bluuebunny/crossref_metadata_2025 huggingface dataset:
Gathering Global Perspectives to Establish the Research Priorities and Minimum Data Sets for Degenerative Cervical Myelopathy: Sampling Strategy of the First Round Consensus Surveys of AO Spine RECODE-DCM
Authors: Mowforth Oliver D. , Khan Danyal Z , Wong Mei Yin , Pickering George A. E. , Dean Lydia , Magee Joe , Mullarkey Laura , Hirayama Yuri , Rihova Martina , Butler Max , Stewart Max , Goulson Beth , Ahmed Shahzaib , Fricke Kai , Popa-Nimigean Vladimir , Millar Zack , Venkatesh Ashwin , Willison Alice , Senthil Keerthi , Hazenbiller Olesja , Sarewitz Ellen , Sadler Iwan , Gronlund Toto , Tetreault Lindsay , Harrop James S. , Aarabi Bizhan , Rahimi-Movaghar Vafa , Kurpad Shekar N , Guest James D. , Wilson Jefferson R. , Kwon Brian K. , Fehlings Michael G. , McNair Angus G.K. , Davies Benjamin M. , Kotter Mark R.N. ,   On behalf of the AO Spine RECODE-DCM Steering Committee and AO Spine RECODE-DCM Consortium
Published: December 2021

Study Design

Survey.

Introduction

AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (AO Spine RECODE-DCM) is an international initiative that aims to accelerate knowledge discovery and improve outcomes by developing a consensus framework for research. This includes defining the top research priorities, an index term and a minimum data set (core outcome set and core data elements set – core outcome set (COS)/core data elements (CDE)).

Objective

To describe how perspectives were gathered and report the detailed sampling characteristics.

Methods

A two-stage, electronic survey was used to gather and seek initial consensus. Perspectives were sought from spinal surgeons, other healthcare professionals and people with degenerative cervical myelopathy (DCM). Participants were allocated to one of two parallel streams: (1) priority setting or (2) minimum dataset. An email campaign was developed to advertise the survey to relevant global stakeholder individuals and organisations. People with DCM were recruited using the international DCM charity Myelopathy.org and its social media channels. A network of global partners was recruited to act as project ambassadors. Data from Google Analytics, MailChimp and Calibrum helped optimise survey dissemination.

Results

Survey engagement was high amongst the three stakeholder groups: 208 people with DCM, 389 spinal surgeons and 157 other healthcare professionals. Individuals from 76 different countries participated; the United States, United Kingdom and Canada were the most common countries of participants.

Conclusion

AO Spine RECODE-DCM recruited a diverse and sufficient number of participants for an international PSP and COS/CDE process. Whilst PSP and COS/CDE have been undertaken in other fields, to our knowledge, this is the first time they have been combined in one process.
Adolescents and Young Adults Knowledge, Adherence and Experiences While on Antiretroviral Therapy in a Tertiary Hospital in Lagos, Nigeria: A Mixed-Method Study
Authors: Aderemi-Williams Roseline Iberi , Razaq Ayomikun Rofiat , Abah Isaac Okoh , Opanuga Olabisi Oluranti , Akanmu Alani Sulaimon
Published: December 2021

In Nigeria, there is a paucity of data on knowledge and experiences of adolescents and young adults (AYAs) with HIV and ART, as well as their challenges maintaining optimal adherence. A mixed-method study was carried out between August and September 2018 among AYAs attending Lagos University Teaching Hospital, Nigeria. Data collection was via AYAs' hospital records, standardized questionnaires, and in-depth interviews (IDIs). The 4-day ACTG tool was used to measure adherence. Collected data were analyzed descriptively. Assessment of 34 AYAs comprising 18 (52.9%) males with 28 (82.4%) students revealed an overall knowledge score about ART and its effect of 73.6%. Twenty-five (73.5%) had poor knowledge of the development of resistant strains of HIV due to non-adherence recorded. Optimal adherence (≥95%) was recorded in 20 (58.8%) AYAs. IDI produced 4 themes: (i) reasons for non-adherence, (ii) ensuring optimal adherence, (iii) Social support systems and disclosure, and (iv) stigmatization. Our study provided formative data and revealed areas for intervention to improve knowledge and adherence to ART.
Short-Stay Admissions Associated With Large COVID-19 Outbreaks in Maryland Nursing Homes
Authors: Mattingly T. Joseph , Trinkoff Alison , Lydecker Alison D. , Kim Justin J. , Yoon Jung Min , Roghmann Mary-Claire
Published: December 2021

At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics.
The Mediating Effect of Model-Based Learning on Attitude and Pain Management Awareness Among Nurses During COVID 19 Pandemic in Saudi Arabia
Authors: Issa Marwan Rasmi , Awanis Muslim Noor , Mat Sharif Zainon
Published: December 2021

Background

All hospitals are required to provide high-quality pain management; one of the most critical issues in achieving high-quality pain management is that the hospitals have a clear plan to manage the patients’ pain and improve the nurses’ awareness of pain management during the COVID 19 pandemic. However, there is a significant gap in the literature that this study can cover.

Aim

This study aimed to investigate the mediating effect of model-based learning on nurses’ attitudes toward nurses’ pain management awareness during the COVID 19 pandemic in Saudi Arabia government hospitals.

Method

The Heath Beliefs Model was used, with a quasi-experimental design, with per experimental one group pre-test post-test design, and a quantitative approach using self-administered questionnaires obtained from 330 nurses working with patients suffering from pain. IBM SPSS V23 and Analysis of Moment Structures (AMOS)V23 were applied to analyze the causal relationships between the variables.

Results

A two-step approach to analyze the study: the first step was to test the measurement models’ constructs’ reliability and validity. The second step was to test research hypotheses in the structural models. The results show a significant positive relationship between model-based learning and pain management awareness among nurses during COVID 19 pandemic. Furthermore, model-based learning fully mediated the relationship between nurses’ attitudes and pain management awareness.

Conclusions

The study successfully improved nurses’ attitudes toward pain management awareness among nurses during COVID 19 pandemic. These findings will help strengthen the debate in the existing literature, and this is a new development window in the pain management area.
Antioxidant, Anti-Inflammatory, Acute Oral Toxicity, and Qualitative Phytochemistry of The Aqueous Root Extract of Launaea cornuta (Hochst. Ex Oliv. & Hiern.)
Authors: Akimat Evans Kapanat , Omwenga George Isanda , Moriasi Gervason Apiri , Ngugi Mathew Piero
Published: December 2021

The root and leaf extracts of Launaea cornuta have been locally used in traditional medicine for decades to manage inflammatory conditions and other oxidative-stress-related syndromes; however, their pharmacologic efficacy has not been scientifically investigated and validated. Accordingly, we investigated the in vitro antioxidant activity, anti-inflammatory ( in vitro, ex vivo, and in vivo) efficacy, acute oral toxicity, and qualitative phytochemical composition of the aqueous root extract of L. cornuta. The ferric-reducing antioxidant power (FRAP) and the 2,2-diphenyl-2-pycrylhydrazyl (DPPH) radical scavenging test methods were used to determine the studied plant extract’s antioxidant activity. Besides, the anti-inflammatory efficacy of the studied plant extract was investigated using in vitro (anti-proteinase and protein denaturation), ex vivo (membrane stabilization), and in vivo (carrageenan-induced paw oedema in Swiss albino mice) methods. The studied plant extract demonstrated significant in vitro antioxidant effects, which were evidenced by higher DPPH radical scavenging and FRAP activities, in a concentration-dependent manner ( p < 0.05). Generally, the studied plant extract exhibited significant in vitro, ex vivo, and in vivo anti-inflammatory efficacy, respectively, and in a concentration/dose-dependent manner compared with respective controls ( p < 0.05). Moreover, the studied plant extract did not cause any observable signs of acute oral toxicity, even at the cut-off dose of 2000 mg/Kg BW (LD50 > 2000 mg/Kg BW), and was thus considered safe. Additionally, qualitative phytochemistry revealed the presence of various antioxidant- and anti-inflammatory-associated phytochemicals, which were deemed responsible for the reported pharmacologic efficacy. Further studies to characterise bioactive molecules and their mode(s) of pharmacologic efficacy are encouraged.
Clinical validation of digital biomarkers for paediatric patients with asthma and cystic fibrosis: potential for clinical trials and clinical care
Authors: Kruizinga Matthijs D. , Essers Esmée , Stuurman Frederik E. , Yavuz Yalçin , de Kam Marieke L. , Zhuparris Ahnjili , Janssens Hettie M. , Groothuis Iris , Sprij Arwen J. , Nuijsink Marianne , Cohen Adam F. , Driessen Gertjan J.A.
Published: December 2021

Background

Digital biomarkers are a promising novel method to capture clinical data in a home setting. However, clinical validation prior to implementation is of vital importance. The aim of this study was to clinically validate physical activity, heart rate, sleep and forced expiratory volume in 1 s (FEV1) as digital biomarkers measured by a smartwatch and portable spirometer in children with asthma and cystic fibrosis (CF).

Methods

This was a prospective cohort study including 60 children with asthma and 30 children with CF (aged 6–16 years). Participants wore a smartwatch, performed daily spirometry at home and completed a daily symptom questionnaire for 28 days. Physical activity, heart rate, sleep and FEV1were considered candidate digital end-points. Data from 128 healthy children were used for comparison. Reported outcomes were compliance, difference between patients and controls, correlation with disease activity, and potential to detect clinical events. Analysis was performed with linear mixed effects models.

Results

Median compliance was 88%. On average, patients exhibited lower physical activity and FEV1compared with healthy children, whereas the heart rate of children with asthma was higher compared with healthy children. Days with a higher symptom score were associated with lower physical activity for children with uncontrolled asthma and CF. Furthermore, FEV1was lower and (nocturnal) heart rate was higher for both patient groups on days with more symptoms. Candidate biomarkers appeared able to describe a pulmonary exacerbation.

Conclusions

Portable spirometer- and smartwatch-derived digital biomarkers show promise as candidate end-points for use in clinical trials or clinical care in paediatric lung disease.
Mechanical ventilation promotes lung tumour spread by modulation of cholesterol cell content
Authors: López-Alonso Inés , López-Martínez Cecilia , Martín-Vicente Paula , Amado-Rodríguez Laura , González-López Adrián , Mayordomo-Colunga Juan , del Busto Cecilia , Bernal Marina , Crespo Irene , Astudillo Aurora , Arias-Guillén Miguel , Fueyo Antonio , Almendros Isaac , Otero Jorge , Sanz-Fraile Héctor , Farré Ramón , Albaiceta Guillermo M.
Published: December 2021

Background

Mechanical stretch of cancer cells can alter their invasiveness. During mechanical ventilation, lungs may be exposed to an increased amount of stretch, but the consequences on lung tumours have not been explored.

Methods

To characterise the influence of mechanical ventilation on the behaviour of lung tumours, invasiveness assays and transcriptomic analyses were performed in cancer cell lines cultured in static conditions or under cyclic stretch. Mice harbouring lung melanoma implants were submitted to mechanical ventilation and metastatic spread was assessed. Additionalin vivoexperiments were performed to determine the mechanodependent specificity of the response. Incidence of metastases was studied in a cohort of lung cancer patients that received mechanical ventilation compared with a matched group of nonventilated patients.

Results

Stretch increases invasiveness in melanoma B16F10luc2 and lung adenocarcinoma A549 cells. We identified a mechanosensitive upregulation of pathways involved in cholesterol processingin vitro, leading to an increase in pro-protein convertase subtilisin/kexin type 9 (PCSK9) and LDLR expression, a decrease in intracellular cholesterol and preservation of cell stiffness. A course of mechanical ventilation in mice harbouring melanoma implants increased brain and kidney metastases 2 weeks later. Blockade of PCSK9 using a monoclonal antibody increased cell cholesterol and stiffness and decreased cell invasivenessin vitroand metastasisin vivo. In patients, mechanical ventilation increased PCSK9 abundance in lung tumours and the incidence of metastasis, thus decreasing survival.

Conclusions

Our results suggest that mechanical stretch promote invasiveness of cancer cells, which may have clinically relevant consequences. Pharmacological manipulation of cholesterol endocytosis could be a novel therapeutic target in this setting.
Neonatal metabolome of caesarean section and risk of childhood asthma
Authors: Gürdeniz Gözde , Ernst Madeleine , Rago Daniela , Kim Min , Courraud Julie , Stokholm Jakob , Bønnelykke Klaus , Björkbom Anders , Trivedi Urvish , Sørensen Søren J. , Brix Susanne , Hougaard David , Rasmussen Morten , Cohen Arieh S. , Bisgaard Hans , Chawes Bo
Published: December 2021

Background

Birth by caesarean section is linked to an increased risk of developing asthma, but the underlying mechanisms are unclear.

Objective

To elucidate the link between birth by caesarean section and asthma using newborn metabolomic profiles and integrating early-life gut microbiome data and cord blood immunology.

Methods

We investigated the influence of caesarean section on liquid chromatography mass spectrometry metabolomic profiles of dried blood spots from newborns of the two independent Copenhagen Prospective Studies on Asthma in Childhood cohorts,i.e.COPSAC2010 (n=677) and COPSAC2000 (n=387). We assessed the associations between the caesarean section metabolic profile, gut microbiome data and frequency of cord blood regulatory T-cells (Tregs) at 1 week of age.

Results

In COPSAC2010, a partial least square discriminant analysis model showed that children born by caesarean sectionversusnatural delivery had different metabolic profiles (area under the curve (AUC)=0.77, p=2.2×10−16), which was replicated in COPSAC2000 (AUC=0.66, p=1.2×10−5). The metabolic profile of caesarean section was significantly associated with an increased risk of asthma at school age in both COPSAC2010 (p=0.03) and COPSAC2000 (p=0.005). Caesarean section was associated with lower abundance of tryptophan, bile acid and phenylalanine metabolites, indicative of a perturbed gut microbiota. Furthermore, gut bacteria dominating after natural delivery,i.e. BifidobacteriumandBacteroideswere correlated with caesarean section-discriminative microbial metabolites, suggesting maternal microbial transmission during birth regulating the newborn's metabolism. Finally, the caesarean section metabolic profile was associated with frequency of cord blood Tregs.

Conclusions

These findings propose that caesarean section programmes the risk of childhood asthma through perturbed immune responses and gut microbial colonisation patterns reflected in the blood metabolome at birth.
Non-obstructive idiopathic azoospermia vs azoospermia with antecedents of cryptorchidism: ways and probabilities of becoming parents
Authors: Sangwan Jacques Singh , Petit Claire , Rose Romane Sainte , Frapsauce Cynthia , Dijols Laura , Rigot Jean Marc , Guérif Fabrice
Published: December 2021

Background

Non-obstructive azoospermia (NOA) with history of cryptorchidism and idiopathic NOA are the most common forms of NOA without genetic aetiology. Of all patients with one of these two types of NOA, only a few will have a positive TEsticular Sperm Extraction (TESE). Of those with positive extraction followed by sperm freezing, not all will have a child after TESE-ICSI. What are the ways and probabilities of taking home a baby for patients with NOA and a history of cryptorchidism compared with patients with idiopathic NOA?

Results

Patients with idiopathic NOA or NOA and a history of cryptorchidism who underwent their first TESE were included. The patients were divided into two groups: Group 1 was composed of 125 patients with idiopathic NOA and Group 2 of 55 patients with NOA and a history of surgically treated cryptorchidism. Our results showed that more than half of the NOA patients succeeded in becoming parents. The main way to fulfil their plans for parenthood is to use sperm or embryo donation (72%) for men with idiopathic NOA, whereas the majority of men with NOA and a history of cryptorchidism had a child after TESE-ICSI (58.8%).

Conclusions

In our centre, before considering TESE for a patient with NOA, we explain systematically TESE-ICSI alternatives (sperm donation, embryo donation or adoption). As a result, the couple can consider each solution to become parents.
Microtubule organization changes severely after mannitol and n-butanol treatments inducing microspore embryogenesis in bread wheat
Authors: Dubas E. , Castillo A. M. , Żur I. , Krzewska M. , Vallés M. P.
Published: December 2021

Background

A mannitol stress treatment and a subsequent application of n-butanol, known as a microtubule-disrupting agent, enhance microspore embryogenesis (ME) induction and plant regeneration in bread wheat. To characterize changes in cortical (CMT) and endoplasmic (EMT) microtubules organization and dynamics, associated with ME induction treatments, immunocytochemistry studies complemented by confocal laser scanning microscopy (CLSM) were accomplished. This technique has allowed us to perform advanced 3- and 4D studies of MT architecture. The degree of MT fragmentation was examined by the relative fluorescence intensity quantification.

Results

In uni-nucleated mannitol-treated microspores, severe CMT and EMT fragmentation occurs, although a complex network of short EMT bundles protected the nucleus. Additional treatment with n-butanol resulted in further depolymerization of both CMT and EMT, simultaneously with the formation of MT aggregates in the perinuclear region. Some aggregates resembled a preprophase band. In addition, a portion of the microspores progressed to the first mitotic division during the treatments. Bi-nucleate pollen-like structures showed a high MT depolymerization after mannitol treatment and numerous EMT bundles around the vegetative and generative nuclei after n-butanol. Interestingly, bi-nucleate symmetric structures showed prominent stabilization of EMT.

Conclusions

Fragmentation and stabilization of microtubules induced by mannitol- and n-butanol lead to new configurations essential for the induction of microspore embryogenesis in bread wheat. These results provide robust insight into MT dynamics during EM induction and open avenues to address newly targeted treatments to induce ME in recalcitrant species.
Stress and coping among unmarried pregnant university students in South Africa
Authors: Phiri Thandiwe Msipu , Nyamaruze Patrick , Akintola Olagoke
Published: December 2021

Background

The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy.

Methods

Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis.

Results

The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents’ reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy.

Conclusion

The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children.
Brain and renal oxygenation measured by NIRS related to patent ductus arteriosus in preterm infants: a prospective observational study
Authors: Navikiene Jurate , Virsilas Ernestas , Vankeviciene Ramune , Liubsys Arunas , Jankauskiene Augustina
Published: December 2021

Background

Patent ductus arteriosus (PDA) is common among preterm neonates. Haemodynamically significant ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes. Our aim was to evaluate ductus arteriosus patency and significance using two-site near-infrared spectroscopy (NIRS) measurements in preterm infants older than 72 h as a supplemental tool to echocardiography.

Methods

In this prospective observational study, 123 preterm infants (gestational age (GA) < 32 weeks, birth weight < 1500 g) were enrolled. Sixty-four newborns had closed ductus arteriosus (noPDA), and 41 and 18 patients were assigned to the PDA and hsPDA groups, respectively, per predefined echocardiographic criteria. Cerebral and renal oxygenation were assessed during NIRS monitoring.

Results

A higher renal mean (±SD) regional tissue oxygen saturation (rSpO2) (76.7 (±7.64)) was detected in the noPDA group than in the PDA (71.7 (±9.02)) and hsPDA (67.4 (±13.48)) groups (p < 0.001). Renal fractional tissue oxygen extraction (FTOE) (0.18 (±0.079)) was lower in the noPDA group than in the PDA (0.23 (±0.092)) and hsPDA (0.24 (±0.117))0.117 groups (p = 0.002). Cerebral oxygenation was significantly lower in the hsPDA group (77.0 (±5.16)) than in the noPDA (79.3 (±2.45)) and PDA (79.7 (±2.27)) groups (p = 0.004). There was no significant difference in cerebral fractional tissue oxygen extraction (FTOE) between any of the groups.

Conclusions

Our results suggest that renal oxygenation is affected by ductus patency in preterm infants older than 72 h. Significant differences in cerebral oxygenation were observed between the hsPDA group and the PDA and noPDA groups.

Trial registration

ClinicalTrials.gov Identifier: NCT04295395. Registration date: 4 March 2020. This study was retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04295395.
Cognitive strengths in first episode psychosis: a thematic analysis of clinicians’ perspectives
Authors: Steele Peter , Cheng Nicholas , Phillips Lisa J. , Bryce Shayden , Alvarez-Jimenez Mario , Allott Kelly
Published: December 2021

Background

Cognitive deficits are associated with poor functional outcomes in individuals recovering from a first episode of psychosis (FEP). Existing treatments that target cognitive deficits in FEP may enhance cognitive function, but improvements to real-world functioning are less consistent. Furthermore, these treatments may not adequately address the personal recovery goals of young people attending FEP services. A novel cognitive strengths-based approach may overcome these shortcomings.

Methods

This qualitative study used semi-structured interviews to explore clinicians’ (N = 12) perspectives toward the potential development of a cognitive strengths-based assessment or treatment in FEP. The interviews were analysed using thematic analysis.

Results

Five higher-order themes emerged: (1) pro-strengths attitude despite unfamiliarity and minimal use, (2) default to a cognitive deficit lens, (3) potential benefits of a cognitive strengths approach, (4) potential risks and barriers, and (5) considerations for successful implementation. While clinicians acknowledged their current deficit approach, they supported implementing a cognitive strengths assessment or treatment and highlighted their potential benefits for the personal recovery needs of young people with FEP.

Conclusions

These findings suggest that a deficit-focused approach to cognitive function amongst clinicians may be common practice in FEP services. Nevertheless, a cognitive strengths approach was viewed favourably by clinicians and may represent a novel method of supporting personal recovery. Thus, the design and implementation of a cognitive strengths approach may be worthwhile. Future exploration of other stakeholder perspectives, such as young people with FEP, is essential.
Robotic-assisted pancreatic surgery in the elderly patient: experiences from a high-volume centre
Authors: Hillebrandt Karl H. , Knitter Sebastian , Timmermann Lea , Felsenstein Matthäus , Benzing Christian , Schmelzle Moritz , Pratschke Johann , Malinka Thomas
Published: December 2021

Background

Robotic-assisted pancreatic surgery (RPS) has fundamentally developed over the past few years. For subgroups, e.g. elderly patients, applicability and safety of RPS still needs to be defined. Given prognosticated demographic developments, we aim to assess the role of RPS based on preoperative, operative and postoperative parameters.

Methods

We included 129 patients undergoing RPS at our institution between 2017 and 2020. Eleven patients required conversion to open surgery and were excluded from further analysis. We divided patients into two groups; ≥ 70 years old (Group 1; n = 32) and < 70 years old (Group 2; n = 86) at time of resection.

Results

Most preoperative characteristics were similar in both groups. However, number of patients with previous abdominal surgery was significantly higher in patients ≥ 70 years old (78% vs 37%, p < 0.0001). Operative characteristics did not significantly differ between both groups. Although patients ≥ 70 years old stayed significantly longer at ICU (1.8 vs 0.9 days; p = 0.037), length of hospital stay and postoperative morbidity were equivalent between the groups.

Conclusion

RPS is safe and feasible in elderly patients and shows non-inferiority when compared with younger patients. However, prospectively collected data is needed to define the role of RPS in elderly patients accurately.

Trial registration Clinical Trial Register: Deutschen Register Klinischer Studien (DRKS; German Clinical Trials Register). Clinical Registration Number: DRKS00017229 (retrospectively registered, Date of Registration: 2019/07/19, Date of First Enrollment: 2017/10/18).
Suicide and deliberate self-harm among women in Nepal: a scoping review
Authors: Kasaju Sarina Pradhan , Krumeich Anja , Van der Putten Marc
Published: December 2021

Background

Suicide is a growing public health problem globally. Suicide accounts for 70% of violent deaths among women in low and middle income countries. In Nepal suicide is the single leading cause of death among women of reproductive age. The aim of this scoping review is to explore and understand the various contexts related to vulnerability of Nepalese woman towards suicide and deliberate self-harm.

Methods

A scoping review based on Arksey and O’Malley’s methodological framework including a combination of peer-reviewed publications and grey literature was conducted. The National Library of Medicine’s PubMed and Google Scholar search engines were used during July 2019 applying a Boolean search strategy.

Results

Suicide incidence was found to be higher among younger age group and married women, with poisoning as the most common means of suicide. Psychosocial and economic factors such as abuse, interpersonal conflicts, marital disputes, relationship problems, adjustment problems, unpaid loans and financial losses; and mental health conditions such as mood disorder, adjustment disorder and substance abuse disorder were found to be contributing factors for suicide and deliberate self-harm among women in Nepal.

Conclusion

Socio-cultural and economic factors shape family and marital relationships which impacts psycho-social and mental wellbeing of women in Nepal inciting suicidal attempts and deliberate self-harm. However, very few studies were found that explore the context of poverty, social exclusion, gender inequality, education, traditional/cultural and patriarchal system in which suicide among women in Nepal occurs.
Feasibility, acceptability, and sustainability of Project ECHO to expand capacity for pediatricians in Vietnam
Authors: Nhung Le Hong , Kien Vu Duy , Lan Nguyen Phuong , Cuong Pham Viet , Thanh Pham Quoc , Dien Tran Minh
Published: December 2021

Background

The Project Extension for Community Healthcare Outcomes (ECHO) model is considered a platform for academic medical centers to expand their healthcare workforce capacity to medically underserved populations. It has been known as an effective solution of continuing medical education (CME) for healthcare workers that used a hub-and-spoke model to leverage knowledge from specialists to primary healthcare providers in different regions. In this study, we aim to explore the views of healthcare providers and hospital leaders regarding the feasibility, acceptability, and sustainability of Project ECHO for pediatricians.

Methods

This qualitative study was conducted at the Vietnam National Children’s Hospital and its satellite hospitals from July to December 2020. We conducted 39 in-depth interviews with hospital managers and healthcare providers who participated in online Project ECHO courses. A thematic analysis approach was performed to extract the qualitative data from in-depth interviews.

Results

Project ECHO shows high feasibility when healthcare providers find motivated to improve their professional knowledge. Besides, they realized the advantages of saving time and money with online training. Although the courses had been covered fully by the Ministry of Health’s fund, the participants said they could pay fees or be supported by the hospital’s fund. In particular, the expectation of attaining the CME-credited certificates after completing the course also contributes to the sustainability of the program. Project ECHO’s online courses should be improved if the session was better monitored with suitable time arrangements.

Conclusions

Project ECHO model is highly feasible, acceptable, and sustainable as it brings great benefits to the healthcare providers, and is appropriate with the policy theme of continuing medical education of the Ministry of Health. We recommend that further studies should be conducted to assess the impact of the ECHO program, especially for patient and community outcomes.
Intravenous versus subcutaneous delivery of biotherapeutics in IBD: an expert’s and patient’s perspective
Authors: Jonaitis Laimas , Marković Srdjan , Farkas Klaudia , Gheorghe Liana , Krznarić Željko , Salupere Riina , Mokricka Viktorija , Spassova Zoya , Gatev Dimo , Grosu Isabella , Lijović Anton , Mitrović Olga , Saje Mateja , Schafer Eszter , Uršič Viktor , Roblek Tina , Drobne David
Published: December 2021

Several biologic treatments are available in addition to intravenous also in subcutaneous form for treatment of chronic diseases. Benefits of the subcutaneous application of drugs include self-administration by the patient, shorter time of application process with less infusion related adverse events and consequently lower healthcare costs. With appropriate education and support patients are able to administer their treatments at home. This leads to improvement of quality of life, reduction of time needed to travel to the healthcare institution and consequently also reduces costs also for the patient.

Over one million residents in the USA and 2.5 million in Europe are estimated to have inflammatory bowel disease (IBD), with substantial costs for health care. These estimates do not factor in the ‘real’ price of IBD, which can impede career aspirations, instil social stigma and impair quality of life in patients.

The Virtual Community Meeting, which offered an exchange of experience and opinions from healthcare professionals who are active in treating IBD, and patients with this chronic disease, revealed in-depth arguments and answers to some essential questions: which patients prefer subcutaneous over intravenous dosing; which patients continue to favour intravenous infusions; what are the limitations regarding both applications; what is the patient’s role in therapeutical decision-making and how does IBD affect the patient’s work, finances and quality of life? The aim of this article is to discuss the differences between subcutaneous and intravenous dosing from the health-economic, scientific, and personal perspectives.

The meeting offered strong confirmation that most of the patients and healthcare professionals prefer subcutaneous over intravenous drug administration but emphasise the management of risks associated with treatment compliance. Patient education provided by the IBD team in this regard is mandatory. Quality of life of patients is poorer during active disease, but the findings that it can improve over time, including as a result of home- or self-administration of biologics, may be encouraging for individuals with this chronic disease.
Prodigiosin inhibits cholangiocarcinoma cell proliferation and induces apoptosis via suppressing SNAREs-dependent autophagy
Authors: Zheng Dijie , Chen Shiyu , Cai Kun , Lei Linhan , Wu Chunchen , Sun Chengyi , Deng Yazhu , Yu Chao
Published: December 2021

Background

Prodigiosin (PG), a natural red pigment produced by numerous bacterial species, has been a eye-catching research point in recent years for its anticancer activity. However, the role of PG in the cancer biology of cholangiocarcinoma (CCA) remains vague.

Methods

The proliferation of CCA cells was detected by Cell Counting Kit-8(CCK-8), Colony formation assay and 5-ethynyl-2′-deoxyuridine (EdU) assay. Cell apoptosis was evaluated by flow cytometry assay and western blot assay. The effects of PG or SNAREs on cell autophagy were measured by autophagy flux assay and western blot assay. Xenograft mouse models were used to assess the role of PG in CCA cells in vivo.

Results

PG could inhibit the proliferation and viability of CCA cells in a concentration- and time-dependent manner via suppressing the late stage of autophagy. Mechanistically, PG inhibits the fusion of autophagosomes and lysosomes by blocking STX17 and SNAP29, components of soluble N-ethyl-maleimide-sensitive factor attachment protein receptors (SNAREs)complex. When STX17 and SNAP29 were overexpressed, the inhibitory effect of PG on CCA cells autophagy was relieved. In addition, PG showed obvious inhibitory effects on cancer cell viability but no toxic effects on organs in xenotransplantation models.

Conclusion

Taken together, our results demonstrated that PG inhibits CCA cell proliferation via suppressing SNAREs-dependent autophagy, implying that PG could be a potential chemotherapy drug for advanced CCA.
Community knowledge, perceptions, and practices regarding malaria and its control in Jabi Tehnan district, Amhara Region, Northwest Ethiopia
Authors: Asale Abebe , Abro Zewdu , Enchalew Bayu , Teshager Alayu , Belay Aklilu , Kassie Menale , Mutero Clifford Maina
Published: December 2021

Background

Use of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria education, prompt diagnosis and treatment are key programme components of malaria prevention and control in Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening).

Methods

The study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March 2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.

Results

Malaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total cases reported from households being from among individuals who were 15 years or older. The second most affected group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden, respectively.

Conclusion

Despite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritized in the study area to bring about the desired behavioural changes.
Implementing a low-threshold audio-only telehealth model for medication-assisted treatment of opioid use disorder at a community-based non-profit organization in Washington, D.C.
Authors: Yeo Ellis Jaewon , Kralles Hannah , Sternberg David , McCullough Dana , Nadanasabesan Ajetha , Mayo Richard , Akselrod Hana , Catalanotti Jillian
Published: December 2021

Background

The COVID-19 pandemic has had especially devastating effects on people who use drugs. Due to pandemic protocols in the USA, medication-assisted treatment (MAT) regulations became more flexible, permitting our community-based nonprofit organization to transition its low-threshold MAT clinic to an audio-only telehealth model of care in 2020. Lessons learned have the potential to improve MAT delivery to people with OUD.

Case presentation

This case study describes our transition from a low-threshold community-based in-person MAT clinic to an audio-only telehealth model. We extracted data from electronic health records to describe patient characteristics and to calculate treatment retention rates. Patients were predominantly male (74.4%) and black (90.6%). The mean age was 53 years old with more than half of the clients aged 55 or older. Less than half (42.3%) of the patients lived in stable housing. Patients commonly had self-reported comorbid conditions such as hypertension (35.4%), hepatitis C (23.5%), diabetes (11.9%), human immunodeficiency virus (HIV) (7.2%). A majority of patients (68.6%) reported engagement with behavioral health care. We measure the success of our intervention relative to published retention rates, both overall as well as for in-person and telehealth care. In-person retention rates at 90- and 180-days were substantially higher than telehealth retention rates (93.9% vs 68.4% and 91.5% vs 51.9%, respectively).

Conclusions

Low-threshold medication-assisted treatment in the care of people with opioid use disorder is essential to increasing treatment access and continuity. We found that an audio-only telehealth model was viable. Although we had decreased retention rates following the transition to an audio-only telehealth model, our rates remained excellent compared to published values for in-person MAT care. We call for advocacy and regulations to support continued use of telehealth services throughout and beyond the COVID-19 pandemic.
Strengthening the national health information system through a capacity-building and mentorship partnership (CBMP) programme: a health system and university partnership initiative in Ethiopia
Authors: Tilahun Binyam , Gashu Kassahun D. , Mekonnen Zeleke A. , Endehabtu Berhanu F. , Asressie Moges , Minyihun Amare , Mamuye Adane , Atnafu Asmamaw , Ayele Wondimu , Gutema Keneni , Abera Admas , Abera Mulumebet , Gebretsadik Teklit , Abate Biruk , Mohammed Mesoud , Animut Netsanet , Belay Hiwot , Alemu Hibret , Denboba Wubishet , Gebeyehu Abebaw , Wondirad Naod , Tadesse Lia
Published: December 2021

Background

A strong health information system (HIS) is one of the essential building blocks for a resilient health system. The Ministry of Health (MOH) of Ethiopia is working on different initiatives to strengthen the national HIS. Among these is the Capacity-Building and Mentorship Partnership (CBMP) Programme in collaboration with public universities in Ethiopia since November 2017. This study aims to evaluate the outcomes and share experiences of the country in working with universities to strengthen the national HIS.

Methods

The study employed a mixed-methods approach that included 247 health organizations (health offices and facilities) of CBMP-implementing woredas (districts) and 23 key informant interviews. The programme focused on capacity-building and mentoring facilities and woreda health offices. The status of HIS was measured using a connected woreda checklist before and after the intervention. The checklist consists of items related to HIS infrastructure, data quality and administrative use. The organizations were classified as emerging, candidate or model based on the score. The findings were triangulated with qualitative data collected through key informant interviews.

Results

The results showed that the overall score of the HIS implementation was 46.3 before and 74.2 after implementation of the programme. The proportion of model organizations increased from 1.2% before to 31.8% after the programme implementation. The health system–university partnership has provided an opportunity for higher education institutions to understand the health system and tune their curricula to address real-world challenges. The partnership brought opportunities to conduct and produce local- and national-level evidence to improve the HIS. Weak ownership, poor responsiveness and poor perceptions of the programme were mentioned as major challenges in programme implementation.

Conclusion

The overall HIS has shown substantial progress in CBMP implementation woredas. A number of facilities became models in a short period of time after the implementation of the programme. The health system–university partnership was found to be a promising approach to improve the national HIS and to share the on-the-ground experiences with the university academicians. However, weak ownership and poor responsiveness to feedback were the major challenges identified as needing more attention in future programme implementation.
Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): a study protocol for a randomized single-blind controlled trial
Authors: Jwair Saad , Boerboom Ralf A. , Versnel Huib , Stokroos Robert J. , Thomeer Hans G. X. M.
Published: December 2021

Background

In order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a “straight” lateral wall lying electrode array (LW) or a “pre-curved” perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that there is a difference in hearing preservation outcomes between the four possible treatment options.

Methods

We designed a monocenter, multi-arm, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of an electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is the comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar translocation, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG).

Discussion

Cochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relatively simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation.

Trial registration

Netherlands Trial Register (NTR) NL8586. Registered on 4 May 2020. Retrospectively registered; 3/48 participants were included before registration.