bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Pneumococcal Vaccination Rates in Cochlear Implant Programs: A Systematic Review and Meta‐analysis
Authors: Britt Annie F. , Poupore Nicolas S. , Nguyen Shaun A. , White David R.
Published: July 2022

Objective

To review the literature on pneumococcal vaccination compliance rates among cochlear implant (CI) patients and to examine the utility of intervention programs on increasing vaccination rates.

Data Sources

PubMed, Scopus, and CINAHL.

Review Methods

A systematic review was performed following PRISMA guidelines. Studies of pneumococcal vaccination rates at baseline and before and after the implementation of a quality improvement (QI) intervention were included. A total of 641 studies were screened, and 13 studies met inclusion criteria. Meta‐analyses of pneumococcal vaccination rates pre‐ and post‐QI intervention in CI patients were performed.

Results

A total of 12,973 children and adults were included. The baseline PCV13 and PPSV23 vaccination rates were 53.45% (95% CI, 37.02%‐69.51%) and 42.53% (95% CI, 31.94%‐53.48%), respectively. Comparing children and adults, PCV13 and PPSV23 baseline vaccination rates were not statistically significant. The PPSV23 vaccine rate after QI initiatives was significantly higher than the baseline rate at 83.52% (95% CI, 57.36%‐98.46%). After these interventions, patients had a 15.71 (95% CI, 4.32‐57.20, P < .001) increased odds of receiving PPSV23 vaccination compared to before QI implementation.

Conclusions

The baseline rates of PCV13 and PPSV23 are highly variable and lower than expected, given current vaccination recommendations for CI patients. QI programs appear successful in increasing compliance rates with the PPSV23 vaccination; however, they are still far from full compliance. Further intervention programs with stricter surveillance, monitoring, and follow‐up systems are needed to achieve improved compliance with the PCV13 and PPSV23 vaccination in CI recipients.
The time of dialogic sociology
Authors: Flecha Ramon , Saso Carmen Elboj , Torras-Gómez Elisabeth , Joanpere Mar
Published: July 2022

There is a wide and rich literature about how neoliberalism is promoting the budgetary cuts to science and universities, especially to the critical sectors, such as the social sciences. There is scarce literature on the analysis of the role of sociology in the internal processes and debates on the elaboration of the scientific programs of research. Focusing on the European programs of research, this article analyzes how sociology is leading the new requirements of social impact and co-creation. The result of this analysis shows the great opportunity for sociology to get an unprecedented acknowledgment and valorization from society and all sciences, including those which had not been previously interested in sociology.
A Model of Economic Growth and Long Cycles
Authors: Nikolaos Chatzarakis , Persefoni Tsaliki , Tsoulfidis Lefteris
Published: July 2022

The purpose of this article is to derive an endogenous growth and cycles model that integrates the general law of capital accumulation, the reserve army of labor, technological change, devaluation of capital, and the law of the tendential fall in the rate of profit. The phase space of this model is analyzed by estimating its equilibrium solutions and exploring its economically meaningful stability properties. The so derived endogenous growth-and-cycles model is then simulated with realistic parameter values. The solutions of our model display periodicity, which may be treated as long cycles like attractors conditioned by the long-run movement of profitability. The salient feature of our model is the growth of the rate of surplus value, which becomes the regulating variable of our system for it explains the deviations from equilibrium and at the same time provides a realistic solution to Harrodian instability.

JEL Classification: C61, E11, E32, O41
Distributed control for coordinated tracking of fixed-wing unmanned aerial vehicles subject to velocity constraints
Authors: Wang Qipeng , Zhao Shulong , Yu Yangguang , Wang Xiangke
Published: July 2022

This paper considers a coordinated tracking problem of fixed-wing unmanned aerial vehicles (UAVs), whose kinematics is described as unicycle type with the constraints of both saturated angular speed and bounded linear velocity. A distributed velocity controller based on the consensus theory is designed such that UAVs can converge to the predefined formation and track the target vehicle, while the velocity constraints are satisfied. Moreover, due to the limitation of measurement range of sensors and communication bandwidth of UAV, an observer is designed when the information of neighbors’ velocity cannot be obtained. The stability of the closed-loop system is proved by using a technique lemma, which is developed based on the cascaded system. Finally, the results of numerical simulation compared with another algorithm show the effectiveness of the proposed algorithm, and a hardware-in-loop (HIL) simulation is carried out to prove the practical of the algorithm.
Acoustical optimization of mufflers hybridized with spiral perforated tubes using finite element method, Artificial Neural Network, and Genetic Algorithm
Authors: Chiu Min-Chie , Chang Ying-Chun
Published: July 2022

Because venting noise emitted from high pressure valve often occurred in industry and is huge, the noise abatement of the venting noise to protect human’s hearing health is necessary. In order to depress the high speed noise, a muffler internally equipped with spiral perforated tube is presented. To mitigate this noise, a dissipative muffler with perforated spiral tube installed on the pipeline is proposed. To evaluate the acoustical performance, a finite element method using COMSOL software is adopted. Also, the sensitivity analyses of Transmission Loss (TL) of the proposed muffler with respect to (1) diameter of the spiral and perforated tube ( D), (2) pitch of the spiral tube ( L), (3) acoustical impedance of the dissipative acoustic material ( R), and (4) perforation rate of a perforated tube (σ) has been carried out. For the optimization studies, both Artificial Neural Network (ANN) and Genetic Algorithm (GA) to optimize the muffler parameters L and D are applied. Here, two high target frequencies (2000 and 3500 Hz) to optimize the proposed muffler are exemplified. Consequently, the hybrid design of perforated spiral tube optimized using ANN and GA will mitigate the high pressure valve noise efficiently.
Telephone networks and transactional motherhood in Channel 4’s It’s A Sin
Authors: Harrison Rebecca
Published: July 2022

This article offers an analysis of women’s representation in the 2021 Channel 4 series It’s A Sin. Focusing on the show’s narrative and ideological use of the telephone network as a system of transactional care, the article critiques depictions of motherhood and questions the erasure of narratives about experiences of gender, race, sexuality, class and disability in queer communities. By way of textual analysis and histories of communication technologies in the 1980s and 1990s, the article argues that It’s A Sin perpetuates conservative and moralising perspectives on a range of issues, particularly with regard to gender and sexual activity.
I will help you survive but not thrive: Helping decisions in situations that empower women
Authors: Bareket Orly , Ein-Gar Danit , Kogut Tehila
Published: July 2022

This research examines gender-based helping behavior from a social dominance perspective. We focused on the interplay between the gender of a prospective donor and the gender of the recipient in shaping donation decisions in contexts that either empower recipients or not. In two studies ( N = 866), male (but not female) donors chose to donate less often (Study 2) and to give lower amounts (Studies 1–2) to women in need than to men when donations were made in a potentially empowering context – a business context (e.g., donating to a person whose shop burned down), than in a nonempowering context – a domestic context (e.g., donating to a person whose house burned down). Lack of empathy for the female recipient among men partially mediated this gender–donation bias effect (Study 2). These findings suggest that men are less likely to help women in situations that empower women and challenge the existing gender hierarchy.
State of the evidence on simulation-based electronic health records training: A scoping review
Authors: Nuamah Joseph K , Adapa Karthik , Mazur Lukasz M
Published: July 2022

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O’Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.
Fuzzy logic, genetic algorithms, and artificial neural networks applied to cognitive radio networks: A review
Authors: Alkhayyat Ahmed , Abedi Firas , Bagwari Ashish , Joshi Pooja , Jawad Haider Mahmood , Mahmood Sarmad Nozad , Yousif Yousif K
Published: July 2022

Cognitive radios are expected to play an important role in capturing the constantly growing traffic interest on remote networks. To improve the usage of the radio range, a cognitive radio hub detects the weather, evaluates the open-air qualities, and then makes certain decisions and distributes the executives’ space assets. The cognitive radio works in tandem with artificial intelligence and artificial intelligence methodologies to provide a flexible and intelligent allocation for continuous production cycles. The purpose is to provide a single source of information in the form of a survey research to enable academics better understand how artificial intelligence methodologies, such as fuzzy logics, genetic algorithms, and artificial neural networks, are used to various cognitive radio systems. The various artificial intelligence approaches used in cognitive radio engines to improve cognition capabilities in cognitive radio networks are examined in this study. Computerized reasoning approaches, such as fuzzy logic, evolutionary algorithms, and artificial neural networks, are used in the writing audit. This topic also covers cognitive radio network implementation and the typical learning challenges that arise in cognitive radio systems.
Gender and the Far-right in the United States: Female Extremists and the Mainstreaming of Contemporary White Nationalism
Authors: Stern Alexandra Minna
Published: July 2022

This article explores gender and the far-right in the United States with specific attention to female actors and gendered ideologies in the realms of culture and media. By focusing on several female extremists, I show how traditional and rigid ideas of home, marriage, family and community bolster the xenophobia and racism of white nationalism in the United States. This article includes a historical overview of the concept of metapolitics and emphasizes its centrality to the mainstreaming of the contemporary far-right. I suggest that the internet and social media have become the far-right's premier metapolitical spaces, which can help to explain both the normalization of white nationalism and the unique role of female extremists. Several case studies of far-right women elucidate how gender norms are performed online, and how they reinforce anxious narratives of white erasure and victimhood, while fomenting antagonism towards feminism, globalism and multiculturalism. This article explores how female actors are galvanizing white nationalism in the United States, as they build on earlier eras of far-right activism and amplify the far-right via social media.
Stroke Patients’ Free-Time Activities and Spatial Preferences During Inpatient Recovery in Rehabilitation Centers
Authors: Kevdzija Maja , Bozovic-Stamenovic Ruzica , Marquardt Gesine
Published: July 2022

Objectives:

To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want.

Background:

Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities.

Methods:

Patients’ free-time activities were recorded via patient shadowing ( n = 70, 840 hr), and their spatial preferences were collected using a survey ( n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets.

Results:

Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone.

Conclusions:

Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.
Diffuse subcortical white matter restriction: An uncommon finding on metronidazole toxicity
Authors: Salari Mehri , Etemadifar Masoud , Ashourizadeh Helia
Published: July 2022

Metronidazole is a common and widely used antibiotic to treat a wide range of infectious diseases and has been associated with serious neurologic disturbances which in some cases were irreversible. We present a metronidazole-induced encephalopathy in a 19-year-old girl after 7 days of metronidazole treatment, with diffusion restricted subcortical white matter lesions along with the corpus callosum involvements. Diverse clinical presentation of a serious neurologic disturbance caused by a common widely used antibiotic should be carefully addressed in the setting of both short- and long-term treatment.
Eating Behavior and Environments of Severe Alzheimer’s Disease Patients With Loss of Language Skills
Authors: Rie Ketu , Yokoi Teruo , Miyoshi Yayoi , Watanabe Hiroyuki , Fukuda Toshihide
Published: July 2022

Background: As Alzheimer’s disease (AD) progresses, AD patients become more and more dependent on the environment. To prevent the patients from being distracted from eating, it is necessary to pay attention to the environment. Purpose: Five severe AD patients with loss of language skills were observed closely to identify the environments that interfered with their eating behaviors and environments that encouraged them to eat. Methods: The author, a certified care worker, recorded the behaviors of five severe AD patients while providing care for the overall aspects of their daily lives. From these records, the author extracted the situations in which the subjects exhibited self-eating behavior and situations in which they were distracted from eating, and organized the meanings of these environments for the subjects. Results: Eating behavior was interrupted: (1) when staff members started conversations nearby a subject, or when a caregiver attempted to stop a subject’s behavior in order to get her to eat; (2) by physical environmental changes, such as phone ringing and reflection of artificial light on their table. Conclusion: By organizing the meanings of the environments surrounding each individual, we can identify the environments that encourage a patient to start eating and environments that interfere with a patient’s eating behavior.
Nanotechnology-based formulations to amplify intraocular bioavailability
Authors: Kagkelaris Konstantinos , Panayiotakopoulos George , Georgakopoulos Constantinos D.
Published: July 2022

Conventional drug delivery formulations, such as eye drops and ointments, are mainly administered by topical instillation. The topical delivery of ophthalmic drugs is a challenging endeavor despite the eye is easily accessible. Unique and complex barriers, serving as protection against extrinsic harmful factors, hamper therapeutic intraocular drug concentrations. Bioavailability for deeper ocular tissues of the anterior segment of the eye is exceptionally low. As the bioavailability of the active substance is the major hurdle to overcome, dosing is increased, so the side effects do. Both provoke patient poor compliance, confining the desired therapeutic outcome. The incidence and severity of adverse reactions amplify evenly in the case of chronic treatments. Current research focuses on the development of innovative delivery strategies to address low ocular bioavailability and provide safe and convenient dosing schemes. The main objective of this review is to explore and present the latest developments in ocular drug delivery formulations for the treatment of the pathology of the anterior segment of the eye. Nanotechnology-based formulations, that is, organic nanoparticles (liposomes, niosomes/discosomes, dendrimers, nanoemulsions, nanosuspensions, nanoparticles/nanospheres) and inorganic nanoparticles, nanoparticle-laden therapeutic contact lenses, in situ gelling systems, and ocular inserts, are summarized and presented accordingly.
Dedifferentiated Liposarcoma: A Rare Case Report of Retroperitoneal Myxoid Soft Tissue Tumour with Diagnostic Dilemma
Authors: Chaudhary Ritica , Lisa Mona , Kumari Payal , Kumar Aman
Published: July 2022

Background:

The retroperitoneum can host a wide spectrum of soft tissue lesions. These tumours pose a challenge to the pathologist as the morphology is not of much help and immunohistochemistry becomes a necessity.

Case report:

Sixty years old male presented with 2 months history of abdominal lump, pain and dyspepsia. The MRI revealed a heterogeneous mass in the retroperitoneum involving right para spinal muscle, right iliac fossa and right perinephric region with destruction of right transverse process and erosion of adjacent L3 vertebra. Trucut biopsy of the mass was reported as fibroliposarcoma at an outside lab. Patient underwent a wide local excision. Grossly the tumour gave an impression of a liposarcoma but the microscopy showed areas of spindle cells, epitheloid cells, focal areas of ganglion like cells and large areas of myxoid change. IHC panel of S-100, SMA, caldesmon, myogenin, myoglobin and Alk-1 was negative. MDM2, CDK4 and p16 IHC came positive proving it to be a dedifferentiated liposarcoma.

Conclusion:

We report a curious case of retroperitoneal soft tissue tumour with complex morphology and IHC features diagnosed as dedifferentiated liposarcoma based on MDM2, CDK and p16 positivity.
Anger without a voice, anger without a solution: Parent–child triadic processes and the experience of caring for a child with a diagnosis of autism
Authors: Dallos Rudi , Grey Ben , Stancer Rebecca
Published: July 2022

The paper offers an exploration of triadic attachment dynamics in families with a child with a diagnosis of autism. The Meaning of the Child (MotC) framework was employed as part of a multiple case study design with 18 parents (9 couples) in order to examine their representation of parenting and relationship with their child. The MotC analysis employed concepts of parental sensitivity, mentalisation and reflective functioning, and a triadic, analysis was added to consider the family relational processes. The findings indicate that the parents were significantly influenced by the use of a dominant ‘autism discourse’. ‘Autism’ in their child presented a severe challenge for them and could foster a sense of disempowerment and emotional withdrawal. Locating the difficulties as reflecting ‘autism’ could also serve to detour conflicts between the parents, and in the parents themselves, trapping the family in unresolved anger or fear that could neither be named nor its impact addressed. Autism discourse tended to rob the actions of family members of interpersonal meaning, rendering conflict fixed and unalterable and requiring them to mask the deep feelings inherent in these relational ruptures. The analysis included an exploration of the parents’ own childhood attachment histories which revealed that the parents were also driven by corrective scripts in wishing to form better relationships with their child than had been their own childhood experiences of parenting. A sense of failure to achieve these added to their sense of disappointment and frustration, but also indicated potential avenues for positive changes and growth.
Changing nature of the work units and urban governance in China: The enduring influence of public institutions
Authors: Wang Kevin
Published: July 2022

Economic reform and housing commercialisation have fundamentally changed employer and employee relations and resulted in new patterns of urban governance in China. Consequently, recent research has focused on the emergence of new residential forms, their corresponding homeowners’ associations, neighbourhood committees and shequ governance structures – shedding light on state re-emergence at the grassroots level. However, an important omission in the literature is the changing roles played by the large number of existing work units within urban governance. This paper examines the new status of urban work units and assesses the changing nature of public institutions and their impact on socio-economic relations in communities – using a 70-year-old city hospital ( shiye- danwei) as a case study. Key actor interviews and field observations reveal that these type of work units have created a framework of ‘one work unit, multiple systems’ – where mainstream employees not only enjoyed high pay, enhanced support and benefits at work, but also more opportunities to exercise influence in the neighbourhoods where they live. The case demonstrates that neighbourhoods and work units form two pillars within contemporary Chinese urban society in which shequ, resident associations and the work units all provide social and economic support and concurrently exercise social and political control.
Route choice estimation in rail transit systems using smart card data: handling vehicle schedule and walking time uncertainties
Authors: Tiam-Lee Thomas James , Henriques Rui
Published: July 2022

Several cities around the world rely on urban rail transit systems composed of interconnected lines, serving massive numbers of passengers on a daily basis. Accessing the location of passengers is essential to ensure the efficient and safe operation and planning of these systems. However, passenger route choices between origin and destination pairs are variable, depending on the subjective perception of travel and waiting times, required transfers, convenience factors, and on-site vehicle arrivals. This work proposes a robust methodology to estimate passenger route choices based only on automated fare collection data, i.e. without privacy-invasive sensors and monitoring devices. Unlike previous approaches, our method does not require precise train timetable information or prior route choice models, and is robust to unforeseen operational events like malfunctions and delays. Train arrival times are inferred from passenger volume spikes at the exit gates, and the likelihood of eligible routes per passenger estimated based on the alignment between vehicle location and the passenger timings of entrance and exit. Applying this approach to automated fare collection data in Lisbon, we find that while in most cases passengers preferred the route with the least transfers, there were a significant number of cases where the shorter distance was preferred. Our findings are valuable for decision support among rail operators in various aspects such as passenger traffic bottleneck resolution, train allocation and scheduling, and placement of services.
Evaluation of droplet digital PCR rapid detection method and precise diagnosis and treatment for suspected sepsis (PROGRESS): a study protocol for a multi-center pragmatic randomized controlled trial
Authors: Zhao Yuanhan , Lin Ke , Zhang Haocheng , Yuan Guanmin , Zhang Yanliang , Pan Jingye , Hong Liang , Huang Yan , Ye Ying , Huang Lisu , Chen Xiaohua , Liu Jun , Li Xiang , He Xiaoju , Yue Qiaoyan , Zhang Hong , Zhou Aiming , Zhuang Yangyang , Chen Jie , Wu Caixia , Zhou Wei , Cai Fujing , Zhang Shengguo , Li Liang , Li Shaling , Bian Tingting , Li Jiabin , Yin Jun , Ruan Zhengshang , Xu Shanshan , Zhang Yan , Chen Jie , Zhang Ying , Han Jun , Su Tingting , Tu Fan , Jiang Lijing , Lei Chen , Du Qiu , Ai Jingwen , Zhang Wenhong
Published: July 2022

Background

Sepsis is still a major public health concern and a medical emergency due to its high morbidity and mortality. Accurate and timely etiology diagnosis is crucial for sepsis management. As an emerging rapid and sensitive pathogen detection tool, digital droplet PCR (ddPCR) has shown promising potential in rapid identification of pathogens and antimicrobial resistance genes. However, the diagnostic value and clinical impact of ddPCR tests remains to be studied in patients with suspected sepsis. PROGRESS trial is aimed to evaluate the clinical effectiveness of a novel ddPCR assay compared with standard practice.

Methods

PROGRESS is a multicenter, open-label, pragmatic randomized controlled trial (pRCT) set in ten hospitals, including departments of infectious disease and intensive care units. In this study, a total of 2292 patients with suspected sepsis will be randomly assigned to two arms: the ddPCR group and the control group with a ratio of 3:1. The primary outcome is the diagnostic efficacy, that is, the sensitivity and specificity of the ddPCR assay compared with the synchronous blood culture. Secondary outcomes include the mortality rates and the mean Sequential Organ Failure Assessment (SOFA) score at follow-up time points, the length of stay in the hospital, the time to directed antimicrobial therapy, duration of broad-spectrum antibiotic use, and the EQ-5D-5L score on day 90.

Discussion

It is the first multicenter pragmatic RCT to explore the diagnostic efficacy and clinical impact of the ddPCR assay in patients with suspected sepsis, taking advantage of both RCT’s ability to establish causality and the feasibility of pragmatic approaches in real-world studies (RWS). This trial will help us to get a comprehensive view of the assay’s capacity for precise diagnosis and treatment of sepsis. It has the potential to monitor the pathogen load change and to guide the antimicrobial therapy, making a beneficial impact on the prognosis of sepsis patients.

Trial registration: ClinicalTrial.gov, NCT05190861. Registered January 13, 2022—‘Retrospectively registered’, https://clinicaltrials.gov/ct2/show/NCT05190861.
Fetal congenital heart disease - mode of delivery and obstetrical complications
Authors: Zloto Keren , Hochberg Alyssa , Tenenbaum-Gavish Kinneret , Berezowsky Alexandra , Barbash-Hazan Shiri , Bardin Ron , Hadar Eran , Shmueli Anat
Published: July 2022

Background

The optimal mode of delivery in cases of fetal congenital heart disease (CHD) is not established. The few relevant studies did not address operative vaginal delivery. The aim of this study was to assess the impact of fetal CHD on mode of delivery during a trial of labor, and to secondarily describe some obstetric complications.

Methods

The database of a tertiary medical center was searched for women who gave birth to a singleton, liveborn neonate in 2015–2018. Mode of delivery was compared between women carrying a fetus with known CHD and women with a healthy fetus matched 1:5 for maternal age, parity, body mass index, and gestational age.

Results

The cohort included 616 women, 105 in the CHD group and 511 in the control group. The rate of operative vaginal delivery was significantly higher in the CHD group (18.09% vs 9.78%, OR 2.03, 95% CI 1.13–3.63, p = 0.01); the difference remained significant after adjustment for nulliparity and gestational age at delivery (aOR 2.58, 95% CI 1.36–4.9, p < 0.01). There was no difference between the CHD and control group in rate of intrapartum cesarean delivery (9.52% vs 10.76%, respectively, OR 0.97, 95% CI 0.47–1.98, p = 0.93). The most common indication for operative vaginal delivery was non-reassuring fetal heart rate (78.94% vs 64%, respectively). Median birth weight percentile was significantly lower in the CHD group (45th vs 53rd percentile, p = 0.04).

Conclusions

Our findings suggest that operative vaginal delivery, performed mostly because of non-reassuring fetal heart rate, is more common in pregnancies complicated by a prenatal diagnosis of CHD than non-anomalous pregnancies.
Healthcare utilization, costs, and productivity losses in treatment-resistant depression in Finland – a matched cohort study
Authors: Taipale Heidi , Lähteenvuo Markku , Tanskanen Antti , Huoponen Saara , Rannanpää Saara , Tiihonen Jari
Published: July 2022

Background

Due to its relatively high prevalence and recurrent nature, depression causes a major burden on healthcare systems, societies and individuals. Our objective was to investigate healthcare resource utilization and costs associated with treatment-resistant depression (TRD) compared with non-treatment-resistant depression in Finland.

Methods

Of all patients aged 16–65 years and diagnosed with depression in Finland during 2004–2016, persons with TRD (N = 15,405) were identified from nationwide registers and matched 1:1 with comparison persons with depression who initiated antidepressant use but did not have TRD at the time of matching. TRD was defined as initiation of a third treatment trial after having failed two pharmacological treatment trials. Follow-up period covered 5 years after TRD or corresponding matching date (until end of 2018). Health care resource utilization was studied with negative binomial regression and costs of TRD (per patient per year) with generalized estimating equations, by adjusting for baseline costs, comorbidity and baseline severity of depression.

Results

Persons with TRD (mean age 38.7, SD 13.1, 60.0% women) had more health care utilization and work disability (sick leaves and disability pensions), adjusted incidence rate ratio for work disability days was 1.72 (95% CI 1.64–1.80). This resulted in 1.9-fold higher total costs for persons with TRD (15,907 versus 8335 EUR), adjusted mean difference 7572 (95% CI 7215–7929) EUR per patient per year, higher productivity losses (due to sick leaves and disability pensions, mean difference 5296, 95% CI 5042–5550), and direct healthcare costs (2003, 95% CI 1853–2151) compared with non-TRD patients. Mean difference was the highest during the first year after TRD (total costs difference 11,760, 95% CI 11,314–12,206) and the difference decreased gradually after that.

Conclusion

Treatment-resistant depression is associated with about two-fold cost burden compared with non-treatment-resistant depression.
A typical presentation of moxifloxacin-induced DRESS syndrome with pulmonary involvement: a case report and review of the literature
Authors: Zhang Yinhong , Wang Xiaoyan , Cheng Yang , Wang Xiaofang , Zhang Yunjian
Published: July 2022

Background

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a kind of hypersensitivity drug reaction involving the skin and multiple internal organ systems. Moxifloxacin has rarely been reported to be a drug that is associated with DRESS syndrome. Lungs are less frequently involved in DRESS syndrome, but their involvements may herald more serious clinical processes. We present a rare typical case of moxifloxacin-induced DRESS syndrome with lungs involved. Valuable clinical data such as changes in the pulmonary imaging and pulmonary function tests was recorded. This case is important for the differential diagnosis of DRESS syndrome with lungs involved by providing clinical manifestations, CT imaging, pulmonary function tests, and biopsy pathological characteristics. The changes in pulmonary imaging and pulmonary function tests may help us understand the mechanism of DRESS syndrome further.

Case presentation

We report a case of a 47-year-old woman who was treated with oral moxifloxacin for community-acquired pneumonia. The patient subsequently developed a cough, fever, liver injury, skin rash, hematologic abnormalities, and shortness of breath (SOB) followed by pharyngeal herpes and peripheral neuritis. These symptoms, clinical lab index, and CT scan of the lungs improved after the withdrawal of moxifloxacin. The probability of moxifloxacin-induced DRESS syndrome was rated as “Definite”, with 7 scores graded by RegiSCAR. A literature search was also performed with “fluoroquinolones,” “moxifloxacin,” “ciprofloxacin,” “levofloxacin,” “delafloxacin,” and “DRESS” or “drug-induced hypersensitivity syndrome (DIHS)” as the keywords that were put into PubMed. The overall pulmonary involvement was approximately 9.1% (1/11). It is a rare reported case of DRESS syndrome with pulmonary involvement induced by moxifloxacin. We summarized detailed clinical data, including pulmonary imaging and pulmonary function changes.

Conclusion

This is a rare reported case of DRESS syndrome with pulmonary involvement induced by moxifloxacin. Prompt recognition and correct diagnosis can promote appropriate treatment and accelerate recovery. This case is important for us as a reference in the differential diagnosis of DRESS syndrome and helps us further understand the mechanism of DRESS syndrome.
Sodium butyrate inhibits osteogenesis in human periodontal ligament stem cells by suppressing smad1 expression
Authors: Hou Jingyi , Xu Junji , Liu Yi , Zhang Haiping , Wang Sihan , Jiao Yao , Guo Lijia , Li Song
Published: July 2022

Background

Butyrate is a major subgingival microbial metabolite that is closely related to periodontal disease. It affects the proliferation and differentiation of mesenchymal stem cells. However, the mechanisms by which butyrate affects the osteogenic differentiation of periodontal ligament stem cells (PDLSCs) remain unclear. Here, we investigated the effect of sodium butyrate (NaB) on the osteogenic differentiation of human PDLSCs.

Methods

PDLSCs were isolated from human periodontal ligaments and treated with various concentrations of NaB in vitro. The cell counting kit-8 assay and flow cytometric analysis were used to assess cell viability. The osteogenic differentiation capabilities of PDLSCs were evaluated using the alkaline phosphatase activity assay, alizarin red staining, RT-PCR, western blotting and in vivo transplantation.

Results

NaB decreased PDLSC proliferation and induced apoptosis in a dose- and time-depend manner. Additionally, 1 mM NaB reduced alkaline phosphatase activity, mineralization ability, and the expression of osteogenic differentiation-related genes and proteins. Treatment with a free fatty acids receptor 2 (FFAR2) antagonist and agonist indicated that NaB inhibited the osteogenic differentiation capacity of PDLSCs by affecting the expression of Smad1.

Conclusion

Our findings suggest that NaB inhibits the osteogenic differentiation of PDLSCs by activating FFAR2 and decreasing the expression of Smad1.
Assessment of the association of OCT3/4 with GLUT1 and CD105 in oral squamous cell carcinoma using dual immunohistochemistry
Authors: Derakhshan Samira , Mahdavi Nazanin , Kardouni Khoozestani Neda , Nasr Esfahani Bita , Heidarian Foroozan , Rahrotaban Sedigheh , Abdolrahmani Ali
Published: July 2022

Background

Oral squamous cell carcinoma (OSCC) is the most common cancer affecting the oral and maxillofacial region. This study aimed to investigate the role of cancer stem cells (CSCs) in angiogenesis and hypoxic response in OSCC.

Methods

This retrospective observational study evaluated 56 cases of OSCC using dual immunohistochemistry. Octamer-binding transcription factor 3/4 (OCT3/4) marker was used to evaluate CSC activity. Glucose transporter 1 (GLUT1) marker was used to evaluate the hypoxic response and angiogenesis, while endoglin (CD105) was used to evaluate the late stage of angiogenesis and blood vessel formation.

Results

Co-expression of OCT3/4 and GLUT1 was noted in 11 of 12 patients with grade III OSCC. However, we did not observe co-expression of these markers in 13 of 22 patients with grade I OSCC. Although we observed a significant correlation between co-expression of GLUT1 and OCT3/4 and tumor grade, there was no significant correlation between co-expression of OCT3/4 and CD105 and different grades of OSCC.

Conclusions

CSCs could play important roles in the initial stages of hypoxic response and angiogenesis. Our result reported that in higher grades of OSCC, GLUT1 as a first response to hypoxic situations might be a result of CSCs. Further studies are required to discover other biomarkers, their roles, and associated pathways of CSCs in OSCC.
The impact of COVID-19 on medical students’ practical skills and hygiene behavior regarding venipuncture: a case control study
Authors: Meyer Annika , Stosch Christoph , Klatt Andreas R. , Streichert Thomas
Published: July 2022

Background

Despite their importance to current and future patient care, medical students’ hygiene behaviors and acquisition of practical skills have rarely been studied in previous observational study. Thus, the aim of this study was to investigate the potential impact of the COVID-19 pandemic on medical student’s hygiene and practical skills.

Methods

This case-control study assessed the effect of the COVID-19 pandemic on hygiene behavior by contrasting the practical skills and hygiene adherence of 371 medical students post the pandemic associated lockdown in March 2020 with that of 355 medical students prior to the SARS-CoV-2 outbreak. Students’ skills were assessed using an objective structured clinical examination (OSCE). Their skills were then compared based on their results in hygienic venipuncture and the total OSCE score.

Results

During the SARS-CoV-2 pandemic, medical students demonstrated an increased level of compliance regarding hand hygiene before (prior COVID-19: 83.7%; during COVID-19: 94.9%; p < 0.001) and after patient contact (prior COVID-19: 19.4%; during COVID-19: 57.2%; p = 0.000) as well as disinfecting the puncture site correctly (prior COVID-19: 83.4%; during COVID-19: 92.7%; p < 0.001). Prior to the pandemic, students were more proficient in practical skills, such as initial venipuncture (prior COVID-19: 47.6%; during COVID-19: 38%; p < 0.041), patient communication (prior COVID-19: 85.9%; during COVID-19: 74.1%; p < 0.001) and structuring their work process (prior COVID-19: 74.4%; during COVID-19: 67.4%; p < 0.024).

Conclusion

Overall, the COVID-19 pandemic sensitized medical students’ attention and adherence to hygiene requirements, while simultaneously reducing the amount of practice opportunities, thus negatively affecting their practical skills. The latter development may have to be addressed by providing additional practice opportunities for students as soon as the pandemic situation allows.
Relationship between medical students’ perceived instructor role and their approaches to using online learning technologies in a cloud-based virtual classroom
Authors: Wang Rong , Han Jiying , Liu Chuanyong , Wang Lixiang
Published: July 2022

Background

Students can take different approaches to using online learning technologies: deep and surface. It is important to understand the relationship between instructor role and student approaches to using online learning technologies in online learning settings supported by cloud computing techniques.

Methods

A descriptive, cross-sectional study was conducted to analyze the relationships between medical students’ perceptions of instructor role (instructor support, instructor-student interaction, and instructor innovation) and students’ approaches to using online learning technologies in cloud-based virtual classrooms. A 25-item online questionnaire along with a sheet with basic demographic was administered to all medical students at Qilu Medical Schools of Shandong University China. Overall, 213 of 4000 medical students (5.34%) at the medical school participated in the survey.

Results

The results showed high levels of medical students’ perceived instructor support, instructor-student interaction and instructor innovation. Most students adopted the deep approaches to using online learning technologies. Instructor support, instructor-student interaction and innovation were positively related to students’ deep approaches to using online learning technologies. Instructor support was negatively related to students’ surface approaches to using online learning technologies.

Conclusions

The relationship between instructor role (instructor support, instructor-student interaction and instructor innovation) and students’ approaches to using online learning technologies highlight the importance of instructor support and innovation in facilitating students’ adoption of desirable approaches to learning from the application of technologies.
“Lost trust in the system”: system barriers to publicly available mental health and substance use services for transgender women in San Francisco
Authors: Baguso Glenda N. , Aguilar Karen , Sicro Sofia , Mañacop Malaya , Quintana Jerry , Wilson Erin C.
Published: July 2022

Background

Little is known about the barriers to mental health and substance use services for trans women living with HIV. We conducted a qualitative study with trans women living with HIV and providers to explore barriers to mental health and substance use services in San Francisco.

Methods

We conducted focus group discussions and key informant interviews with a total of 15 medical, mental health, substance use, and social service providers and trans women living with HIV. We identified, analyzed, and reported themes using thematic analysis and derived themes directly from the data.

Results

Our study participants identified two main themes and three subthemes. One main theme is that trans women and providers have lost trust in the system due to (a) lack of a linkage system between referrals and services, (b) structural barriers such as service location, language capacity, clinic hours, and (c) constant changes in services available. Another main theme is anti-trans and mental health stigma.

Conclusions

Interventions to coordinate linkage from medical to mental health and substance use (MHSU) services are urgently needed to facilitate the utilization of MHSU services. Other interventions to improve quality monitoring and system improvement, and to address multiple stigmas broadly in society are needed to improve unmet MHSU service needs among trans women living with HIV in San Francisco.
Applying the RE-AIM framework to evaluate a holistic caregiver-centric hospital-to-home programme: a feasibility study on Carer Matters
Authors: Chan Ee Yuee , Wu Ling Ting , Ng Emmalene Joo Yong , Glass George Frederick , Tan Robyn Hwee Teng
Published: July 2022

Background

Prolonged caregiving of an older adult can cause family caregivers to be overwhelmed, potentially affecting the well-being of both the caregivers and their care-recipients. Carer Matters is a holistic hospital-to-home programme, centred on caregivers’ needs as their care-recipients transit from hospital to home. The programme was piloted to support caregivers through caregivers needs assessment, tailored resources, tele-support, training courses, and community support network. This study aimed to examine the feasibility of Carer Matters in a tertiary hospital in Singapore.

Methods

This feasibility study was conducted on the pilot implementation from January to December 2021, during the Covid-19 pandemic. It adopted the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study highlighted quantitative data collected from key process indicators, such as number of caregivers screened, assessed on their needs and provided with assistance. Additionally, qualitative data was collected from in-depth interviews with 51 stakeholders involved in the implementation to examine their perspectives and experiences. These included family caregivers, clinician caregiver support nurses, hospital leaders and community partners.

Results

During the pilot, 550 caregivers were enrolled. All caregivers received educational resources when they completed the needs assessment, while 69 of them who reported high burden were given tele-support and 252 attended our caregiver training courses. Despite initial recruitment challenges and obstacles to adoption, stakeholders interviewed found Carer Matters to be effective in providing caregivers with emotional support, knowledge and skills that improved their caregiving abilities, and reduced their sense of isolation and caregiving stress. Among caregivers, the training courses were effective with majority of caregivers agreeing that the courses addressed their needs (99%) and improved their knowledge of the relevant disease conditions (97%). Programme maintenance considered among stakeholders included strategies such as multipronged approach in recruiting caregivers and inviting caregiver advocates to share their experiences.

Conclusion

This feasibility study highlights that Carer Matters is a valuable component to the ecosystem of support for family caregivers and their care recipients. Carer Matters extends the current patient-centric care model to a more holistic post-discharge continuity of care for both caregivers and their care-recipients, improving and maintaining their overall well-being to better allow transition from hospital-to home.

Trial registration

Feasibility Study of Project Carer Matters for Family Caregivers of Persons with Dementia (NCT number: NCT05205135).
Depleting TMED3 alleviates the development of endometrial carcinoma
Authors: Zhang Jin , Qi Yue
Published: July 2022

Background

As one of gynecologic tumors, endometrial carcinoma (EC) has been characterized by high incidence rate, but its molecular pathogenesis has remained unclear. TMED3 is a membrane protein and has been indicated to implicate several tumor-related diseases. In the current study, we aimed to explore the physiological function of TMED3 in EC progression.

Methods

Through bioinformatic analysis using The Cancer Genome Atlas database and immunohistochemistry assay on tissue microarray, we examined whether TMED3 was upregulated in EC tissues. After constructing TMED3-knockdown cell models via lentiviral transfection, qPCR and western blot were employed to determine the expression levels of TMED3 mRNA and protein. Then, Celigo cell counting assay, CCK8 assay, flow cytometry, wound-healing assay and Transwell assay were used to detect cell proliferation, cell cycle, cell apoptosis and cell migration, respectively.

Results

As a result, it was found that TMED3 was upregulated in EC cells, which was also verified in clinical samples. We then found that downregulation of TMED3 considerably restrained cell cycle, cell growth and migration but promoted apoptosis of EC cells. The followingin-vivoexperiments also verified that tumor growth was inhibited after TMED3 knockdown. The exploration in molecular mechanisms showed that TMED3 deletion may weaken cellular viability through upregulating pro-apoptotic proteins and targeting PI3K/AKT signaling pathways.

Conclusions

This study suggested that knocking down TMED3 affected the malignant phenotype of EC cells and thus limited tumor progression, which provided insights to the development of targeted drugs for EC treatment.