bluuebunny/crossref_metadata_2025 huggingface dataset:
A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee
Authors: Payton Colleen , Kumar Gayathri S. , Kimball Sarah , Clarke Sarah K. , AlMasri Ibrahim , Karaki Fatima M.
Published: September 2021

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)—the largest medical society dedicated to refugee health in North America—have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.
Care Matters: Student Perspectives of Mental Health Determinants in an Alternative High School
Authors: Jordan Adam W. , Jordan Kasey H. , Sutphin Allison
Published: September 2021

Public alternative schools in the United States are multifaceted educational entities that often serve students marginalized from traditional spaces, yet little research exists highlighting the perceptions of alternative school students regarding mental health–promoting school practices. In this qualitative study, the voices of seven alternative high school students (four female and three male) are presented through the use of a targeted focus group. The following two research questions guided this study: What aspects of the public alternative school environment do students perceive to facilitate their mental health? What aspects of public alternative school environments do students perceive as barriers to mental health? Using qualitative descriptive methods, findings suggested that for these students the alternative school is a unique institution, designed for them, in which they can thrive due to the caring nature of the professionals they encounter. Implications for practitioners dedicated to producing mental health–promoting, inclusive school spaces for marginalized youth are presented.
Effects of lipid-lowering therapy on major adverse limb events in patients with peripheral arterial disease: A meta-analysis of randomized clinical trials
Authors: Masson Walter , Lobo Martín , Barbagelata Leandro , Molinero Graciela , Bluro Ignacio
Published: September 2021

Objective

Patients with peripheral artery disease (PAD) are at increased risk of major adverse limb events (MALE). Furthermore, MALE have several clinical implications and a poor prognosis, so prevention is a fundamental issue. The main objective of the present meta-analysis of randomized clinical trials is to evaluate the effect of different lipid-lowering therapies on MALE incidence in patients with PAD.

Methods

A meta-analysis of randomized studies that evaluated the use of lipid-lowering therapy in patients with PAD and reported MALE was performed, after searching the PubMed/MEDLINE, Embase, ScieLO, Google Scholar, and Cochrane Controlled Trials databases. A fixed- or random-effects model was used.

Results

Five randomized clinical trials including 11,603 patients were identified and considered eligible for the analyses (5903 subjects were allocated to receive lipid-lowering therapy, while 5700 subjects were allocated to the respective placebo/control arms). The present meta-analysis revealed that lipid-lowering therapy was associated with a lower incidence of MALE (OR: 0.76, 95% confidence interval: 0.66–0.87; I2: 28%) compared to placebo/control groups. The sensitivity analysis shows that the results are robust.

Conclusion

This study demonstrated that the use of lipid-lowering therapy compared with the placebo/control arms was associated with a marked reduction in the risk of MALE. Physicians involved in the monitoring and treatment of patients with PAD must work hard to ensure adequate lipid-lowering medication in these patients.
Incidence, prevalence, and economic burden of sarcoidosis in Puerto Rico: Estimates from a government health insurance claims database
Authors: Scharbaai-Vázquez Ramón , Tremblay Raymond L
Published: September 2021

Objectives

To estimate the epidemiology of sarcoidosis in Puerto Rico.

Methods

Patients with a diagnosis of sarcoidosis between January 2015 and December 2018 were selected from the Puerto Rico Health Insurance Administration Administración de Seguros de Salud de Puerto Rico claims database. The International Classification of Diseases-Tenth Revision coding for sarcoidosis was used for case detection and utilization of health care services. Cases by sex and age were evaluated.

Results

A total of 488 individuals with sarcoidosis were identified over the 4-year study. The median age at diagnosis was 59 years old. The average annual incidence rate was 9.9/100,000. The baseline prevalence was 14.9 per 100,000. Females represented 68.4% of the cases. Patients with lung and unspecified sarcoidosis predominate with 45.6% and 28.2% of cases, respectively. Overall, the yearly cost of health care utilization and medications per patient was $234 and $13,638, respectively.

Conclusions

Annual incidence rate and the median age of sarcoidosis in Puerto Ricans are among the highest and oldest reported globally. The demographic profile of sarcoidosis in Puerto Rico presents a patient in the mid-to advanced age, mostly female. While costs for medications were relatively high for a patient with sarcoidosis, the economic burden of the disease to the national health care system is not substantial.
Family caregivers for older persons with dementia offer recommendations to current caregivers: a qualitative investigation
Authors: Hovland Cynthia A , Mallett Christopher A
Published: September 2021

Background and aims

Family members who care for older adults with dementia encounter significant difficulties across many domains. There is limited research in this area; thus, the aim here is to share the actual experiences of 30 family caregivers to other family caregivers and to show how these experiences can provide help and recommendations.

Methods

This qualitative study of 30 family caregivers of family members aged 65 and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period for data collection and content analysis to understand the data. The study asked what they learned and what subsequent recommendations these caregivers had for other family caregivers taking care of an older person with dementia.

Results

Four primary themes emerged from the content data analysis and included the following: (1) “do not do it alone”; (2) patience, love, and kindness; (3) “ first of all, take care of yourself”; and (4) “ get educated.”

Conclusions

This study is unique in asking directly of family caregivers of older persons who died of dementia what they learned and what they want to share and recommend to ongoing and future family caregivers.
Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review
Authors: Toyoda Kazunori , Yoshimura Sohei , Fukuda-Doi Mayumi , Qureshi Adnan I , Martin Renee’ Hebert , Palesch Yuko Y , Ihara Masafumi , Suarez Jose I , Okada Yasushi , Hsu Chung Y , Itabashi Ryo , Wang Yongjun , Yamagami Hiroshi , Steiner Thorsten , Sakai Nobuyuki , Yoon Byung-Woo , Inoue Manabu , Minematsu Kazuo , Yamamoto Haruko , Koga Masatoshi ,   the ATACH Trial Investigators and the SAMURAI Investigators
Published: September 2021

Background and aims

Nicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined.

Methods

A systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase ≥6 mL from baseline to 24-h computed tomography.

Summary of review

Three studies met the eligibility criteria. For 1265 patients enrolled (age 62.6 ± 13.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00–1.26 per 10 mmHg) and hematoma expansion (1.16, 1.02–1.32). Mean hourly systolic blood pressure from 1 h to any timepoint during the initial 24 h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140 mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00–1.05 per hour).

Conclusions

Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.
Memory and far-right historiography: The case of the Christchurch shooter
Authors: Baun Phillip Stenmann
Published: September 2021

This article investigates far-right conceptions of history and memory through the case of Christchurch shooter. Scholarly work on far-right memory practices is still in its infancy, and research into the Christchurch shooter in particular has underplayed this crucial aspect of his ideological drive for violence. By investigating the narrative elements of his historiography, the article argues that far-right extremism taps into a range of historical templates to structure a trajectory of time and historical development that seeks to legitimize present violence in relation to the legacies and exemplary instances of the past as well as historically contingent aspirations for the future. The danger of this memory working is its utility—through the channels of digital culture and communication—in promising to canonize the terrorist as a historicized object in a chronicle of ancient struggle, providing temporalized purpose to his violence in both a retrospective and prospective manner.
Engineering and clinical use of artificial intelligence (AI) with machine learning and data science advancements: radiology leading the way for future
Authors: Hameed B.M. Zeeshan , Prerepa Gayathri , Patil Vathsala , Shekhar Pranav , Zahid Raza Syed , Karimi Hadis , Paul Rahul , Naik Nithesh , Modi Sachin , Vigneswaran Ganesh , Prasad Rai Bhavan , Chłosta Piotr , Somani Bhaskar K.
Published: September 2021

Over the years, many clinical and engineering methods have been adapted for testing and screening for the presence of diseases. The most commonly used methods for diagnosis and analysis are computed tomography (CT) and X-ray imaging. Manual interpretation of these images is the current gold standard but can be subject to human error, is tedious, and is time-consuming. To improve efficiency and productivity, incorporating machine learning (ML) and deep learning (DL) algorithms could expedite the process. This article aims to review the role of artificial intelligence (AI) and its contribution to data science as well as various learning algorithms in radiology. We will analyze and explore the potential applications in image interpretation and radiological advances for AI. Furthermore, we will discuss the usage, methodology implemented, future of these concepts in radiology, and their limitations and challenges.
Distribution of comorbidities in spondyloarthritis with regard to the phenotype and psoriasis: data from the ASAS-COMOSPA study
Authors: Puche-Larrubia M. Ángeles , Ladehesa-Pineda Lourdes , Font-Ugalde Pilar , Escudero-Contreras Alejandro , Moltó Anna , López-Medina Clementina , Collantes-Estévez Eduardo
Published: September 2021

Introduction:

The aim of the study was to compare the prevalence of comorbidities between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities.

Methods:

Patients from the cross-sectional Assessment in SpondyloArthritis Inter-national Society (ASAS)-COMOSPA study were classified as having either the axial (presence of sacroiliitis on X-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of peripheral involvement). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial/peripheral phenotype with/without psoriasis) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and sex as fixed effects and country as random effect.

Results:

A total of 3291 patients were included in this analysis. The peripheral involvement with psoriasis phenotype showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while the axial involvement without psoriasis phenotype exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%). Among patients with psoriasis, the axial phenotype showed a significantly lower prevalence of hypertension (OR: 0.51, 95% CI: 0.35–0.75) and lower prevalence of Framingham score ⩾15 (OR: 0.57, 95% CI: 0.38–0.85) than patients with peripheral involvement after adjusting for disease duration, sex and country. Among patients with the axial phenotype, patients with psoriasis showed a higher prevalence of hypertension (OR 1.76, 1.40–2.20), dyslipidaemia (OR: 1.99, 95% CI: 1.56–2.53), diabetes (OR: 2.05, 95% CI: 1.39–3.02) and Framingham score ⩾15 (OR: 2.00, 95% CI: 1.57–2.55) than non-psoriatic patients. No differences were found across groups concerning bone metabolism disorders.

Conclusion:

Both the peripheral phenotype and psoriasis are independently associated with an increased prevalence of cardiovascular risk factors. No differences were found for bone metabolism disorders.
A retrospective study on the prevalence of anti-phospholipid antibodies, thrombotic events and cutaneous signs of vasculopathy in 173 hospitalized COVID-19 patients
Authors: Gasparini Giulia , Canepa Paola , Verdiani Simonetta , Carmisciano Luca , Cozzani Emanuele , De Grazia Denise , Andrea Orsi , Icardi Giancarlo , Parodi Aurora
Published: September 2021

Background

Hypercoagulability is a risk factor of thromboembolic events in COVID-19. Anti-phospholipid (aPL) antibodies have been hypothesized to be involved. Typical COVID-19 dermatological manifestations of livedo reticularis and digital ischemia may resemble cutaneous manifestations of anti-phospholipid syndrome (APS).

Objectives

To investigate the association between aPL antibodies and thromboembolic events, COVID-19 severity, mortality, and cutaneous manifestations in patients with COVID-19.

Methods

aPL antibodies [anti-beta2-glycoprotein-1 (B2GP1) and anti-cardiolipin (aCL) antibodies] were titered in frozen serum samples from hospitalized COVID-19 patients and the patients’ clinical records were retrospectively analyzed.

Results

173 patients were enrolled. aPL antibodies were detected in 34.7% of patients, anti-B2GP1 antibodies in 30.1%, and aCL antibodies in 10.4%. Double positivity was observed in 5.2% of patients. Thromboembolic events occurred in 9.8% of patients, including 11 pulmonary embolisms, 1 case of celiac tripod thrombosis, and six arterial ischemic events affecting the cerebral, celiac, splenic, or femoral-popliteal arteries or the aorta. aPL antibodies were found in 52.9% of patients with vascular events, but thromboembolic events were not correlated to aPL antibodies (adjusted OR = 1.69, p = 0.502). Ten patients (5.8%) had cutaneous signs of vasculopathy: nine livedo reticularis and one acrocyanosis. No significant association was observed between the presence of cutaneous vasculopathy and aPL antibodies ( p = 0.692).

Conclusions

Anti-phospholipid antibodies cannot be considered responsible for hypercoagulability and thrombotic events in COVID-19 patients. In COVID-19 patients, livedo reticularis and acrocyanosis do not appear to be cutaneous manifestations of APS.
“We just need the developer to develop”: Entrepreneurialism, financialization and urban redevelopment in Lexington, Kentucky
Authors: Ward Kevin , Wood Andrew
Published: September 2021

Since the 1980s US city governments have increased their use of more speculative means of financing economic redevelopment. This has involved experimenting with a variety of financial and taxation instruments as a way of growing their economies and redeveloping their built environments. This very general tendency, of course, masks how some cities have done well through the use of these instruments while others have not. The work to date has tended to pivot around a “winner-loser dichotomy”, which emphasises either the capacity of US cities to be able to experiment and speculate through the use of one financial instrument or another or their failings with these instruments, resulting in bankruptcy and fiscal crisis. This paper presents a case study of Lexington, Kentucky and using archival research and interviews we argue that speculative financial instruments are harder to choreograph for some cities than for others. We draw particular attention to US cities beyond those that tend to be over-represented in the metro-centric academic literature. This argument has conceptual significance. Building theory out of the experiences of US cities such as Lexington, Kentucky turns attention to the work required by city governments as they seek to finance the redevelopment of their downtowns. We make the case for a continued appreciation of the messy politics around the use of financial instruments, and its indeterminate, open and unpredictable nature in an era of fragile and uncertain entrepreneurial US urban policy-making.
When no news is bad news: Improving diagnostic testing communication through patient engagement
Authors: Zomerlei Terri , Carraher Amanda , Chao Albert , Vink Shonda , Chandawarkar Rajiv
Published: September 2021

Importance

Up to 17% of diagnostic test results are missed, lost or ignored despite conventional fixes such as electronic physician reminders – naïvely, patients assume: ‘No-News-is-Good-News’. These lapses can result in poor outcomes, complications, and even death. In response, Centers for Medicare and Medicaid Services (CMS)-led physician quality reporting system measure#265 emphasizes prevention. This study aims to improve the timely review of results through increasing patient engagement.

Design and Participants

Ninety patients undergoing diagnostic testing were included in this Internal Review Board (IRB)-approved study. Two groups, group-A (patients with medical chart access through our EHR, n = 40); and group-B (controls, n = 50) were included. Group-A was reminded via written AVS and EHR portal messages to ask about their test results at their next appointment. Controls were sent no reminders, mimicking the status- quo.

Main Outcomes

At subsequent visits whether patients ‘asked’ or ‘did not ask’ about their results was recorded and analyzed. Study group participants were also surveyed on their preferences for reminder communication.

Results

Patients that were sent reminders were up to twenty times more likely to ask their provider regarding their test results than the control group ( p < 0.0001). Eighty-one percent indicated that the reminders were helpful with 90% indicating they were ‘necessary’. Neither gender nor age seemed predictive factors of patient engagement.

Conclusions and Relevance

This pilot study demonstrates that engaging patients in their own care through already-existing tools (AVS, EHR portal messages) improves patient-physician communication, and could lead to lower rates of missed diagnostic tests.
The impact of COVID-19 on child welfare-involved families: Implications for parent–child reunification and child welfare professionals
Authors: Goldberg Abbie E. , Brodzinsky David , Singer Jacqueline , Crozier Patience
Published: September 2021

The COVID-19 pandemic has impacted children and parents involved in the child welfare system and the professionals working with these families. Using survey data collected August–September of 2020, this mixed-methods study examined the perspectives of 196 child welfare-involved professionals (77 attorneys, 99 caseworkers, and 20 therapists) in the United States about the impact of COVID-19 on parents of origin, children, foster parents, and child welfare professionals. Particular attention was paid to the implications of COVID-19 and associated challenges for parent–child contact and reunification. With respect to professional stresses, more than half of participants worried about their own personal safety and health amidst COVID-19, and more than three-quarters expressed concerns about the safety and well-being of child welfare-involved families. Participants, especially attorneys, expressed concerns about parent–child contact and disruptions to reunification. In-person parent–child visits had all but ceased during the early part of the pandemic, and participants identified barriers to effective virtual visits, including lack of foster parent oversight, technology issues, and children’s developmental stage and/or lack of engagement. Attorneys were especially critical of the cessation of in-person visits and viewed this as a serious threat to child-parent bonds and reunification. Participants, especially child welfare workers, voiced concerns about children’s mental health and educational outcomes amidst the pandemic. Findings have implications for attorneys, child welfare workers, and other practitioners who directly and indirectly interface with child welfare-involved families.
Hapln1b, a central organizer of the ECM, modulates kit signaling to control developmental hematopoiesis in zebrafish
Authors: Mahony Christopher B. , Cacialli Pietro , Pasche Corentin , Monteiro Rui , Savvides Savvas N. , Bertrand Julien Y.
Published: September 2021

During early vertebrate development, hematopoietic stem and progenitor cells (HSPCs) are produced in hemogenic endothelium located in the dorsal aorta, before they migrate to a transient niche where they expand to the fetal liver and the caudal hematopoietic tissue, in mammals and zebrafish, respectively. In zebrafish, previous studies have shown that the extracellular matrix (ECM) around the aorta must be degraded to enable HSPCs to leave the aortic floor and reach blood circulation. However, the role of the ECM components in HSPC specification has never been addressed. In this study, hapln1b, a key component of the ECM, was specifically expressed in hematopoietic sites in the zebrafish embryo. Gain- and loss-of-function experiments all resulted in the absence of HSPCs in the early embryo, showing that hapln1b is necessary, at the correct level, to specify HSPCs in the hemogenic endothelium. Furthermore, the expression of hapln1b was necessary to maintain the integrity of the ECM through its link domain. By combining functional analyses and computer modeling, we showed that kitlgb interacts with the ECM to specify HSPCs. The findings show that the ECM is an integral component of the microenvironment and mediates the cytokine signaling that is necessary for HSPC specification.
Heparin-induced thrombocytopenia in patients with COVID-19: a systematic review and meta-analysis
Authors: Uaprasert Noppacharn , Tangcheewinsirikul Nuanrat , Rojnuckarin Ponlapat , Patell Rushad , Zwicker Jeffrey I. , Chiasakul Thita
Published: September 2021

Heparin thromboprophylaxis is routinely administered during hospitalization for COVID-19. Because of the immune stimulation related to COVID-19, there is ongoing concern regarding a heightened incidence of heparin-induced thrombocytopenia (HIT). We performed a literature search using PubMed, EMBASE, Cochrane, and medRxiv database to identify studies that reported clinical and laboratory characteristics and/or the incidence of HIT in patients with COVID-19. The primary aim was to systematically review the clinical features and outcomes of patients with COVID-19 with confirmed HIT. The secondary objective was to perform a meta-analysis to estimate the incidence of HIT in hospitalized patients with COVID-19. A meta-analysis of 7 studies including 5849 patients revealed the pooled incidence of HIT in COVID-19 of 0.8% (95% confidence interval [CI], 0.2%-3.2%; I2 = 89%). The estimated incidences were 1.2% (95% CI, 0.3%-3.9%; I2 = 65%) vs 0.1% (95% CI, 0.0%-0.4%; I2 = 0%) in therapeutic vs prophylactic heparin subgroups, respectively. The pooled incidences of HIT were higher in critically ill patients with COVID-19 (2.2%; 95% CI, 0.6%-8.3%; I2 = 72.5%) compared with noncritically ill patients (0.1%; 95% CI, 0.0%-0.4%: I2 = 0%). There were 19 cases of confirmed HIT and 1 with autoimmune HIT for clinical and laboratory characterization. The median time from heparin initiation to HIT diagnosis was 13.5 days (interquartile range, 10.75-16.25 days). Twelve (63%) developed thromboembolism after heparin therapy. In conclusion, the incidence of HIT in patients with COVID-19 was comparable to patients without COVID-19, with higher incidences with therapeutic anticoagulation and in critically ill patients.
The mechanism of nicotinamide on reducing acute lung injury by inhibiting MAPK and NF-κB signal pathway
Authors: Zhang Qun , Li Junyao , Zhong Haixia , Xu Yanling
Published: September 2021

Background

Acute lung injury is an important factor that leads to the death of patients with pneumonia. Previous studies have shown that nicotinamide (NAM) plays a role in reducing cell damage, so this study explored the mechanism by which NAM functions in acute lung injury.

Methods

We explored the mechanism by which NAM affects acute lung injury in vivo and in vitro by qRT-PCR, western blotting and ELISA.

Results

The results showed that NAM could significantly reduce lung injury and proinflammatory mediator accumulation. Further mechanistic studies showed that NAM could significantly inhibit the MAPK and AKT/NF-κB signaling pathways.

Conclusion

These results suggested that NAM may reduce the release of proinflammatory mediators by inhibiting the MAPK and AKT/NF-κB signaling pathways and ultimately alleviate lung injury.
Osteoblast Response to Copper-Doped Microporous Coatings on Titanium for Improved Bone Integration
Authors: Wang Lai-jie , Ni Xiao-hui , Zhang Fei , Peng Zhi , Yu Fu-xun , Zhang Lei-bing , Li Bo , Jiao Yang , Li Yan-kun , Yang Bing , Zhu Xing-yuan , Zhao Quan-ming
Published: September 2021

Due to their excellent mechanical properties and good biocompatibility, titanium alloys have become a popular research topic in the field of medical metal implants. However, the surface of the titanium alloy does not exhibit biological activity, which may cause poor integration between the interface of the titanium implant and the interface of the bone tissue and subsequently may cause the implant to fall off. Therefore, surface biological inertness is one of the problems that titanium alloys must overcome to become an ideal orthopedic implant material. Surface modification can improve the biological properties of titanium, thereby enhancing its osseointegration effect. Copper is an essential trace element for the human body, can promote bone formation and plays an important role in maintaining the physiological structure and function of bone and bone growth and development. In this study, a microporous copper-titanium dioxide coating was prepared on the surface of titanium by microarc oxidation. Based on the evaluation of its surface characteristics, the adhesion, proliferation and differentiation of MC3T3-E1 cells were observed. A titanium rod was implanted into the rabbit femoral condyle, and the integration of the coating and bone tissue was evaluated. Our research results show that the microporous copper-titanium dioxide coating has a nearly three-dimensional porous structure, and copper is incorporated into the coating without changing the structure of the coating. In vitro experiments found that the coating can promote the adhesion, proliferation and differentiation of MC3T3-E1 cells. In vivo experiments further confirmed that the titanium copper-titanium dioxide microporous coating can promote the osseointegration of titanium implants. In conclusion, copper-titanium dioxide microporous coatings can be prepared by microarc oxidation, which can improve the biological activity and biocompatibility of titanium, promote new bone formation and demonstrate good osteoinductive properties. Therefore, the use of this coating in orthopedics has potential clinical application.
Successful treatment of severe electrolyte imbalance-induced cardiac arrest caused by adrenal tuberculosis with ECMO in the ED
Authors: Yang Ning , Zhou Liping , Mo Xiaoye , Huang Guoqing , Wu Ping
Published: September 2021

Background

Tuberculosis (TB) is a chronic infectious disease, common in China. TB bacteria can invade multiple organs throughout the body, but they rarely cause critical illness. We present a complex critically ill case in this report.

Case presentation

A 40-year-old man suffered sudden cardiac arrest during an emergency room visit. Spontaneous circulation resumed after emergency cardiopulmonary resuscitation (CPR), but recurrent ventricular fibrillation and refractory cardiac shock emerged. Thereafter, extracorporeal membrane oxygenation (ECMO) was implemented to maintain hemodynamic stability. Blood test results revealed that the patient had severe electrolyte imbalance and adrenal insufficiency. Further imaging examination showed multiple tuberculosis lesions throughout the body, including the lungs, adrenal glands, and lumbar spine. In the end, the patient was successfully moved from the ICU after weaning from ECMO and the ventilator, and then transferred to an infectious disease specialist hospital for standard anti-tuberculosis therapy.

Conclusions

ECMO has won the opportunity for the diagnosis and treatment of this young patient who suffered from a rare cause of cardiac arrest and finally achieved a good prognosis.
The transcription factor reservoir and chromatin landscape in activated plasmacytoid dendritic cells
Authors: Mann-Nüttel Ritu , Ali Shafaqat , Petzsch Patrick , Köhrer Karl , Alferink Judith , Scheu Stefanie
Published: September 2021

Background

Transcription factors (TFs) control gene expression by direct binding to regulatory regions of target genes but also by impacting chromatin landscapes and modulating DNA accessibility for other TFs. In recent years several TFs have been defined that control cell fate decisions and effector functions in the immune system. Plasmacytoid dendritic cells (pDCs) are an immune cell type with the unique capacity to produce high amounts of type I interferons quickly in response to contact with viral components. Hereby, this cell type is involved in anti-infectious immune responses but also in the development of inflammatory and autoimmune diseases. To date, the global TF reservoir in pDCs early after activation remains to be fully characterized.

Results

To fill this gap, we have performed a comprehensive analysis in naïve versus TLR9-activated murine pDCs in a time course study covering early timepoints after stimulation (2 h, 6 h, 12 h) integrating gene expression (RNA-Seq) and chromatin landscape (ATAC-Seq) studies. To unravel the biological processes underlying the changes in TF expression on a global scale gene ontology (GO) analyses were performed. We found that 70% of all genes annotated as TFs in the mouse genome (1014 out of 1636) are expressed in pDCs for at least one stimulation time point and are covering a wide range of TF classes defined by their specific DNA binding mechanisms. GO analysis revealed involvement of TLR9-induced TFs in epigenetic modulation, NFκB and JAK-STAT signaling, and protein production in the endoplasmic reticulum. pDC activation predominantly “turned on” the chromatin regions associated with TF genes. Our in silico analyses pointed at the AP-1 family of TFs as less noticed but possibly important players in these cells after activation. AP-1 family members exhibit (1) increased gene expression, (2) enhanced chromatin accessibility in their promoter region, and (3) a TF DNA binding motif that is globally enriched in genomic regions that were found more accessible in pDCs after TLR9 activation.

Conclusions

In this study we define the complete set of TLR9-regulated TFs in pDCs. Further, this study identifies the AP-1 family of TFs as potentially important but so far less well characterized regulators of pDC function.
Patient-centered infertility questionnaire for female clients (PCIQ-F): part I: questionnaire development
Authors: Webair Hana Hasan , Ismail Tengku Alina Tengku , Ismail Shaiful Bahari , Khaffaji Azza Jameel , Hussain Nik Hazlina Nik , Kadir Azidah Abdul , Muhamad Rosediani , Bakar Fatin Aina Abu , Ismail Nur Raihan , Badri Nagwa
Published: September 2021

Background

Patient-centered care is an essential component of health care quality. To achieve patient-centered care, health care authorities should have a clear definition and an applicable tool to measure the extent of its application. The real concept of patient centeredness should be developed by the patients themselves. We aimed to demonstrate a way to develop a draft Arabic patient-centered infertility care (PCIC) questionnaire for females clients following practical steps that address women with infertility.

Methods

An iterative process of questionnaire development was undertaken by combining two approaches: the steps proposed by Robert F. DeVellis for scale development and the recommended practices for questionnaire development and testing in the European statistical system. We attempted to develop the draft questionnaire that involved conceptualization and operationalization, generation of an item pool, development of the questionnaire format, review of the initial item pool by experts, and consideration of validation items for inclusion.

Results

We generated an item pool from in-depth interviews with 14 women who sought infertility care within 6 months before the interview time. We then added more items from a literature review. The item pool contained 123 items distributed through 10 domains. Ten women with infertility were included for face validation. Then, experts with backgrounds in Obstetrics and Gynecology, Family Medicine, and Public Health reviewed the item pool using content validation (n = 10 professors and/or specialists). The item pool was finally reduced to 57 items. We developed the draft Arabic patient-centered infertility care questionnaire for female clients (PCIQ-F) with three sections, including 66 items: background variables, PCIC experience variables, and a general question about the quality of infertility care in the health facility. The draft questionnaire was further reviewed and edited last by experts in preparation for part 2, which will test the questionnaire and prepare the final version.

Conclusion

The PCIQ-F questionnaire development is a multi-step iterative process started and ended by the target users as experts. Experts’ participation in infertility care and in questionnaire format development had a great impact on questionnaire development and conflict resolution. We recommend this transparent and replicable approach for new instrument developers; it is likely to generate a questionnaire that is valid and acceptable to target users. The draft PCIQ-F questionnaire is ready for testing of its psychometric properties before the final version to measure the PCIC level in health facilities.
Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence
Authors: Barker Timothy Hugh , Migliavaca Celina Borges , Stein Cinara , Colpani Verônica , Falavigna Maicon , Aromataris Edoardo , Munn Zachary
Published: September 2021

Background

Single group data present unique challenges for synthesises of evidence. Proportional meta-analysis is becoming an increasingly common technique employed for the synthesis of single group data. Proportional meta-analysis shares many similarities with the conduct and reporting of comparative, or pairwise, meta-analysis. While robust and comprehensive methods exist detailing how researchers can conduct a meta-analysis that compares two (or more) groups against a common intervention, there is a scarcity of methodological guidance available to assist synthesisers of evidence in the conduct, interpretation, and importance of proportional meta-analysis in systematic reviews.

Main body

This paper presents an overview targeted to synthesisers of evidence and systematic review authors that details the methods, importance, and interpretation of a proportional meta-analysis. We provide worked examples of how proportional meta-analyses have been conducted in research syntheses previously and consider the methods, statistical considerations, and presentation of this technique.

Conclusion

This overview is designed to serve as practical guidance for synthesisers of evidence in the conduct of proportional meta-analyses.
Minimizing bias in massive multi-arm observational studies with BCAUS: balancing covariates automatically using supervision
Authors: Belthangady Chinmay , Stedden Will , Norgeot Beau
Published: September 2021

Background

Observational studies are increasingly being used to provide supplementary evidence in addition to Randomized Control Trials (RCTs) because they provide a scale and diversity of participants and outcomes that would be infeasible in an RCT. Additionally, they more closely reflect the settings in which the studied interventions will be applied in the future. Well-established propensity-score-based methods exist to overcome the challenges of working with observational data to estimate causal effects. These methods also provide quality assurance diagnostics to evaluate the degree to which bias has been removed and the estimates can be trusted. In large medical datasets it is common to find the same underlying health condition being treated with a variety of distinct drugs or drug combinations. Conventional methods require a manual iterative workflow, making them scale poorly to studies with many intervention arms. In such situations, automated causal inference methods that are compatible with traditional propensity-score-based workflows are highly desirable.

Methods

We introduce an automated causal inference method BCAUS, that features a deep-neural-network-based propensity model that is trained with a loss which penalizes both the incorrect prediction of the assigned treatment as well as the degree of imbalance between the inverse probability weighted covariates. The network is trained end-to-end by dynamically adjusting the loss term for each training batch such that the relative contributions from the two loss components are held fixed. Trained BCAUS models can be used in conjunction with traditional propensity-score-based methods to estimate causal treatment effects.

Results

We tested BCAUS on the semi-synthetic Infant Health & Development Program dataset with a single intervention arm, and a real-world observational study of diabetes interventions with over 100,000 individuals spread across more than a hundred intervention arms. When compared against other recently proposed automated causal inference methods, BCAUS had competitive accuracy for estimating synthetic treatment effects and provided highly concordant estimates on the real-world dataset but was an order-of-magnitude faster.

Conclusions

BCAUS is directly compatible with trusted protocols to estimate treatment effects and diagnose the quality of those estimates, while making the established approaches automatically scalable to an arbitrary number of simultaneous intervention arms without any need for manual iteration.
A Bayesian latent class mixture model with censoring for correlation analysis in antimicrobial resistance across populations
Authors: Zhang Min , Wang Chong , O’Connor Annette M.
Published: September 2021

Background

The emergence of antimicrobial resistance across populations is a global threat to public health. Surveillance programs often monitor human and animal populations to evaluate trends of emergence in these populations. Many national level antibiotic resistance surveillance programs quantify the proportion of resistant bacteria as a means of monitoring emergence and control measures. The reason for monitoring these different populations are many, including interest in similar changes in resistance which might provide insight into emergence and control options.

Methods

In this research, we developed a method to quantify the correlation in antimicrobial resistance across populations, for the conventionally unnoticed mean shift of the susceptible bacteria. With the proposed Bayesian latent class mixture model with censoring and multivariate normal hierarchy, we address several challenges associated with analyzing the minimum inhibitory concentration data.

Results

Application of this approach to the surveillance data from National Antimicrobial Resistance Monitoring System led to a detection of positive correlation in the central tendency of azithromycin resistance of the susceptible populations from Salmonella serotype Typhimurium across food animal and human populations.

Conclusions

Our proposed approach has been shown to be accurate and superior to the commonly used naïve estimation by simulation studies. Further implementation of this Bayesian model could serve as a useful tool to indicate the co-existence of antimicrobial resistance, and potentially a need of clinical intervention.
Spot specimen testing with GeneXpert MTB/RIF results compared to morning specimen in a programmatic setting in Cotonou, Benin
Authors: Massou Faridath , Fandohan Merlin , Wachinou Ablo Prudence , Agbla Schadrac Christin , Agodokpessi Gildas , Rigouts Leen , de Jong Bouke Catherine , Affolabi Dissou
Published: September 2021

Background

The diagnosis of tuberculosis (TB) using smear microscopy has been based on testing two specimens: one spot and one early morning sputa. Recently, the World Health Organization (WHO) has recommended to replace, whenever possible, microscopy with GeneXpert® MTB/RIF performed on a single specimen. However, as the bacterial load is higher in early morning specimens than in spot specimens, one could expect lower sensitivity of GeneXpert® MTB/RIF performed only on spot specimens. In this study, we compared results of GeneXpert® MTB/RIF on spot specimens versus early morning specimens, under programmatic conditions in Cotonou, Benin.

Methods

From June to September 2018, all sputa received from presumptive TB patients at the Supranational Reference Laboratory for Tuberculosis of Cotonou were included in the study. From each patient, two specimens were collected (one spot and one early morning) and GeneXpert® MTB/RIF was performed on both specimens.

Results

In total, 886 participants were included in the study, of whom 737 provided both sputa and 149 (16.8%) gave only the spot specimen. For the 737 participants who provided both sputa, GeneXpert® MTB/RIF was positive for both specimens in 152 participants; for three participants GeneXpert® MTB/RIF was positive on spot specimen but negative on morning specimen while for another three, the test was positive on morning specimen but negative on spot specimen. The overall percentage of agreement was excellent (99.2%) with a positive and negative percent agreement greater than 98%.

Conclusion

For TB diagnosis under programmatic conditions in Cotonou, GeneXpert® MTB/RIF in spot specimens gave similar results with the test in morning specimens. Performing GeneXpert® MTB/RIF in both specimens did not significantly increase the number of cases detected. To avoid losing patients from the diagnostic cascade, it is preferable to test sputa produced at the time of the first visit at the health center.
Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa
Authors: Etoori David , Rice Brian , Reniers Georges , Gomez-Olive Francesc Xavier , Renju Jenny , Kabudula Chodziwadziwa Whiteson , Wringe Alison
Published: September 2021

Background

Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women.

Methods

We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods.

We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression.

We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression.

Results

Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother’s age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU.

Conclusion

Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.