bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor affecting severe atherothrombotic cerebral infarction in patients with type 2 diabetes mellitus: Large‐scale claim database analysis of Japan
Authors: Horii Takeshi , Oikawa Yoichi , Kidowaki Kasumi , Shimada Akira , Mihara Kiyoshi
Published: September 2024

Aims

This study aimed to investigate the factors associated with the exacerbation of the severity of atherothrombotic brain infarction at discharge in patients with type 2 diabetes using a large‐scale claims database.

Materials and Methods

This retrospective cross‐sectional study utilized the Medical Data Vision administrative claims database, a nationwide database in Japan using acute care hospital data, and the Diagnosis Procedure Combination system. Diagnosis Procedure Combination data collected between April 1, 2008, and December 31, 2022, were extracted. Patients with type 2 diabetes were included. Severe atherothrombotic brain infarction was defined as a modified Rankin scale score of ≥3.

Results

Severe atherothrombotic brain infarction occurred in 43,916/99,864 (44.0%) patients with type 2 diabetes. The odds ratio for severe atherothrombotic brain infarction increased significantly per 10 year increments in age (odds ratio: 1.69, 95% confidence interval: 1.66–1.71). A body mass index of <25 kg/m2, with a body mass index of ≥25 kg/m2 as reference, also increased the risk for severe atherothrombotic brain infarction (odds ratio: 1.11, 95% confidence interval: 1.08–1.15). The odds ratios in insulin and dipeptidyl peptidase 4 inhibitor use were significantly higher than 1. In particular, statin use (odds ratio: 0.85, 95% confidence interval: 0.83–0.88), fibrate use (odds ratio: 0.68, 95% confidence interval: 0.59–0.78), aspirin use (odds ratio: 0.78, 95% confidence interval: 0.75–0.80), and P2Y12 inhibitor use (odds ratio: 0.88, 95% confidence interval: 0.85–0.91) were associated with a lower odds ratio for severe atherothrombotic brain infarction.

Conclusions

The active management of lipid levels using statins and fibrates may be beneficial in preventing the exacerbation of atherothrombotic brain infarction in type 2 diabetes patients.
Humans‐written versus ChatGPT‐generated case reports
Authors: Matsubara Shigeki
Published: September 2024

Aim

Artificial intelligence, especially ChatGPT, has been used in various aspects of medicine; however, whether ChatGPT can be used in case report writing is unknown. This study aimed to provoke discussion and provide a platform for it.

Methods

I wrote a theoretical case report where cyst aspiration cured a twisted ovarian cyst (Manuscript 4). I tasked ChatGPT with generating case reports by inputting information at three different levels: (1) key message and case profile, (2) addition of key introduction information (including known facts and problems to be solved), and (3) further addition of main discussion points. These inputs resulted in the creation of Manuscripts 1–3, which were subjected to analysis. Manuscript 3, generated by ChatGPT with the deepest information input, was compared with Manuscript 4, the human‐authored counterpart.

Results

With the least information, Manuscript 1 can stand on its own, but its content is superficial. The more detailed data input, the more readable and reasonable the manuscripts become. A human‐written manuscript involves personal experience and viewpoints other than obstetrics‐gynecology.

Conclusions

Better input produced more reasonable and readable case reports. Human‐written paper, compared with ChatGPT‐generated one, can involve “human touch.” Whether such human touch enriches the case report awaits further discussion. Whether ChatGPT can be used in case report writing, and if it can, to what extent, should be worthy of further study. I encourage every doctor to form their own stance towards ChatGPT use in medical writing.
Development and Validation of the Epidemiological Diagnostic Instrument for Temporomandibular Disorders
Authors: Borges Raul Elton Araújo , Mendonça Luana da Rocha Alves , Roncalli da Costa Oliveira Angelo Giuseppe , dos Santos Calderon Patrícia
Published: September 2024

Background

Temporomandibular disorders (TMD) are a highly misreported health problem. Its diagnosis is complex and requires the use of valid and reliable instruments.

Objective

To develop and validate the Epidemiological Diagnostic Instrument for TMD (EDI/TMD).

Methods

Content validity (CV), response process (RP), construct validity (EFA), reliability (inter and intraobserver consistency), and convergence validity of the EDI/TMD were assessed and compared to the Diagnostic Criteria for TMD (DC/TMD).

Results

An instrument composed of a 9‐question questionnaire and a 12‐step clinical protocol was developed. CV analysis reduced the instrument to a 5‐question and 7‐step clinical protocol (CVI = 0.93). Some instructions were included after the RP. The EFA found three factors: myogenous TMD, arthrogenous TMD, and differential diagnosis. The reliability scores ranged from substantial to excellent. When compared to the DC/TMD, the EDI/TMD total score indicated that this instrument is valid and provides satisfactory diagnostic criteria (Kappa = 0.906;p < 0.001), and can distinguish non‐TMD and TMD individuals, with a cut‐off point of 4.9 (Sensitivity = 1.0; Specificity = 1.0; AUC = 1.0). For individuals who had both myogenous and arthrogenous TMD, the cut‐off point was 14 or higher (Sensitivity = 0.8; Specificity = 1.0; AUC = 0.987). For individuals who had either myogenous TMD (Sensitivity = 1.0; Specificity = 0.88; PPV = 0.89; NPV = 1.0) or arthrogenous TMD (Sensitivity = 0.95; Specificity = 0.87; PPV = 0.83; NPV = 0.96), the cut‐off point was between 5 and 13.9, with the highest EFA score being the determinant factor for final diagnosis.

Conclusion

Based on its psychometric properties, the EDI/TMD is a valid and reliable assessment tool that is capable of diagnosing TMD and classifying its subtypes.
A prospective multicenter observational study assessing incidence and risk factors for acute blood transfusion reactions in dogs
Authors: Hall Georgina B. F. , Birkbeck Rachael , Brainard Benjamin M. , Camacho Fernanda , Davidow Elizabeth B. , LeVine Dana N. , Mackin Andrew , Moss Taylor , Nash Katherine J. , Stanzani Giacomo , Starybrat Daria , Stoye David Q. , Tai Carolyn , Thomason John , Walker Julie M. , Wardrop K. Jane , Wilson Helen , Wurlod Virginie A. , Humm Karen
Published: September 2024

Background

Reported incidence of blood transfusion reactions (TR) varies greatly.

Objective

To prospectively evaluate the incidence of acute TRs in dogs receiving allogenic blood products, using consensus definitions, and to assess factors associated with TRs.

Animals

Dogs (n = 858) administered allogenic blood products (n = 1542) between March and November 2022.

Methods

Prospective, multicenter surveillance study occurring in referral hospitals in the United States, United Kingdom, and Australia recording TRs in dogs administered blood products as defined by the consensus guidelines published by The Association of Veterinary Hematology and Transfusion Medicine in 2021.

Results

The incidence of acute TR was 8.9% (95% CI 7.0‐11.1) for packed red blood cells (pRBCs) and 4.5% (95% CI 2.9‐6.6) for plasma products. The most frequently reported TRs were febrile nonhemolytic TRs (FNHTR; 4%, 95% CI 2.8‐5.5) when administering pRBCs and allergic TRs (3.2%, 95% CI 1.80‐5.10) when administering plasma products. A higher dose of pRBC (adjusted odds ratio [aOR] 1.04 [95% CI 1.00‐1.08]) was associated with a higher odds of TR. Administration of pRBCs stored for longer than 28 days was associated with higher odds of FNHTR (aOR 4.10 [95% CI 1.58‐10.65]) and acute hemolytic TR (AHTR; OR 15.2 [95% CI 3.35‐68.70]) when compared with pRBCs stored for 14 days or fewer. Leukoreduction of pRBC was not associated with lower odds of developing a TR (OR 1.47 [95% CI 0.89‐2.42]).

Conclusions and Clinical Importance

Clinicians should be mindful of the age and dose of pRBC prescribed to dogs.
Longitudinal Epidemiology of Mucormycosis Within the Veterans Health Administration: A Retrospective Cohort Study Over a 20‐Year Period
Authors: Muthukumarasamy Nirmal , Suzuki Hiroyuki
Published: September 2024

Background

Mucormycosis is a rare but critical infection. Due to its rarity, there is scarce evidence about the longitudinal changes in the epidemiology of mucormycosis in the US.

Objectives

We investigated the longitudinal epidemiology, detailed clinical characteristics, treatment and outcomes of patients with mucormycosis within the US Veterans Health Administration (VHA) over 20‐year period.

Patients/Methods

All adult patients who were admitted to an acute‐care hospital with a diagnosis of mucormycosis within the VHA from January 2003 to December 2022.

Results

Our study included 201 patients from 68 hospitals. Incidence rates of mucormycosis increased from 1.9 per 100,000 hospitalisations in 2003 to 3.3 per 100,000 hospitalisations in 2022, with a peak incidence at 5.9 per 100,000 hospitalisations in 2021, when the Delta wave of COVID‐19 hit the US. Rhino‐orbital (37.3%) and pulmonary mucormycosis (36.8%) were the most common types of infection. Diabetes mellitus (59.1%) and leukaemia (28.9%) were most common comorbidities predisposing to mucormycosis. Use of posaconazole or isavuconazole increased over time. The 90‐day and 1‐year mortalities were 35.3% and 49.8%, respectively. The mortality was lower in more recent years (2013–2017, 2018–2022) compared to earlier years (2003–2007). Age ≥65 (adjusted odds ratio [aOR]: 3.47, 95% CI 1.59–7.40), leukaemia as a comorbidity (aOR: 2.66, 95% CI 1.22–5.89) and central nervous system infection (aOR: 10.59, 95% CI 2.81–44.57) were significantly associated with higher 90‐day mortality.

Conclusions

Our longitudinal cohort study suggests the increasing incidence rates but lower mortality of mucormycosis over this 20‐year period.
AtALMT5 mediates vacuolar fumarate import and regulates the malate/fumarate balance in Arabidopsis
Authors: Doireau Roxane , Jaślan Justyna , Cubero‐Font Paloma , Demes‐Causse Elsa , Bertaux Karen , Cassan Cédric , Pétriacq Pierre , De Angeli Alexis
Published: September 2024

Malate and fumarate constitute a significant fraction of the carbon fixed by photosynthesis, and they are at the crossroad of central metabolic pathways. In Arabidopsis thaliana, they are transiently stored in the vacuole to keep cytosolic homeostasis.

The malate and fumarate transport systems of the vacuolar membrane are key players in the control of cell metabolism. Notably, the molecular identity of these transport systems remains mostly unresolved. We used a combination of imaging, electrophysiology and molecular physiology to identify an important molecular actor of dicarboxylic acid transport across the tonoplast.

Here, we report the function of the A. thaliana Aluminium‐Activated Malate Transporter 5 (AtALMT5). We characterised its ionic transport properties, expression pattern, localisation and function in vivo. We show that AtALMT5 is expressed in photosynthetically active tissues and localised in the tonoplast. Patch‐clamp and in planta analyses demonstrated that AtALMT5 is an ion channel‐mediating fumarate loading of the vacuole. We found in almt5 plants a reduced accumulation of fumarate in the leaves, in parallel with increased malate concentrations.

These results identified AtALMT5 as an ion channel‐mediating fumarate transport in the vacuoles of mesophyll cells and regulating the malate/fumarate balance in Arabidopsis.
From marketization to agency reclassification: A qualitative comparative analysis of de‐agencification in China
Authors: He Chenyang , Lo Carlos Wing‐Hung , Liu Ning , Tang Shui‐Yan
Published: September 2024

A standing contention in the agencification/de‐agencification literature concerns how to explain the adoption or reversal of the agency form for service delivery. What considerations—transaction costs or political and institutional factors—drive the choice of specific reform strategies? Employing a configurational perspective, this article examines this question in the context of China's service organization reform. By tracing the de‐agencification process and strategy shift of 11 service organizations in the environmental management system of Guangzhou, this article shows that transaction‐cost changes are neither sufficient nor necessary to explain strategy shifts or a slowdown of de‐agencification. A combination of political‐institutional factors can offset the influence of transaction‐cost changes. Reform uncertainty, if combined differently with other factors, can result in divergent outcomes. Moreover, political priority, rather than party politics, shapes China's de‐agencification. A shift in reform strategy does not necessarily impede the pace of de‐agencification reform.
Moving social‐ecological restoration forward: how mangrove project managers' perceptions of social monitoring and community engagement serve as a model for broader restoration efforts
Authors: Grimm Kerry E. , Archibald Jessica L. , Axelsson E. Petter , Grady Kevin C.
Published: September 2024

Restoration is effective for improving ecosystem health and protecting biodiversity. However, restoration initiatives often neglect socioeconomic dimensions that affect local communities. When these factors are included, they are often under the purview of managers whose perspectives of public engagement remain understudied. Here, we focused on mangroves and surveyed restoration project managers in Latin America and the Caribbean to explore if and how they have engaged in socioeconomic best practices such as including the community, local knowledge, and social monitoring. We also sought to understand how these activities related to perceptions of project outcomes. Most managers (n = 182) reported that they engaged in some best practices, such as community engagement in various project stages and incorporating local information. Differences existed as to which types of information were included, which project stages included the community, and how frequently the community was involved. Overall, managers, especially those who engaged the community more frequently and throughout the entire restoration process, believed projects were successful and provided numerous community benefits. However, despite the reported number of benefits, less than half of the respondents conducted social monitoring to assess the actualization of these benefits or other social indicators. We provide suggestions for how mangrove restoration projects, and restoration efforts more broadly, can increase the inclusion of communities, their knowledge, and social monitoring to better assess the achievement of project outcomes.
Perceptions and Experiences of Gender Transformative Approaches in Rural Honduras*
Authors: Velasco Palacios Hazel , Castellanos Paige , Jensen Leif , Larson Janelle , Reyes Rocha Francisco Alfredo , Sachs Carolyn , Sanders Arie , Sexsmith Kathleen
Published: September 2024

This research examines the potential of gender‐transformative approaches (GTAs) to improve gender equality in agricultural extension programs and food security through experiential learning and participatory methods. Scholars of gender and agriculture have long highlighted the gender gap in access to agricultural resources; to address this issue, development organizations have integrated GTAs into their initiatives. The article presents an empirical case study of a gender transformative‐farmer field school (GTA‐FFS) in rural Honduras and examines participants' perceptions of the short‐ and long‐term benefits and limitations of these programs. The findings indicate that GTA‐FFSs can provide participants with valuable knowledge and skills in agriculture, but structural barriers such as lack of suitable land, access to water, labor, and time hinder their ability to apply the learnings. These barriers are particularly salient for women participants. This research contributes to the literature on GTAs by identifying structural barriers to their short‐ and long‐term success. It also offers insights for development practitioners and policymakers engaged in advancing gender equality and food security in rural contexts; in particular, strengthening the rural social safety net.
Valuative invariants for large classes of matroids
Authors: Ferroni Luis , Schröter Benjamin
Published: September 2024

We study an operation in matroid theory that allows one to transition a given matroid into another with more bases via relaxing a stressed subset. This framework provides a new combinatorial characterization of the class of (elementary) split matroids. Moreover, it permits to describe an explicit matroid subdivision of a hypersimplex, which, in turn, can be used to write down concrete formulas for the evaluations of any valuative invariant on these matroids. This shows that evaluations on these matroids depend solely on the behavior of the invariant on a tractable subclass of Schubert matroids. We address systematically the consequences of our approach for several invariants. They include the volume and Ehrhart polynomial of base polytopes, the Tutte polynomial, Kazhdan–Lusztig polynomials, the Whitney numbers of the first and second kinds, spectrum polynomials and a generalization of these by Denham, chain polynomials and Speyer's ‐polynomials, as well as Chow rings of matroids and their Hilbert–Poincaré series. The flexibility of this setting allows us to give a unified explanation for several recent results regarding the listed invariants; furthermore, we emphasize it as a powerful computational tool to produce explicit data and concrete examples.
GluN2C/D‐containing NMDA receptors enhance temporal summation and increase sound‐evoked and spontaneous firing in the inferior colliculus
Authors: Drotos Audrey C. , Zarb Rachel L. , Booth Victoria , Roberts Michael T.
Published: September 2024

Along the ascending auditory pathway, there is a broad shift from temporal coding, which is common in the lower auditory brainstem, to rate coding, which predominates in auditory cortex. This temporal‐to‐rate transition is particularly prominent in the inferior colliculus (IC), the midbrain hub of the auditory system, but the mechanisms that govern how individual IC neurons integrate information across time remain largely unknown. Here, we report the widespread expression of Glun2c and Glun2d mRNA in IC neurons. GluN2C/D‐containing NMDA receptors are relatively insensitive to voltage‐dependent Mg2+ blockade, and thus can conduct current at resting membrane potential. Using in situ hybridization and pharmacology, we show that vasoactive intestinal peptide neurons in the IC express GluN2D‐containing NMDA receptors that are activatable by commissural inputs from the contralateral IC. In addition, GluN2C/D‐containing receptors have much slower kinetics than other NMDA receptors, and we found that GluN2D‐containing receptors facilitate temporal summation of synaptic inputs in vasoactive intestinal peptide neurons. In a model neuron, we show that a GluN2C/D‐like conductance interacts with the passive membrane properties of the neuron to alter temporal and rate coding of stimulus trains. Consistent with this, we show in vivo that blocking GluN2C/D‐containing receptors decreases both the spontaneous firing rate and the overall firing rate elicited by amplitude‐modulated sounds in many IC neurons. These results suggest that GluN2C/D‐containing NMDA receptors influence rate coding for auditory stimuli in the IC by facilitating the temporal integration of synaptic inputs.

image

Key points

NMDA receptors are critical components of most glutamatergic circuits in the brain, and the diversity of NMDA receptor subtypes yields receptors with a variety of functions.

We found that many neurons in the auditory midbrain express GluN2C and/or GluN2D NMDA receptor subunits, which are less sensitive to Mg2+ blockade than the more commonly expressed GluN2A/B subunits.

We show that GluN2C/D‐containing receptors conducted current at resting membrane potential and enhanced temporal summation of synaptic inputs.

In a model, we show that GluN2C/D‐containing receptors provide additive gain for input‐output functions driven by trains of synaptic inputs.

In line with this, we found that blocking GluN2C/D‐containing NMDA receptors in vivo decreased both spontaneous firing rates and firing evoked by amplitude‐modulated sounds.
¿Cómo aprendimos en pandemia? Percepción de estudiantes universitarios chilenos
Authors: Cabrera-Murcia Elsa Piedad , Pizarro-Cordero Claudia Constanza , González-Sanzana Álvaro , Oval-Soto Carmen Paz , Villarroel-Henríquez Verónica
Published: September 2024

La pandemia del coronavirus desencadenó una serie de transformaciones en la forma de enseñar y de aprender en todos los niveles educativos. Si bien la enseñanza remota fue la estrategia utilizada para garantizar la continuidad de los aprendizajes en el mundo, no se ha desarrollado un cuerpo de conocimientos que permita comprender su implementación, considerando la perspectiva del aprendiz. Bajo tal consideración, esta investigación buscó determinar las variables que inciden en la percepción de estudiantes universitarios chilenos sobre su aprendizaje en pandemia, así como caracterizar barreras y facilitadores del proceso de aprendizaje en la educación remota. La metodología fue de corte mixto, basada en el análisis de una encuesta en formato online que contestaron 1677 estudiantes de 34 universidades chilenas (incluidas públicas y privadas, de regiones y de la capital). Los resultados señalan que la didáctica y la participación son variables predictoras de la percepción de aprendizaje en el estudiantado, y se presentan hallazgos que invitan a considerarlas como aspectos claves en el diseño e implementación de procesos de enseñanza remota.
Hydrogen & Ammonia Powered Turbofan Design Implications For Next Generation Of Aircraft Engines
Authors: Sasi Sarath , Mourouzidis Christos , Rajendran David John , Roumeliotis Ioannis
Published: September 2024

This paper aims to establish the cycle design implications for turbofan engines that will be powered by Hydrogen and Ammonia. Appropriate methodologies are employed to address the identified research questions. A comprehensive turbofan design space exploration is performed for Hydrogen and Ammonia. An evaluation of engine size and weight is carried out for both Hydrogen and Ammonia, with the support of three distinct turbofan design strategies. The impact of fan size (specific thrust) on the cycle design of turbofan engines powered by Hydrogen and Ammonia is assessed. The turbofan design opportunities when powered by Hydrogen across aircraft category is explored. The impact of fan size and the cryogenic tank technology on a Hydrogen aircraft is investigated. It is identified that Hydrogen and Ammonia offered three main turbofan design opportunities. Hydrogen and Ammonia significantly affects the engine size, weight and operating temperatures based on the design strategy selected. With similar ESFC breakpoints for very low specific thrust values, Hydrogen and Ammonia showcases significant departure in BPRs from kerosene for all ranges of fan sizes. Hydrogen offers significant turbofan redesign opportunities across aircraft category (SMR and LR). Cryogenic tank technology is a major design driver for both Hydrogen turbofan and aircraft mission energy burn.
Effects of Foot-Strike Pattern on Neuromuscular Function During a Prolonged Graded Run
Authors: Vernillo Gianluca , Aguiar Matheus , Savoldelli Aldo , Martinez Aaron , Giandolini Marlene , Horvais Nicolas , Edwards W. Brent , Millet Guillaume Y.
Published: September 2024

Purpose: To study whether, during typical-level running, non-rear-foot strikers (non-RFS) or rear-foot strikers (RFS) presented a similar or different extent of neuromuscular fatigue after a prolonged graded run. Methods: Sixteen experienced male trail runners (8 non-RFS and 8 RFS) performed a 2.5-hour treadmill graded running exercise. Before and after exercise, neuromuscular tests were performed to assess neuromuscular fatigue of the plantar flexors. Biomechanical gait parameters were acquired with an instrumented treadmill, and electromyographic activity of the lower-limb muscles was collected as an index of muscle activation. Results: There were no significant time × foot strike interactions for neuromuscular (all P ≥ .742), muscle activation (all P ≥ .157), or biomechanical (all P ≥ .096) variables. Conclusions: A dominant level running foot-strike pattern did not directly affect the extent of neuromuscular fatigue during a prolonged graded run. This suggests that no ideal running foot-strike pattern exists to minimize neuromuscular fatigue during prolonged-duration races wherein cumulative uphill and downhill segments are high, such as in trail running.
Lung-innervating nociceptor sensory neurons promote pneumonic sepsis during carbapenem-resistant
Klebsiella pneumoniae
lung infection
Authors: Joshi Prabhu Raj , Adhikari Sandeep , Onah Chinemerem , Carrier Camille , Judd Abigail , Mack Matthias , Baral Pankaj
Published: September 2024

Carbapenem-resistant
Klebsiella pneumoniae
(CRKP) causes Gram-negative lung infections and fatal pneumonic sepsis for which limited therapeutic options are available. The lungs are densely innervated by nociceptor sensory neurons that mediate breathing, cough, and bronchoconstriction. The role of nociceptors in defense against Gram-negative lung pathogens is unknown. Here, we found that lung-innervating nociceptors promote CRKP pneumonia and pneumonic sepsis. Ablation of nociceptors in mice increased lung CRKP clearance, suppressed trans-alveolar dissemination of CRKP, and protected mice from hypothermia and death. Furthermore, ablation of nociceptors enhanced the recruitment of neutrophils and Ly6C
hi
monocytes and cytokine induction. Depletion of Ly6C
hi
monocytes, but not of neutrophils, abrogated lung and extrapulmonary CRKP clearance in ablated mice, suggesting that Ly6C
hi
monocytes are a critical cellular population to regulate pneumonic sepsis. Further, neuropeptide calcitonin gene–related peptide suppressed the induction of reactive oxygen species in Ly6C
hi
monocytes and their CRKP-killing abilities. Targeting nociceptor signaling could be a therapeutic approach for treating multidrug-resistant Gram-negative infection and pneumonic sepsis.
Activation of NF-κB/MAPK signaling and induction of apoptosis by salicylate synthase NbtS in
Nocardia farcinica
promotes neuroinflammation development
Authors: Shen Jirao , Ji Xing zhao , Han Lichao , Yao Jiang , Liang Yihe , Yuan Min , Xu Shuai , Li Zhenjun
Published: September 2024

Nocardia farcinica
can cause a rare, yet potentially fatal, central nervous system infection. NbtS protein may be a key virulence factor in
N. farcinica
infection of the brain. In this study, we investigated the function of the virulence-associated factor NbtS in microglial cells
in vitro
and in infected mice
in vivo
. We explored the interactions between NbtS and microglial cells (BV2 and human microglial clone 3), revealing that NbtS activates the toll-like receptor 4-dependent MyD88-IRAK4-IRAK1 and MAPK/nuclear factor kappa B (NF-κB) pathways, significantly enhancing pro-inflammatory responses as indicated by increased levels of tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β), as measured by ELISA and quantitative PCR. Apoptosis was elevated in these cells, as shown by increased expression of Bax and caspase-3 and decreased Bcl-2 levels. The terminal deoxynucleotidyl transferase dUTP nick end labeling assay also confirmed the occurrence of apoptosis. In vivo, mice infected with an
RS03155
-deficient strain of
N. farcinica
exhibited higher survival rates and reduced brain inflammation, suggesting a pivotal role for the NbtS protein in the pathogenesis of
Nocardia
. Conservation of the
RS03155
gene across
Nocardia
spp. was verified by PCR, and the immunogenic potential of NbtS was confirmed by Western blot analysis using sera from infected mice. These findings suggest that targeting NbtS may offer a novel therapeutic strategy against
Nocardia
infection.

IMPORTANCE

The study presented in this article delves into the molecular underpinnings of
Nocardia farcinica
-induced neuroinflammation. By focusing on the salicylate synthase gene,
RS03155
, and its encoded protein, NbtS, we uncover a pivotal virulence factor that triggers a cascade of immunological responses leading to apoptosis in microglial cells. This research not only enhances our comprehension of the pathogenesis of
Nocardia
infections but also provides a potential therapeutic target. Given the rising importance of understanding host-microbe interactions within the context of the central nervous system, especially in immunocompromised individuals, the findings are of significant relevance to the field of microbiology and could inform future diagnostic and treatment modalities for
Nocardia
-associated neurological disorders. Our work emphasizes the need for continued research into the intricate mechanisms of microbial pathogenesis and the development of novel strategies to combat life-threatening infections.
Acinetobacter calcoaceticus-baumannii
complex prevalence, spatial-temporal distribution, and contamination sources in Canadian aquatic environments
Authors: Benoit Thomas , Sajjad Dania , Cloutier Michel , Lapen David R. , Craiovan Emilia , Sykes Ellen M. E. , Kumar Ayush , Khan Izhar U. H.
Published: September 2024

Acinetobacter calcoaceticus-baumannii
(ACB) complex has been identified as a group of emerging opportunistic pathogens that cause nosocomial infections. The current study investigates the prevalence, distribution, and diversity of pathogenic ACB complex in various aquatic systems with different uses. Of the total 157 agricultural, raw drinking water intake, recreational beach, and wastewater treatment plant (WWTP) effluent samples, acinetobacters were isolated, quantified, and confirmed by genus- and ACB complex-specific PCR assays. Of all agricultural surface water samples,
A. calcoaceticus
(65%) was more frequently detected than
A. pittii
(14%),
A. nosocomialis
(9%), and
A. baumannii
(3%). In WWTP effluent samples,
A. baumannii
was more prevalent in de-chlorinated (60%) samples compared to both
A. pittii
and
A. nosocomialis
(40%). Interestingly
, A. nosocomialis
(43%),
A. calcoaceticus
(29%), and
A. baumannii
(14%) were detected in raw drinking water intake samples, whereas
A. pittii
(50%) and
A. nosocomialis
(25%) were detected in beach samples. Although no sampling location-specific differences were recorded, significant (
P
< 0.05) seasonal differences were observed when agricultural surface water samples collected in spring were compared with the summer and fall. Whereas effluent chlorination significantly impacted the degree of prevalence of
Acinetobacter
in WWTP effluent samples, overall, the prevalence of ACB complex in all sampling locations and seasons indicates that these water sources, containing human-associated ACB complex, may pose potential health risks as community-acquired opportunistic infections.

IMPORTANCE

Acinetobacter calcoaceticus-baumannii
(ACB) complex is a group of organisms known to cause problematic nosocomial opportunistic infections. A member of the species complex,
A. baumannii
, is becoming a global threat to infection treatment as strains are increasingly develop resistance to antibiotics. The prevalence and distribution of potentially pathogenic
Acinetobacter calcoaceticus-baumannii
complex species remain poorly understood, and there is a need to better understand the occurrence of
A. baumannii
in non-nosocomial environments. Our research details the spatial-temporal distribution of ACB complex species in a regional watershed and highlights the presence of ACB complex in wastewater effluent that is discharged into a river. These findings deepen our understanding of this group of species in non-nosocomial environments and encourage the development of monitoring programs for these species in regional waters.
Patient safety culture in home healthcare centres: protocol for a scoping review
Authors: Etebarian Khorasgani Abolfazl , Najafi Ghezeljeh Tahereh , Sharif-Nia Hamid , Ashghali Farahani Mansoureh , Golestan Fateme , Saraipour Ferdos
Published: September 2024

Introduction

Patient safety culture is a critical factor in improving the quality of home healthcare and preventing adverse events in patients receiving care in home health centres. However, the concept of patient safety culture in home healthcare centres is not clearly defined, and its dimensions and characteristics are still largely unknown. The aim of this scoping review is to provide a comprehensive overview of research on patient safety culture in home healthcare centres, identify related definitions and characteristics, and focus on key factors to fill the existing knowledge gaps.

Methods and analysis

This review will follow Arksey and O’Malley’s methodological framework, updated by the Joanna Briggs Institute (JBI), which comprises five stages: identifying the research question, identifying relevant studies, selecting the studies, charting the data, and collating, summarising and reporting the results. The inclusion criteria will be based on the Population, Concept and Context framework. A comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources, with no date restrictions, was conducted with the assistance of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic. The search will be continuously updated until the study is completed. In addition, we will review the reference lists of the final included studies and their citations to find further relevant studies. Studies that are duplicates and those not written in Persian or English will be excluded. The selection of studies based on the eligibility criteria will carried out by two independent reviewers who will perform a title/abstract screening followed by a full-text screening. Data extraction will be conducted using a standardised form from the JBI. Descriptive and content analyses will be conducted to identify key concepts in the literature reviewed.

Ethics and dissemination

No ethical review is required for this study. Results will be submitted for publication in a peer-reviewed journal and presented at conferences.
Implementing a pharmacogenomic-driven algorithm to guide antiplatelet therapy among Caribbean Hispanics: a non-randomised clinical trial
Authors: Nuñez-Medina Hector J , Monero Mariangeli , Torres Lorna M , Leal Enrique , Gonzalez-Sepulveda Lorena , Mayor Ángel M , Renta Jessicca Y , González-García Edgardo R , González Ariel , Melin Kyle , Scott Stuart A , Ruaño Gualberto , Hernandez-Suarez Dagmar F , Duconge Jorge
Published: September 2024

Objectives

To assess whether genotype-guided selection of oral antiplatelet drugs using a clinical decision support (CDS) algorithm reduces the rate of major adverse cardiovascular and cerebrovascular events (MACCEs) among Caribbean Hispanic patients, after 6 months.

Design

An open-label, multicentre, non-randomised clinical trial.

Setting

Eight secondary and tertiary care hospitals (public and private) in Puerto Rico.

Participants

300 Caribbean Hispanic patients on clopidogrel, both genders, underwent percutaneous coronary intervention (PCI) for acute coronary syndromes, stable ischaemic heart disease and documented extracardiac vascular diseases.

Interventions

Patients were separated into standard-of-care (SoC) and genotype-guided (pharmacogenetic (PGx)-CDS) groups (150 each) and stratified by risk scores. Risk scores were calculated based on a previously developed CDS risk prediction algorithm designed to make actionable treatment recommendations for each patient. Individual platelet function, genotypes, clinical and demographic data were included. Ticagrelor was recommended for patients with a high-risk score ≥2 in the PGx-CDS group only, the rest were kept or de-escalated to clopidogrel. The intervention took place within 3–5 days after PCI. Adherence medication score was also measured.

Primary and secondary outcomes

The occurrence rate of MACCEs (primary) and bleeding episodes (secondary). Statistical associations between patient time free of events and predictor variables (ie, treatment groups, risk scores) were tested using Kaplan-Meier survival analyses and Cox proportional-hazards regression models.

Results

The genotype-guided group had a clinically lower but not significantly different risk of MACCEs compared with the SoC group (8.7% vs 10.7%, p=0.56; HR=0.56). Among high-risk score patients, genotype-driven guidance of antiplatelet therapy showed superiority over SoC in reducing MACCE incidence 6 months postcoronary stenting (adjusted HR=0.104; p< 0.0001).

Conclusions

The potential benefit of implementing our PGx-CDS algorithm to significantly reduce the incidence rate of MACCEs in post-PCI Caribbean Hispanic patients on clopidogrel was observed exclusively among high-risk patients, with apparently no evident effect in other patient groups.

Trial registration number

NCT03419325.
Qualitative study of UK health and care professionals to determine resources and processes that can support actions to improve quality of data used to address and monitor health inequalities
Authors: Moorthie Sowmiya , Oguzman Emre , Evans Sian , Brayne Carol , LaFortune Louise
Published: September 2024

Introduction

Health inequalities in the UK are investigated and addressed by analysing data across socioeconomic factors, geography and specific characteristics, including those protected under law. It is acknowledged that the quality of data underpinning these analyses can be improved. The objective of this work was to gain insights from professionals working across the health and care sector in England into the type(s) of resource(s) that can be instrumental in implementing mechanisms to improve data quality into practice.

Design

Qualitative study based on semistructured interviews involving health and care professionals.

Setting

England.

Participants

A total of 16 professionals, mainly from the East of England.

Results

Awareness of mechanisms that could be put in place to improve quality of data related to health inequalities was high among interviewees. However, logistical (eg, workforce time, capacity and funding) as well as data usage (eg, differences in data granularity, information governance structures) barriers impacted on implementation of many mechanisms. Participants also acknowledged that concepts and priorities around health inequalities can vary across the system. While there are resources already available that can aid in improving data quality, finding them and ensuring they are suited to needs was time-consuming. Our analysis indicates that resources to support the creation of a shared understanding of what health inequalities are and share knowledge of specific initiatives to improve data quality between systems, organisations and individuals are useful.

Conclusions

Different resources are needed to support actions to improve quality of data used to investigate heath inequalities. These include those aimed at raising awareness about mechanisms to improve data quality as well as those addressing system-level issues that impact on implementation. The findings of this work provide insights into actionable steps local health and care services can take to improve the quality of data used to address health inequalities.
Identifying combinations of long-term conditions associated with sarcopenia: a cross-sectional decision tree analysis in the UK Biobank study
Authors: Hillman Susan J , Dodds Richard M , Granic Antoneta , Witham Miles D , Sayer Avan A , Cooper Rachel
Published: September 2024

Objectives

This study aims to determine whether machine learning can identify specific combinations of long-term conditions (LTC) associated with increased sarcopenia risk and hence address an important evidence gap—people with multiple LTC (MLTC) have increased risk of sarcopenia but it has not yet been established whether this is driven by specific combinations of LTC.

Design

Decision trees were used to identify combinations of LTC associated with increased sarcopenia risk. Participants were classified as being at risk of sarcopenia based on maximum grip strength of <32 kg for men and <19 kg for women. The combinations identified were triangulated with logistic regression.

Setting

UK Biobank.

Participants

UK Biobank participants with MLTC (two or more LTC) at baseline.

Results

Of 140 001 participants with MLTC (55.3% women, median age 61 years), 21.0% were at risk of sarcopenia. Decision trees identified several LTC combinations associated with an increased risk of sarcopenia. These included drug/alcohol misuse and osteoarthritis, and connective tissue disease and osteoporosis in men, which showed the relative excess risk of interaction of 3.91 (95% CI 1.71 to 7.51) and 2.27 (95% CI 0.02 to 5.91), respectively, in age-adjusted models.

Conclusion

Knowledge of LTC combinations associated with increased sarcopenia risk could aid the identification of individuals for targeted interventions, recruitment of participants to sarcopenia studies and contribute to the understanding of the aetiology of sarcopenia.
Effectiveness of acceptance commitment therapy for head and neck cancer patients with body image distress in China: a study protocol for randomised controlled trial
Authors: Xu Wenjie , Xiang Lina , Wang Shuman , Zhu Yu , Zheng Mimi , Wan Hongwei
Published: September 2024

Introduction

The head and neck comprise vital organs and are apparent human body parts. Tumours here impair physical and sensory functions as well as appearance and social interactions, leading to body image distress (BID) and threatening mental health and quality of life. Acceptance and commitment therapy has shown effectiveness in improving BID in groups such as breast cancer patients. This study aims to apply this therapy to intervene in head and neck cancer (HNC) patients, aiming to improve BID and promote better psychological well-being.

Methods and analysis

This study is a prospective, parallel-group, randomised controlled trial. A total of 64 HNC patients will be allocated to either an intervention group or a control group. The intervention group will engage in a 3 week, six-session group-based acceptance and commitment therapy programme, while the control group will receive standard treatment. The primary outcome is cancer-related BID, and secondary outcomes are HNC-related BID, psychological flexibility, coping style and psychological distress. These indicators will be measured at baseline, postintervention and 1 month following the intervention’s completion.

Ethics and dissemination

The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2308-67-02). The study results will be shared through peer-reviewed journals and conferences.

Trial registration number

ChiCTR2300077863.
Unveiling the prevalence of anaemia and its predictors among adults on highly active antiretroviral therapy in the dolutegravir era: a retrospective cross-sectional study
Authors: Sisay Zewdu Woretaw , Molla Zeleke Mulugeta , Ferede Yared Andargie , Kassie Achenef Bogale , Singh Pradeep , Alemu Muluken Adela , Desta Getaye Tessema
Published: September 2024

Objective

This study examined the prevalence, severity and risk factors of anaemia among adult people living with HIV attending an antiretroviral therapy centre in Woreta Primary Hospital, Woreta town, Ethiopia.

Design

Hospital-based retrospective cross-sectional study.

Setting

Public health facility that provides HIV care in Woreta town.

Participants

A total of 289 medical records of adults living with HIV/AIDS on highly active antiretroviral therapy from February 2019 to September 2023 at government hospital were reviewed using a systematic sampling method. The data were entered using Epi-info V.7 and exported to SPSS V.23 for data analysis. The data were analysed using bivariate and then multivariate logistic regression models in order to identify variables associated with anaemia. At the 95% CI level, variables having a p value of <0.05 were deemed to be statistically significant predictors.

Primary outcome

Prevalence and severity of anaemia and its predictors among adult patients living with HIV on antiretroviral therapy in Woreta Primary Hospital.

Results

The total prevalence of anaemia was 31.5% (95% CI 28.9 to 33.8). The prevalence of mild, moderate and severe anaemia was 20.42%, 10.38% and 0.70%, respectively. Predictors independently linked with anaemia were female sex (adjusted OR (AOR) 1.08), age ≥40 years (AOR 1.21), lived with HIV >10 years (AOR 2.31), CD4 counts <200 cells/µL (AOR 3.81), non-suppressed viral load (AOR 1.28), history of opportunistic infections (AOR 1.54), WHO clinical stages III and IV (AOR 1.37 and 2.23, respectively) and history of parasitic infestation (AOR 2.81).

Conclusions

A sizeable proportion of participants were found anaemic. Female sex, older age, longer periods lived with the virus, lower CD4 count, non-suppressed viral load, history of opportunistic infections, WHO clinical stages III and IV and history of parasitic infestation were the contributing factors. Therefore, to improve the anaemic status and living circumstances of patients living with HIV, immediate action on the linked factors is needed, such as monitoring for maintenance of CD4 counts >200 cells/μL and avoiding progression of HIV to the advanced WHO clinical stages, suppressed viral load, preventing opportunistic infections and parasitic infestation.
Effects of a hospital-based food security programme for children with complex diseases in an upper-middle-income country: a before-and-after study
Authors: Gómez-Casas Ángela María , Gempeler Andrés , Montoya Diana , González Luisa Fernanda , Prada Sergio I , Escobar Luis Alberto , Madriñán Jorge Mario , Granados Marcela
Published: September 2024

Background

To reduce health inequities in paediatric patients with complex diseases, our hospital developed a food security programme in 2022. The programme aims to mitigate food insecurity (FI) in paediatric patients with oncological, transplantation and congenital cardiovascular diagnoses, by providing a monthly nutritious food supply that covers up to 50% of the patient’s family food intake, accompanied by social and nutritional follow-up. In this study, we aimed to assess the effect of the programme on FI and nutritional status and describe its implementation.

Method

We conducted a before-and-after study of patients who entered the programme in a 14-month period. We used the Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) scale score, FI level and nutritional status measures to assess the effect of the programme. We used the Wilcoxon and McNemar tests to assess changes in scores and proportions of patients with moderate and severe FI, respectively, 31.5%–14.4% (p=0.0008) and of moderate FI from 68.5% to 36.9%.

Results

111 patients were included. They had a baseline median (IQR) ELCSA score=8 (7–11) that changed to 6 (4–9) (p<0.0001). Severe FI according to ELCSA changed from 31.5% to 14.4% (p<0.001) and moderate from 68.5% to 36.9% (p<0.001). We found no differences in nutritional status regarding height for age (49.5% vs 51.3%, p=0.76), weight for height (42.5% vs 59.1%, p=0.75) or body mass index for age (38% vs 46%, p=0.42)

Conclusion

The programme reduced FI in families by improving its level to mild or moderate. Children who entered the programme maintained an appropriate nutritional status despite the considerable risk of malnutrition described for oncological paediatric patients and paediatric solid organ transplantation receptors.