bluuebunny/crossref_metadata_2025 huggingface dataset:
The shape of Anthropocene: The early contribution of the water sciences
Authors: Luciano Eugenio
Published: December 2022

The conceptual history of the Anthropocene is well-known: after a few scattered appearances in Soviet literature, the term Anthropocene was reignited independently by Paul Crutzen during his famous intervention at the IGBP-SC meeting in Cuernavaca in February 2000. The standard narrative of the history of the term emphasizes the role of Earth System Science and geology in institutionalizing the term, and in paving the way for the term’s current popularity within and beyond the natural sciences. Yet this standard account misses a third important contribution to the earliest assimilation, spread, and evolution of the term in the scientific literature: the water sciences. The present contribution reconsiders the role of seminal papers, individuals, and disciplinary areas in the water sciences in the early conceptual history of the Anthropocene concept. The analysis draws on three main findings concerning the early appearance, assimilation, and application of the term in water sciences literature which has been largely overshadowed in existing accounts of the history of the Anthropocene concept. Discussing these literary sources at the intersection of conceptual history, history of science, and scientometrics, the research argues that the water sciences were crucial in the early assimilation and application of the Anthropocene as a suitable and useful category in the international scientific community. In doing so, the analysis also advances that the water sciences should be considered as the third vector (together with Earth System Science and geology) in reconstructing the earliest conceptual history of the Anthropocene.
Noninvasive Monitoring to Demonstrate Postoperative Differences in Regional Hemodynamics in Newborn Infants With d-Transposition of the Great Arteries and Hypoplastic Left Heart Syndrome
Authors: Sahni Prateek V , Krishnamurthy Ganga , Sahni Rakesh
Published: December 2022

Background

The adequacy of tissue O2 delivery in infants receiving intensive care is difficult to measure directly. Regional O2 (rSO2) and fractional tissue O2 extraction (FTOE), the ratio of O2 consumption to O2 delivery, obtained from newer noninvasive tools, such as near-infrared spectroscopy (INVOS) and microvascular tissue oximetry (T-Stat) can provide important information on the adequacy of tissue oxygenation and aid in managing critically ill infants.

Methods

We prospectively evaluated differences in rSO2 and FTOE in 26 infants with hypoplastic left heart syndrome (HLHS) (n = 12) or d-transposition of the great arteries (d-TGA) (n = 14). Continuous noninvasive monitoring of SpO2, heart rate, and perfusion index with pulse oximetry, cerebral-rSO2 and renal-rSO2 with INVOS, and buccal tissue oxygenation using T-Stat were performed during immediate postoperative period for 24 hours.

Results

The SpO2 and rSO2 in infants with d-TGA were higher compared with the infants with HLHS at all measured sites (buccal mucosa, cerebral, and renal). Significant regional differences were also observed in FTOE across all infants with the highest at the buccal mucosa tissue level, followed by cerebral and renal measurement sites. As compared with infants with d-TGA, infants with HLHS had higher regional FTOE and heart rate, with a lower arterial O2 content and perfusion index.

Conclusions

Our study demonstrates the utility of noninvasive hemodynamic monitoring to assess regional oxygenation and perfusion, as evidenced by significant differences in infants with HLHS and d-TGA, conditions with different circulation physiologies. Such comprehensive monitoring can potentially aid in evaluating treatment strategies aimed at preventing organ damage from O2 insufficiency.
From Documents to Data: A Framework for Total Corpus Quality
Authors: Hurtado Bodell Miriam , Magnusson Måns , Mützel Sophie
Published: December 2022

As large corpora of digitized text become increasingly available, researchers are rediscovering textual data’s potential fruitfulness for inquiries into social and cultural phenomena. Although textual corpora promise to enrich our knowledge of the social world, avoiding problems related to data quality remains a challenge to related empirical research. Hence, evaluating the quality of a corpus will be pivotal for future social scientific inquiries. The authors propose a conceptual framework for total corpus quality, incorporating three crucial dimensions: total corpus error, corpus comparability, and corpus reproducibility. These dimensions affect the validity and reliability of inferences drawn from textual data. In addition, the authors’ framework provides insights toward evaluating and improving studies on the basis of large-scale textual analyses. After outlining this framework, the authors then illustrate an application of the total corpus quality framework by an example case study using digitized newspaper articles to study topic salience over 75 years.
Fast-track institutionalization: The opening of urban planning best practice agencies in Mexico City
Authors: Whitney Ryan Anders , López-García David
Published: December 2022

The article explores the related concepts of best practice agencies (BPAs) and fast-track institutionalization. We define BPAs as agencies that have been inspired by international trends in urban governance, often opened within local urban contexts to implement urban planning best practice policies and programs. Importantly, we argue that BPAs often go through processes of “fast-track institutionalization”, meaning that in an attempt by mayors to showcase their effectiveness to their constituents, the institutionalization of BPAs is deemphasized. Through exploring two BPAs in Mexico City, namely the Laboratorio para la Ciudad (LabCDMX) and the Autoridad del Espacio Público (AEP), we illustrate how each BPA bypassed the capacity-building and public action processes required to build consensus on their importance within city government. We then suggest that fast-track institutionalization is one aspect that can eventually contribute to the closure of BPAs. We conclude by exploring how BPAs have created a site of contention between best practice adoption and local processes of institutionalization, eroding their ability to implement their mandates over the short and long-term.
How mothers talk about their relationship with their young sons following intimate partner violence and the implications for intergenerational prevention and systemic intervention
Authors: Nankivell Louise , Taggart Danny
Published: December 2022

The aim of this study was to understand how women describe their relationship with their young son(s) in a context of and following intimate partner violence. Face-to-face interviews with eight women were conducted. The analysis suggested that women constructed violence as being a cycle and their relationship with their son was impacted by this in multiple ways. The paper critically draws on attachment, family systems and trauma literature to consider the data in context, and offers a range of clinical implications for practice, training and supervision.
Marine facies differentiation along complex paleotopography: an example from the Middle Miocene (Serravallian) of Lower Austria
Authors: Piller Werner E. , Auer Gerald , Graber Hugo , Gross Martin
Published: December 2022

In the area of Bad Deutsch-Altenburg (Hainburg Mountains, Lower Austria) a Middle Miocene transgression over Mesozoic basement was explored in the course of the Danube power plant project “Hainburg”. The Mesozoic basement forms a narrow ridge dipping to the northeast towards the Vienna Basin, covered by various Miocene sediments. The ridge represents a specific paleotopography that required a detailed study with 78 shallow, fully cored drill holes in an area of c. 0.5 km2. Ten drillings were selected for this study based on sedimentary composition and position relative to the Mesozoic ridge. These 10 cores, ranging in drilling depth from 26.5 to 96.4 m, were studied in respect to sedimentology, corallinacean algae, calcareous nannoplankton, foraminifers and ostracodes to reconstruct sediment distribution and paleoenvironment. Sediment distribution clearly shows that the Mesozoic ridge formed a physical barrier with siliciclastics dominating in the SW of the ridge and carbonate sediments prevailing in the NE. Based on biostratigraphy (calcareous nannoplankton, foraminifera, ostracodes, dinoflagellates) the majority of the sediments can be dated to the late Badenian (early Serravallian) only in some drillholes lower Sarmatian (upper Serravallian) sediments were detected. In terms of sequence stratigraphy, the Badenian sediments represent the transgressive and highstand systems tract of 3rdorder sequence TB 2.5 (bound by the lowstands Ser 2 and Ser 3), the lower Sarmatian sediments can be correlated to sequence TB 2.6. Carbonate sediments show a wide spectrum of 13 facies which are mostly dominated by coralline algae. According to the relative positions of the drill holes a water depth between 0 and about 50 m can be reconstructed what is supported by the occurrence of the benthic biota. This biota indicates that the sedimentary succession started from the very beginning under full marine conditions. Except of basal conglomerates/breccias water energy conditions were low and turbidity high. Close to the Sarmatian boundary a reduction in salinity and depth may have occurred which is also observed in the Sarmatian sediments. Carbonate sediments and, in particular, larger benthic foraminifers indicate tropical to warm-temperate conditions for the late Badenian of the studied sections. The siliciclastic sediments NW of the Mesozoic ridge reflect riverine input indicated by the occurrence of freshwater ostracodes and characean oogonias. Calcareous nannoplankton and dinoflagellates show a high share of reworking from Upper Cretaceaous and Paleogene sediments.
Graph4Med: a web application and a graph database for visualizing and analyzing medical databases
Authors: Schäfer Jero , Tang Ming , Luu Danny , Bergmann Anke Katharina , Wiese Lena
Published: December 2022

Background

Medical databases normally contain large amounts of data in a variety of forms. Although they grant significant insights into diagnosis and treatment, implementing data exploration into current medical databases is challenging since these are often based on a relational schema and cannot be used to easily extract information for cohort analysis and visualization. As a consequence, valuable information regarding cohort distribution or patient similarity may be missed. With the rapid advancement of biomedical technologies, new forms of data from methods such as Next Generation Sequencing (NGS) or chromosome microarray (array CGH) are constantly being generated; hence it can be expected that the amount and complexity of medical data will rise and bring relational database systems to a limit.

Description

We present Graph4Med, a web application that relies on a graph database obtained by transforming a relational database. Graph4Med provides a straightforward visualization and analysis of a selected patient cohort. Our use case is a database of pediatric Acute Lymphoblastic Leukemia (ALL). Along routine patients’ health records it also contains results of latest technologies such as NGS data. We developed a suitable graph data schema to convert the relational data into a graph data structure and store it in Neo4j. We used NeoDash to build a dashboard for querying and displaying patients’ cohort analysis. This way our tool (1) quickly displays the overview of patients’ cohort information such as distributions of gender, age, mutations (fusions), diagnosis; (2) provides mutation (fusion) based similarity search and display in a maneuverable graph; (3) generates an interactive graph of any selected patient and facilitates the identification of interesting patterns among patients.

Conclusion

We demonstrate the feasibility and advantages of a graph database for storing and querying medical databases. Our dashboard allows a fast and interactive analysis and visualization of complex medical data. It is especially useful for patients similarity search based on mutations (fusions), of which vast amounts of data have been generated by NGS in recent years. It can discover relationships and patterns in patients cohorts that are normally hard to grasp. Expanding Graph4Med to more medical databases will bring novel insights into diagnostic and research.
In-hospital mortality and SpO2 incritical care patients with cerebral injury: data from the MIMIC‑IV Database
Authors: Yin Haoyang , Yang Rui , Xin Yun , Jiang Tao , Zhong Dong
Published: December 2022

Background

Evidence regarding the relationship between in-hospital mortality and SpO2 was low oxygen saturations are often thought to be harmful, new research in patients with brain damage has found that high oxygen saturation actually enhances mortality. However, there is currently no clear study to point out the appropriate range for oxygen saturation in patients with craniocerebral diseases. 

Methods

By screening all patients in the MIMIC IV database, 3823 patients with craniocerebral diseases (according to ICD-9 codes and ICD-10) were selected, and non-linear regression was used to analyze the relationship between in-hospital mortality and oxygen saturation. Covariates for all patients included age, weight, diagnosis, duration of ICU stay, duration of oxygen therapy, etc.

Results

In-hospital mortality in patients with TBI and SAH was kept to a minimum when oxygen saturation was in the 94–96 range. And in all patients, the relationship between oxygen saturation and in-hospital mortality was U-shaped. Subgroup analysis of the relationship between oxygen saturation and mortality in patients with metabolic encephalopathy and other encephalopathy also draws similar conclusions In-hospital mortality and oxygen saturation were all U-shaped in patients with subarachnoid hemorrhage, metabolic and toxic encephalopathy, cerebral infarction, and other encephalopathy, but the nonlinear regression was statistically significant only in patients with cerebral infarction (p for nonlinearity = 0.002).

Conclusion

Focusing too much on the lower limit of oxygen saturation and ignoring too high oxygen saturation can also lead to increase in-hospital mortality. For patients with TBI and SAH, maintaining oxygen saturation at 94–96% will minimize the in-hospital mortality of patients.
Methodological guidance for the evaluation and updating of clinical prediction models: a systematic review
Authors: Binuya M. A. E. , Engelhardt E. G. , Schats W. , Schmidt M. K. , Steyerberg E. W.
Published: December 2022

Background

Clinical prediction models are often not evaluated properly in specific settings or updated, for instance, with information from new markers. These key steps are needed such that models are fit for purpose and remain relevant in the long-term. We aimed to present an overview of methodological guidance for the evaluation (i.e., validation and impact assessment) and updating of clinical prediction models.

Methods

We systematically searched nine databases from January 2000 to January 2022 for articles in English with methodological recommendations for the post-derivation stages of interest. Qualitative analysis was used to summarize the 70 selected guidance papers.

Results

Key aspects for validation are the assessment of statistical performance using measures for discrimination (e.g., C-statistic) and calibration (e.g., calibration-in-the-large and calibration slope). For assessing impact or usefulness in clinical decision-making, recent papers advise using decision-analytic measures (e.g., the Net Benefit) over simplistic classification measures that ignore clinical consequences (e.g., accuracy, overall Net Reclassification Index). Commonly recommended methods for model updating are recalibration (i.e., adjustment of intercept or baseline hazard and/or slope), revision (i.e., re-estimation of individual predictor effects), and extension (i.e., addition of new markers). Additional methodological guidance is needed for newer types of updating (e.g., meta-model and dynamic updating) and machine learning-based models.

Conclusion

Substantial guidance was found for model evaluation and more conventional updating of regression-based models. An important development in model evaluation is the introduction of a decision-analytic framework for assessing clinical usefulness. Consensus is emerging on methods for model updating.
Indications for resection of recurrent lesions in patients with distal cholangiocarcinoma based on prognostic factors: a single-institute retrospective study and brief literature review
Authors: Mashiko Taro , Ogasawara Toshihito , Masuoka Yoshihito , Ei Shigenori , Takahashi Shinichiro , Mori Masaki , Koyanagi Kazuo , Yamamoto Seiichiro , Nakagohri Toshio
Published: December 2022

Background

To evaluate the effectiveness of surgery for recurrent distal cholangiocarcinoma and determine surgical indications based on prognostic factors for the recurrence of distal cholangiocarcinoma.

Methods

We analysed the outcomes of 101 patients who underwent surgical resection for distal cholangiocarcinoma between 2000 and 2018. The clinicopathological factors and prognosis of primary and recurrent distal cholangiocarcinoma were investigated.

Results

Of the 101 patients with resected distal cholangiocarcinoma, 52 (51.5%) had relapsed. Seven (13.5%) and 45 patients (86.5%) underwent resection of recurrent lesions and palliative therapy, respectively. There were no major complications requiring therapeutic intervention after metastasectomy. The median overall survival in patients with and without surgery for recurrent lesions was 83.0 (0.0–185.6) and 34 months (19.0–49.0), respectively. Therefore, patients who had undergone surgery for recurrent lesions had a significantly better prognosis (p = 0.022). Multivariate analyses of recurrent distal cholangiocarcinoma revealed that recurrence within one year was an independent predictor of poor survival. Resection of recurrent lesions improved prognosis.

Conclusions

Radical resection in recurrent distal cholangiocarcinoma may improve the prognosis in selected patients. Although time to recurrence is considered an important factor, the small number of cases of recurrence and resection of recurrent lesions in this study makes it difficult to conclude which patients are best suited for resection of recurrent lesions. This issue requires clarification in a multicentre prospective study, considering patients’ background, such as the recurrence site and number of metastases.
Granulation tissue-type hemangioma in a 6-week-old puppy – a case report
Authors: Müller Janina , Henrich Manfred , Hoogen-Merkel Johanna , Hartung Svenja
Published: December 2022

Background

Hemangioma is a well-known neoplasia in veterinary and human medicine. Several subtypes have been described and are distinguished based on their histologic appearance. The classification schemes of hemangiomas in human and veterinary medicine are different, and various purpose-based schemes can be found in the literature.

Case presentation

A six-week-old puppy was presented that suffered from a neoplasia that extended to the musculature of the hind limb. After surgical excision, the mass was submitted for pathohistological examination. The mass was composed of endothelial cells forming vascular slits admixed with a fibrous stroma and spindle cells. Immunohistological examination was positive for factor VIII-related antigen and smooth muscle actin, supporting the diagnosis of hemangioma.

Conclusion

The final diagnosis of granulation tissue-type hemangioma was given due to the histological appearance of the neoplasia. Granulation tissue-type hemangioma is a rare subtype of hemangioma. In this case an uncommonly young dog was affected.
Acidic ascites inhibits ovarian cancer cell proliferation and correlates with the metabolomic, lipidomic and inflammatory phenotype of human patients
Authors: Yang Qianlu , Bae Gyuntae , Nadiradze Giorgi , Castagna Arianna , Berezhnoy Georgy , Zizmare Laimdota , Kulkarni Aditi , Singh Yogesh , Weinreich Frank J. , Kommoss Stefan , Reymond Marc A. , Trautwein Christoph
Published: December 2022

Background

The poor prognosis of ovarian cancer patients is strongly related to peritoneal metastasis with the production of malignant ascites. However, it remains largely unclear how ascites in the peritoneal cavity influences tumor metabolism and recurrence. This study is an explorative approach aimed at for a deeper molecular and physical–chemical characterization of malignant ascites and to investigate their effect on in vitro ovarian cancer cell proliferation.

Methods

This study included 10 malignant ascites specimens from patients undergoing ovarian cancer resection. Ascites samples were deeply phenotyped by1H-NMR based metabolomics, blood-gas analyzer based gas flow analysis and flow cytomertry based a 13-plex cytokine panel. Characteristics of tumor cells were investigated in a 3D spheroid model by SEM and metabolic activity, adhesion, anti-apoptosis, migratory ability evaluated by MTT assay, adhesion assay, flowcytometry and scratch assay. The effect of different pH values was assessed by adding 10% malignant ascites to the test samples.

Results

 The overall extracellular (peritoneal) environment was alkaline, with pH of ascites at stage II-III = 7.51 ± 0.16, and stage IV = 7.78 ± 0.16. Ovarian cancer spheroids grew rapidly in a slightly alkaline environment. Decreasing pH of the cell culture medium suppressed tumor features, metabolic activity, adhesion, anti-apoptosis, and migratory ability. However, 10% ascites could prevent tumor cells from being affected by acidic pH. Metabolomics analysis identified stage IV patients had significantly higher concentrations of alanine, isoleucine, phenylalanine, and glutamine than stage II-III patients, while stage II-III patients had significantly higher concentrations of 3-hydroxybutyrate. pH was positively correlated with acetate, and acetate positively correlated with lipid compounds. IL-8 was positively correlated with lipid metabolites and acetate. Glutathione and carnitine were negatively correlated with cytokines IL-6 and chemokines (IL-8 & MCP-1).

Conclusion

Alkaline malignant ascites facilitated ovarian cancer progression. Additionally, deep ascites phenotyping by metabolomics and cytokine investigations allows for a refined stratification of ovarian cancer patients. These findings contribute to the understanding of ascites pathology in ovarian cancer.
Structural and functional distinctions of co-resident microglia and monocyte-derived macrophages after retinal degeneration
Authors: Ronning Kaitryn E. , Karlen Sarah J. , Burns Marie E.
Published: December 2022

Background

Both resident microglia and invading peripheral immune cells can respond to injury and degeneration in the central nervous system. However, after dead and dying neurons have been cleared and homeostasis is re-established, it is unknown whether resident immune cells fully resume normal functions and to what degree the peripheral immune cells take up residence.

Methods

Using flow cytometry, in vivo retinal imaging, immunohistochemistry, and single-cell mRNA sequencing, we assess resident microglia and monocyte-derived macrophages in the retina during and after the loss of photoreceptors in the Arr1−/− mouse model of inducible degeneration.

Results

We find that photoreceptor loss results in a small, sustained increase in mononuclear phagocytes and, after degeneration wanes, these cells re-establish a spatial mosaic reminiscent of healthy retinas. Transcriptomic analysis revealed the population remained unusually heterogeneous, with several subpopulations expressing gene patterns consistent with mildly activated phenotypes. Roughly a third of “new resident” cells expressed markers traditionally associated with both microglial and monocytic lineages, making their etiology ambiguous. Using an inducible Cre-based fluorescent lineage tracing paradigm to confirm the origins of new resident immune cells, we found approximately equal numbers of microglia and monocyte-derived macrophages after degeneration had subsided. In vivo retinal imaging and immunohistochemical analysis showed that both subpopulations remained functionally responsive to sites of local damage, though on average the monocyte-derived cells had less morphological complexity, expressed higher levels of MHCII, and had less migratory activity than the native resident population.

Conclusions

Monocytic cells that infiltrate the retina during degeneration differentiate into monocyte-derived macrophages that can remain in the retina long-term. These monocyte-derived macrophages adopt ramified morphologies and microglia-like gene expression. However, they remain distinguishable in morphology and gene expression from resident microglia and appear to differ functionally, showing less responsiveness to subsequent retinal injuries. These findings support the idea that persistent changes in the local immune population that occur in response to cell loss in aging and progressive retinal diseases may include the establishment of subpopulations of bone marrow-derived cells whose ability to respond to subsequent insults wanes over time.
Targeting neuroinflammation as a preventive and therapeutic approach for perioperative neurocognitive disorders
Authors: Cheng Chun , Wan Hanxi , Cong Peilin , Huang Xinwei , Wu Tingmei , He Mengfan , Zhang Qian , Xiong Lize , Tian Li
Published: December 2022

Perioperative neurocognitive disorders (PND) is a common postoperative complication associated with regional or general anesthesia and surgery. Growing evidence in both patient and animal models of PND suggested that neuroinflammation plays a critical role in the development and progression of this problem, therefore, mounting efforts have been made to develop novel therapeutic approaches for PND by targeting specific factors or steps alongside the neuroinflammation. Multiple studies have shown that perioperative anti-neuroinflammatory strategies via administering pharmacologic agents or performing nonpharmacologic approaches exert benefits in the prevention and management of PND, although more clinical evidence is urgently needed to testify or confirm these results. Furthermore, long-term effects and outcomes with respect to cognitive functions and side effects are needed to be observed. In this review, we discuss recent preclinical and clinical studies published within a decade as potential preventive and therapeutic approaches targeting neuroinflammation for PND.
Where is “policy” in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example
Authors: Crable Erika L. , Lengnick-Hall Rebecca , Stadnick Nicole A. , Moullin Joanna C. , Aarons Gregory A.
Published: December 2022

Background

Implementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy — and its inseparable politics, polity structures, and policymakers — in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based “thing” to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers’ evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy’s role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I.

Recommendations

(1) Specify dimensions of a policy’s function (policy goals, type, contexts, capital exchanged).

(2) Specify dimensions of a policy’s form (origin, structure, dynamism, outcomes).

(3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts.

(4) Describe the temporal roles that stakeholders play in policy D&I over time.

(5) Consider policy-relevant outer and inner context adaptations.

(6) Identify and describe bridging factors necessary for policy D&I success.

Conclusion

Researchers should use TMF to meaningfully conceptualize policy’s role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.
Use of minimally invasive cerclage wiring for displaced major fragments of femoral shaft fractures after intramedullary nailing promotes bone union and a functional outcome
Authors: Tao Xingguang , Yang Qing
Published: December 2022

Background

Femoral shaft fractures caused by high energy trauma can be very challenging due to the large variability in fracture morphology and poor functional outcomes. Displaced major fragments of femoral shaft fractures are difficult to manage after closed reduction and intramedullary nailing (IMN). The minimally invasive cerclage wiring (CW) procedure has become an optimal tool for major fragment resetting and stabilization after IMN. However, arguments continue for the potential risk of arterial injury, blood supply disruption, and delayed bone union or non-union with the CW procedure. The surgical algorithm for treating femoral shaft fractures with displaced major fragments remains controversial. Thus, emphasis is placed on whether the CW procedure can promote the bone union rate and improve functional outcomes without significant complications.

Methods

We performed a retrospective study on all patients of femoral shaft fractures with displaced major fragments between June 2015 and August 2019 in our trauma centre. Eligible patients were included and stratified into the CW group and IMN group. Demographics, radiological data, callus formation, union time, and functional outcomes were critically compared between the two groups.

Results

Thirty-seven patients were included in the present study according to our inclusion/exclusion criteria, of whom 16 (43.2%) were stratified into the CW group, and 21 (56.8%) into the IMN group. The modified radiographic union score for femorae (mRUSH) in the CW group and IMN group was significantly different (11.94 ± 1.29 vs. 7.95 ± 0.74, 6 months; 15.88 ± 0.50 vs. 10.33 ± 0.91, 12 months) (p < 0.0001). The mean union time was significantly different between the CW and IMN groups (7.9 ± 3.2 months vs. 20.1 ± 8.48 months) (p < 0.0001). Bone union at 12 months differed significantly between the CW and IMN groups (15 vs. 5) (p < 0.05). The Harris Hip Score in the CW group was significantly higher than that in the IMN group (88.19 ± 4.69 vs. 76.81 ± 5.26, 12 months; 93.19 ± 4.68 vs. 87.57 ± 5.38, 24 months) (p < 0.01). The Hospital for Special Surgery Knee Score was significantly different between the CW and IMN groups (78.50 ± 5.65 vs. 67.71 ± 4.65, 12 months; 89.50 ± 5.05 vs. 75.81 ± 8.90, 24 months) (p < 0.0001).

Conclusions

Minimally invasive CW is an optimal supplement for IMN in the treatment of femoral shaft fractures with displaced major fragments. As illustrated, the benefits of CW potentially include promotion of the bone union rate and improvement in functional outcomes.
Adult mortality before and during the first wave of COVID-19 pandemic in nine communities of Yemen: a key informant study
Authors: Alhaffar Mervat , Basaleem Huda , Othman Fouad , Alsakkaf Khaled , Naji Sena Mohammed Mohsen , Kolaise Hussein , Babattah Abdullah K. , Salem Yassin Abdulmalik Mahyoub , Brindle Hannah , Yahya Najwa , Pepe Pasquale , Checchi Francesco
Published: December 2022

Introduction

Widespread armed conflict has affected Yemen since 2014. To date, the mortality toll of seven years of crisis, and any excess due to the COVID-19 pandemic, are not well quantified. We attempted to estimate population mortality during the pre-pandemic and pandemic periods in nine purposively selected urban and rural communities of southern and central Yemen (Aden and Ta’iz governorates), totalling > 100,000 people.

Methods

Within each study site, we collected lists of decedents between January 2014–March 2021 by interviewing different categories of key community informants, including community leaders, imams, healthcare workers, senior citizens and others. After linking records across lists based on key variables, we applied two-, three- or four-list capture-recapture analysis to estimate total death tolls. We also computed death rates by combining these estimates with population denominators, themselves subject to estimation.

Results

After interviewing 138 disproportionately (74.6%) male informants, we identified 2445 unique decedents. While informants recalled deaths throughout the study period, reported deaths among children were sparse: we thus restricted analysis to persons aged ≥ 15 years old. We noted a peak in reported deaths during May–July 2020, plausibly coinciding with the first COVID-19 wave. Death rate estimates featured uninformatively large confidence intervals, but appeared elevated compared to the non-crisis baseline, particularly in two sites where a large proportion of deaths were attributed to war injuries. There was no clear-cut evidence of excess mortality during the pandemic period.

Conclusions

We found some evidence of a peak in mortality during the early phase of the pandemic, but death rate estimates were otherwise too imprecise to enable strong inference on trends. Estimates suggested substantial mortality elevations from baseline during the crisis period, but are subject to serious potential biases. The study highlighted challenges of data collection in this insecure, politically contested environment.
Diagnoses and mortality among prehospital emergency patients calling 112 with unclear problems: a population-based cohort study from Denmark
Authors: Ibsen Stine , Dam-Huus Karoline Bjerg , Nickel Christian H. , Christensen Erika Frischknecht , Søvsø Morten Breinholt
Published: December 2022

Background

Patients calling for an emergency ambulance and assessed as presenting with ‘unclear problem’ account for a considerable part of all emergency calls. Previous studies have demonstrated that these patients are at increased risk for unfavourable outcomes. A deeper insight into the underlying diagnoses and outcomes is essential to improve prehospital treatment. We aimed to investigate which of these diagnoses contributed most to the total burden of diseases in terms of numbers of deaths together with 1- and 30-day mortality.

Methods

A historic regional population-based observational cohort study from the years 2016 to 2018. Diagnoses were classified according to the World Health Organisation ICD-10 System (International Statistical Classification of Diseases and Related Health Problems, 10th edition). The ICD-10 chapters, R (‘symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified)’ and Z (‘factors influencing health status and contact with health services”) were combined and designated “non-specific diagnoses”.

Poisson regression with robust variance estimation was used to estimate proportions of mortality in percentages with 95% confidence intervals, crude and adjusted for age, sex and comorbidities.

Results

Diagnoses were widespread among the ICD-10 chapters, and the most were ‘non-specific diagnoses’ (40.4%), ‘circulatory diseases’ (9.6%), ‘injuries and poisonings’ (9.4%) and ‘respiratory diseases’ (6.9%). The diagnoses contributing most to the total burden of deaths (n = 554) within 30 days were ‘circulatory diseases’ (n = 148, 26%) followed by ‘non-specific diagnoses’ (n = 88, 16%) ‘respiratory diseases’ (n = 85, 15%), ‘infections’ (n = 54, 10%) and ‘digestive disease’ (n = 39, 7%). Overall mortality was 2.3% (1-day) and 7.1% (30-days). The risk of mortality was highly associated with age.

Conclusion

This study found that almost half of the patients brought to the hospital after calling 112 with an ‘unclear problem’ were discharged with a ‘non-specific diagnosis’ which might seem trivial but should be explored more as these contributed the second-highest to the total number of deaths after 30 days only exceeded by ‘circulatory diseases’.
Exploring the consequences of food insecurity and harnessing the power of peer navigation and mHealth to reduce food insecurity and cardiometabolic comorbidities among persons with HIV: protocol for development and implementation trial of weCare/Secure
Authors: Tanner Amanda E. , Palakshappa Deepak , Morse Caryn G. , Mann-Jackson Lilli , Alonzo Jorge , Garcia Manuel , Wright Elena , Dharod Ajay , Isom Scott , Sucaldito Ana D. , Aviles Lucero Refugio , Rhodes Scott D.
Published: December 2022

Background

Food insecurity, or the lack of consistent access to nutritionally adequate and safe foods, effects up to 50% of people living with HIV (PWH) in the United States (US). PWH who are food insecure have lower antiretroviral adherence, are less likely to achieve viral suppression, and are at increased risk developing of serious illnesses, including cardiometabolic comorbidities. The objectives of this study are to better understand how food insecurity contributes to the development of cardiometabolic comorbidities among PWH and to test a novel bilingual peer navigation-mHealth intervention (weCare/Secure) designed to reduce these comorbidities in food-insecure PWH with prediabetes or Type 2 diabetes (T2DM).

Methods

In Aim 1, we will recruit a longitudinal cohort of 1800 adult (≥18 years) PWH from our clinic-based population to determine the difference in the prevalence and incidence of cardiometabolic comorbidities between food-secure and food-insecure PWH. Food insecurity screening, indicators of cardiometabolic comorbidities, and other characteristics documented in the electronic health record (EHR) will be collected annually for up to 3 years from this cohort. In Aim 2, we will conduct a randomized controlled trial among a sample of food-insecure PWH who have prediabetes or T2DM to compare changes in insulin sensitivity over 6 months between participants in weCare/Secure and participants receiving usual care. In Aim 3, we will conduct semi-structured individual in-depth interviews to explore the effect of the intervention among intervention participants with varying insulin sensitivity outcomes.

Trial status

Aim 1 (longitudinal cohort) recruitment began in May 2022 and is ongoing. Aim 2 (intervention) recruitment is planned for spring 2023 and is expected to be completed in spring 2024. Aim 3 (process evaluation) data collection will occur after sufficient completion of the 6-month assessment in Aim 2. Final results are anticipated in fall 2025.

Conclusions

This research seeks to advance our understanding of how food insecurity impacts the development of cardiometabolic comorbidities among PWH and how food insecurity interventions may alleviate relevant comorbidities. Given the growing interest among health systems in addressing food insecurity, if the intervention is found to be efficacious, it could be broadly disseminated across HIV clinical care settings.

Trial registration

ClinicalTrials.gov NCT04943861. Registered on June 29, 2021.
mPFC-rTMS for patients with insomnia disorder using resting-state functional magnetic resonance imaging: a protocol for a randomized controlled trial
Authors: Sun Jingjing , Li Guohai , Zhang Danwei , Ding Kaimo , Zhu Jun , Luo Si , Xu Wenyue , Wang Zhoubing
Published: December 2022

Background

Insomnia is the most common sleep disorder. Repetitive transcranial magnetic stimulation (rTMS) is safe and effective for insomnia disorder (ID). Convergent evidence show that the medial prefrontal cortex (mPFC) may be involved in the regulation of sleep and awakening at the cortical level and may serve as a potential target of rTMS in the treatment of ID. The purpose of this clinical trial is to study the efficacy of mPFC-rTMS in the treatment ID and explore the neural mechanism using resting-state functional magnetic resonance imaging (fMRI).

Methods and design

This will be a parallel-group randomized, patient- and assessor-blinded trial. The study will recruit 60 ID patients assigned to a real mPFC-rTMS group or a sham mPFC-rTMS group. The allocation ratio is 1:1, with 30 subjects in each group. Interventions will be administered five times per week over a 4-week period, with an 8-week follow-up period. All participants will undergo neuropsychological and fMRI evaluations. The primary outcome measure of this study is the change scores of the Pittsburgh Sleep Quality Index (PSQI). The secondary outcome measures include the fMRI measurements, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), a sleep diary, and a polysomnography. Assessment of all parameters will be performed at baseline, post-treatment, and during follow-up.

Discussion

It is expected that the study results will provide strong evidence of the effectiveness and the neural mechanism by which mPFC-rTMS improves sleep quality in ID patients.

Trial registration

Chinese Clinical Trials Register ChiCTR2100054154. Registered on 10 December 2021.
Online Parent Training for The Initial Management of ADHD referrals (OPTIMA): the protocol for a randomised controlled trial of a digital parenting intervention implemented to support parents and children on a treatment waitlist
Authors: Kostyrka-Allchorne Katarzyna , Ballard Claire , Byford Sarah , Cortese Samuele , Daley David , Downs Johnny , French Blandine , Glazebrook Cristine , Goldsmith Kimberley , Hall Charlotte L. , Hedstrom Ellen , Kovshoff Hanna , Kreppner Jana , Lean Nancy , Sayal Kapil , Shearer James , Simonoff Emily , Thompson Margaret , Sonuga-Barke Edmund J. S.
Published: December 2022

Background

Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents’ self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents’ convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children’s clinical services.

Methods

Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children’s oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU.

Discussion

Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services.

Trial registration

ISRCTN 16523503. Prospectively registered on 18 November 2021. https://www.isrctn.com/ISRCTN16523503
CARE 1000: randomized controlled trial for the evaluation of the effectiveness of a mHealth app for supporting the first 1000 days of life
Authors: Brunelli Laura , Bussolaro Sofia , Dal Cin Margherita , Ronfani Luca , Zanchiello Sara , Cassone Andrea , Verardi Giuseppa , Dobrina Raffaella , Bava Michele , Stampalija Tamara
Published: December 2022

Background

Recent developments in eHealth and mobile health (mHealth), as well as the introduction of information and communication technology innovations in clinical practice, such as telemedicine, telemonitoring, and remote examinations, are already changing the current scenario and will continue to generate innovations in the coming decades. The widespread use of mobile devices, with an estimated nearly 30 billion devices and more than 325,000 apps worldwide, will provide various opportunities for people to take control of their own health. Already in 2017, most of the apps available were focused on pregnancy support, more than any other medical field. There have been some reported experiences with social media and mHealth that could benefit the promotion of maternal physical and mental health during pregnancy. However, many apps targeting the first 1000 days of a child’s life do not consider the continuity between the prenatal and postnatal periods and their joint impact on maternal and child health. The aim of this study is to evaluate the effectiveness of this mHealth app to support women during the first 1000 days (from conception to 24 months of age) and to improve health prevention behaviours such as immunizations during pregnancy, weight gain during pregnancy, abstinence from smoking and alcohol consumption, and adherence to the routine childhood immunization schedule. In addition, the study aims to understand the level of appreciation of this mHealth app as a tool to overcome information and communication gaps between patients and institutions.

Methods

Conduction of a randomized controlled trial.

Discussion

Our results will be relevant for improving this mHealth app to promote health and prevention and to support the first 1000 days of life for both mother and child. Our results will be relevant to the future expansion of such an mHealth app to promote positive health-related outcomes in patients and co-user satisfaction and to support the organization of health services.

Trial registration

ClinicalTrials.gov NCT05500339.