bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec’s health services register cohort
Authors: Lunghi Carlotta , Cailhol Lionel , Massamba Victoria , Laouan Sidi Elhadji A. , Sirois Caroline , Rahme Elham , Rochette Louis , Renaud Suzane , Villeneuve Evens , Koch Marion , Biskin Robert , Martineau Cathy , Vincent Philippe , David Pierre , Lesage Alain
Published: November 2023

Background

Cluster B personality disorders (PDs) are considered some of the most severe mental health conditions. Scarce evidence exists about the real-world utilization of psychotropics for cluster B PD individuals.

Objective

We aimed to uncover trends and patterns of psychotropic medication use among individuals diagnosed with cluster B PD in the year before and after their diagnosis and to identify factors associated with medication use in a large cohort of individuals newly diagnosed with cluster B PDs.

Methods

We conducted a population-based observational study using Quebec’s health services register. We identified Quebec residents aged ≥14 years and insured with the provincial drug plan with a first diagnosis of cluster B PD recorded between April 1, 2002, and March 31, 2019. Cluster B PD was defined with ICD-9/10 diagnostic codes. We retrieved all claims for the main psychotropic medication classes: antipsychotics, antidepressants, anxiolytics, mood stabilizers, and attention-deficit/hyperactivity disorder (ADHD) medications. We calculated the proportion of individuals exposed to these medication classes and analyzed trends over the years using robust Poisson regression models, adjusting for potential confounders. We used robust Poisson regression to identify factors associated with medication class use.

Results

We identified 87,778 new cases of cluster B PD, with a mean age of 44.5 years; 57.5% were women. Most frequent psychiatric comorbidities in the five years before cluster B PD diagnosis were depression (50.9%), anxiety (49.7%), and psychotic disorders (37.5%). Most individuals (71.0%) received at least one psychotropic during the year before cluster B PD diagnosis, and 78.5% received at least one of these medications in the subsequent year. The proportion of users increased after the diagnosis for antidepressants (51.6–54.7%), antipsychotics (35.9–45.2%), mood stabilizers (14.8–17.0%), and ADHD medications (5.1–5.9%), and remained relatively stable for anxiolytics (41.4–41.7%). Trends over time showed statistically significant increased use of antipsychotics and ADHD medications, decreased use of anxiolytics and mood stabilizers, and a stable use of antidepressants.

Conclusion

Psychotropic medication use is highly prevalent among cluster B PD individuals. We observed an increase in medication use in the months following the diagnosis, particularly for antipsychotics, antidepressants, and mood stabilizers.
Pediatric collaborative care outcomes in a regional model
Authors: Parkhurst John T. , Garcia-Goetting Catherine , Peist Eric , Ballard Rachel , Romba Courtney , Lavigne John V.
Published: November 2023

Background

Despite the movement toward hospital-based medical centers acquiring pediatric primary care offices, many primary care pediatricians still work in small, independent practices. To expand mental healthcare access, service delivery models must consider primary care practice needs and regionally available resources.

Objective

This report describes the implementation and evaluation of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program over a 4 years period. MAACC. MAACC engaged 97 pediatric primary care clinicians across 39 practices in mental health training and supported the treatment of referred patients through a collaborative care model. To support psychosocial treatment needs, we built a child community therapy referral network of 213 licensed psychotherapy providers.

Methods

Data were collected on service delivery patterns (e.g., referrals, treatment use, and attrition) and patient outcomes. Measures included parent and children and adolescents PROMIS anxiety and depression short forms and the Parent NICHQ Vanderbilt.

Results

Six hundred ninety-six children and adolescents aged 6–18 were evaluated and provided treatment recommendations. Anxiety disorders were the most common diagnosis (45.4%), followed by ADHD (30.7%) and mood disorder (17%). For children and adolescents with an anxiety or mood disorder, significant improvement was observed from baseline to any initial follow-up and from baseline to 6, 12-, and 18 weeks on children and adolescents and parent measures of anxiety and depression. For children and adolescents with ADHD, significant improvement was observed from baseline to any initial follow-up measure and at 6 and 18 weeks on parent-reported inattentive symptoms. Significant differences in treatment outcomes were identified for children and adolescents with anxiety receiving psychotherapy alone and medication management and psychotherapy.

Conclusion

MAACC utilization and patient outcomes suggest that real-world collaborative care can effectively provide high-quality care while cultivating increased primary care treatment capacity and building on existing community resources.
Experiences of individuals with intellectual disability who lecture in higher education
Authors: Mevold Silje , Johansen Leif Inge , Wynn Rolf , Ramsdal Gro H.
Published: November 2023

Introduction

Prior studies have suggested that adults with intellectual disabilities who are in employment in general report a high level of well-being and life satisfaction. Less is known about which experiences and outcomes that are most important for the experiences of those who are employed.

Methods

We interviewed six persons with intellectual disabilities that worked as lecturers at a health and social education programme at a university about which experiences and outcomes that they believed were of importance to their work experiences.

Results

The participants spontaneously focused on three main themes that described their experiences with work: the high degree of autonomy at work, their involvement in positive new relationships, and their experiences of accomplishment and coping on new social arenas. Although there were challenges, these were often overcome by working closely with another teacher.

Discussion

The three main themes by which the participants described their work experiences and outcomes can be related to the concepts of autonomy, relatedness, and competence. The experiences described by the participants are valuable for the future facilitation of work assignments for people with intellectual disability in ordinary working life.
The relationship between addiction and hikikomori tendencies: a case-control study
Authors: Muris Peter , van de Pasch Veerle , van Kessel Janno , Peet Josine
Published: November 2023

Aim

The present study examined the relationship between addiction and hikikomori (extreme social withdrawal) symptoms.

Method

A group of clinically referred addiction patients (n = 31) and a group of age- and gender-matched non-clinical controls (n = 34) completed a self-report scale for measuring hikikomori symptoms (the Hikikomori Questionnaire-25) along with some other questionnaires assessing substance use (frequency and severity) and quality of life.

Results

The results showed that addiction patients displayed significantly higher levels of hikikomori symptoms than the non-clinical control (Cohen's d = 3.41); 87.1% even showed such a high score that they were identified as being at risk for the hikikomori syndrome (vs. only 2.9% in the non-clinical control group). Correlational analyses revealed that within the addiction group, the severity of the substance use problem (as quantified by an index of craving) correlated positively with the level of hikikomori symptoms and negatively with quality of life. In other words, the more severe the addiction, the more extreme the social withdrawal tendencies and the lower the quality of life.

Conclusion

Altogether, the findings provide further support for the marked social impairments of people with substance use problems and underline that this should be an important target of intervention.
Early disruptions to syringe services programs during the Russian invasion of Ukraine
Authors: Nikitin Benjamin M. , Bromberg Daniel J. , Pykalo Iryna , Ivasiy Roman , Islam Zahedul , Altice Frederick L.
Published: November 2023

Introduction

The widespread HIV epidemic in Ukraine is concentrated among people who inject drugs (PWID), making access to sterile injection paraphernalia (SIP) like sterile needles and syringes a critical method of HIV/AIDS prevention; however, the Russian invasion has threatened to disrupt the operations of syringe services programs (SSPs), creating a risk of HIV outbreaks among PWID.

Methods

We conducted 10 semi-structured interviews with outreach workers from SSPs. Interviews were purposively sampled to cover three prototypic regions of Ukraine: temporarily Russian-controlled, frontline, and destination. Qualitative results from interviews were then compared against a standardized, nationwide harm reduction database.

Results

We found that the Russian invasion triggered both supply and demand challenges for SSPs. Demand increased for all regions due to client transitions from pharmacies that closed to SSPs, increases in illicit drug use, greater client openness to NGO support, and displacement of clients to destination regions. Supply decreased for all areas (except for remote destination regions) due to battle-related barriers like curfews, roadblocks, and Internet disruptions; diminished deliveries of SIP and funding; and staff displacement. Time series plots of the number of unique clients accessing harm reduction services showed that an initial decrease in service provision occurred at the start of the war but that most regions recovered within several months except for Russian-controlled regions, which continued to provide services to fewer clients relative to previous years.

Conclusion

To ensure continued scale-up of SIP and other HIV prevention services, the SyrEx database should be leveraged to serve as a streamlined harm reduction locator that can inform workers and clients of open site locations and other pertinent information.
Mediating effects of workgroup processes on the relationship between nurse turnover and nurse outcomes in hospitals
Authors: Bae Sung-Heui , Kim Suin , Myung Hwasook
Published: November 2023

Background

Nurse turnover is often considered to be an outcome, and few studies have investigated its consequences in nursing care. The underlying mechanism of the nurse turnover–nurse outcome relationship has not been empirically investigated. Therefore, this study examines workgroup processes and nurse outcomes as the consequences of nurse turnover and the mediating effect of workgroup processes on the nurse turnover–nurse outcomes relationship.

Methods

A cross-sectional design was adopted to investigate the data collected from 264 staff nurses. Furthermore, six-month turnover rates, workgroup processes (nurse–nurse collaboration, team cohesion), and nurse outcomes (job satisfaction, intent to leave) were utilized in the multivariate regression models.

Results

Overall, 53 (24.4%) nurses had worked in nursing units with a zero six-month turnover rate. The average mean six-month turnover rate was 15.5%. Nurse turnover adversely affected nurses’ job satisfaction and several subscales of team cohesion including task cohesion and social cohesion. Team cohesion partially mediated the relationship between nurse turnover and job satisfaction.

Conclusion

Nurse turnover decreased job satisfaction and team cohesion, and team cohesion partially mediated the nurse turnover–nurse outcomes relationship. These findings provide evidence supporting the significant adverse effects of nurse turnover and suggest the potential role of workgroup processes in explaining the underlying mechanism of the relationship between nurse turnover and nurse outcomes.

Implications for nursing and health policy

Healthcare organizations must create a positive work environment to reduce nurse turnover. Further, states and countries should try to develop and establish nursing and health policies to prevent turnover.
Determinants and indicators of successful aging as a multidimensional outcome: a systematic review of longitudinal studies
Authors: Rodrigues Caue Egea , Grandt Caine Lucas , Alwafa Reem Abu , Badrasawi Manal , Aleksandrova Krasimira
Published: November 2023

Background

Successful aging (SA) has been coined as a term to describe the multidimensional aspects associated with achieving optimal combination of physical and mental health along with social well-being health, mental and social well-being at older age. In recent years there has been an increased interest in understanding the role of determinants of SA, such as demographic, biological, behavioral, psychological and social factors. To synthesize the recent evidence, we conducted a systematic review of longitudinal studies on a range of determinants and indicators of SA defined as a multidimensional outcome.

Methods

A systematic search of PubMed, MEDLINE and Web of Science for finding eligible papers published between August 2016 and June 2023 was conducted following the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (Registration number: CRD42021250200). The web-based automated screening tool–Rayyan–was used for title and abstract screening. The study quality was assessed using the Quality in Prognosis Studies (QUIPS) tool.

Results

A total of 3,191 records were initially identified using the predefined search strategy. Out of 289 articles selected for full text screening, 22 were found eligible and included in the review. A variety of factors have been explored in relation to SA, ranging from socio-demographic factors, nutrition, lifestyle, biological pathways, psychological health, and well-being. Overall, the results of recent studies have confirmed the role of metabolic health, adherence to healthy dietary patterns, such as the Mediterranean diet, physical activity, non-smoking, and higher socio-economic status as main factors associated with higher odds for SA. Emerging research highlights the role of psycho-social factors and early life health as determinants of SA.

Conclusion

In summary, this review highlights the importance of healthy living and monitoring metabolic risk along with sustaining psychological well-being in adult life as major determinants of SA. Further methodological and research work on SA would pave the way toward development of adequate health promotion policies in aging societies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250200, CRD42021250200.
Is the COVID-19 epidemic affecting the body mass of Chinese teenagers? – A longitudinal follow-up study
Authors: Qin Guoyang , Li Hui , Qin Yong , Liu Bin
Published: November 2023

Background

After the spread and outbreak of COVID-19 worldwide, the learning, lifestyle, and health level of young individuals have been immensely impacted. With regard to the existing studies, the development trend of adolescents’ body shape in the late COVID-19 period is not sufficiently analyzed, and relevant targeted investigation is lacking. This study aimed to explore the body mass index (BMI) changes of 6–14 years-old adolescents before and after the COVID-19 epidemic, and to provide a reference for promoting the continuous enhancement of adolescent health.

Methods

The BMI and related data pertaining to 93,046 individuals from 2019 to 2022 were collected by cluster sampling, and changes in the BMI Z score and detection rate of overweight and obese adolescents before and after the epidemic were analyzed. Furthermore, the trend of obesity rates among adolescents in Jinan from 2019 to 2022 was analyzed using a logistic regression analysis model.

Results

The one-way ANOVA models indicated that the BMI Z score of 6–14 years-old adolescents in 2020 significantly increased compared to 2019 (p < 0.01), and decreased in 2021 and 2022; in 2020, the obesity rate of adolescents exhibited a significant increase; however, the rate decreased after being controlled in 2021 and 2022. The normal-body size proportion continued to rise (p < 0.01), and adolescents of different age groups and genders exhibited similar development trends; the results of the logistic regression analysis indicate that there was a significant increase in obesity rates in 2020, adolescents of different age groups and genders exhibited similar development trends (p < 0.05).

Conclusion

This study demonstrated that the COVID-19 epidemic impacts the BMI and obesity detection rate of adolescents. Adolescents from different age groups and genders exhibited similar development trends.
Sexually transmitted diseases knowledge assessment and associated factors among university students in the United Arab Emirates: a cross-sectional study
Authors: Alshemeili Abdulla , Alhammadi Ahmed , Alhammadi Abdulrahman , Al Ali Mohamed , Alameeri Eisa Saud , Abdullahi Aminu S. , Abu-Hamada Bayan , Sheek-Hussein Mohamud M. , Al-Rifai Rami H. , Elbarazi Iffat
Published: November 2023

Background

Sexually transmitted diseases and infections (STDIs) remain a serious public health menace with over 350 million cases each year. Poor knowledge of STDIs has been identified as one of the bottlenecks in their control and prevention. Hence, assessment of knowledge, both general and domain-specific, is key to the prevention and control of these diseases. This study assessed the knowledge of STDIs and identified factors associated with STDI knowledge among university students in the United Arab Emirates (UAE).

Methods

This is a cross-sectional study among 778 UAE University students across all colleges. An online data collection tool was used to collect data regarding the participants' demographics and their level of knowledge of STDIs across different domains including general STDI pathogens knowledge (8 items), signs and symptoms (9 items), mode of transmission (5 items), and prevention (5 items). Knowledge was presented both as absolute and percentage scores. Differences in STDI knowledge were statistically assessed using Mann-Whitney U and Chi-squared tests. Logistic regression models were further used to identify factors associated with STDI knowledge.

Results

A total of 778 students participated in the study with a median age of 21 years (IQR = 19, 23). The overall median STDI knowledge score of the participants was 7 (out of 27), with some differences within STDI domains–signs & symptoms (1 out of 9), modes of transmission (2 out of 5), general STDI pathogens (2 out of 8), and prevention (1 out of 5). Higher STDI knowledge was significantly associated with being non-Emirati (OR = 1.85, 95% CI = 1.24–2.75), being married (OR = 2.89, 95% CI = 1.50–5.56), residing in emirates other than Abu Dhabi (OR = 1.61, 95% CI = 1.16–2.25), and being a student of health sciences (OR = 4.45, 95% CI = 3.07–6.45).

Conclusion

In general, STDI knowledge was low among the students. Having good knowledge of STDIs is essential for their prevention and control. Therefore, there is a need for informed interventions to address the knowledge gap among students, youths, and the general population at large.
Association between acoustic features and brain volumes: the Framingham Heart Study
Authors: Ding Huitong , Hamel Alexander P. , Karjadi Cody , Ang Ting F. A. , Lu Sophia , Thomas Robert J. , Au Rhoda , Lin Honghuang
Published: November 2023

Introduction

Although brain magnetic resonance imaging (MRI) is a valuable tool for investigating structural changes in the brain associated with neurodegeneration, the development of non-invasive and cost-effective alternative methods for detecting early cognitive impairment is crucial. The human voice has been increasingly used as an indicator for effectively detecting cognitive disorders, but it remains unclear whether acoustic features are associated with structural neuroimaging.

Methods

This study aims to investigate the association between acoustic features and brain volume and compare the predictive power of each for mild cognitive impairment (MCI) in a large community-based population. The study included participants from the Framingham Heart Study (FHS) who had at least one voice recording and an MRI scan. Sixty-five acoustic features were extracted with the OpenSMILE software (v2.1.3) from each voice recording. Nine MRI measures were derived according to the FHS MRI protocol. We examined the associations between acoustic features and MRI measures using linear regression models adjusted for age, sex, and education. Acoustic composite scores were generated by combining acoustic features significantly associated with MRI measures. The MCI prediction ability of acoustic composite scores and MRI measures were compared by building random forest models and calculating the mean area under the receiver operating characteristic curve (AUC) of 10-fold cross-validation.

Results

The study included 4,293 participants (age 57 ± 13 years, 53.9% women). During 9.3 ± 3.7 years follow-up, 106 participants were diagnosed with MCI. Seven MRI measures were significantly associated with more than 20 acoustic features after adjusting for multiple testing. The acoustic composite scores can improve the AUC for MCI prediction to 0.794, compared to 0.759 achieved by MRI measures.

Discussion

We found multiple acoustic features were associated with MRI measures, suggesting the potential for using acoustic features as easily accessible digital biomarkers for the early diagnosis of MCI.
BPSD reconsidered: diagnostic considerations to preserve personhood in persons with dementia
Authors: Warren Alison
Published: November 2023

BPSD is relatively common but profoundly disturbing to persons with dementia, their family, and caregivers. Growing recognition of the impact of BPSD on quality of life has improved recently, but assessment and management approaches are still lacking. Considerable controversy surrounding the label of BPSD has garnered a great deal of attention, with implications of its contribution to the already pervasive dementia-related stigma experienced by persons with dementia and their caregivers. This brief review aims to summarize salient viewpoints, controversies, and considerations of the assessment, management, and perception of BPSD, in an effort to offer potential recharacterizations of BPSD to promote and prioritize personhood in persons with dementia.
Enhancing sensitivity and versatility of Tn5-based single cell omics
Authors: Seufert Isabelle , Sant Pooja , Bauer Katharina , Syed Afzal P. , Rippe Karsten , Mallm Jan-Philipp
Published: November 2023

The analysis of chromatin features in single cells centers around Tn5 transposase and exploits its activity to simultaneously fragment target DNA and integrate adapter sequences of choice. This reaction provides a direct readout in the assay for transposase-accessible chromatin in single cells (scATAC-seq) to map open chromatin loci. However, a current limitation is the sparse coverage of these open sites in a given single cell by droplet-based methods. Thus, enhancing Tn5 activity to improve genomic coverage of scATAC-seq or facilitating multi-omics readouts of chromatin features via Tn5 together with the transcriptome is of great interest. Here, we address these issues by optimizing scATAC-seq for an increased number of integrations per cell. In addition, we provide a protocol that combines mapping of histone modification with scRNA-seq from the same cell by targeting Tn5 to antibody-bound chromatin epitopes. Our experimental workflows improve the results obtained from the downstream data analysis and serve to better resolve epigenetic heterogeneity and transcription regulation in single cells.
Health research systems in Somaliland: a qualitative study on perspectives of government and non-governmental staff
Authors: Ahmed Soheir H. , Kiruja Jonah , Solieman Ayanle , Wangamati Cynthia Khamala
Published: November 2023

Background

Globally, the importance of effective national health research systems has gained considerable attention. Literature indicates low research output in Africa; Africa accounts for only 2% of the world's research output and 1.3% of global publications. In Somaliland, where provision of quality healthcare services is crucial, understanding and enhancing the health research system is a critical endeavor.

Aim

The aim of this study is to explore the perspectives of government and non-governmental stakeholders on the health research systems in Somaliland.

Method

The study employed an exploratory qualitative study design that entailed in-depth interviews with participants. Thirty-four study participants were interviewed; they included key persons in the academic and health sector, government and international and local non-governmental organisations (NGOs) involved in health research systems. A semi structured interview guide was used to conduct the in-depth interviews with purposively selected participants. The collected data was analyzed thematically.

Findings

We found that there was no national health research center in Somaliland. The country also lacked a national health research policy. There was limited funding for research, funds were mostly from international organisations and researchers' own funds. In addition, staff working in research centers were ill equipped to conduct research and study participants highlighted the need for national health research governance.

Conclusion

This study highlights the importance of health research systems in Somaliland. We recommend the establishment of a national health research institute, development of a national health research policy and priorities, allocation of sufficient and sustainable funding, capacity building of staff and strengthening of the national health research governance in health research systems.
Genetic research with Indigenous Peoples: perspectives on governance and oversight in the US
Authors: Garrison Nanibaa' A. , Carroll Stephanie Russo
Published: November 2023

Introduction

Indigenous Peoples are increasingly exerting governance and oversight over genomic research with citizens of their nations, raising questions about how best to enforce research regulation between American Indian, Alaska Native, and Native Hawaiian peoples and researchers.

Methods

Using a community-engaged research approach, we conducted 42 semi-structured interviews with Tribal leaders, clinicians, researchers, policy makers, and Tribal research review board members about their perspectives on ethical issues related to genetics research with Indigenous Peoples in the US.

Results

We report findings related to (1) considerations for Indigenous governance, (2) institutional relationships upholding sovereignty, (3) expectations for research approvals, and (4) agreements enacting Indigenous governance. Participants described concerns about different ways of exerting oversight, relationships and agreements between Indigenous Peoples and researchers, and gaps that need to be addressed to strengthen existing governance of genomic data.

Discussion

The results will ultimately guide policy-making and development of new strategies for Indigenous Peoples to enforce oversight in research to promote ethically and culturally appropriate research.
Artificial consciousness: the missing ingredient for ethical AI?
Authors: Chella Antonio
Published: November 2023

Can we conceive machines that can formulate autonomous intentions and make conscious decisions? If so, how would this ability affect their ethical behavior? Some case studies help us understand how advances in understanding artificial consciousness can contribute to creating ethical AI systems.
Enhancing skill learning with dual-user haptic feedback: insights from a task-specific approach
Authors: Zhang Yao , Wang Olyvia , Wang Yanqing , Tavakoli Mahdi , Zheng Bin
Published: November 2023

Introduction: This study was to examine whether inter-user haptic feedback would have a differential impact on skill acquisition based on the nature of the surgical task involved. Specifically, we hypothesized that haptic feedback would facilitate target orientation more than cutting tasks in the context of laparoscopic surgery.

Methods: Ten novice participants were recruited and assigned to one of two training groups. Each group underwent six half-hour training sessions dedicated to laparoscopic pattern-cutting tasks. In the haptic group, five participants received expert guidance during the training sessions, whereas the remaining five participants in the control group engaged in self-practice. All trials were recorded on video, enabling a comparative analysis of task performance between the participants’ left hand (target manipulation) and right hand (cutting task). Additionally, the number of haptic feedback instances provided to the trainees in the haptic group was recorded.

Results: Practice led to a reduction in total task time, grasping time, and cutting errors. However, no significant differences were observed between the two training groups, except for the grasping time, where haptic feedback significantly reduced the grasping time compared to the control group. Moreover, the frequency of haptic feedback instances provided to the trainees was notably higher for the grasping than for the cutting task.

Discussion: Our study suggests that haptic feedback has a more substantial impact on orientation tasks than on cutting tasks in laparoscopic surgery training. However, we acknowledge that a larger sample size would provide a more robust evaluation of this effect.
Challenges and opportunities from water under soft nanoconfinement
Authors: Mezzenga Raffaele
Published: November 2023

Nanoconfined water differs significantly from bulk water and challenges our common understanding of liquid water in both its most fundamental features, as well as in many applied aspects which stem out from its peculiar behavior. This brief perspective pinpoints both challenges associated with the study of water under soft nanoconfinement as well as some opportunities which arise from it, and which would not be at reach with standard bulk water. A special focus is given to the strong nanoconfinement (∼1–10 nm) offered by inverse lipidic mesophases, viewed as a natural soft nanoconfinement environment for water.
‘Total pain’: reverence and reconsideration
Authors: Rattner Maxxine
Published: November 2023

Dame Cicely Saunders’ conceptualization of ‘total pain’, or ‘total suffering’, is one of her most significant and lasting contributions to the field of palliative care. It was Saunders’ unique combination of knowledge and experiences as a trained social worker, nurse and physician that influenced her understanding of suffering specific to a life-limiting illness as being multi-dimensional: that suffering may be simultaneously physical, psychological, emotional, social, spiritual and/or existential in nature. ‘Total pain’ remains a highly relevant and significant concept within palliative care and Saunders’ lasting contributions are to be revered. This paper invites us to reconsider one particular aspect of Saunders’ conceptualization: that patients’ ‘mental reactions’ to their anticipated dying/death is a key contributor to their ‘total pain’. Drawing upon Saunders’ works from the late 1950s to the early 2000s, this paper details the socio-historical manifestation of this aspect of ‘total pain’ within Saunders’ writings, including influences from her Christian religion and Viktor Frankl, and its enduring impact on palliative care philosophy, practice, and discourse. Then, drawing upon patient stories rooted in my own clinical experiences over a 10 year period as a hospice social worker, I suggest that this particular feature of Saunders’ ‘total pain’ may, unintentionally, work to pathologize both the patient for whom suffering persists and remains unsolvable, and the palliative care clinician who may struggle to relieve it — and why it therefore stands to be revisited. It is my sincere hope and intention that ongoing reverence for Saunders’ significant contributions can sit alongside respectful reconsideration.
Combined effect of age and body mass index on postoperative mortality and morbidity in laparoscopic cholecystectomy patients
Authors: Fakhoury Hana M. A. , Yousef Ziad , Tamim Hani , Daher Sarah , Attasi Abdul Aleem , Al Ajlan Abdulaziz , Hajeer Ali H.
Published: November 2023

Background

Previous studies have assessed the impact of age and body mass index (BMI) on surgery outcomes separately. This retrospective cohort study aimed to investigate the combined effect of age and BMI on postoperative mortality and morbidity in patients undergoing laparoscopic cholecystectomy.

Methods

Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database for laparoscopic cholecystectomy patients between 2008 and 2020 were analyzed. Patient demographics, functional status, admission sources, preoperative risk factors, laboratory data, perioperative variables, and 30-day postoperative outcomes were included in the dataset. Logistic regression was used to determine the association of age, BMI, and age/BMI with mortality and morbidity. Patients were stratified into different subcategories based on their age and BMI, and the age/BMI score was calculated. The chi-square test, independent sample t-test, and ANOVA were used as appropriate for each category.

Results

The study included 435,052 laparoscopic cholecystectomy patients. Logistic regression analysis revealed that a higher age/BMI score was associated with an increased risk of mortality (adj OR 13.13 95% CI, 9.19–18.77, p < 0.0001) and composite morbidity (adj OR 2.57, 95% CI 2.23–2.95, p < 0.0001).

Conclusion

Older age, especially accompanied by a low BMI, appears to increase the post-operative mortality and morbidity risks in laparoscopic cholecystectomy patients, while paradoxically, a higher BMI seems to be protective. Our hypothesis is that a lower BMI, perhaps secondary to malnutrition, can carry a greater risk of surgery complications for the elderly. Age/BMI is strongly and positively associated with mortality and morbidity and could be used as a new scoring system for predicting outcomes in patients undergoing surgery. Nevertheless, laparoscopic cholecystectomy remains a very safe procedure with relatively low complication rates.
Feasibility and safety of one-stage sacral laminoplasty with autologous sacral laminar reimplantation fixed by absorbable fixation clamps in direct microsurgical treatment of symptomatic sacral extradural spinal meningeal cysts
Authors: Yin Xiaoliang , Zhang Jia , Ma Qianquan , Chen Suhua , Wu Chao , Yang Chenlong , Si Yu , Jiang Haihui , Guo Wei , Liu Ying , Yuan Huishu , Yang Jun , Sun Jianjun
Published: November 2023

Introduction

Sacral laminoplasty with titanium mesh and titanium screws can reduce symptomatic sacral extradural spinal meningeal cysts (SESMCs) recurrence and operation complications. However, due to a defect or thinning of the sacrum, the screws cannot be securely anchored and there are also problems with permanent metal implantation for titanium mesh and screws. We propose that sacral laminoplasty with absorbable clamps can provide rigid fixation even for a thinned or defected sacrum without leaving permanent metal implants.

Methods

In the direct microsurgical treatment of symptomatic SESMCs, we performed one-stage sacral laminoplasty with autologous sacral lamina reimplantation fixed by absorbable fixation clamps. Retrospectively, we analyzed intraoperative handling, planarity of the sacral lamina, and stability of the fixation based on clinical and radiological data.

Results

Between November 2021 to October 2022, we performed sacral laminoplasty with the absorbable craniofix system in 28 consecutive patients with SESMCs. The size of the sacral lamina flaps ranged from 756 to 1,052 mm2 (average 906.21 ± 84.04 mm2). We applied a minimum of two (in four cases) and up to four (in four cases) Craniofix clamps in the operation, with three (in 20 cases) being the most common (82.14%, 20/28) and convenient to handle. Excellent sacral canal reconstruction could be confirmed intraoperatively by the surgeons and postoperatively by CT scans. No intraoperative complications occurred.

Conclusions

One-stage sacral laminoplasty with absorbable fixation clamps is technically feasible, and applying 3 of these can achieve a stable fixation effect and are easy to operate. Restoring the normal structure of the sacral canal could reduce complications and improve surgical efficacy.
Reliability and interobserver variability of a grading system of ventricular distension in dogs
Authors: Czerwik Adriana , Schmidt Martin Jürgen , Olszewska Agnieszka , Hinz Steven , Büttner Kathrin , Farke Daniela
Published: November 2023

Introduction

Internal hydrocephalus is the most common malformation of the central nervous system in dogs. Although the grades of ventricular distension have importance for long-term prognosis, there is no standard classification scheme describing the grade of the ventricular distension in dogs.

Materials and methods

Magnetic resonance imaging (MRI) scans from 147 dogs of various breed, sex, skull conformation, and weight were reviewed retrospectively and blinded between three observers. Based on objectively assessable morphologic characteristics, the lateral cerebral ventricles were graded as normal, minimally, mildly, moderately, severely enlarged or end stage (grade 0 to grade 5), respectively. Evans’ index or the ventricle brain index was also measured in all animals. Interobserver agreement between a very experienced, experienced, and unexperienced person was evaluated by the Spearman coefficient and kappa tests. Additionally, correlation to the ventricle brain index was determined using the Spearman coefficient and F-tests.

Results

The Spearman correlation coefficient reached a very strong correlation (r = 0.97) between the experienced and very experienced observer and a strong correlation (r = 0.91) between the very experienced and unexperienced observer. The kappa value revealed excellent interobserver agreement between the very experienced and experienced observers (weighted kappa 0.91) and moderate between the very experienced and unexperienced observers (weighted kappa 0.75). The ventricular-brain index correlated (r = 0.94, Spearman coefficient test) with the grading system, indicating that a more elevated ratio was related to a more advanced degree of ventricular enlargement. The interobserver agreement with regard to the grade between the neurologist in training and a board-certified neurologist was excellent and between the board-certified neurologist and general practitioner achieved lower values.

Conclusion

The presented MRI-based grading of ventricular enlargement is a reliable and functional method for an objective grading of the ventricular system in dogs. Some experience in MRI and brain anatomy is needed for interpretation and grading.
Emerging threat of ranavirus: prevalence, genetic diversity, and climatic drivers of Ranavirus (Iridoviridae) in ectothermic vertebrates of Asia
Authors: Herath Jayampathi , Sun Dan , Ellepola Gajaba , Subramaniam Kuttichantran , Meegaskumbura Madhava
Published: November 2023

Introduction

Ranavirus disease, caused by viruses within the genus Ranavirus (Iridoviridae), is considered a globally emerging infectious disease linked to mass mortality events in both wild and cultured ectothermic vertebrates. Surveillance work is, however, limited in Asia hence prevalence and the dynamics of the disease remain poorly understood. To understand disease burden and the potential biotic and abiotic drivers in southern China region, we conducted a systematic surveillance of the ranavirus across Guangxi Zhuang Autonomous region (GAR).

Methods

For this, we used a multifaceted approach involving screening of amphibians and other potential hosts, diagnostic tests, phylogenetic analyses, prevalence estimation, co-infection assessments, and climatic niche analyses. Over one thousand individuals were sampled across 25 sampling sites.

Results

We found ninety-two individuals from 18 species of ectothermic vertebrates to be infected with ranavirus. Two lineages were responsible – Rana nigromaculata ranavirus and tiger frog virus were identified using phylogenetic analysis based on the major capsid protein (MCP) gene fragment. Out of these two lineages, the presence of tiger frog virus is rare as we came across only one case. We also found evidence of a co-infection with ranavirus and Batrachochytrium dendrobatidis that can be highly detrimental to host populations; possibly the first such documentation in Asia. Our niche modelling analysis suggests that precipitation seasonality plays an important role in ranavirus prevalence in GAR – southwestern, southeastern, central and northeastern regions of GAR can be considered to be optimum habitats for ranaviruses. Infection rates in wild frog species have reached 100% in some areas, even in nature reserves.

Discussion

Our research also indicates that culture facilities and pet markets are frequently infected, serving as likely vectors for the regional and global spread of ranaviruses. The knowledge generated suggests the need for systematic surveillance, stringent biosecurity measures, and control of international animal trade to prevent further transmission and protection of biodiversity and aquaculture industries across Asia.
Antimicrobial resistance and genomic characteristics of Salmonella from broilers in Shandong Province
Authors: Zhao Liyuan , Liu Gang , Tang Wenli , Song Xiangbin , Zhao Xiaoyu , Wang Chu , Li Youzhi , Zou Ming
Published: November 2023

Introduction

The emergence of multidrug-resistant (MDR) strains of Salmonella, which is a genus of important zoonotic pathogens, has aroused great public health concern worldwide.

Methods

In this study, 167 strains of Salmonella were isolated from 947 samples from broiler farms, slaughterhouses, and markets in Shandong Province. Antibiotic sensitivity testing was performed, and 70 strains of Salmonella were screened out by whole-genome sequencing (WGS) to evaluate serotypes, antimicrobial resistance genes (ARGs), the prevalence of class 1 integrons, the plasmid carriage rate, and phylogenetic characteristics and for multilocus sequence typing (MLST).

Results

The results showed that the 167 isolates showed the highest resistance to ampicillin (AMP, 87.4%), sulfamethoxazole (SF, 87.4%), compound sulfamethoxazole (SXT, 81.4%), nalidixic acid (NAL, 80.2%), and amoxicillin/clavulanic acid (A/C, 77.8%). All the strains were sensitive to meropenem (MEM), and 91.0% of the isolates were MDR strains. We screened a total of 45 ARGs, with the highest detection rate observed for the tetracycline (TET) resistance gene tet (A) (81.4%). A total of 21 types of plasmid replicons were detected in Salmonella, of which IncX1 was the most common (74.3%), and 62.9% of the isolates carried a class 1 integron. In addition, a total of 11 different serotypes were detected, with S. enteritidis as the predominant serovar., followed by S. infantis and S. Newport. Twelve different sequence types (STs) were detected, among which ST11 was the main type. There was a strong correspondence between serotypes and STs. We also found that S. Indiana and S. Kentucky had extremely high rates of resistance to ciprofloxacin (CIP) and third-generation cephalosporins. System-wide genome analysis showed the occurrence of long-distance transmission across fields.

Conclusion

In conclusion, the detection of multidrug resistance and isolates carrying multidrug resistance genes is the main problem, and emergency strategies should be implemented to address this issue.
Optimized Design of Fixture Mechanism for Cotton Bundle Fiber
Authors: Jiang Daiyu , Wang Huting , Zhang Ruoyu , Hu Rong , Liu Hong
Published: November 2023

The linkage mechanism of a cotton bundle fiber strength tester will have an unstable clamping force when clamping fiber bundle samples with uneven thickness, resulting in slippage or damage to the fibers increasing the pectin residue, leading to inaccurate test results and increased maintenance costs. To address this problem, according to the structural principle of the connecting rod-clamping mechanism, through the geometric relationship between the connecting rods to establish a parametric model of the mechanism and the use of the principle of virtual work on the mechanism to solve the force, the proposed new Dynamic Alternative Static Approximate Analysis Method (DASAAM) was based on Adams 2020. The Isight integrated Adams automatic optimization design framework was built. The variance of the change curve of the end force of the mechanism when clamping samples of different thicknesses was used as the evaluation function and the assembly conditions were used as the constraints. The dimensional parameters and angles of the mechanism were optimized using the multi-island genetic algorithm. The simulation results showed that when the thickness of the clamped sample varied in the range of 0–4 mm, the clamping force of the mechanism varied in the range of 8920–8630 N. Finally, the variance of the clamping force measured by the clamping force measurement component was 0.0367. The above results show that the DASAAM provided a new method for solving the static problem of mechanism morphological and position change, and the optimized linkage mechanism had better clamping force stability, which made the strength detection of cotton fiber more accurate, thus improving the quality of textile products.
The Impact of Data Injection on Predictive Algorithm Developed within Electrical Manufacturing Engineering in the Context of Aerospace Cybersecurity
Authors: Bautista-Hernández Jorge , Martín-Prats María Ángeles
Published: November 2023

Cybersecurity plays a relevant role in the new digital age within the aerospace industry. Predictive algorithms are necessary to interconnect complex systems within the cyberspace. In this context, where security protocols do not apply, challenges to maintain data privacy and security arise for the organizations. Thus, the need for cybersecurity is required. The four main categories to classify threats are interruption, fabrication, modification, and interception. They all share a common thing, which is to soften the three pillars that cybersecurity needs to guarantee. These pillars are confidentiality, availability, and integrity of data (CIA). Data injection can contribute to this event by the creation of false indicators, which can lead to error creation during the manufacturing engineering processes. In this paper, the impact of data injection on the existing dataset used in manufacturing processes is described. The design model synchronizes the following mechanisms developed within machine learning techniques, which are the risk matrix indicator to assess the probability of producing an error, the dendrogram to cluster the dataset in groups with similarities, the logistic regression to predict the potential outcomes, and the confusion matrix to analyze the performance of the algorithm. The results presented in this study, which were carried out using a real dataset related to the electrical harnesses installed in a C295 military aircraft, estimate that injection of false data indicators increases the probability of creating an error by 24.22% based on the predicted outcomes required for the generation of the manufacturing processes. Overall, implementing cybersecurity measures and advanced methodologies to detect and prevent cyberattacks is necessary.