bluuebunny/crossref_metadata_2025 huggingface dataset:
A protocolized five strategies in open repair for ruptured abdominal aortic aneurysm
Authors: Lee Sang Su , Park Hyo Won , Kim Min Soo , Sohn Jeong Eun , Kim Dae Hwan , Yie Kilsoo
Published: June 2024

Objectives

Although the medical field has made significant progress, there has been little improvement in the survival rate of patients with ruptured abdominal aortic aneurysms (rAAAs). We implemented a protocol consisting of five strategies in the management of rAAA patients who underwent open repair surgery.

Methods

The protocol comprised the following strategies: intentional hypotension <70 mmHg, lung first and kidney last policy (restricted fluid resuscitation and permissive oligoanuria), immediate postoperative extubation, free-water intake with active ambulation, and open abdomen with the routine second-look operation. The study included 13 patients (11 male) with a mean age of 75.5 ± 7.4 (range: 58-87) years who underwent the procedure from 2016 to 2018, with a mean follow-up of 40.1 ± 9.04 months. Five deteriorating to hemodynamic shock and decreased consciousness requiring intubation and ventilation prior to surgery were observed. Two of these patients required preoperative cardiopulmonary resuscitation (CPR).

Results

All patients regained consciousness after surgery, including the two patients who required cardiopulmonary resuscitation. Immediate postoperative extubation was performed in nine patients, but two (22.2%) of them needed re-intubation due to ventilation/perfusion mismatch. Four patients underwent continuous renal replacement therapy, with three of them having anuria for up to 48 h after surgery. Two of these patients made a full recovery. Daily ambulation was carried out for a mean of 4.77 ± 3.5 (range 1-13) days with an open abdomen, during which no significant events were reported. Four cases of colon ischemia/necrosis were identified in the second-look operation, with two patients requiring Hartman’s procedure and the other two undergoing left colon partial resection. There were two in-hospital mortalities (15.4%).

Conclusions

A protocol-based approach, through multidisciplinary team consensus and the development of optimal surgical strategies, could improve clinical outcomes for patients undergoing emergency surgery for rAAA. Further studies with larger sample sizes are needed to refine the protocols.
A comparative study on assessment methods used by high school teachers in Uganda and Turkey
Authors: Wood Passy Claire , Doğan C. Deha
Published: June 2024

Assessment and evaluation are crucial to improving educational quality. Examining the opinions of teachers from various countries on in-class assessments can significantly enhance education systems. Similarities and differences in Uganda’s and Turkey’s educational systems justify comparing them. This study aimed to examine and compare the assessment methods used by teachers working in high schools in Uganda and Turkey to determine student achievement. The researcher administered the questionnaire to 119 Ugandan and 85 Turkish high school teachers working in public and private schools in both countries. The researcher used Casual comparative research. The Mann–Whitney U test was used for data analysis. The findings show that Turkish teachers use many in-class assessment methods more often than Ugandan teachers. Compared to Turkish teachers, Ugandan teachers view themselves as more capable of giving student feedback but less competent in taking measures to increase objective scoring. The article outlines further findings and provides recommendations.
Pull-Out Strength of Orthodontic Miniscrews in the Temporal Bone
Authors: Menke Christian , Kluge Marcel , Welke Bastian , Lenarz Thomas , Majdani Omid , S. Rau Thomas
Published: June 2024

Background

Minimally invasive cochlear implant surgery by using a microstereotactic frame demands solid connection to the bone. We aimed to determine the stability of commercially available orthodontic miniscrews to evaluate their feasibility for frame’s fixation. In addition, which substitute material most closely resembles the mechanical properties of the human temporal bone was evaluated.

Methods

Pull-out tests were carried out with five different types of orthodontic miniscrews in human temporal bone specimens. Furthermore, short fiber filled epoxy (SFFE), solid rigid polyurethane (SRPU50), bovine femur, and porcine iliac bone were evaluated as substitute materials. In total, 57 tests in human specimens and 180 tests in the substitute materials were performed.

Results

In human temporal bone, average pull-out forces ranged from 220 N to 285 N between screws. Joint stiffness in human temporal bone ranged between 14 N/mm and 358 N/mm. Statistically significant differences between the tested screws were measured in terms of stiffness and elastic energy. One screw type failed insertion due to tip breakage. No significant differences occurred between screws in maximum pull-out force. The average pull-out values of SFFE were 14.1 N higher compared to human specimen.

Conclusion

Orthodontic miniscrews provided rigid fixation when partially inserted in human temporal bone, as evidenced by pull-out forces and joint stiffness. Average values exceeded requirements despite variations between screws. Differences in stiffness and elastic energy indicate screw-specific interface mechanics. With proper insertion, orthodontic miniscrews appear suitable for microstereotactic frame anchoring during minimally invasive cochlear implant surgery. However, testing under more complex loading is needed to better predict clinical performance. For further pull-out tests, the most suitable substitute material is SFFE.
Delayed Presentation of a Post-infarction Ventricular Septal Rupture
Authors: Ahmed Omair , Singh Harjinder , Bai Sakshi , Maraj Diva , Qureshi Muhammad Ahmad , Hawes Elise , Alamelumangapuram Chidamber , Othman Hussein
Published: June 2024

Ventricular septal rupture, a formidable complication of acute myocardial infarction (AMI), is linked to significant morbidity and mortality. The clinical manifestation typically involves pronounced hemodynamic compromise necessitating prompt surgical intervention. This report outlines the case of a 60-year-old male presenting with acute heart failure 3 weeks post a presumed AMI. On evaluation, a substantial ventricular septal defect with left-to-right shunt was observed. The patient, although hemodynamically stable with mild symptoms, underwent surgical closure of the defect and coronary artery bypass graft for multivessel coronary artery disease. This case contributes to the literature on the delayed presentation of post-myocardial infarction (MI) ventricular septal rupture, a scenario deviating from the anticipated severe hemodynamic instability given the timing of the MI and the extent of the septal defect.
Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022
Authors: Yendluri Avanish , Hrabarchuk Eugene I. , Obana Kyle K. , Namiri Nikan K. , Plancher Kevin D. , Trofa David P. , Parisien Robert L.
Published: June 2024

Background:

While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries.

Purpose:

To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States.

Study Design:

Descriptive epidemiology study.

Methods:

The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis.

Results:

Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 ( P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains ( P < .01) and contusions/abrasions ( P < .01), but not in concussions ( P = .57) or fractures ( P = .70).

Conclusion:

Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.
Performance enhancement of solar distillation system with hemispherical projections and low-cost coating on absorber plate
Authors: Katekar Vikrant P , Rao Anand B , Sardeshpande Vishal R
Published: June 2024

Solar distillation systems are environmentally compassionate and valuable for water purification in water-fed regions. Nevertheless, it has a huge surface area need and deprived energy efficiency. Energy efficiency, surface area and cost are three crucial factors influencing the dissemination of this device to communities. The present study proposes a solar distiller for widespread users using a low-cost, high-absorbent absorber plate coating. In addition, a novel absorber plate design (plate with hemispherical projections) was used to provide more surface area for heat transfer. Experimental investigations show that blackboard paint and blackboard paint with 30% aluminium oxide nanoparticles are the most effective oil paints for absorber plate coating to avoid costly selective absorber coatings. This will contribute to developing low-cost distillers. The highest and lowest average temperatures were observed for blackboard paint with aluminium oxide nanoparticles (86.1°C) and eyeliner (74°C). Even pure blackboard paint was too appropriate, with an average temperature of 79.7°C. Testing indicates that the most energy-efficient solar distiller design is an absorber plate with hemispherical projections coated with blackboard paint containing aluminium oxide nanoparticles. This research concludes that a blackboard-pained absorber plate with hemispherical projections should be used to build energy-efficient and cost-effective solar distillation equipment.
Who can access what? Uncovering urban inequality in access to service for senior citizens
Authors: Sulis Patrizia , Proietti Paola
Published: June 2024

The scarcity or lack of access to essential services at the local and neighbourhood levels in cities can result in significant spatial inequalities, as some areas and their residents can deal with disadvantages and a lower quality of daily life. In particular, the spatial distribution and the variety of amenities at the local scale represent an important feature of the liveliness of places. The local availability and access to essential services are particularly relevant for some demographic groups experiencing limited mobility or mobility poverty, such as older adults living in cities, and spatial disparities have been further exacerbated by the COVID-19 pandemic, which highlighted severe difficulties in accessing essential services. This work explores the issue focussing on the following question: who can access what depending on where they live in cities? Using Machine Learning and Spatial Autocorrelation applied to different data sources for spatial information on the location of urban amenities and Internet access, this work aims to identify the most underserved places in terms of the variety of available amenities and access to quality broadband in three European capital cities. A comparison to urban areas where high percentages of older adults reside makes it possible to identify where residents can locally access several essential services (green spaces, health care, and local shopping) and where this need cannot be satisfied because of a lack in the amenity variety available at walking distance to their home. The combination of underserved areas with a high concentration of senior residents identifies left-behind areas in these cities, where interventions on inequalities are most needed. Results can inform policies aiming at favouring fair access to services at the local scale, possibly including slow and active mobility modes, and in general to develop comprehensive and sustainable planning strategies for cities, leaving no place and no person behind.
Stronger together: Moving towards a combined multimodal and intermedial model
Authors: Jensen Signe Kjaer , Schirrmacher Beate
Published: June 2024

This article explores the complementary potential of intermedial and multimodal semiotic analysis. Both multimodal and intermedial research explore the multifaceted nature of communication. However, since research fields have different foci and analytical methods, they are less connected than they could be. We approach intermediality and multimodality as complementary frameworks and argue that there is much to gain in drawing on the analytical strengths of both. To this end, underlying differences in method and theoretical assumptions need to be made explicit. Drawing on John A. Bateman and Lars Elleström’s previous explorations of the common ground between the frameworks, we map an arena where multimodal and intermedial analysis can work together. We demonstrate how a combined multimodal and intermedial perspective can function by zooming in and out between the perspectives as we explore the role of “Ride of the Valkyries” in Wagner’s opera Die Walküre (1870), in a Nazi newsreel, and in Francis Ford Coppola’s movie Apocalypse Now (1979). The multimodal perspective provides us with nuanced language for transcribing and discussing how different semiotic resources work together, and the intermedial perspective allows us to discuss the chain of media transformation, where each instance increases and transforms the meaning potential of the “Ride of the Valkyries”.
Centering multimodality: A personal and disciplinary journey
Authors: Ravelli Louise
Published: June 2024

While museums have always been multimodal in and of themselves, and while museum studies have long engaged with different modalities in the museum (exhibition design, visitor movement, etc.), a comprehensive understanding of museums as ‘multimodal constellations’ has been missing. This was certainly the case in the 1990s, particularly for linguistics as a discipline, in which language was likely to be viewed as an isolated, and primary, form of communication. Yet in a museum, every label is connected to an exhibit, an exhibition, and the museum itself, and communication needs to be understood as a holistic, multimodal enterprise. For me as a linguist involved with the Australian Museum, Australia’s foremost museum of natural history, the multimodal environment of language was critical in our project to improve communication with visitors through better label writing. This article explains the personal and disciplinary developments resulting in the centering of multimodality as a research agenda. An important feature of this approach is the metafunctional theory of Michael Halliday as a core tenet. I explain how this theory of meaning operates across different levels of the institution, in relation to different modes, and in relation to subsequent developments in multimodal research.
Neurobeachin regulates hematopoietic progenitor differentiation and survival by modulating Notch activity
Authors: Ganuza Miguel , Morales-Hernández Antonio , Van Huizen Alanna , Chabot Ashley , Hall Trent , Caprio Claire , Finkelstein David , Kilimann Manfred W. , McKinney-Freeman Shannon
Published: June 2024

Hematopoietic stem cells (HSCs) can generate all blood cells. This ability is exploited in HSC transplantation (HSCT) to treat hematologic disease. A clear understanding of the molecular mechanisms that regulate HSCT is necessary to continue improving transplant protocols. We identified the Beige and Chediak-Higashi domain–containing protein (BDCP), Neurobeachin (NBEA), as a putative regulator of HSCT. Here, we demonstrated that NBEA and related BDCPs, including LPS Responsive Beige-Like Anchor Protein (LRBA), Neurobeachin Like 1 (NBEAL1) and Lysosomal Trafficking Regulator (LYST), are required during HSCT to efficiently reconstitute the hematopoietic system of lethally irradiated mice. Nbea knockdown in mouse HSCs induced apoptosis and a differentiation block after transplantation. Nbea deficiency in hematopoietic progenitor cells perturbed the expression of genes implicated in vesicle trafficking and led to changes in NOTCH receptor localization. This resulted in perturbation of the NOTCH transcriptional program, which is required for efficient HSC engraftment. In summary, our findings reveal a novel role for NBEA in the control of NOTCH receptor turnover in hematopoietic cells and supports a model in which BDCP-regulated vesicle trafficking is required for efficient HSCT.
IgG testing, immunoglobulin replacement therapy, and infection outcomes in patients with CLL or NHL: real-world evidence
Authors: Soumerai Jacob D. , Yousif Zaid , Gift Thais , Desai Raj , Huynh Lynn , Ye Mingchen , Banatwala Azeem , Clear Louise , Pinaire Megan , Belsky Gregory , Hsieh Yichuan Grace , Herrick Christopher , Darnell Eli P. , Duh Mei Sheng , Sanchirico Marie , Murphy Shawn N.
Published: June 2024

Patients with chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) can develop hypogammaglobulinemia, a form of secondary immune deficiency (SID), from the disease and treatments. Patients with hypogammaglobulinemia with recurrent infections may benefit from immunoglobulin replacement therapy (IgRT). This study evaluated patterns of immunoglobulin G (IgG) testing and the effectiveness of IgRT in real-world patients with CLL or NHL. A retrospective, longitudinal study was conducted among adult patients diagnosed with CLL or NHL. Clinical data from the Massachusetts General Brigham Research Patient Data Registry were used. IgG testing, infections, and antimicrobial use were compared before vs 3, 6, and 12 months after IgRT initiation. Generalized estimating equation logistic regression models were used to estimate odds ratios, 95% confidence intervals, and P values. The study population included 17 192 patients (CLL: n = 3960; median age, 68 years; NHL: n = 13 232; median age, 64 years). In the CLL and NHL cohorts, 67% and 51.2% had IgG testing, and 6.5% and 4.7% received IgRT, respectively. After IgRT initiation, the proportion of patients with hypogammaglobulinemia, the odds of infections or severe infections, and associated antimicrobial use, decreased significantly. Increased frequency of IgG testing was associated with a significantly lower likelihood of severe infection. In conclusion, in real-world patients with CLL or NHL, IgRT was associated with significant reductions in hypogammaglobulinemia, infections, severe infections, and associated antimicrobials. Optimizing IgG testing and IgRT are warranted for the comprehensive management of SID in patients with CLL or NHL.
Frontiers in plasma proteome profiling platforms: innovations and applications
Authors: Soni Rajesh Kumar
Published: June 2024

Biomarkers play a crucial role in advancing precision medicine by enabling more targeted and individualized approaches to diagnosis and treatment. Various biofluids, including serum, plasma, cerebrospinal fluid (CSF), saliva, tears, pancreatic cyst fluids, and urine, have been identified as rich sources of potential for the early detection of disease biomarkers in conditions such as cancer, cardiovascular diseases, and neurodegenerative disorders. The analysis of plasma and serum in proteomics research encounters challenges due to their high complexity and the wide dynamic range of protein abundance. These factors impede the sensitivity, coverage, and precision of protein detection when employing mass spectrometry, a widely utilized technology in discovery proteomics. Conventional approaches such as Neat Plasma workflow are inefficient in accurately quantifying low-abundant proteins, including those associated with tissue leakage, immune response molecules, interleukins, cytokines, and interferons. Moreover, the manual nature of the workflow poses a significant hurdle in conducting large cohort studies. In this study, our focus is on comparing workflows for plasma proteomic profiling to establish a methodology that is not only sensitive and reproducible but also applicable for large cohort studies in biomarker discovery. Our investigation revealed that the Proteograph XT workflow outperforms other workflows in terms of plasma proteome depth, quantitative accuracy, and reproducibility while offering complete automation of sample preparation. Notably, Proteograph XT demonstrates versatility by applying it to various types of biofluids. Additionally, the proteins quantified widely cover secretory proteins in peripheral blood, and the pathway analysis enriched with relevant components such as interleukins, tissue necrosis factors, chemokines, and B and T cell receptors provides valuable insights. These proteins, often challenging to quantify in complex biological samples, hold potential as early detection markers for various diseases, thereby contributing to the improvement of patient care quality.
Comparative transcriptome analysis reveals transcriptional regulation of anthocyanin biosynthesis in purple radish (Raphanus sativus L.)
Authors: Liu Yi , Wang Chenchen , Chen Haidong , Dai Guoqiang , Cuimu Qiushi , Shen Wenjie , Gao Liwei , Zhu Bo , Gao Changbin , Chen Lunlin , Chen Daozong , Zhang Xueli , Tan Chen
Published: June 2024

Radish exhibits significant variation in color, particularly in sprouts, leaves, petals, fleshy roots, and other tissues, displaying a range of hues such as green, white, red, purple, and black. Although extensive research has been conducted on the color variation of radish, the underlying mechanism behind the variation in radish flower color remains unclear. To date, there is a lack of comprehensive research investigating the variation mechanism of radish sprouts, leaves, fleshy roots, and flower organs. This study aims to address this gap by utilizing transcriptome sequencing to acquire transcriptome data for white and purple radish flowers. Additionally, the published transcriptome data of sprouts, leaves, and fleshy roots were incorporated to conduct a systematic analysis of the regulatory mechanisms underlying anthocyanin biosynthesis in these four radish tissues. The comparative transcriptome analysis revealed differential expression of the anthocyanin biosynthetic pathway genes DFR, UGT78D2, TT12 and CPC in the four radish tissues. Additionally, the WGCNA results identified RsDFR.9c and RsUGT78D2.2c as hub genes responsible for regulating anthocyanin biosynthesis. By integrating the findings from the comparative transcriptome analysis, WGCNA, and anthocyanin biosynthetic pathway-related gene expression patterns, it is hypothesized that genes RsDFR.9c and RsUGT78D2.2c may serve as pivotal regulators of anthocyanins in the four radish tissues. Furthermore, the tissue-specific expression of the four copies of RsPAP1 is deemed crucial in governing anthocyanin synthesis and accumulation. Our results provide new insights into the molecular mechanism of anthocyanin biosynthesis and accumulation in different tissues of radish.
Physiological and transcriptomic analyses reveal the regulatory mechanisms of Anoectochilus roxburghii in response to high-temperature stress
Authors: Zhang Linghui , Yang Heyue , Zheng Mengxia , Zhou Guo , Yang Yuesheng , Liu Siwen
Published: June 2024

Background

High temperatures significantly affect the growth, development, and yield of plants. Anoectochilus roxburghii prefers a cool and humid environment, intolerant of high temperatures. It is necessary to enhance the heat tolerance of A. roxburghii and breed heat-tolerant varieties. Therefore, we studied the physiological indexes and transcriptome of A. roxburghii under different times of high-temperature stress treatments.

Results

Under high-temperature stress, proline (Pro), H2O2 content increased, then decreased, then increased again, catalase (CAT) activity increased continuously, peroxidase (POD) activity decreased rapidly, then increased, then decreased again, superoxide dismutase (SOD) activity, malondialdehyde (MDA), and soluble sugars (SS) content all decreased, then increased, and chlorophyll and soluble proteins (SP) content increased, then decreased. Transcriptomic investigation indicated that a total of 2740 DEGs were identified and numerous DEGs were notably enriched for “Plant-pathogen interaction” and “Plant hormone signal transduction”. We identified a total of 32 genes in these two pathways that may be the key genes for resistance to high-temperature stress in A. roxburghii.

Conclusions

To sum up, the results of this study provide a reference for the molecular regulation of A. roxburghii’s tolerance to high temperatures, which is useful for further cultivation of high-temperature-tolerant A. roxburghii varieties.
Comparison of blended learning and traditional lecture method on learning outcomes in the evidence-based medicine course: a comparative study
Authors: Liu Kui , Liu Shuang , Ma Yifei , Jiang Jun , Liu Zhenhua , Wan Yi
Published: June 2024

Background

Blended learning comprised with flipped classroom (FC) and “internet plus” is a new learning strategy that reverses the position of teacher and students in class, and provides abundant learning resources before and after class. This study aimed to assess the impact of blended learning on learning outcomes in evidence-based medicine course, and compare with traditional learning method.

Methods

The participants of the two groups were from two difference cohorts in Air force medical university in China. The two groups toke the same pre-test before class and then were given the teaching of same chapters of evidence-based medicine with two different learning strategy. In the blended learning group, the participants were required to create a debriefing slide about their learning outcomes and the answers of questions given in advance after study the learning material sent by teacher a week before class, and the teacher gave a detailed summary based on the common problems, and distributed multimedia resources for review. After the experiment was carried out, learning outcomes including mastering knowledge, learning satisfaction, and self-evaluation were compared.

Results

37 and 39 participants were enrolled to blended learning and traditional learning groups, respectively, and no statistically significant difference were found in baseline information and pre-test grades. Statistically significant differences were found in learning outcomes including post-test score (t = 2.90, p = 0.005), changes of scores between pre-test and post-test (t = 2.49, p = 0.022), learning satisfaction (t = 12.41, p = 0.001), and self-evaluation of the two groups (t = 7.82, p = 0.001). Especially, the changes of scores between pre-test and post-test of blended learning and traditional learning groups were 4.05 (4.26), and 2.00 (2.85), respectively.

Conclusions

This study showed that compared with traditional learning strategy, blended learning can effectively enhanced participants’ acquisition of knowledge, learning satisfaction, and self-evaluation in evidence-based medicine. Using blended learning method including “internet plus” and flipped classroom is recommended in the teaching of evidence-based medicine course.
Nurses’ knowledge of, attitudes towards and awareness of the metaverse, and their future time perspectives: a cross-sectional study
Authors: Ergin Eda , Yalcinkaya Turgay , Cinar Yucel Sebnem
Published: June 2024

Background

The metaverse is a new and developing technology used in the field of healthcare. The perception of future explains time as a psychological phenomenon rather than a physical one. This study aimed to determine nurses’ thoughts of the metaverse and their perceptions of future.

Methods

The study in which the cross-sectional descriptive design was used was conducted with nurses working in a hospital in Trkiye from September 2022 to December 2022. Face-to-face interviews were conducted with 374 nurses who were chosen using the convenience sampling method. Personal Identification Form, Metaverse Scale (MS) and Future Time Perspective Scale (FTPS) were used to collect data. The Statistical Package for Social Sciences (SPSS) for Windows 25.0 program was used to analyse the data.

Results

The findings revealed that 81.6% of the nurses believed that they could provide patient education using the metaverse in the future, whereas 46% believed that they could do virtual nursing. The mean scores obtained from the FTPS and MS by the nurses were 3.45 (SD = 0.37) and 3.74 (SD = 0.56), respectively. There was a weak positive relationship between perception of future, and knowledge of, attitudes towards and awareness of the metaverse (r = 0.157, p = 0.002), and a weak, positive relationship between internet use duration and MS (r = 0.169, p = 0.001).

Conclusions

This study underscores the potential of the metaverse in nursing, revealing that nurses are optimistic about its application in patient education and virtual care. We recommend the development of specialized training programs to equip nurses with the necessary skills and knowledge to effectively utilize the metaverse in healthcare settings.
Responding to health literacy of refugees in Australian primary health care settings: a qualitative study of barriers and potential solutions
Authors: Peprah Prince , Lloyd Jane , Harris Mark
Published: June 2024

Background

Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy.

Methods

Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis.

Results

Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy.

Conclusion

The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities.
The impact of antifibrotic use on long-term clinical outcomes in the pulmonary fibrosis foundation registry
Authors: Lee Cathryn T. , Hao Wei , Burg Cindy A. , Best Jennie , Kolenic Giselle E. , Strek Mary E.
Published: June 2024

Background

Idiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease (ILD) with a high mortality rate. The antifibrotic medications pirfenidone and nintedanib have been in use since 2014 for this disorder and are associated with improved rate of lung function decline. Less is known about their long-term outcomes outside of the clinical trial context.

Methods

The Pulmonary Fibrosis Foundation Patient Registry was used for this study. Patients with an IPF diagnosis made within a year of enrollment were included. The treated group was defined as patients receiving either pirfenidone or nintedanib for at least 180 days. The untreated group did not have any record of antifibrotic use. Demographic data, comorbidities, serial lung function, hospitalization, and vital status data were collected from the registry database. The primary outcomes were transplant-free survival, time to first respiratory hospitalization, and time to 10% absolute FVC decline. Time-to-event analyses were performed utilizing Cox proportional hazards models and the log-rank test. Model covariates included age, gender, smoking history, baseline lung function, comorbidities, and oxygen use.

Results

The registry contained 1212 patients with IPF; ultimately 288 patients met inclusion criteria for the treated group, and 101 patients were designated as untreated. Patients treated with antifibrotics were significantly younger (69.8 vs. 72.6 years, p = 0.008) and less likely to have smoked (61.1% ever smokers vs. 72.3% never smokers, p = 0.04). No significant differences were seen in race, gender, comorbidities, or baseline pulmonary function between groups. The primary outcome of transplant-free survival was not significantly different between the two groups (adjusted HR 0.799, 95% CI 0.534–1.197, p = 0.28). Time to respiratory hospitalization was significantly shorter in the treated group (adjusted HR 2.12, 95% CI 1.05–4.30, p = 0.04). No significant difference in time to pulmonary function decline was seen between groups.

Conclusions

This multicenter study demonstrated 63% of newly diagnosed IPF patients had continuous antifibrotic usage. Antifibrotics were not associated with improved transplant-free survival or pulmonary function change but was associated with an increased hazard of respiratory hospitalization. Future studies should further investigate the role of antifibrotic therapy in clinically important outcomes in real-world patients with IPF and other progressive ILDs.
Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent’s population
Authors: Drapeau Vicky , Laramée Catherine , Lafreniere Jacynthe , Trottier Christiane , Brochu Charlotte , Robitaille Julie , Lamarche Benoît , Lemieux Simone
Published: June 2024

Background

Healthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop efficient interventions and identify groups that are more at risk of inadequate intakes. This study aimed to assess the relative validity of the self-administered web-based 24-h dietary recall (R24W) for evaluating energy and nutrient intakes among active adolescents.

Methods

Participants were invited to complete one interviewer-administered 24-h dietary dietary recall and the R24W on up to three occasions within one month. A total of 272 French-speaking active adolescents aged 12 to 17 years from the province of Québec were invited to complete three R24W and one interview-administered 24-h recall. Student’s t-test and correlations were conducted on sex-adjusted data. Percent differences, cross-classification (percentage of agreement), weighted Kappa and Bland-Altman plots were calculated.

Results

Mean (SD) energy intake from the R24W was 8.8% higher than from the interview-administered 24-h dietary recall (2558 kcal ± 1128 vs. 2444 kcal ± 998, p < 0.05). Significant differences in mean nutrient intake between the R24W and the interview-administered 24-h dietary recall ranged from 6.5% for % E from fat (p < 0.05) to 25.2% for saturated fat (p < 0.001), i.e., higher values with R24W. Sex-adjusted correlations were significant for all nutrients except for % E from proteins and thiamin (range: 0.24 to 0.52, p < 0.01). Cross-classification demonstrated that 36.6% of the participants were classified in the same fourth with both methods, 39.6% in the adjacent fourth, and 5.7% misclassified. Bland-Atman plots revealed proportional bias between the two methods for 7/25 nutrients. Completing at least two recalls with the R24W increased the precision of intake estimates.

Conclusion

These data suggest that the R24W presents an acceptable relative validity compared to a standard interview-administered 24-h recall for estimating energy and most nutrients in a cohort of French-speaking adolescents from the province of Québec.
Epidemiological and genomic characteristics of global blaNDM-carrying Escherichia coli
Authors: Xia Changyu , Yan Ruyu , Liu Chang , Zhai Junbin , Zheng Jie , Chen Wei , Cao Xiaoli
Published: June 2024

Background

Escherichia. coli is the most frequent host for New Delhi metallo-β-lactamase (NDM) which hydrolyzes almost all β-lactams except aztreonam. The worldwide spread of blaNDM-carrying E. coli heavily threatens public health.

Objective

This study aimed to explore the global genomic epidemiology of blaNDM- carrying E. coli isolates, providing information for preventing the dissemination of such strains.

Methods

Global E. coli genomes were downloaded from NCBI database and blaNDM was detected using BLASTP. Per software was used to extract meta information on hosts, resources, collection data, and countries of origin from GenBank. The sequence types (STs) and distribution of antimicrobial resistance gene (ARG) were analyzed by CLC Workbench; Plasmid replicons, serotypes and virulence genes (VFs) were analyzed by submitting the genomes to the websites. Statistical analyses were performed to access the relationships among ARGs and plasmid replicons.

Results

Until March 2023, 1,774 out of 33,055 isolates collected during 2003–2022 were found to contain blaNDM in total. Among them, 15 blaNDM variants were found with blaNDM-5 (74.1%) being most frequent, followed by blaNDM-1 (16.6%) and blaNDM-9 (4.6%). Among the 213 ARGs identified, 27 blaCTX-M and 39 blaTEM variants were found with blaCTX-M-15 (n = 438, 24.7%) and blaTEM-1B (n = 1092, 61.6%) being the most frequent ones, respectively. In addition, 546 (30.8%) plasmids mediated ampC genes, 508 (28.6%) exogenously acquired 16 S rRNA methyltransferase encoding genes and 262 (14.8%) mcr were also detected. Among the 232 distinct STs, ST167 (17.2%) were the most prevalent. As for plasmids, more than half of isolates contained IncFII, IncFIB and IncX3. The VF terC, gad, traT and iss as well as the serotypes O101:H9 (n = 231, 13.0%), O8:H9 (n = 115, 6.5%) and O9:H30 (n = 99, 5.6%) were frequently observed.

Conclusions

The study delves into the intricate relationship between plasmid types, virulence factors, and ARGs, which provides valuable insights for clinical treatment and public health interventions, and serves as a critical resource for guiding future research, surveillance, and implementation of effective strategies to address the challenges posed by blaNDM-carrying E. coli. The findings underscore the urgent need for sustained global collaboration, surveillance efforts, and antimicrobial stewardship to mitigate the impact of these highly resistant strains on public health.
Genomic and immunocyte characterisation of bloodstream infection caused by Klebsiella pneumoniae
Authors: Yu Wei , Huang Chen , Lian Xiang , Jinag Lushun , Li Hong , Shen Ping , Xiao Yonghong
Published: June 2024

Objectives

The aim of this study was to evaluate the characteristics of immunocyte associated with bloodstream infection (BSI) caused by Klebsiella pneumoniae (Kpn).

Methods

Patients with BSI-Kpn were included from 2015 to 2022 in our hospital. Immunocyte subpopulations of enrolled BSI-Kpn patients were tested on the same day of blood culture using multicolor flow cytometry analysis. Antibiotic susceptibility test was determined by agar dilution or broth dilution method. All included isolates were subjected to whole genome sequencing and comparative genomics analysis. Clinical and genetic data were integrated to investigate the risk factors associated with clinical outcome.

Results

There were 173 patients with non-duplicate BSI-Kpn, including 81 carbapenem-resistant Kpn (CRKP), 30 extended-spectrum β-lactamases producing Kpn (ESBL-Kpn), 62 none CRKP or ESBL-Kpn (S-Kpn). Among 68 ST11-CRKP isolates, ST11-O2v1:KL64 was the most common serotypes cluster (77.9%, 53/68), followed by ST11-OL101: KL47 (13.2%, 9/68). Compared with CSKP group, subpopulations of immunocyte in patients with CRKP were significantly lower (P < 0.01). In patients with ST11-O2v1:KL64 BSI-Kpn, the level of cytotoxic T lymphocytes (CD3 + CD8 +) is the highest, while the B lymphocytes (CD3-CD19 +) was the least. In addition, the level of immunocyte in patients with Kpn co-harbored clpV-ybtQ-qacE were lower than that in patients with Kpn harbored one of clpV, ybtQ or qacE and without these three genes. Furthermore, co-existence of clpV-ybtQ-qacE was independently associated with a higher risk for 30-day mortality.

Conclusions

The results demonstrate that patients with BSI-CRKP, especially for ST11-O2v1:KL64, exhibit lower leukomonocyte counts. In addition, BSI-Kpn co-harbored clpV-ybtQ-qacE is correlated to higher 30-day mortality.
The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hyperuricaemia
Authors: Wang Zhaoxiang , Wu Menghuan , Du Ruiqin , Tang Fengyan , Xu Mengjiao , Gu Tian , Yang Qichao
Published: June 2024

Purpose

The ratio of non-high-density lipoprotein cholesterol (non-HDL-c) to high-density lipoprotein cholesterol (HDL-c) (NHHR) is a novel comprehensive lipid index. The aim of this study was to investigate the relationship between the NHHR and the prevalence of hyperuricaemia (HUA) in the adult population of the U.S.

Methods

This cross-sectional study collected data from the National Health and Nutrition Examination Survey (NHANES) (2007–2018). HUA was defined as a serum uric acid (SUA) concentration ≥ 7 mg/dL in men and ≥ 6 mg/dL in women. Multivariate logistic regression models and the restricted cubic spline (RCS) method were applied to examine the relationship between the NHHR and the risk of developing HUA. Subgroup analyses and interaction tests were also performed.

Results

The prevalence of HUA increased with increasing NHHR values (9.01% vs. 13.38% vs. 17.31% vs. 25.79%, P < 0.001). The NHHR was independently correlated with the risk of developing HUA (OR = 1.10, 95% CI: 1.05–1.16; P < 0.001). Furthermore, the risk of developing HUA was significantly greater among individuals with the highest NHHR quartile than among those with the lowest NHHR quartile (OR = 1.94, 95% CI: 1.62–2.33; P < 0.001). This relationship was consistent across subgroups. According to the RCS analysis, an inverted U-shaped relationship existed between the NHHR and the risk of developing HUA.

Conclusions

The NHHR was closely associated with an increased risk of developing HUA. Further studies on the NHHR could be beneficial for preventing and treating HUA.
Microcirculatory disturbance in acute liver injury is triggered by IFNγ-CD40 axis
Authors: Kurokawa Miho , Goya Takeshi , Kohjima Motoyuki , Tanaka Masatake , Iwabuchi Sadahiro , Shichino Shigeyuki , Ueha Satoshi , Hioki Tomonobu , Aoyagi Tomomi , Takahashi Motoi , Imoto Koji , Tashiro Shigeki , Suzuki Hideo , Kato Masaki , Hashimoto Shinichi , Matsuda Hideo , Matsushima Kouji , Ogawa Yoshihiro
Published: June 2024

Background

Acute liver failure (ALF) is a life-threatening disorder that progresses from self-limiting acute liver injury (ALI). Microcirculatory disturbance characterized by sinusoidal hypercoagulation and subsequent massive hypoxic hepatocyte damage have been proposed to be the mechanism by which ALI deteriorates to ALF; however, the precise molecular pathway of the sinusoidal hypercoagulation remains unknown. Here, we analyzed ALI patients and mice models to uncover the pathogenesis of ALI with microcirculatory disturbance.

Methods

We conducted a single-center retrospective study for ALI and blood samples and liver tissues were analyzed to evaluate the microcirculatory disturbance in ALI patients (n = 120). Single-cell RNA sequencing analysis (scRNA-seq) was applied to the liver from the concanavalin A (Con A)‑induced mouse model of ALI. Interferon-gamma (IFNγ) and tumor necrosis factor-alpha knockout mice, and primary human liver sinusoidal endothelial cells (LSECs) were used to assess the mechanism of microcirculatory disturbance.

Results

The serum IFNγ concentrations were significantly higher in ALI patients with microcirculatory disturbance than in patients without microcirculatory disturbance, and the IFNγ was upregulated in the Con A mouse model which presented microcirculatory disturbance. Hepatic IFNγ expression was increased as early as 1 hour after Con A treatment prior to sinusoidal hypercoagulation and hypoxic liver damage. scRNA-seq revealed that IFNγ was upregulated in innate lymphoid cells and stimulated hepatic vascular endothelial cells at the early stage of liver injury. In IFNγ knockout mice treated with Con A, the sinusoidal hypercoagulation and liver damage were remarkably attenuated, concomitant with the complete inhibition of CD40 and tissue factor (TF) upregulation in vascular endothelial cells. By ligand-receptor analysis, CD40-CD40 ligand interaction was identified in vascular endothelial cells. In human LSECs, IFNγ upregulated CD40 expression and TF was further induced by increased CD40-CD40 ligand interaction. Consistent with these findings, hepatic CD40 expression was significantly elevated in human ALI patients with microcirculatory disturbance.

Conclusion

We identified the critical role of the IFNγ-CD40 axis as the molecular mechanism of microcirculatory disturbance in ALI. This finding may provide novel insights into the pathogenesis of ALI and potentially contribute to the emergence of new therapeutic strategies for ALI patients.