigated the incremental distress we hypothesized for vulnerable students.
Automated Risk Stratification of Hip Osteoarthritis Development in Patients With Femoroacetabular Impingement Using an Unsupervised Clustering Algorithm: A Study From the Rochester Epidemiology Project
Authors: Ko Sunho , Pareek Ayoosh , Jo Changwung , Han Hyuk-Soo , Lee Myung Chul , Krych Aaron J. , Ro Du Hyun
Published: November 2021

Background:

Studies evaluating the natural history of femoroacetabular impingement (FAI) are limited.

Purpose:

To stratify the risk of progression to osteoarthritis (OA) in patients with FAI using an unsupervised machine-learning algorithm, compare the characteristics of each subgroup, and validate the reproducibility of staging.

Study Design:

Cohort study (prognosis); Level of evidence, 2.

Methods:

A geographic database from the Rochester Epidemiology Project was used to identify patients with hip pain between 2000 and 2016. Medical charts were reviewed to obtain characteristic information, physical examination findings, and imaging details. The patient data were randomly split into 2 mutually exclusive sets: train set (70%) for model development and test set (30%) for validation. The data were transformed via Uniform Manifold Approximation and Projection and were clustered using Hierarchical Density-based Spatial Clustering of Applications with Noise.

Results:

The study included 1071 patients with a mean follow-up period of 24.7 ± 12.5 years. The patients were clustered into 5 subgroups based on train set results: patients in cluster 1 were in their early 20s (20.9 ± 9.6 years), female dominant (84%), with low body mass index (<19 ); patients in cluster 2 were in their early 20s (22.9 ± 6.7 years), female dominant (95%), and pincer-type FAI (100%) dominant; patients in cluster 3 were in their mid 20s (26.4 ± 9.7) and were mixed-type FAI dominant (92%); patients in cluster 4 were in their early 30s (32.7 ± 7.8), with high body mass index (≥29 ), and diabetes (17%); and patients in cluster 5 were in their early 30s (30.0 ± 9.1), with a higher percentage of males (43%) compared with the other clusters and with limited internal rotation (14%). Mean survival for clusters 1 to 5 was 17.9 ± 0.6, 18.7 ± 0.3, 17.1 ± 0.4, 15.0 ± 0.5, and 15.6 ± 0.5 years, respectively, in the train set. The survival difference was significant between clusters 1 and 4 ( P = .02), 2 and 4 ( P < .005), 2 and 5 ( P = .01), and 3 and 4 ( P < .005) in the train set and between clusters 2 and 5 ( P = .03) and 3 and 4 ( P = .01) in the test set. Cluster characteristics and prognosis was well reproduced in the test set.

Conclusion:

Using the clustering algorithm, it was possible to determine the prognosis for OA progression in patients with FAI in the presence of conflicting risk factors acting in combination.
Transitioning to Full Online Teaching During Covid-19 Crisis: The Associate Degree Nurse Faculty Experience
Authors: Iheduru-Anderson Kechi , Foley Jo Anne
Published: November 2021

As the COVID-19 crisis escalated in early 2020, schools of nursing and nursing programs in the United States and around the world shut down. Nurse faculty were forced transition to online teaching in a short time. Descriptive phenomenology was used to explore the experiences of associate degree nurse faculty who transitioned to online teaching during the early months of the COVID-19 pandemic. Inductive thematic analysis was performed on the interview data from 41 faculty teaching at associate degree nursing programs in the U.S. The findings of the study are presented under 6 main themes: stressful/overwhelming, feeling emotionally and physically exhausted, support, new knowledge and growth under pressure, new opportunities for nursing education, and leadership in times of crisis. To prevent the worsening of the nurse faculty shortage and help educate nurses for the future, nurse educators must be supported and recognized for their work during this period and beyond.
Descriptive Biostatistics and Epidemiology for Craniofacial Surgeons: The What, Who, When, Where, How, and Why in Data Description, Analysis, Presentation, and Interpretation
Authors: Yu Jack C. , Shukla Dhairya , Doroodchi Atbin , Doroodchi Ramtin , Khodadadi Hesamoldin , Linder Daniel
Published: November 2021

Physicians often make diagnosis and treatment decisions based on incomplete data. That is why we practice medicine. We use accumulated knowledge and prior experience, individual and collective, to restore form and function of our patients to return them to normalcy with continued, durable homeostasis. However, due to the complex nature, our diagnosis may be wrong and our treatments ineffective or even harmful. The history of medicine and surgery is replete with such examples from snake oil and bloodletting to Halstedian radical mastectomy. Without knowing the governing dynamics, the cause-effect relationship is often obscure. Prospective, blinded, placebo-controlled trials provide the highest level of evidence, like the COVID vaccine trials, to determine if a treatment works. However, trials cannot explain in detail how and why a treatment works, or why it does not. Variabilities and uncertainty abound and require the correct mathematical methods to tease out the signal from the noise, causality from association. Collectively, statistics is the science of uncertainty and the extraction of reliable, useful information from raw data. The objectives of this review are to provide craniofacial surgeons with a primer in descriptive statistics: how to design investigations, collect, prepare, present, and interpret clinical data. Since large datasets at regional and national depositories represent powerful and valuable resources, and that their proper use requires a working knowledge in epidemiology, we included sections on incidence, prevalence, sensitivity, and specificity regarding diagnosis, treatments, and testing.
Identification of cell states using super-enhancer RNA
Authors: Tu Yueh-Hua , Juan Hsueh-Fen , Huang Hsuan-Cheng
Published: November 2021

Background

A new class of regulatory elements called super-enhancers, comprised of multiple neighboring enhancers, have recently been reported to be the key transcriptional drivers of cellular, developmental, and disease states.

Results

Here, we defined super-enhancer RNAs as highly expressed enhancer RNAs that are transcribed from a cluster of localized genomic regions. Using the cap analysis of gene expression sequencing data from FANTOM5, we systematically explored the enhancer and messenger RNA landscapes in hundreds of different cell types in response to various environments. Applying non-negative matrix factorization (NMF) to super-enhancer RNA profiles, we found that different cell types were well classified. In addition, through the NMF of individual time-course profiles from a single cell-type, super-enhancer RNAs were clustered into several states with progressive patterns. We further investigated the enriched biological functions of the proximal genes involved in each pattern, and found that they were associated with the corresponding developmental process.

Conclusions

The proposed super-enhancer RNAs can act as a good alternative, without the complicated measurement of histone modifications, for identifying important regulatory elements of cell type specification and identifying dynamic cell states.
Decreasing trends in potentially inappropriate medications in older people: a nationwide repeated cross-sectional study
Authors: Drusch Solène , Le Tri Thien , Ankri Joël , Zureik Mahmoud , Herr Marie
Published: November 2021

Background

Potentially Inappropriate Medications (PIMs) and polypharmacy are widely used indicators of suboptimal prescribing for older people. The aim of this study was to describe the changes in the prevalence of PIMs and polypharmacy among people aged 75 years and over between 2011 and 2019 in France.

Methods

PIMs and polypharmacy were assessed among people aged 75 years and over every two years between 2011 and 2019 using the French health insurance data system. Sixteen PIM criteria from the 2015 Beers and STOPP lists were assessed. Polypharmacy (5 to 9 drugs) and hyper-polypharmacy (≥10 drugs) were defined based on the average number of drugs dispensed per quarter. The Annual Percent Change (APC) and 95%CI were assessed using linear regression models after standardization of the prevalence on age and sex.

Results

The study population included 5,777,645 individuals over 75 years old in 2011 and 6,328,155 in 2019. The prevalence of PIMs decreased from 49.6 to 39.6% over the study period (APC: − 1.19% [− 1.35;-1.04]). Of the sixteen indicators assessed, the prevalence of thirteen decreased between 2011 and 2019. Benzodiazepines were the most frequent PIMs (34.7% in 2011 to 26.9% in 2019), followed by anticholinergic drugs (12.1% in 2011 to 8.3% in 2019), oral non-steroidal anti-inflammatory drugs (11.4 to 7.8%), and PIMs related to antihypertensive drugs (7.4 to 6.0%). Overall, women and individuals aged 85 years and older were more likely to receive PIMs. The prevalence of hyper-polypharmacy decreased from 30.5 to 25.9% over the study period.

Conclusion

This study, which is the first to assess the change in prevalence of PIMs and polypharmacy over time from comprehensive health data in France, highlights that PIMs and hyper-polypharmacy declined between 2011 and 2019. However, PIMs remains frequent for older people and often involves benzodiazepines.
Exploring the benefits of participation in community-based running and walking events: a cross-sectional survey of parkrun participants
Authors: Quirk Helen , Bullas Alice , Haake Steve , Goyder Elizabeth , Graney Mike , Wellington Chrissie , Copeland Robert , Reece Lindsey , Stevinson Clare
Published: November 2021

Background

Whilst the benefits of physical activity for health and wellbeing are recognised, population levels of activity remain low. Significant inequalities exist, with socioeconomically disadvantaged populations being less physically active and less likely to participate in community events. We investigated the perceived benefits from participation in a weekly running/walking event called parkrun by those living in the most socioeconomically deprived areas and doing the least physical activity.

Methods

A cross-sectional online survey was emailed to 2,318,135 parkrun participants in the UK. Demographic and self-reported data was collected on life satisfaction, happiness, health status, physical activity, motives, and the perceived benefits of parkrun. Motivation, health status and benefits were compared for sub-groups defined by physical activity level at parkrun registration and residential Index of Multiple Deprivation.

Results

60,000 completed surveys were received (2.7% of those contacted). Respondents were more recently registered with parkrun (3.1 v. 3.5 years) than the parkrun population and had a higher frequency of parkrun participation (14.5 v. 3.7 parkruns per year). Those inactive at registration and from deprived areas reported lower happiness, lower life satisfaction and poorer health compared to the full sample. They were more likely to want to improve their physical health, rather than get fit or for competition. Of those reporting less than one bout of activity per week at registration, 88% (87% in the most deprived areas) increased their physical activity level and 52% (65% in the most deprived areas) reported improvements to overall health behaviours. When compared to the full sample, a greater proportion of previously inactive respondents from the most deprived areas reported improvements to fitness (92% v. 89%), physical health (90% v. 85%), happiness (84% v. 79%) and mental health (76% v. 69%).

Conclusion

The least active respondents from the most socioeconomically deprived areas reported increases to their activity levels and benefits to health and wellbeing since participating in parkrun. Whilst the challenge of identifying how community initiatives like parkrun can better engage with underrepresented populations remains, if this can be achieved they could have a critical public health role in addressing inequalities in benefits associated with recreational physical activity.
Survival analysis of factors affecting the timing of COVID-19 non-pharmaceutical interventions by U.S. universities
Authors: Cevasco Kevin E. , Roess Amira A. , North Hayley M. , Zeitoun Sheryne A. , Wofford Rachel N. , Matulis Graham A. , Gregory Abigail F. , Hassan Maha H. , Abdo Aya D. , von Fricken Michael E.
Published: November 2021

Background

During March of 2020 the Centers for Disease Control and Prevention (CDC) announced non-pharmaceutical intervention (NPI) guidance as the primary mitigation strategy against growing COVID-19 community spread due to the absence of a vaccine or effective treatment at that time. CDC guidance states that NPIs are most effective when instituted in an early, targeted, and layered fashion. NPIs are effective in slowing spread, and measures should be custom-tailored to each population. This study examines factors associated with implementation and timing of NPI interventions across large public and private U.S. universities at the onset of the COVID-19 pandemic.

Methods

NPI decisions of interest include when U.S. universities canceled international travel, shifted to online learning, moved faculty/staff to remote work, limited campus housing, and closed campus for all non-essential personnel. Cox proportional hazard analyses of retrospective data were conducted to assess the time to NPI events. Hazard ratios were calculated for university governance, campus setting, religious affiliation, health infrastructure, faculty diversity, and student demographics. The methods control for variance inflation factors, COVID case prevalence, and time varying covariates of spring break and states’ state of emergency (SOE) orders. This study captures NPI decisions at 575 U.S. universities during spring of 2020 which affected the movement of seven million students and two million employees.

Results

Universities located in districts represented by Democratic party congressional members reported earlier NPI implementation than Republican (Cox proportional hazard ratio (HR) range 0.61–0.80). University religious affiliation was not associated with the timing any of the NPI decisions. Universities with more diverse faculty showed an association with earlier NPI implementation (HR range 0.65–0.76). The existence of university-affiliated health infrastructure was not associated with NPI timing.

Conclusion

University NPI implementation was largely driven by local COVID-19 epidemiology, culture and political concerns. The timing of university NPI decisions varied by regional politics, faculty demographics, university governance, campus setting, and foreign student prevalence adjusting for COVID-19 state case prevalence and spring break timing. Religious affiliation and presence of university health infrastructure were not associated with timing.
Polyphenol-rich extract of Ocimum gratissimum leaves prevented toxic effects of cyclophosphamide on the kidney function of Wistar rats
Authors: Alabi Quadri K. , Akomolafe Rufus O. , Omole Joseph G. , Aturamu Ayodeji , Ige Mokolade S. , Kayode Oyindasola O. , Kajewole-Alabi Deborah
Published: November 2021

Background

Cyclophosphamide (CP) is one of the potent and low cost chemotherapy used in clinical setting against a variety of tumors. However, its association with nephrotoxicity limits its therapeutic use.Ocimum gratissimumleaf is a medicinal plant with numerous pharmacological and therapeutic efficacies, such as antioxidant, anti-inflammation, and anti-apoptotic properties.

Methods

The present study was designed to evaluate the protective effect ofOcimum gratissimum(OG) against CP-induced kidney dysfunction in rats. Rats were pre-treated with 400 mg/kg b.w. of leave extract ofOcimum gratissimum(Ocimum G.) for 4 days and then 50 mg/kg b.w. of CP was co-administered from day 5 to day 7 along withOcimum G.Markers of renal function and oxidative stress, food and water intake, electrolytes, aldosterone, leukocytes infiltration, inflammation and histopathological alteration were evaluated.

Results

Obvious renal inflammation and kidney injuries were observed in CP treated groups. However, administration of leave extract ofOcimum G.prevented oxidative stress, kidney injuries, attenuated inflammation, increased aldosterone production and reduced sodium ion and water loss in rats. The plasma creatinine, urea and urine albumin concentration were normalized after the administration ofOcimum G.extract in rats treated with CP.Ocimum G.also decreased the plasma concentrations of Interleukin-(IL)-6, C-reactive protein and activity of myeloperoxidase and malondialdehyde in CP treated rats.

Conclusion

Ocimum G.prevented kidney injury and enhanced renal function via inhibiting inflammation and oxidant-induced CP toxicity. The efficacy ofOcimum G.is related to the presence of various phytochemicals in the plant.
Low-cost peer-taught virtual research workshops for medical students in Pakistan: a creative, scalable, and sustainable solution for student research
Authors: Ukrani Ronika Devi , Shaikh Ayesha Niaz , Martins Russell Seth , Fatima Syeda Sadia , Naseem Hamna Amir , Baig Mishall Ahmed
Published: November 2021

Background

Pakistan has not been a major contributor to medical research, mainly because of the lack of learning opportunities to medical students. With the increase in online learning systems during COVID-19, research related skills can be taught to medical students via low-cost peer taught virtual research workshops.

Aim of the Study

To assess the effectiveness of a comprehensive low-cost peer-taught virtual research workshops amongst medical students in Pakistan.

Methods

This quasi-experimental study assessed the effectiveness of five virtual research workshops (RWs) in improving core research skills. RWs for medical students from across Pakistan were conducted over Zoom by medical students (peer-teachers) at the Aga Khan University, Pakistan, with minimal associated costs. The content of the workshops included types of research, ethical approval and research protocols, data collection and analysis, manuscript writing, and improving networking skills for research. Improvement was assessed via pre-and post-quizzes for each RW, self-efficacy scores across 16 domains, and feedback forms. Minimum criteria for completion of the RW series was attending at least 4/5 RWs and filling the post-RW series feedback form. A 6-month post-RW series follow-up survey was also emailed to the participants.

Results

Four hundred medical students from 36 (/117; 30.8%) different medical colleges in Pakistan were enrolled in the RWs. However, only 307/400 (76.75%) medical students met the minimum requirement for completion of the RW series. 56.4% of the participants belonged to the pre-clinical years while the rest were currently to clinical years. The cohort demonstrated significant improvement in pre-and post-quiz scores for all 5 RWs (p <  0.001) with the greatest improvement in Data Collection and Analysis (+ 34.65%), and in self-efficacy scores across all domains (p <  0.001). 166/307 (54.1%) participants responded to the 6 months post-RWs follow-up survey. Compared to pre-RWs, Research involvement increased from 40.4 to 62.8% (p <  0.001) while proportion of participants with peer-reviewed publications increased from 8.4 to 15.8% (p = 0.043).

Conclusion

Virtual RWs allow for a wide outreach while effectively improving research-related knowledge and skills, with minimal associated costs. In lower-middle-income countries, virtual RWs are a creative and cost-effective use of web-based technologies to facilitate medical students to contribute to the local and global healthcare research community.
Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction
Authors: Wang Suhuai , Li Jingjie , Sun Lin , Cai Jianing , Wang Shihui , Zeng Linwen , Sun Shaoqing
Published: November 2021

Background

Early identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI).

Methods

A total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set.

Results

Three ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI.

Conclusions

We used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research.

Trial registration Clinical Trial Registry No.: ChiCTR2100041960.
Medium & long-chain acylcarnitine’s relation to lipid metabolism as potential predictors for diabetic cardiomyopathy: a metabolomic study
Authors: Zheng Dan-meng , An Zhen-ni , Ge Ming-hao , Wei Dong-zhuo , Jiang Ding-wen , Xing Xue-jiao , Shen Xiao-lei , Liu Chang
Published: November 2021

Background

Acylcarnitine is an intermediate product of fatty acid oxidation. It is reported to be closely associated with the occurrence of diabetic cardiomyopathy (DCM). However, the mechanism of acylcarnitine affecting myocardial disorders is yet to be explored. This current research explores the different chain lengths of acylcarnitines as biomarkers for the early diagnosis of DCM and the mechanism of acylcarnitines for the development of DCM in-vitro.

Methods

In a retrospective non-interventional study, 50 simple type 2 diabetes mellitus patients and 50 DCM patients were recruited. Plasma samples from both groups were analyzed by high throughput metabolomics and cluster heat map using mass spectrometry. Principal component analysis was used to compare the changes occurring in the studied 25 acylcarnitines. Multivariable binary logistic regression was used to analyze the odds ratio of each group for factors and the 95% confidence interval in DCM. Myristoylcarnitine (C14) exogenous intervention was given to H9c2 cells to verify the expression of lipid metabolism-related protein, inflammation-related protein expression, apoptosis-related protein expression, and cardiomyocyte hypertrophy and fibrosis-related protein expression.

Results

Factor 1 (C14, lauroylcarnitine, tetradecanoyldiacylcarnitine, 3-hydroxyl-tetradecanoylcarnitine, arachidic carnitine, octadecanoylcarnitine, 3-hydroxypalmitoleylcarnitine) and factor 4 (octanoylcarnitine, hexanoylcarnitine, decanoylcarnitine) were positively correlated with the risk of DCM. Exogenous C14 supplementation to cardiomyocytes led to increased lipid deposition in cardiomyocytes along with the obstacles in adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK) signaling pathways and affecting fatty acid oxidation. This further caused myocardial lipotoxicity, ultimately leading to cardiomyocyte hypertrophy, fibrotic remodeling, and increased apoptosis. However, this effect was mitigated by the AMPK agonist acadesine.

Conclusions

The increased plasma levels in medium and long-chain acylcarnitine extracted from factors 1 and 4 are closely related to the risk of DCM, indicating that these factors can be an important tool for DCM risk assessment. C14 supplementation associated lipid accumulation by inhibiting the AMPK/ACC/CPT1 signaling pathway, aggravated myocardial lipotoxicity, increased apoptosis apart from cardiomyocyte hypertrophy and fibrosis were alleviated by the acadesine.
Integrated space–frequency–time domain feature extraction for MEG-based Alzheimer’s disease classification
Authors: Yang Su , Bornot Jose Miguel Sanchez , Fernandez Ricardo Bruña , Deravi Farzin , Wong-Lin KongFatt , Prasad Girijesh
Published: November 2021

Magnetoencephalography (MEG) has been combined with machine learning techniques, to recognize the Alzheimer’s disease (AD), one of the most common forms of dementia. However, most of the previous studies are limited to binary classification and do not fully utilize the two available MEG modalities (extracted using magnetometer and gradiometer sensors). AD consists of several stages of progression, this study addresses this limitation by using both magnetometer and gradiometer data to discriminate between participants with AD, AD-related mild cognitive impairment (MCI), and healthy control (HC) participants in the form of a three-class classification problem. A series of wavelet-based biomarkers are developed and evaluated, which concurrently leverage the spatial, frequency and time domain characteristics of the signal. A bimodal recognition system based on an improved score-level fusion approach is proposed to reinforce interpretation of the brain activity captured by magnetometers and gradiometers. In this preliminary study, it was found that the markers derived from gradiometer tend to outperform the magnetometer-based markers. Interestingly, out of the total 10 regions of interest, left-frontal lobe demonstrates about 8% higher mean recognition rate than the second-best performing region (left temporal lobe) for AD/MCI/HC classification. Among the four types of markers proposed in this work, the spatial marker developed using wavelet coefficients provided the best recognition performance for the three-way classification. Overall, the proposed approach provides promising results for the potential of AD/MCI/HC three-way classification utilizing the bimodal MEG data.