bluuebunny/crossref_metadata_2025 huggingface dataset:
The Importance of Cutaneous Innervation in Wound Healing: From Animal Studies to Clinical Applications
Authors: Ge Shealinna , Khachemoune Amor
Published: September 2021

The skin is a neuroimmunoendocrine organ that regularly undergoes injury and repair. The complex process of wound healing relies heavily on the cutaneous nervous system. Despite the observation that wound healing deficiencies cause significant morbidity and mortality for patients with nervous dysfunction across many disciplinaries, the role of cutaneous innervation in wound repair has not been well elucidated. In a previous article, we learned the basics of cutaneous neuroanatomy and the important neuropeptides involved in the wound healing process. Currently, we aim to synthesize the basics with observations from animal models and human studies for a more comprehensive understanding of nervous system involvement in cutaneous wound healing. We have demonstrated in this review, the importance of the cutaneous nervous system in each phase of wound healing through basic science research, animal experiments, and human studies.
Securitizing cyberspace: Protecting political judgment
Authors: Ördén Hedvig
Published: September 2021

The contemporary debate in democracies routinely refers to online misinformation, disinformation, and deception, as security-issues in need of urgent attention. Despite this pervasive discourse, however, policymakers often appear incapable of articulating what security means in this context. This paper argues that we must understand the unique practical and normative challenges to security actualized by such online information threats, when they arise in a democratic context. Investigating security-making in the nexus between technology and national security through the concept of “cybersovereignty,” the paper highlights a shared blind spot in the envisaged protection of national security and democracy in cyberspace. Failing to consider the implications of non-territoriality in cyberspace, the “cybersovereign” approach runs into a cul de sac. Security-making, when understood as the continuous constitution of “cybersovereign” boundaries presumes the existence of a legitimate securitizing actor; however, this actor can only be legitimate as a product of pre-existing boundaries. In response to the problems outlined, the article proposes an alternative object of protection in the form of human judgment and, specifically, “political judgment” in the Arendtian sense. The turn to political judgment offers a conceptualization of security that can account for contemporary policy practises in relation to security and the online information threat, as well as for the human communicating subject in the interactive and essentially incomplete information and communication environment.
Investigation on aerodynamic characteristics of bionic membrane nano rotor
Authors: Zhao Shanyong , Liu Zhen , Lu Ke , Su Dacheng , Wu Shangjing
Published: September 2021

In this paper, the bionic membrane structure is introduced to improve the aerodynamic performance of nano rotor at the low Reynolds number. The aerodynamic characteristics of nano rotor made of hyperelastic material as membrane blades are studied. Firstly, based on the hyperelastic constitutive model, a finite element model of the rotor is established and compared with the results of the modal test to verify the accuracy of the model. Then the computational fluid dynamics model of membrane nano rotor is established which combined with the finite element model. The aerodynamic characteristics of the membrane rotor under hovering conditions are studied using fluid–structure interaction method. It is found that the calculation results matched well with the experiment results. The design of the structural parameters such as the membrane proportion, shape, and position of the membrane rotor is optimized. The influence of each parameter on the aerodynamic performance of the rotor is obtained. Under certain structural conditions, the performance can be effectively improved, which provides a new idea for the design of the nano rotor.
Landscape memories of land struggles in plateaus of two Nsukka villages in Nigeria
Authors: Nwankwo Cletus Famous , Ayadiuno Romanus U.
Published: September 2021

The memories of landscapes that people hold can stabilize histories and traditions in rural areas, are entwined with everyday lives and have several meanings. The paper explores the memories that people hold about plateaus in two adjoining villages (Alor-Uno and Edem-Ani) in the Nsukka area of Enugu State, Southeastern Nigeria. This area is an exciting and essential area of the world, distinctly underrepresented in landscape memory scholarship. The paper shows that the plateaus separating Alor-Uno and Edem-Ani are landscapes of political memory of the ancient wars between the two communities and more contemporary disputes regarding territorial extent of the communities and use of the land behind the plateaus if you are in Alor-Uno. Alor-Uno claims that wars waged against it by several kingdoms displaced the community, permitting occupation of parts of the community’s land, and they seek to reclaim it from Edem-Ani. However, extant narratives often recognize the disputed area as part of Edem-Ani because of the use of the plateaus as a boundary by colonial administrators. The presence of the plateaus helps the people recollect these ancient wars’ memories, and they use it to seek legitimation of their claim over the land. The paper argues that the memory of past land use reinforces the legitimacy of current land tenure configurations and shapes sensitivity to territoriality leading to exclusion. This can sustain group identities across generations translating into a ground for future fighting. It calls for more attention to the non-human agency and in connection to landscapes’ political memory, which speaks to the current post-human thinking in human geography. It suggests that resource conflicts analysis should take social meanings, memories and identities connected to the physical landscape seriously, as they contain ideological and symbolic elements foregrounding conflict environments.
Who Gets to Vote? Racialized Mental Images of Legitimate and Illegitimate Voters
Authors: Brown-Iannuzzi Jazmin L. , Cooley Erin , Cipolli William , Payne B. Keith
Published: September 2021

When people support voter identification (ID) laws, who do they imagine they are keeping in and out of the voting booth? We investigated this question across three studies. First, using a traditional survey approach, we found support for voter ID laws was associated with beliefs that ID requirements reduce illegal voting by both Black and White people to the same degree. Because explicit surveys are vulnerable to social desirability concerns, in the following two studies, we utilized an indirect measure, reverse correlation, to investigate mental images of those who try to vote illegally (Study 2) and mental images of those who should and should not get to vote (Study 3). The findings of these studies suggest that support for voter ID laws is associated with racially biased perceptions of illegal voters and who should get to vote. Critically, these biased perceptions may be underestimated by traditional explicit survey approaches.
The Homeless-Poor and the COVID-19 Stay-at-Home Policy of Government: Rethinking the Plight of Homelessness in Nigeria
Authors: Obasi Cletus O. , Anierobi Christopher M.
Published: September 2021

The Government Stay-at-Home policy regarding the COVID-19 pandemic has seemingly aggravated the plight of the homeless, especially in Nigeria that has about 108 million homeless people who require special attention. Observations show that most of them situate randomly across urban centers in Nigeria and have no access to pronounced shelter, healthcare facilities, hygiene materials, and defined source of income. In response to the global COVID-19 pandemic currently ravaging many countries, most governments adopted the Stay-at-Home policy among some other policy measures that were recommended by the World Health Organization toward containing the spread of the virus. Given the COVID-19 Stay-at-Home policy of Nigerian Government, this study looked into the plight of the homeless-poor with a view to evolve an inclusive pro-poor housing strategy for the country. Findings show that the homeless poor have negative perceptions of the Stay-at-Home policy, which they see as being rather inimical to their survival. The study highlights lack of space and shelter as major reasons for their aversion to social distancing. Their reasons have serious implications for compliance to the COVID-19 Stay-at-Home policy as well as the spread curve of the virus. The study therefore recommends a review of the COVID-19 Regulation toward incorporating “Pro-Poor Housing Provisions” measures strictly for the homeless poor in the country. Strong collaboration between government and established institutions, such as Government-Church/Mosque strategy, is also recommended.
Measuring Equity-Promoting Behaviors in Digital Teaching Simulations: A Topic Modeling Approach
Authors: Littenberg-Tobias Joshua , Borneman Elizabeth , Reich Justin
Published: September 2021

Diversity, equity, and inclusion (DEI) issues are urgent in education. We developed and evaluated a massive open online course ( N = 963) with embedded equity simulations that attempted to equip educators with equity teaching practices. Applying a structural topic model (STM)—a type of natural language processing (NLP)—we examined how participants with different equity attitudes responded in simulations. Over a sequence of four simulations, the simulation behavior of participants with less equitable beliefs converged to be more similar with the simulated behavior of participants with more equitable beliefs ( ES [effect size] = 1.08 SD). This finding was corroborated by overall changes in equity mindsets ( ES = 0.88 SD) and changed in self-reported equity-promoting practices ( ES = 0.32 SD). Digital simulations when combined with NLP offer a compelling approach to both teaching about DEI topics and formatively assessing learner behavior in large-scale learning environments.
Development and validation of a 1 K sika deer (Cervus nippon) SNP Chip
Authors: Fan Huanhuan , Wang Tianjiao , Li Yang , Liu Huitao , Dong Yimeng , Zhang Ranran , Wang Hongliang , Shang Liyuan , Xing Xiumei
Published: September 2021

Background

China is the birthplace of the deer family and the country with the most abundant deer resources. However, at present, China’s deer industry faces the problem that pure sika deer and hybrid deer cannot be easily distinguished. Therefore, the development of a SNP identification chip is urgently required.

Results

In this study, 250 sika deer, 206 red deer, 23 first-generation hybrid deer (F1), 20 s-generation hybrid deer (F2), and 20 third-generation hybrid deer (F3) were resequenced. Using the chromosome-level sika deer genome as the reference sequence, mutation detection was performed on all individuals, and a total of 130,306,923 SNP loci were generated. After quality control filtering was performed, the remaining 31,140,900 loci were confirmed. From molecular-level and morphological analyses, the sika deer reference population and the red deer reference population were established. The Fst values of all SNPs in the two reference populations were calculated. According to customized algorithms and strict screening principles, 1000 red deer-specific SNP sites were finally selected for chip design, and 63 hybrid individuals were determined to contain red deer-specific SNP loci. The results showed that the gene content of red deer gradually decreased in subsequent hybrid generations, and this decrease roughly conformed to the law of statistical genetics. Reaction probes were designed according to the screening sites. All candidate sites met the requirements of the Illumina chip scoring system. The average score was 0.99, and the MAF was in the range of 0.3277 to 0.3621. Furthermore, 266 deer (125 sika deer, 39 red deer, 56 F1, 29 F2,17 F3) were randomly selected for 1 K SNP chip verification. The results showed that among the 1000 SNP sites, 995 probes were synthesized, 4 of which could not be typed, while 973 loci were polymorphic. PCA, random forest and ADMIXTURE results showed that the 1 K sika deer SNP chip was able to clearly distinguish sika deer, red deer, and hybrid deer and that this 1 K SNP chip technology may provide technical support for the protection and utilization of pure sika deer species resources.

Conclusion

We successfully developed a low-density identification chip that can quickly and accurately distinguish sika deer from their hybrid offspring, thereby providing technical support for the protection and utilization of pure sika deer germplasm resources.
Reverse remodeling of tricuspid valve morphology and function in chronic thromboembolic pulmonary hypertension patients following pulmonary thromboendarterectomy: a cardiac magnetic resonance imaging and invasive hemodynamic study
Authors: Frederiksen Christian Alcaraz , Waziri Farhad , Ringgaard Steffen , Mellemkjær Søren , Clemmensen Tor Skibsted , Hjortdal Vibeke Elisabeth , Nielsen Sten Lyager , Poulsen Steen Hvitfeldt
Published: September 2021

Background

To investigate changes in tricuspid annulus (TA) and tricuspid valve (TV) morphology among chronic thromboembolic pulmonary hypertension (CTEPH) patients before and 12 months after pulmonary thromboendarterectomy (PEA) and compare these findings to normal control subjects.

Methods

20 CTEPH patients and 20 controls were enrolled in the study. The patients were examined with echocardiography, right heart catherization and cardiac magnetic resonance imaging prior to PEA and 12 months after.

Results

Right atrium (RA) volume was significantly reduced from baseline to 12 months after PEA (30 ± 9 vs 23 ± 5 ml/m2, p < 0.005). TA annular area in systole remained unchanged (p = 0.11) and was comparable to controls. The leaflet area, tenting volume and tenting height in systole were significantly increased at baseline but decreased significantly with comparable values to controls after 12 months (p < 0.005). There was correlation between the changes of right ventricular-pulmonary artery coupling and changes of TV tenting height (r = − 0.54, p = 0.02), TV tenting volume (r = − 0.73, p < 0.001) and TV leaflet area (− 0.57, p = 0.01) from baseline to 12 months after PEA. Tricuspid regurgitation jet area/RA area was significantly (p < 0.01) reduced from baseline (30 ± 13%) to 12 months after PEA (9 ± 10%).

Conclusion

In CTEPH patients selected for PEA, TV tenting height, volume and valve area are significantly increased whereas annulus size and shape are less affected. The alterations in TV morphology are fully reversed after PEA and correlates to improvements of right ventricular-pulmonary arterial coupling.
Reproducibility and responsiveness of the Frailty Index and Frailty Phenotype in older hospitalized patients
Authors: Feenstra Marlies , Oud Frederike M.M. , Jansen Carolien J. , Smidt Nynke , van Munster Barbara C. , de Rooij Sophia E.
Published: September 2021

Background

There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older.

Methods

Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC).

Results

At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up analyses, respectively. ICC of the FI were 0.85 (95 % confidence interval [CI]: 0.76; 0.91) and 0.84 (95% CI: 0.77; 0.90), and 0.65 (95% CI: 0.49; 0.77) and 0.77 (95% CI: 0.65; 0.84) for the FP. SEM ranged from 5 to 13 %; SDC from 13 to 37 %. SRMs were good in patients with unchanged frailty status (< 0.50), and doubtful to good for deteriorated and improved patients (0.43–1.00). AUC’s over three months were 0.77 (95% CI: 0.69; 0.86) and 0.71 (95% CI: 0.62; 0.79) for the FI, and 0.68 (95% CI: 0.58; 0.77) and 0.65 (95% CI: 0.55; 0.74) for the FP. Over twelve months, AUCs were 0.78 (95% CI: 0.69; 0.87) and 0.82 (95% CI: 0.73; 0.90) for the FI, and 0.78 (95% CI: 0.69; 0.87) and 0.75 (95% CI: 0.67; 0.84) for the FP.

Conclusions

The Frailty Index showed better reproducibility and responsiveness properties compared to the Frailty Phenotype among acutely hospitalized older patients.
Severe bilateral pleuropneumonia caused by Legionella sainthelensi: a case report
Authors: Kamus Laure , Roquebert Bénédicte , Allyn Jérôme , Allou Nicolas , Valance Dorothée , Simon Charles , Jaffar-Bandjee Marie-Christine , Descours Ghislaine , Jarraud Sophie , Miltgen Guillaume
Published: September 2021

Background

Legionella spp. are ubiquitous freshwater bacteria responsible for rare but potentially severe cases of Legionnaires’ disease (LD). Legionella sainthelensi is a non-pneumophila Legionella species that was first isolated in 1980 from water near Mt. St-Helens (USA). Although rare cases of LD caused by L. sainthelensi have been reported, very little data is available on this pathogen.

Case presentation

We describe the first documented case of severe bilateral pleuropneumonia caused by L. sainthelensi. The patient was a 35-year-old woman with Sharp’s syndrome treated with long-term hydroxychloroquine and corticosteroids who was hospitalized for an infectious illness in a university hospital in Reunion Island (France). The patient’s clinical presentation was complicated at first (bilateral pneumonia, multiloculated pleural effusion, then bronchopleural fistula) but her clinical condition eventually improved with the reintroduction of macrolides (spiramycin) in intensive care unit. Etiological diagnosis was confirmed by PCR syndromic assay and culture on bronchoalveolar lavage.

Conclusions

To date, only 14 documented cases of L. sainthelensi infection have been described worldwide. This pathogen is difficult to identify because it is not or poorly detected by urinary antigen and molecular methods (like PCR syndromic assays that primarily target L. pneumophila and that have only recently been deployed in microbiology laboratories). Pneumonia caused by L. sainthelensi is likely underdiagnosed as a result. Clinicians should consider the possibility of non-pneumophila Legionella infection in patients with a compatible clinical presentation when microbiological diagnostic tools targeted L. pneumophila tested negative.
Prevention of SARS-CoV-2 (COVID-19) transmission in residential aged care using ultraviolet light (PETRA): a two-arm crossover randomised controlled trial protocol
Authors: Brass Amanda , Shoubridge Andrew P. , Crotty Maria , Morawska Lidia , Bell Scott C. , Qiao Ming , Woodman Richard J. , Whitehead Craig , Inacio Maria C. , Miller Caroline , Corlis Megan , Larby Nicolas , Elms Levi , Sims Sarah K. , Taylor Steven L. , Flynn Erin , Papanicolas Lito E. , Rogers Geraint B.
Published: September 2021

Background

SARS-CoV-2 poses a considerable threat to those living in residential aged care facilities (RACF). RACF COVID-19 outbreaks have been characterised by the rapid spread of infection and high rates of severe disease and associated mortality. Despite a growing body of evidence supporting airborne transmission of SARS-CoV-2, current infection control measures in RACF including hand hygiene, social distancing, and sterilisation of surfaces, focus on contact and droplet transmission. Germicidal ultraviolet (GUV) light has been used widely to prevent airborne pathogen transmission. Our aim is to investigate the efficacy of GUV technology in reducing the risk of SARS-CoV-2 infection in RACF.

Methods

A multicentre, two-arm double-crossover, randomised controlled trial will be conducted to determine the efficacy of GUV devices to reduce respiratory viral transmission in RACF, as an adjunct to existing infection control measures. The study will be conducted in partnership with three aged care providers in metropolitan and regional South Australia. RACF will be separated into paired within-site zones, then randomised to intervention order (GUV or control). The initial 6-week period will be followed by a 2-week washout before crossover to the second 6-week period. After accounting for estimated within-zone and within-facility correlations of infection, and baseline infection rates (10 per 100 person-days), a sample size of n = 8 zones (n = 40 residents/zone) will provide 89% power to detect a 50% reduction in symptomatic infection rate. The primary outcome will be the incidence rate ratio of combined symptomatic respiratory infections for intervention versus control. Secondary outcomes include incidence rates of hospitalisation for complications associated with respiratory infection; respiratory virus detection in facility air and fomite samples; rates of laboratory confirmed respiratory illnesses and genomic characteristics.

Discussion

Measures that can be deployed rapidly into RACF, that avoid the requirement for changes in resident and staff behaviour, and that are effective in reducing the risk of airborne SARS-CoV-2 transmission, would provide considerable benefit in safeguarding a highly vulnerable population. In addition, such measures might substantially reduce rates of other respiratory viruses, which contribute considerably to resident morbidity and mortality.

Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12621000567820 (registered on 14th May, 2021).
Efficacy of bedaquiline in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis
Authors: Wang Ming-Gui , Wu Shou-Quan , He Jian-Qing
Published: September 2021

Background

Drug-resistant tuberculosis (DR-TB) remains a major public health concern worldwide. Bedaquiline, a novel diarylquinoline, was added to the WHO-recommended all-oral regimen for patients with multidrug-resistant tuberculosis. We performed a systematic review and meta-analysis to determine the effect of bedaquiline on tuberculosis treatment outcomes.

Methods

We searched the PubMed, Web of Science and EMBASE databases for relevant studies published up to March 12, 2021. We included studies in which some participants received bedaquiline and others did not. Stata version 16.0 (Stata Corp., College Station, Texas, USA) was used to analyze the results of the meta-analysis. Risk ratios (RRs) with 95% confidence intervals (95% CIs) were calculated to evaluate the effect of bedaquiline on drug-resistant tuberculosis. Between-study heterogeneity was examined by the I-squared test. Randomized controlled trials were assessed for quality using the Jadad scale, and cohort studies were assessed using the Newcastle–Ottawa scale.

Results

Eight studies, including 2 randomized controlled trials and 6 cohort studies involving a total of 21,836 subjects, were included. When compared with the control, bedaquiline treatment was associated with higher rates of culture conversion (risk ratio (RR):1.272 (1.165–1.389), P < 0.001). We found substantial evidence of a significant reduction in all-cause death (RR: 0.529 (0.454–0.616), P < 0.001)) in the bedaquiline treatment group. There was no significant reduction in treatment success (RR = 0.980 (0.948–1.013, P = 0.234)).

Conclusions

This study demonstrated that compared with patients who do not receive bedaquiline, this drug has the potential to achieve a higher culture conversion rate and a lower mortality risk among drug-resistant tuberculosis cases.
Clinical characteristics and outcomes of neonates with polymicrobial ventilator-associated pneumonia in the intensive care unit
Authors: Wang Hsiao-Chin , Tsai Ming-Horng , Chu Shih-Ming , Liao Chen-Chu , Lai Mei-Yin , Huang Hsuan-Rong , Chiang Ming-Chou , Fu Ren-Huei , Hsu Jen-Fu
Published: September 2021

Background

Ventilator associated pneumonia (VAP) caused by more than one microorganisms is not uncommon and may be potentially challenging, but the relevant data is scarce in ventilated neonates. We aimed to investigate the clinical characteristics and outcomes of polymicrobial VAP in the neonatal intensive care unit (NICU).

Methods

All neonates with definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and September 2020 were prospectively observed and enrolled for analyses. All clinical features, therapeutic interventions and outcomes were compared between the polymicrobial VAP and monomicrobial VAP episodes. Multivariate regression analyses were used to find the independent risk factors for treatment failure.

Results

Among 236 episodes of neonatal VAP, 60 (25.4%) were caused by more than one microorganisms. Polymicrobial VAP episodes were more likely to be associated with multidrug-resistant pathogens (53.3% versus 34.7%, P = 0.014), more often occurred in later days of life and in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. Otherwise most clinical characteristics of polymicrobial VAP were similar to those of monomicrobial VAP. The therapeutic responses and treatment outcomes were also comparable between these two groups, although modification of therapeutic antibiotics were significantly more common in polymicrobial VAP episodes than monomicrobial VAP episodes (63.3% versus 46.2%; P < 0.001). None of any specific pathogens was significantly associated with worse outcomes. Instead, it is the severity of illness, including presence of concurrent bacteremia, septic shock, and requirement of high-frequency oscillatory ventilator and underlying neurological sequelae that are independently associated with treatment failure.

Conclusions

Polymicrobial VAP accounted for 25.4% of all neonatal VAP in the NICU, and frequently occurred in neonates with prolonged intubation and underlying bronchopulmonary dysplasia. In our cohort, most clinical features, therapeutic responses and final outcomes of neonates with monomicrobial and polymicrobial VAP did not differ significantly.
The prevalence of denture stomatitis in cigarette and hookah smokers and opium addicts: findings from Rafsanjan Cohort Study
Authors: Sardari Farimah , Khalili Parvin , Hakimi Hamid , Mahmoudaghaei Saadat , Abedi Pouya
Published: September 2021

Background

The aim of this study was to investigate the association of denture stomatitis prevalence with cigarette, hookah and opium consumption and also dose–response relationship between the cigarette smoking duration and odds of denture stomatitis in population of Rafsanjan cohort center.

Methods

This cross-sectional study based on data of Rafsanjan Cohort Study (RCS) with 10,000 participants. After applying inclusion and exclusion criteria, 1619 participants were included in the analysis. Data were collected by oral examination and completion of pre-designed questionnaires to assess denture hygiene, smoking behavior, opium use and some other exposure variables. Multivariable logistic regression models were fitted to investigate possible association of cigarette, hookah and opium consumption and denture stomatitis.

Results

Prevalence of denture stomatitis among all 1619 denture wearers was 21.6%. Cigarette smoking was associated with a higher odds of denture stomatitis, with the adjusted odds ratio (95% CI) of 2.29 (1.53–3.41). Also, dose–response increases were observed with the highest odds ratio in the 4th quartile for denture stomatitis (p-value < 0.001). Opium consumption was associated with a decreased odds of denture stomatitis (adjusted OR; 0.81, 95% CI 0.58–1.13) which was not statistically significant. Also interaction between opium consumption and cigarette smoking was not associated with higher odds of denture stomatitis (adjusted OR: 1.65, 95% CI 0.85–3.22).

Conclusions

Based on the findings of the present study, while cigarette smoking had a dose–response relationship with the increased odds of denture stomatitis; this association was not found with opium consumption.
Quality of complementary and alternative medicine information for type 2 diabetes: a cross-sectional survey and quality assessment of websites
Authors: Ng Jeremy Y. , Nayeni Manav , Gilotra Kevin
Published: September 2021

Background

The global prevalence of diabetes mellitus is projected to reach approximately 700 million by the year 2045, with roughly 90–95% of all diabetes cases being type 2 in nature. Patients with type 2 diabetes mellitus (T2DM) frequently seek information about complementary and alternative medicine (CAM) online. This study assessed the quality of publicly accessible websites providing consumer health information at the intersection of T2DM and CAM.

Methods

An online search engine (Google) was searched to identify pertinent websites containing information specific to CAM for T2DM patients, and the relevant websites were then screened with an eligibility criteria. Consumer health information found on eligible websites were then assessed for quality using the DISCERN instrument, a 16-item standardized scoring system.

Results

Across the 480 webpages identified, 94 unique webpages remained following deduplication, and 37 eligible webpages belonged to and were collapsed into 30 unique websites that were each assessed using the DISCERN instrument. The mean overall quality score (question 16) across all 30 assessed websites was 3.55 (SD = 0.86), and the mean summed DISCERN score was 52.40 (SD = 12.11). Eighty percent of websites presented a wide range of CAM treatment options with the associated benefits/risks of each treatment, but in 56.7% of the websites, the sources used to collect information were unreliable.

Conclusion

This study identified, assessed, and presents findings on the quality of online CAM information for T2DM. Although there were several high scoring websites, there was variability across most of the individual DISCERN items in the assessed websites. This study highlights the importance of awareness among healthcare providers regarding the reliability of online information about CAM treatment and management options for T2DM. Healthcare providers should be aware of patients' information seeking behaviour, guide them in navigating through the content they encounter online, and provide them with resources containing trustworthy and reliable information.
Number of musculoskeletal pain sites leads to increased long-term healthcare contacts and healthcare related costs – a Danish population-based cohort study
Authors: Mose S. , Kent P. , Smith A. , Andersen J. H. , Christiansen D. H.
Published: September 2021

Background

People with musculoskeletal pain seek more healthcare than the general population, however little is known about the long-term effect on healthcare use. The aim of this study was to examine the consequences of number of musculoskeletal pain sites on long-term care-seeking and healthcare-related costs and explore how health anxiety influences this relationship.

Methods

We conducted a Danish population-based longitudinal cohort study of 4883 participants combining self-reported survey data from 2008 with ten-year follow-up data from national health registers. Using a causal inference framework, we examined associations between number of pain sites (range 0–7)/level of health anxiety (high/low level) and face-to-face healthcare contacts/healthcare-related costs. Data were analyzed using negative binomial regression with generalized estimating equations. Regression models were adjusted for sex, age, duration of pain, level of education, comorbidity, personality traits, risk of depression, marital status, physical job exposure, and previous healthcare utilization.

Results

For each additional pain site general healthcare contacts (Incidence Rate Ratio (IRR): 1.04 (95% CI: 1.03–1.05)), healthcare-related costs (IRR: 1.06 (95% CI: 1.03–1.08) and musculoskeletal healthcare contacts (IRR: 1.11 (95% CI:1.09–1.14) increased. Those with high levels of health anxiety at baseline had a slightly higher number of general healthcare contacts (IRR 1.06 (1.01–1.11), independent of number of pain sites. However, level of anxiety did not influence the effect of number of pain sites on any healthcare use or cost outcomes.

Conclusions

We found evidence for a causal association between increasing number of pain sites and greater healthcare use and cost, and high levels of health anxiety did not increase the strength of this association. This suggests that number of pain sites could be a potential target for biopsychosocial interventions in order to reduce the need for future care-seeking.
What is the impact of removing performance-based financial incentives on community health worker motivation? A qualitative study from an infant and young child feeding program in Bangladesh
Authors: Glenn Jeffrey , Moucheraud Corrina , Payán Denise Diaz , Crook Allison , Stagg James , Sarma Haribondhu , Ahmed Tahmeed , Epstein Adrienne , Luies Sharmin Khan , Rahman Mahfuzur , Kruk Margaret E. , Bossert Thomas J.
Published: September 2021

Background

Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh.

Methods

This qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach.

Results

Results suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities.

Conclusions

This study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.
Alcohol drinking and risks of liver cancer and non-neoplastic chronic liver diseases in China: a 10-year prospective study of 0.5 million adults
Authors: Im Pek Kei , Millwood Iona Y. , Kartsonaki Christiana , Guo Yu , Chen Yiping , Turnbull Iain , Yu Canqing , Du Huaidong , Pei Pei , Lv Jun , Walters Robin G. , Li Liming , Yang Ling , Chen Zhengming ,   on behalf of the China Kadoorie Biobank (CKB) collaborative group
Published: September 2021

Background

Alcohol consumption is an important risk factor for hepatic neoplastic and non-neoplastic diseases. Questions remain, however, about the relevance to disease risk of drinking patterns and alcohol tolerability, which differ appreciably between Chinese and Western populations.

Methods

The prospective China Kadoorie Biobank included 512,715 adults (41% men) aged 30–79 years recruited from ten areas during 2004–2008, recording alcohol intake, drinking patterns, and other characteristics. After median 10 years’ follow-up, 2531 incident liver cancer, 2040 liver cirrhosis, 260 alcoholic liver disease (ALD), and 1262 non-alcoholic fatty liver disease (NAFLD) cases were recorded among 492,643 participants without prior cancer or chronic liver disease at baseline. Cox regression was used to estimate adjusted hazard ratios (HR) relating alcohol intake and drinking patterns to each disease.

Results

Overall, 33% of men and 2% of women drank alcohol regularly (i.e. at least weekly) at baseline. Among male current regular drinkers, alcohol consumption showed positive dose-response associations with risks of several major chronic liver diseases, with HRs per 280 g/week (i.e. around four drinks/day) higher usual alcohol intake of 1.44 (95% CI 1.23–1.69) for liver cancer (n = 547), 1.83 (1.60–2.09) for liver cirrhosis (n = 388), 2.01 (1.77–2.28) for ALD (n = 200), 1.71 (1.35–2.16) for NAFLD (n = 198), and 1.52 (1.40–1.64) for total liver disease (n = 1775). The association with ALD appeared stronger among men reporting flushing (i.e., with low alcohol tolerance). After adjustment for the total amount of weekly alcohol consumption, daily drinkers had significantly increased risk of ALD (2.15, 1.40–3.31) compared with non-daily drinkers, and drinking without meals was associated with significantly greater risks of liver cancer (1.32, 1.01–1.72), liver cirrhosis (1.37, 1.02–1.85), and ALD (1.60, 1.09–2.33) compared with drinking with meals. Female current regular drinkers had significantly higher risk of ALD, but not other liver diseases, than female abstainers.

Conclusions

In Chinese men, alcohol intake was associated with significantly increased risks of several major chronic liver diseases, and certain drinking patterns (e.g. drinking daily, drinking without meals) may further exacerbate the disease risks.
Mendelian randomization rules out the causal relationship between serum lipids and cholecystitis
Authors: Yang Hongqun , Chen Lanlan , Liu Kaiyu , Li Chengnan , Li Haitao , Xiong Kezhen , Li Zehan , Lu Chuang , Chen Wei , Liu Yahui
Published: September 2021

Background

The relationship between serum lipids and cholecystitis is still under investigation. To examine the causal effect of serum lipids on cholecystitis using the Mendelian randomization method.

Methods

We conducted univariable Mendelian randomization (MR) analyses using summary statistics from two independent genome-wide association studies (GWAS) on serum lipids (n = 132,908) and cholecystitis (n = 361,194). Mainly, the inverse-variance weighted (IVW) method was utilized to combine each SNP’s causal estimation, and the MR-Egger was adopted as a complementary method, together with the weighted median. Cochrane’s Q value was employed to appraise heterogeneity. The MR-Egger intercept and MR-PRESSO were used to detect the horizontal pleiotropy.

Results

Our univariable results displayed a minor protective effect of serum low-density lipoprotein (LDL) cholesterol (OR [95% CI] = 0.9984483 [0.9984499, 0.9984468]; p = 0.008) on cholecystitis. No significant causal effect of total cholesterol (TC) (OR [95% CI] = 0.9994228 [0.9994222, 0.9994233]; p = 0.296), triglycerides (OR [95% CI] = 0.9990893 [0.9990882, 0.9990903]; p = 0.238) and high-density lipoprotein (HDL) cholesterol (OR [95% CI] = 0.9997020 [0.9997017, 0.9997023]; p = 0.565) was found on cholecystitis.

Conclusion

These findings suggest that LDL cholesterolhas a slight protective effect on cholecystitis, which can be easily affected by confounding factors. TC, triglycerides and HDL cholesterol don’t have causal effect on cholecystitis. The protective effect of serum lipids on cholecystitis, though possible, remain less certain.
Primary breast double-hit lymphoma management and outcomes: a real-world multicentre experience
Authors: Zhang Tingting , Zhang Yuanfeng , Fei Hairong , Shi Xue , Wang Liang , Wang Peijun , Yu Jie , Shen Yuyan , Feng Sizhou
Published: September 2021

Background

Primary breast double-hit lymphoma (PB-DHL) is a rare, highly aggressive malignancy that poses challenges regarding accurate diagnosis and selecting optimal treatment regimens.

Methods

We retrospectively reviewed 48 cases of patients diagnosed with PB-DHL in six academic centres between June 2014 and June 2020 in China. Study-specific data were recorded, including treatment options, therapeutic evaluation, prognostic factors and relapse patterns, and the overall survival (OS) and progression-free survival (PFS) were evaluated.

Results

In total, 48 patients were enrolled, with 14 patients treated with DA-EPOCH-R/MA (rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, alternating with high-dose methotrexate and cytarabine), 18 patients treated with DA-EPOCH-R (rituximab, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), and 16 patients treated with R-HyperCVAD (rituximab, hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone, alternating with cytarabine plus methotrexate). The overall 5-year OS and PFS rates were 41.7% (95% confidence interval [CI], 27.6–56.8%) and 37.5% (95% CI, 24.0–52.6%), respectively. Of the three treatment regimens, the 5-year OS was higher in DA-EPOCH-R/MA group than in the DA-EPOCH-R or R-HyperCVAD subgroups (57.1% vs. 38.9% vs. 31.3%; P = 0.016), as was the 5-year PFS (50.0% vs. 38.9% vs. 25.0%; P = 0.035). Autologous stem cell transplantation (ASCT) prolonged the OS and PFS compared with non-ASCT patients (5-year OS: 72.2% vs. 23.3%; P < 0.001; 5-year PFS: 72.2% vs. 16.7 %, P < 0.001). Multivariate analysis identified tumour size, risk stratification, treatment with DA-EPOCH-R/MA, breast irradiation, and ASCT as significant prognostic factors.

Conclusions

DA-EPOCH-R/MA is a promising regimen for PB-DHL, and breast irradiation yields complementary benefits for prognosis. ASCT significantly decreased disease relapse, providing a potential curative PB-DHL intervention and justifying ASCT as first-line therapy for young patients. More effective treatment strategies for PB-DHL patients remain encouraging.
Cancer and diabetes: the interlinking metabolic pathways and repurposing actions of antidiabetic drugs
Authors: Olatunde Ahmed , Nigam Manisha , Singh Rahul Kunwar , Panwar Abhaya Shikhar , Lasisi Abdulwahab , Alhumaydhi Fahad A. , Jyoti kumar Vijay , Mishra Abhay Prakash , Sharifi-Rad Javad
Published: September 2021

Cancers are regarded as one of the main causes of death and result in high health burden worldwide. The management of cancer include chemotherapy, surgery and radiotherapy. The chemotherapy, which involves the use of chemical agents with cytotoxic actions is utilised as a single treatment or combined treatment. However, these managements of cancer such as chemotherapy poses some setbacks such as cytotoxicity on normal cells and the problem of anticancer drug resistance. Therefore, the use of other therapeutic agents such as antidiabetic drugs is one of the alternative interventions used in addressing some of the limitations in the use of anticancer agents. Antidiabetic drugs such as sulfonylureas, biguanides and thiazolidinediones showed beneficial and repurposing actions in the management of cancer, thus, the activities of these drugs against cancer is attributed to some of the metabolic links between the two disorders and these includes hyperglycaemia, hyperinsulinemia, inflammation, and oxidative stress as well as obesity. Furthermore, some studies showed that the use of antidiabetic drugs could serve as risk factors for the development of cancerous cells particularly pancreatic cancer. However, the beneficial role of these chemical agents overweighs their detrimental actions in cancer management. Hence, the present review indicates the metabolic links between cancer and diabetes and the mechanistic actions of antidiabetic drugs in the management of cancers.
Risk factors for malaria in high incidence areas of Viet Nam: a case–control study
Authors: Maude Richard J. , Ngo Thang Duc , Tran Duong Thanh , Nguyen Binh Thi Huong , Dang Dung Viet , Tran Long Khanh , Gregory Michael , Maude Rapeephan R. , Sinha Ipsita , Pongsoipetch Kulchada , Martin Nicholas J.
Published: September 2021

Background

A key step to advancing the goal of malaria elimination in Viet Nam by 2030 is focusing limited resources for treatment and prevention to groups most at risk for malaria transmission.

Methods

To better understand risk factors for malaria transmission in central Viet Nam, a survey of 1000 malaria positive cases and 1000 malaria negative controls was conducted. Cases and controls were matched for age and gender and self-presented at commune health stations (CHS) in Binh Phuoc, Dak Nong and Dak Lak Provinces. Diagnoses were confirmed with microscopy, rapid diagnostic test and PCR. Participants were interviewed about 50 potential risk factors for malaria, which included information about occupation, forest visitation, travel, healthcare-seeking behaviour and prior use of anti-malaria interventions. Participants were enrolled by trained government health workers and the samples were analysed in Vietnamese government laboratories. Data were analysed by univariable, block-wise and multivariable logistic regression.

Results

Among cases, 61.8% had Plasmodium falciparum, 35.2% Plasmodium vivax and 3% mixed species infections. Median (IQR) age was 27 (21–36) years and 91.2% were male. Twenty-five risk factors were associated with being a case and eleven with being a control. Multivariable analysis found that malaria cases correlated with forest workers, recent forest visitation, longer duration of illness, having a recorded fever, number of malaria infections in the past year, having had prior malaria treatment and having previously visited a clinic.

Conclusions

This study demonstrates the benefits of increased statistical power from matched controls in malaria surveillance studies, which allows identification of additional independent risk factors. It also illustrates an example of research partnership between academia and government to collect high quality data relevant to planning malaria elimination activities. Modifiable risk factors and implications of the findings for malaria elimination strategy are presented.
Third party drug checking: accessing harm reduction services on the behalf of others
Authors: Larnder Ashley , Burek Piotr , Wallace Bruce , Hore Dennis K.
Published: September 2021

Background

Drug checking uses chemical analytical technologies to analyze drugs from the unregulated market to reduce substance use-related risks. We aim to examine the frequency of third party use of a community drug checking service to explore the potential for harm reduction to extend beyond the individual into the community, increase service accessibility, and to contribute to upstream interventions in the supply.

Methods

Over 31 months, data were collected from a point-of-care drug checking service operated in Victoria, Canada. Through the implementation of survey questions at the intake of the service, data were collected about whether the drug check was for the individual, to sell, and/or for others.

Results

Just over half (52%) of service users were checking for reasons that extended beyond individual use. When checking for others, friends were the most common response, representing 52% of responses, and outreach/support workers checking for others was the second most at 32%. Twelve percent of service users reported checking to sell or for a supplier.

Conclusions

Third party checking is a frequent, and important aspect of drug checking services, which through facilitating community engagement and increasing accessibility, has expanded the reach of interventions beyond individuals to reduce risks within the unregulated market. Therefore, drug checking as an overdose response should be responsive and accessible for those using the service on the behalf of others.