bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Repair of Supravalvar Aortic Stenosis in Association With Transverse and Proximal Descending Aortic Abnormalities
Authors: Mainwaring Richard D. , Collins R. Thomas , Ma Michael , Martin Elisabeth , Arunamata Alisa , Algaze-Yojay Claudia , Hanley Frank L.
Published: April 2022

Background

Supravalvar aortic stenosis (SVAS) may be an isolated defect of the proximal ascending aorta. However, more severe cases have extension of the arteriopathy into the transverse and proximal descending aorta. The purpose of this study was to review our experience with SVAS with and without aortic arch arteriopathy.

Methods

This was a retrospective review of 58 patients who underwent surgical repair of SVAS. The median age at repair was 18 months. A total of 37 patients had Williams syndrome. A total of 31 (53%) patients had associated peripheral pulmonary artery stenosis and 23 (39%) had coronary artery ostial stenosis (CAOS).

Results

A total of 37 of 58 (64%) patients had surgical repair of SVAS without the need for arch intervention while 21 (36%) patients had repair of the distal aortic arch. There were 3 (5.2%) operative deaths, 2 of whom had aortic arch involvement and one without arch involvement. There were 2 deaths after discharge from the hospital. Patients who needed arch surgery were more likely to have severe arch gradients compared to those without arch involvement (71% vs 30%, P < .05), were more likely to undergo concomitant procedures for peripheral pulmonary artery stenosis or CAOS (90% vs 62%, P < .05), and to have Williams syndrome (86% vs 51%, P < .05).

Conclusions

More than one-third of patients who had SVAS repair at our institution had procedures directed at the transverse or proximal descending aorta. Patients with arch involvement had more severe arch obstruction, required more concomitant procedures, and were more likely to have Williams syndrome.
The Performance of MAGEC X Spine Rods: A Comparative Retrieval Study
Authors: Tognini Martina , Hothi Harry , Bergiers Sean , Shafafy Masood , Tucker Stewart , Broomfield Edel , Henckel Johann , Hart Alister
Published: April 2022

Study Design

Multicentre comparative analysis of explanted Spine Magnetically Controlled Growing Rods (MCGRs).

Objectives

MAGEC X, the latest commercially available generation, was recalled in 2020 due to the risk of post-implantation separation of an actuator end-cap component. Currently, the supply of all MAGEC rods was temporarily suspended in the UK and the EU. Objective of this study is to compare the performance of the MAGEC X MCGR to the earlier MAGEC 1.3 design iteration, by means of retrieval analysis.

Methods

Fifteen of both MAGEC X and MAGEC 1.3 rods were consecutively collected from five different hospitals following removal surgery and matched by time to removal. Clinical and implant data was collected for all MCGRs. Analysis comprised visual assessments of external damage, plain radiograph evaluations, force and elongation testing, MAGEC X end-cap torque testing and disassembly. Mann-Whitney U tests were used to statistically compare groups.

Results

Rod distraction reached in vivo was significantly higher in the MAGEC 1.3 ( P = .002). There was no statistically significant difference in the total external damage score ( P = .870), maximum force produced ( P = .695) or distraction reached during force test ( P = .880). No pin fracture was detected. Elongation of stroke was mildly higher ( P = .051) for the MAGEC X implants. One MAGEC X had evident end cap component loosening. Internal damage scores were mildly lower in the MAGEC X group.

Conclusion

MAGEC X showed similar performance results than the previous design iteration MAGEC 1.3. End-cap component loosening was observed, with no major consequences on the internal mechanism.
COVID-19 and Coping Strategies: A Study Among the Salaried Employees in Kerala
Authors: Kumar Jisha S. , Bhagavathi J. S.
Published: April 2022

COVID-19 has become of the most fatal pandemics in the century. It has widely spread among different countries in the world. Also, the pandemic has affected different sections of the society. It has psychologically and financially affected the individuals also. In this scenario, it is important to analyze the feeding and income coping strategies of the salaried class employees. For this, a questionnaire was developed using Google Form and was sent across different salaried class employees of Kerala. A total of 100 samples were taken and the analysis was done. The findings of the study indicated that most of them did stock up food during COVID-19, and those who did not preferred home deliveries from supermarkets. When financial strategies are considered, a higher strain and a lower emergency saving was witnessed among those of the lower income group. The palliative measures by the Government were equally welcomed by all the income groups except the medical facility.
Successful Laparoscopic Treatment of Pancreatic Metastasis From Sigmoid Colon Cancer: A Case Report
Authors: Ishii Masatsugu , Inoue Yoshihiro , Matsuo Kentaro , Miyaoka Yuta , Hamamoto Hiroki , Osumi Wataru , Masubuchi Shinsuke , Yamamoto Masashi , Nitta Toshikatsu , Ishibashi Takashi , Tanaka Keitaro , Okuda Junji , Uchiyama Kazuhisa
Published: April 2022

Progressive colorectal cancer frequently presents with various manifestations, including hepatic, pulmonary, and peritoneal metastases, as well as local and anastomotic site recurrences. However, pancreatic metastasis is extremely rare. Complete surgical resection is currently considered the most effective and only potentially curative treatment for colorectal cancer with distant metastases. We report the successful laparoscopic treatment of a patient with pancreatic metastasis after initial surgery for Stage IV sigmoid colon cancer with pulmonary metastasis. An 84-year-old man was initially diagnosed with sigmoid colon cancer and pulmonary metastasis. Laparoscopic sigmoidectomy and thoracoscopic partial resection of the right lung were performed in 2017. After 8 months, an approximately 20-mm tumor was detected in the pancreatic tail during imaging investigations. We performed laparoscopic distal pancreatectomy without lymph node dissection at 1 year after the initial operation. The histopathological findings suggested metachronous pancreatic metastasis from the sigmoid colon cancer. The patient has had an uneventful postoperative course with no signs of recurrent disease during 29 months of follow-up after the pancreatic surgery. After prior surgery for Stage IV sigmoid colon cancer with pulmonary metastasis, curative resection was performed for pancreatic metastasis. We believe that curative resection may be useful for pancreatic tumors that involve hematogenous metastasis.
The memory bear
Authors: Kavalski Emilian R
Published: April 2022

In the late summer of 2018, like many of her students, friends and admirers, I was very glad to see that L.H.M. Ling’s health was improving. In mid-September, we were having exchanges about the publication of a special issue to which both of us were contributing. It felt like it was possible to plan new intellectual journeys together and I asked Lily whether she might be interested to take part in a panel on the ‘yogurt roads’ of Eurasia for the 2019 EISA conference in Sofia (Bulgaria). Her response was prompt and positive. Knowing that I come from the country, Lily also used the opportunity provided by this exchange to ask me whether there is something personal about my interest in the topic of relationality. Unfortunately, in the following week or so, work and family commitments prevented me from writing back. At the same time, Lily’s brief question appeared to have stirred something that kept her question constantly at the back of my mind and finding it difficult to come up with a meaningful answer. In the end, even though I had no clear idea what I am going to say, I turned on my computer with the firm decision to respond to her message before doing anything else that day. Yet, the first email in my inbox bore the shocking and unbelievable news of Lily’s sudden passing. The following is a belated answer to her question, attempting to draw on her inspiring work melding fiction, experiences and narrative into stories of IR. I truly wish she could have read this.
How Royal Caribbean Navigates Stormy Seas: A Customer Value Analysis
Authors: Weinstein Art , Bishard Autumn , Flack Rebecca , Sturgeon Kaeleigh
Published: April 2022

While the COVID-19 pandemic adversely affected all areas in society, the cruise industry was one of the business sectors impacted the most. Following a year and a half of total lockdown, Royal Caribbean International (RCI) is sailing again and is poised to be the market leader by implementing a customer value strategy. This case study evaluates Royal Caribbean’s marketing strategy, market and competitive situation and customer value practices, and offers thought-provoking end-of-case questions for marketing/business scholars and practitioners. A customer value assessment is conducted based on the Service-Quality-Image-Price (SQIP) framework. RCI successfully executes a customer value strategy and outperforms key rivals. From their attention to detail to their superb customer service, innovative technology and unique shipboard experiences, Royal Caribbean is dedicated to providing the best travel experiences to all guests. The information and insights offered are applicable to service marketers, particularly those in the travel, tourism and hospitality sectors.
Towards standardization of fatigue measurement: Psychometric properties and reference values of the PROMIS Fatigue item bank in the Dutch general population
Authors: Terwee Caroline B , Elsman Ellen BM , Roorda Leo D
Published: April 2022

Background

There is little consensus on how to measure fatigue.

Objectives

To standardize the measurement of fatigue across populations, we aimed to assess the psychometric properties of the PROMIS Fatigue item bank in the Dutch general population and obtain reference values.

Methods

A sample of 1006 people participating in an internet panel completed the full v1.0 PROMIS Fatigue item bank (95 items). Structural validity (item response theory (IRT) assumptions and IRT model fit), measurement invariance/cross-cultural validity (absence of differential items functioning (DIF) for demographic variables and language, compared to data from US participants in PROMIS wave 1), and (internal) reliability (percentage of respondents with reliable estimates) were assessed.

Results

The IRT model assumptions were considered met (ECV 0.86, Omega-H 0.92), all items fitted the IRT model, no items showed DIF for demographic variables and seven for language, but with negligible impact on T-scores. Reliable fatigue T-scores were found for 98.3%, 69.8–82.6%, and 96.5% of the respondents with the full item bank, the standard short forms, and a simulated computerized adaptive test (CAT), respectively. The CAT administered on average only five items. A T-score of 49.1 represented the average score of the Dutch general population, T-scores <55 are considered within normal limits, T-scores of 55–59 indicate mild fatigue, T-scores of 60–70 indicate moderate fatigue, and T-scores >70 indicate severe fatigue.

Conclusions

The PROMIS Fatigue item bank showed sufficient structural validity, no measurement invariance for demographic characteristics, sufficient cross-cultural validity, and sufficient (internal) reliability in the Dutch general population.
Relationships between general giftedness, expertise in mathematics, and mathematical creativity that associated with pattern generalization tasks in different representations
Authors: Eraky Adi , Leikin Roza , Hadad Bat-Sheva
Published: April 2022

The current study investigated creativity-directed problem-solving processing that explicitly requires solving pattern generalization problems in multiple ways. To examine mathematical creativity, we employed a multiple solution tasks approach, asking participants explicitly to solve pattern generalization problems in multiple ways. The participants were engaged with pattern generalization-multiple solution tasks in which patterns were presented numerically, diagrammatically, or contextually. The study aimed to examine whether success and creativity associated with solving pattern generalization-multiple solution tasks are affected (I) by expertise in mathematics (EM) and general giftedness (G) and (II) by task complexity and representation. Two hundred and ninety-eight participants from four research groups that differed in levels of general giftedness (G) and mathematical expertise participated in the study. We found that G affected statistically significant all the components of creativity when solving pattern generalization-multiple solution tasks, independently of task representation. Surprisingly, the effect of EM was lower and dependent on the type of task representation. Also surprising, we found statistically significant interactions between G and EM factors when solving pattern generalization-multiple solution tasks. The findings demonstrate a significant effect of task representation on students’ levels of success and creativity when engaged in solving pattern generalization-multiple solution tasks: contextual representations were approached with the highest level of success and creativity, whereas numerical representations appeared to be tackled with the lowest level of success and creativity. We suggest that mathematical instruction should integrate pattern generalization-multiple solution tasks to promote students’ mathematical expertise and creativity.
High level of persister frequency in clinical staphylococcal isolates
Authors: Manandhar Sarita , Singh Anjana , Varma Ajit , Pandey Shanti , Shrivastava Neeraj
Published: April 2022

Background

Staphylococcus aureus is a notorious human pathogen that causes often lethal systemic conditions that are mostly medical device associated biofilm infections. Similarly, coagulase negative staphylococci are emerging as leading pathogen for nosocomial infections owing to their ability to form biofilm on implanted medical equipment. Chronic in nature, these infections are difficult to treat. Such recalcitrance of these infections is caused mainly due to the presence of persister cells, which exhibit transient yet extreme tolerance to antibiotics. Despite tremendous clinical significance, there is lack of studies on persister cells formation among clinical bacterial isolates. Considering the importance of factors influencing persister formation, in this study, we evaluate the association of antibiotic tolerance with biofilm production, antibiotic stress, growth phase, specimen type, and dependency on staphylococcal species. Biofilm formation was detected among 375 clinical staphylococcal isolates by quantitative tissue culture plate method (TCP) and icaAD genes by genotypic method. The antibiotic susceptibility was determined by Kirby Bauer disc diffusion method while minimum inhibitory concentration values were obtained by agar dilution method. Persister cells were measured in the susceptible staphylococcal isolates in the presence of clinically relevant antibiotics.

Results

In the study, 161 (43%) S. aureus and 214 (57%) coagulase negative staphylococci (CNS) were isolated from different clinical samples. TCP method detected biofilm production in 84 (52.2%) S. aureus and 90 (42.1%) CNS isolates. The genotypic method detected icaAD genes in 86 (22.9%) isolates. Majority (> 90%) of both the biofilm producers and non-producers were sensitive to chloramphenicol and tetracycline but were resistant to penicillin. Interestingly, all isolates were sensitive to vancomycin irrespective of biofilm production. While high persister frequency was observed among all staphylococci isolates in the stationary growth phase, the persister frequency in exponential growth phase was statistically high among isolates possessing icaAD genes compared to icaAD negative isolates.

Conclusion

The research findings provide strong evidence that the clinical staphylococcal isolates exhibit extreme antibiotic tolerance suggesting their causal link with treatment failures. Understanding the factors influencing the formation and maintenance of persister cells are of utmost important aspect to design therapeutics and control recalcitrant bacterial infections.
Effects of adding low-dose ketamine to etomidate on serum cortisol levels in critically ill cardiac patients: a randomized clinical trial
Authors: Elhamamsy Mostafa Mohammed , Aldemerdash Ahmed Mohammed , Zahran Fathi Badie , Ezz Gehan Fawzy Mahmoud , AlSaud Sara Abou , Boules Maged Labib , Abdelhady Mahdy Ahmed , Hamed Mohamed Ahmed
Published: April 2022

Background

Etomidate was associated with an inhibition of adrenal steroid synthesis. This study aimed to evaluate the effects of adding low-dose ketamine to etomidate to minimize the decrease in serum cortisol level in critically ill cardiac patients.

Methods

Sixty adult cardiac patients, ≥ 18 years, who underwent upper endoscopy and Colonoscopy to manage acute anemia in the cardiac intensive care units were enrolled. Patients were randomly divided into two groups: (group (E): n = 30) received etomidate 0.2 mg/kg IV followed by etomidate 0.05 mg/kg IV, and (group (KE): n = 30) received ketamine 0.5 mg/kg IV, then etomidate 0.1 mg/kg IV, followed by etomidate 0.05 mg/kg IV. The primary outcome was Serum cortisol level at 6 h after the procedure.

Results

The mean postoperative cortisol level was significantly lower in group E (295.60 ± 49.218 nmol/L) versus group KE (461.00 ± 67.946 nmol/L), with 95% CI = 351.94 to 404.66; p = 0.000. In addition, the estimated serum cortisol reduction level was also significant between groups; In group E, the estimated cortisol level decreased nearly 53% from 632.40 ± 35.066 nmol/L to 295.60 ± 49.218 nmol/L 6 hours postoperative. While in group KE, the estimated cortisol level decreased only 27% from 639.13 ± 43.035 nmol/L to 461.00 ± 67.946 nmol/L.

Conclusions

Single-dose ketamine (0.5 mg/kg) was helpful to decrease the total dose of etomidate and hence decreased the percentage of serum cortisol level in such critically ill patients with preservation of patient satisfaction.

Trial Registration

This study is registered on ClinicalTrials.gov (NCT04857450; principal investigator: Mostafa Mohammed Elsaid Elhamamsy; registration date: 23/04/ 2021).
Glycemic status, non-traditional risk and left ventricular structure and function in the Jackson Heart Study
Authors: Ani Chizobam , Shavlik David , Knutsen Synnove , Abudayyeh Islam , Banta Jimmie , O’Brien Emily , Mentz Robert J. , Bertoni Alain G. , Fraser Gary
Published: April 2022

Background

Left ventricular structure and function abnormalities may be an early marker of cardiomyopathy among African Americans with diabetes (DM) even in the absence of coronary artery disease (CAD), arrhythmia, valvular heart disease and end-stage renal disease (ESRD). This study examined the association of prediabetes (PDM), DM and HbA1c with left ventricular structure and function among Jackson Heart Study (JHS) participants without traditional risk factors.

Methods

Retrospective cross-sectional analyses of the association of PDM, DM and HbA1c with, left ventricular ejection fraction (LV EF), fractional shortening (LV FS), stroke volume index (SVI), cardiac index (CI), left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), relative wall thickness (RWT), myocardial contraction fraction (MCF) and left ventricular mass index (LVMI). The study was conducted in 2234 adult JHS participants without preexisting CAD, arrhythmia, valvular heart disease or ESRD. Statistical analyses included descriptive, univariate and covariate adjusted linear regression analyses. Sensitivity analyses to explore the impact of hypertension on study outcomes were also carried out.

Results

DM compared with no DM was associated with lower, SVI (− 0.96 ml/m2, p = 0.029), LVEDVI (− 1.44 ml/m2p = 0.015), and MCF (− 1.90% p = 0.007) but higher CI (0.14 L/min/m2, p < 0.001), RWT (0.01 cm, p = 0.002) and LVMI (2.29 g/m2, p = 0.009). After further control for DM duration, only CI remaining significantly higher for DM compared with no DM participants (0.12 L/min/m2, p = 0.009). PDM compared with no PDM was associated with lower, SVI (− 0.87 ml/m2, P = 0.024), LVEDVI (− 1.15 ml/m2p = 0.003) and LVESVI (− 0.62 ml/m2p = 0.025). HbA1c ≥ 8.0% compared with HbA1c < 5.7% was associated with lower SVI (− 2.09 ml/m2, p = 0.004), LVEDVI (− 2.11 ml/m2p = 0.032) and MCF (− 2.94% p = 0.011) but higher CI (0.11 L/min/m2, p = 0.043) and RWT (0.01 cm, p = 0.035).

Conclusions

Glycemic status is associated with important left ventricular structure and function changes among African Americans without prior CAD, arrhythmia, valvular heart disease and ESRD. Longitudinal studies may further elucidate these relationships.
Implicit and explicit ethnic biases in multicultural primary care: the case of trainee general practitioners
Authors: Duveau Camille , Demoulin Stéphanie , Dauvrin Marie , Lepièce Brice , Lorant Vincent
Published: April 2022

Background

General Practitioners (GPs) are the first point of contact for people from ethnic and migrant groups who have health problems. Discrimination can occur in this health care sector. Few studies, however, have investigated implicit and explicit biases in general practice against ethnic and migrant groups. This study, therefore, investigated the extent of implicit ethnic biases and willingness to adapt care to migrant patients among trainee GPs, and the factors involved therein, in order to measure explicit bias and explore a dimension of cultural competence.

Methods

In 2021, data were collected from 207 trainee GPs in the French-speaking part of Belgium. The respondents passed an Implicit Association Test (IAT), a validated tool used to measure implicit biases against ethnic groups. An explicit attitude of willingness to adapt care to diversity, one of the dimensions of cultural competence, was measured using the Hudelson scale.

Results

The overwhelming majority of trainee GPs (82.6%, 95% CI: 0.77 – 0.88) had implicit preferences for their ingroup to the detriment of ethnic and migrant groups. Overall, the majority of respondents considered it the responsibility of GPs to adapt their attitudes and practices to migrants’ needs. More than 50% of trainee GPs, however, considered it the responsibility of migrant patients to adapt to the values and habits of the host country.

Conclusions

This study found that the trainee GPs had high to very high levels of implicit ethnic bias and that they were not always willing to adapt care to the values of migrants. We therefore recommend that they are made aware of this bias and we recommend using the IAT and Hudelson scales as educational tools to address ethnic biases in primary care.
Sarcopenia and associated factors according to the EWGSOP2 criteria in older people living in nursing homes: a cross-sectional study
Authors: Escribà-Salvans Anna , Jerez-Roig Javier , Molas-Tuneu Miriam , Farrés-Godayol Pau , Moreno-Martin Pau , Goutan-Roura Ester , Güell-Masramon Helena , Amblàs-Novellas Jordi , de Souza Dyego Leandro Bezerra , Skelton Dawn A. , Torres-Moreno Miriam , Minobes-Molina Eduard
Published: April 2022

Background

In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the original definition of sarcopenia, establishing new criteria to be used globally. Early diagnosis of sarcopenia in nursing home residents and the identification of contributing factors would target interventions to reduce the incidence of malnutrition, social isolation, functional decline, hospitalization and mortality.

Aim

Verify the prevalence and the degree of severity of sarcopenia according to the new EWSGOP2 criteria and to analyse its associated factors in residents living in nursing homes in Central Catalonia (Spain).

Design

A cross-sectional multicenter study was conducted in 4 nursing homes. SARC-F test was applied as the initial screening, muscle strength was measured by a dynamometer, skeletal muscle mass by bioimpedance analysis and physical performance by Gait Speed. Four categories were used: total probable sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia.

Results

Among the total sample of 104 nursing home residents (mean age 84.6, ± 7.8; median 86, IQR 110), 84.6% were women and 85 (81.7%) (95% confidence interval [CI] 73.0-88.0) had total probable sarcopenia, 63 (60.5%) had probable sarcopenia, 19 (18.3%) had confirmed sarcopenia and 7 (6.7%) had severe sarcopenia. In the bivariate analysis, obesity was negatively associated and total time in sedentary behavior positively associated with all sarcopenia categories. In addition, malnutrition and urinary continence were positively associated with total and probable sarcopenia. Urinary incontinence was a positive associated factor of total and probable sarcopenia. In the multivariate analysis, obesity represented a negative associated factor: OR = 0.13 (0.03 - 0.57), p = 0.007 and OR = 0.14 (0.03 - 0.60), p = 0.008 with total and probable sarcopenia, respectively, adjusted by urinary incontinence status. For confirmed sarcopenia, obesity also represented a negative associated factor OR = 0.06 (0.01 - 0.99), p = 0.049 and the total time in sedentary behavior a positive associated factor OR = 1.10 (1.00- 1.20), p = 0.040.

Conclusions

According the EWGSOP2 criteria, high prevalence of sarcopenia was found in institutionalized older people, ranging from 6.7 to 81.7% depending on the category. Malnutrition, urinary incontinence and total time in sedentary behavior were associated with sarcopenia, whilst obesity represented a protective factor in this population.
Attachment styles and happiness in the elderly: the mediating role of reminiscence styles
Authors: Momeni Khodamorad , Amani Rozita , Janjani Parisa , Majzoobi Mohammad Reza , Forstmeier Simon , Nosrati Parisa
Published: April 2022

Background

The current study aims to investigate the relationship between attachment styles and happiness through the mediating role of reminiscence styles in the elderly.

Methods

This was a correlational study of structural equations modelling (SEM) type. The statistical population included all the elderly aged at least 60 years living in Kermanshah province, Iran in 2021, among whom 380 (182 men and 198 women) were selected using convenience sampling method. Participants filled out the questionnaires of Adult Attachment Styles, Oxford Happiness, and Amani et al.’s Reminiscence Styles.

Results

The results indicated that secure attachment style has a positive and negative relationship with positive reminiscence (PR) and negative reminiscence (NR), respectively. However, the opposite held true for both avoidant and ambivalent attachment styles. It was also found that secure attachment style has a positive relationship, and avoidant and ambivalent attachment styles have a negative relationship with happiness. Moreover, participants’ gender and age had no moderating effect on the mentioned relationships. The results of SEM indicated that secure and ambivalent attachment styles were associated with happiness through both PR and NR, and avoidant attachment style was associated with happiness only through NR.

Conclusions

The findings emphasize the significance of the development of internal working models based on the kind of parent-child’s reminiscences and narratives, and the lifelong effects of these models.
Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review
Authors: Kjelle Elin , Andersen Eivind Richter , Krokeide Arne Magnus , Soril Lesley J. J. , van Bodegom-Vos Leti , Clement Fiona M. , Hofmann Bjørn Morten
Published: April 2022

Background

Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children.

Methods

A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included.

Results

A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations.

Conclusions

A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally.

Systematic review registration: PROSPERO: CRD42020208072.
Validity of self-report measures of cannabis use compared to biological samples among women of reproductive age: a scoping review
Authors: Skelton Kara R. , Donahue Erin , Benjamin-Neelon Sara E.
Published: April 2022

Background

Most existing evidence about the prevalence of prenatal cannabis use relies on self-reported measures, which is limited by social desirability bias and recall bias. To date, several studies have examined the validity of self-reported measures of prenatal cannabis use, but this evidence has yet to be synthesized. To address this gap, we performed a scoping review to systematically identify and synthesize existing evidence on the validity of self-reported measures of cannabis use among pregnant women.

Methods

We searched PubMed, PyschINFO, CINAHL, Cochrane/CENTRAL, and Google Scholar for peer-reviewed studies published in English between January 2010 and June 2021. We included studies that compared self-reported measures of cannabis use to a biochemical measure of cannabis (e.g., urine, hair, meconium) in pregnant women. We excluded studies reporting solely on prenatal cannabis use prevalence as well as those that examined self-reported drug use in which cannabis use was not a distinct category.

Results

We found 12 unique studies (11 primary studies and one systematic review) that examined the validity of self-reported prenatal cannabis use, compared to a biochemical sample. Most studies were conducted in the US and conducted in either a hospital or clinical setting. We found that self-report was more valid in populations with a current or prior history of drug use. Self-report was also more valid when assessed via interviews by research team members than health care provider screenings or self-administered surveys. The most commonly used biochemical measure used was urine drug testing, which was found to have the highest level of concordance with self-report.

Conclusions

This scoping review systematically mapped existing evidence on the validity of self-reported prenatal cannabis use. Although much remains unknown in this area, an important next step is a systematic review that would provide robust evidence on clinical utilization of self-reported use in conjunction with biochemical samples. Further research is needed to examine validity by type of measure and mode of administration. Additionally, future studies could assess factors associated with disclosure of use across different critical maternal health periods beyond pregnancy.
Modular and mechanistic changes across stages of colorectal cancer
Authors: Rahiminejad Sara , Maurya Mano R. , Mukund Kavitha , Subramaniam Shankar
Published: April 2022

Background

While mechanisms contributing to the progression and metastasis of colorectal cancer (CRC) are well studied, cancer stage-specific mechanisms have been less comprehensively explored. This is the focus of this manuscript.

Methods

Using previously published data for CRC (Gene Expression Omnibus ID GSE21510), we identified differentially expressed genes (DEGs) across four stages of the disease. We then generated unweighted and weighted correlation networks for each of the stages. Communities within these networks were detected using the Louvain algorithm and topologically and functionally compared across stages using the normalized mutual information (NMI) metric and pathway enrichment analysis, respectively. We also used Short Time-series Expression Miner (STEM) algorithm to detect potential biomarkers having a role in CRC.

Results

Sixteen Thousand Sixty Two DEGs were identified between various stages (p-value ≤ 0.05). Comparing communities of different stages revealed that neighboring stages were more similar to each other than non-neighboring stages, at both topological and functional levels. A functional analysis of 24 cancer-related pathways indicated that several signaling pathways were enriched across all stages. However, the stage-unique networks were distinctly enriched only for a subset of these 24 pathways (e.g., MAPK signaling pathway in stages I-III and Notch signaling pathway in stages III and IV). We identified potential biomarkers, including HOXB8 and WNT2 with increasing, and MTUS1 and SFRP2 with decreasing trends from stages I to IV. Extracting subnetworks of 10 cancer-relevant genes and their interacting first neighbors (162 genes in total) revealed that the connectivity patterns for these genes were different across stages. For example, BRAF and CDK4, members of the Ser/Thr kinase, up-regulated in cancer, displayed changing connectivity patterns from stages I to IV.

Conclusions

Here, we report molecular and modular networks for various stages of CRC, providing a pseudo-temporal view of the mechanistic changes associated with the disease. Our analysis highlighted similarities at both functional and topological levels, across stages. We further identified stage-specific mechanisms and biomarkers potentially contributing to the progression of CRC.
Exploration of mRNAs and miRNA classifiers for various ATLL cancer subtypes using machine learning
Authors: Ghobadi Mohadeseh Zarei , Emamzadeh Rahman , Afsaneh Elaheh
Published: April 2022

Background

Adult T-cell Leukemia/Lymphoma (ATLL) is a cancer disease that is developed due to the infection by human T-cell leukemia virus type 1. It can be classified into four main subtypes including, acute, chronic, smoldering, and lymphoma. Despite the clinical manifestations, there are no reliable diagnostic biomarkers for the classification of these subtypes.

Methods

Herein, we employed a machine learning approach, namely, Support Vector Machine-Recursive Feature Elimination with Cross-Validation (SVM-RFECV) to classify the different ATLL subtypes from Asymptomatic Carriers (ACs). The expression values of multiple mRNAs and miRNAs were used as the features. Afterward, the reliable miRNA-mRNA interactions for each subtype were identified through exploring the experimentally validated-target genes of miRNAs.

Results

The results revealed that miR-21 and its interactions with DAAM1 and E2F2 in acute, SMAD7 in chronic, MYEF2 and PARP1 in smoldering subtypes could significantly classify the diverse subtypes.

Conclusions

Considering the high accuracy of the constructed model, the identified mRNAs and miRNA are proposed as the potential therapeutic targets and the prognostic biomarkers for various ATLL subtypes.
Underdiagnosis of iron deficiency anemia among patients with colorectal cancer: an examination of electronic medical records
Authors: Bhurosy Trishnee , Jishan Anika , Boland Patrick M. , Lee Yen-Han , Heckman Carolyn J.
Published: April 2022

Background

Timely diagnosis and management of iron deficiency anemia (IDA) in colorectal cancer (CRC) patients improves overall quality of life and survival. This study assessed the proportion of CRC patients who were formally diagnosed with IDA and factors that predict a formal diagnosis of IDA and receiving iron therapy.

Methods

We retrieved electronic medical records (EMRs) of CRC patients from a large comprehensive cancer center in the Northeastern part of the United States (n = 499). We abstracted sociodemographic characteristics, relevant laboratory results, IDA diagnosis, and iron supplementation from the EMRs. We assessed relationships between participant characteristics, a diagnosis of IDA and receiving iron therapy through adjusted logistic regressions.

Results

IDA was formally diagnosed in 26 (5.2%) individuals judged by EMR documentation. Only 153 (30.7%) participants had iron laboratory results available. Among the 153 patients with iron panel data available, 113 (73.9%) had iron deficiency. Seventy-six had absolute iron deficiency as shown by ferritin levels below 100 ng/mL and iron saturation less than 20% and 37 had functional iron deficiency as shown by ferritin levels between 100 and 500 ng/mL and iron saturation less than 20%. 12% of all patients had documentation of iron therapy receipt. A formal diagnosis of IDA was not associated with any of the covariates.

Conclusions

Iron deficiency anemia is under-diagnosed among CRC patients and most likely under-documented in clinical notes. Rates of iron repletion are low, suggesting that many patients with IDA are untreated. Future research should explore provider-level and other strategies for improving assessment and diagnosis of IDA among CRC patients.
Virtual reality-based vision therapy versus OBVAT in the treatment of convergence insufficiency, accommodative dysfunction: a pilot randomized controlled trial
Authors: Li Shijin , Tang Angcang , Yang Bi , Wang Jianglan , Liu Longqian
Published: April 2022

Background

Virtual reality is being increasingly applied in vision therapy. However, the differences in effectiveness, optimal treatment cycle, and prognosis between virtual reality-based vision therapy and traditional therapies remain unknown. The purpose of this study was to compare the effectiveness of virtual reality-based vision therapy and office-based vergence/accommodative therapy in young adults with convergence insufficiency or accommodative dysfunction.

Methods

The patients were randomly assigned to either the virtual reality-based vision therapy group or the office-based vergence/accommodative therapy group. The vision therapy lasted 12 weeks (1 h/week) in both groups. Binocular visual functions (vergence and accommodation) were measured and a subjective questionnaire-based assessment was performed at baseline and after 6 and 12 weeks of therapy.

Results

In total, 33 patients with convergence insufficiency and 30 with accommodative dysfunction completed the study. After 12 weeks of treatment for convergence insufficiency, the Convergence Insufficiency Symptom Survey score (F2,31 = 13.704, P < 0.001), near point of convergence (F2,31 = 21.774,P < 0.001), positive fusional vergence (F2,31 = 71.766,P < 0.001), and near horizontal phoria (F2,31 = 16.482,P < 0.001) improved significantly in both groups. Moreover, the monocular accommodative amplitude (F2,25 = 22.154,P < 0.001) and monocular accommodative facility (F2,25 = 86.164,P < 0.001) improved significantly in both groups after 12 weeks of treatment. A statistically significant difference was observed in monocular accommodative facility (F1,25 = 8.140,P = 0.009) between the two groups, but not in other vergence and accommodative functions (0.098 < P < 0.687).

Conclusion

Virtual reality-based vision therapy significantly improved binocular vision functions and symptoms in patients with convergence insufficiency and accommodative dysfunction, thereby suggesting its effectiveness as a new optional or additional treatment for young adults with these conditions.

Trial registration

This study was registered at the Chinese Clinical Trials Registry on 16/04/2019 (identifier:ChiCTR1900022556).
Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally
Authors: Schnell Tatjana , Krampe Henning
Published: April 2022

Background

Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress.

Methods

N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning.

Results

Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4.

Conclusions

Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.
Effect of interventions for non-emergent medical transportation: a systematic review and meta-analysis
Authors: Shekelle Paul G. , Begashaw Meron M. , Miake-Lye Isomi M. , Booth Marika , Myers Bethany , Renda Andrew
Published: April 2022

Introduction

Transportation is an important social determinant of health. We conducted a systematic review of the associations on health and health care utilization of interventions aimed at reducing barriers to non-emergency transportation and non-medical transportation.

Methods

We searched three databases and the gray literature through mid-January 2022. Included studies needed to assess an intervention targeted at non-emergency or non-medical transportation barriers, report missed (or kept) visits, health care utilization, costs, or health outcomes. Data extraction was performed in duplicate and included information about study design, results, and risk of bias. Primary outcomes were frequency of missed appointments, health care utilization, costs, and health outcomes. Synthesis was both narrative and meta-analytic using a random effects model.

Results

Twelve studies met inclusion criteria, three randomized trials, one controlled trial, and eight observational studies. All included studies had some element of risk of bias. Populations studied usually had chronic or serious health conditions or were poor. Interventions included van rides, bus or taxi vouchers, ride-sharing services, and others. Meta-analysis of seven studies (three trials, four observational studies) yielded a pooled estimate of missed appointments = 0.63 (95% confidence interval [CI] 0.48, 0.83) favoring interventions. Evidence on cost, utilization, and health outcomes were too sparse to support conclusions. Evidence on the effect of non-medical transportation is limited to a single study.

Conclusions and relevance

Interventions aimed at non-emergency transportation barriers to access health care are associated with fewer missed appointments; the association with costs, utilization or health outcomes is insufficiently studied to reach conclusions.

This review was registered in PROSPERO as ID CRD42020201875.
Child marriage among displaced populations – a 2019 study in Kurdistan Region of Iraq
Authors: Goers Matthew , Hunersen Kara , Karim Luqman Saleh , Jeffery Allison , Zedan Ali , Robinson Courtland , Metzler Janna
Published: April 2022

Background

Many of the factors that increase risk of child marriage are common among refugees and internally displaced persons (IDPs). We sought to address the gaps in knowledge surrounding child marriage in displaced and host populations in the Kurdistan Region of Iraq (KRI).

Methods

A multistage cluster sample design was employed collecting data of KRI host communities, Iraqi IDPs, and Syrian refugees. Interviews were conducted in eligible households, requiring at least one adult female and one female adolescent present, addressing views of marriage, demographics and socioeconomic factors. Household rosters were completed to assess WHO indicators, related to child marriage including completed child marriage in females 10–19 and completed risk of previously conducted child marriages in females 20–24.

Results

Interviews were completed in 617 hosts, 664 IDPs, and 580 refugee households, obtaining information on 10,281 household members and 1,970 adolescent females. Overall, 10.4% of girls age 10–19 were married. IDPs had the highest percentage of married 10–19-year-old females (12.9%), compared to the host community (9.8%) and refugees (8.1%). Heads of households with lower overall education had higher percentages of child marriage in their homes; this difference in prevalence was most notable in IDPs and refugees. When the head of the household was unemployed, 14.5% of households had child marriage present compared to 8.0% in those with employed heads of household. Refugees and IDPs had larger percentages of child marriage when heads of households were unemployed (refugees 13.1%, IDPs 16.9%) compared to hosts (11.9%). When asked about factors influencing marriage decisions, respondents predominately cited family tradition (52.5%), family honor (15.7%), money/resources (9.6%), or religion (8.0%). Over a third of those interviewed (38.9%) reported a change in influencing factors on marriage after displacement (or after the arrival of refugees in the area for hosts).

Conclusions

Being an IDP in Iraq, unemployment and lower education were associated with an increase in risk for child marriage. Refugees had similar percentages of child marriage as hosts, though the risk of child marriage among refugees was higher in situations of low education and unemployment. Ultimately, child marriage remains a persistent practice worldwide, requiring continued efforts to understand and address sociocultural norms in low socioeconomic and humanitarian settings.