bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of teleneonatology on the Transport Risk Index of Physiologic Stability score for outborn neonates: A prospective, observational study
Authors: Patel Rahul K , Kreofsky Beth L , Hentz Roland C , Fang Jennifer L
Published: September 2023

Introduction

Teleneonatology (TN) allows neonatologists to use real-time, audio–video telemedicine to manage critically ill neonates located in community hospitals (CHs). The California Transport Risk Index of Physiologic Stability (Ca-TRIPS) score is a validated metric that predicts the risk of 7-day mortality for neonates undergoing medical transport. We hypothesized that neonates born in CHs who received TN consults would have lower (better) Ca-TRIPS scores upon arrival of the transport team than those who did not.

Methods

Neonates born in CHs between 8 December 2018 and 31 July 2022 who were transported to the neonatal intensive care unit were screened for eligibility. TN was available at 50% (12/24) of CHs, where care teams decided when to activate the service. Study data were abstracted from the electronic health record and used to calculate Ca-TRIPS scores. Scores were evaluated using zero-inflated negative binomial regression.

Results

Forty-two percent (161/385) of neonates received a TN consult. Neonates that received TN had lower birth weight, gestational age, and Apgar scores and were more often admitted with respiratory distress syndrome and respiratory failure. Neonates who received TN were less likely to have a Ca-TRIPS score of zero (odds ratio 0.51; 95% confidence interval 0.33, 0.78). When adjusted for baseline characteristics, this difference was no longer significant. Non-zero Ca-TRIPS scores were not different between groups.

Discussion

In this observational study, neonates that received TN did not have lower (better) Ca-TRIPS scores. Findings may be limited by confounding bias given between-group differences in baseline patient characteristics. Randomized studies are needed to determine whether TN impacts the physiologic stability of neonates requiring medical transport.
“I base my life on sadness”: Apparently paradoxical sources of resilience among young Haitians
Authors: Andreassen Kristine Elvevold , Kirkengen Anna Luise , Johansen May-Lill
Published: September 2023

Haitian expressions of resilience also hold deep knowledge of human vulnerability. This longitudinal, qualitative study with young Haitians from urban shantytowns combines ethnographic and participatory methods to explore the complexities behind such idioms. Artistic and creative products made by or with the youth facilitated interviews, focus group discussions, and workshops. Through the life stories of participants and rich ethnographic material, this study presents locally situated idioms of resilience (and distress). By including local social ecology, the idioms were framed as historically and culturally rooted, thus shaping contextual, pragmatic, and gendered coping strategies grounded in embodied experiences of vulnerability and resistance. The study adds essential insights into Haitian resilience, revealing the local logics behind seemingly paradoxical statements. By drafting a conceptual framework for further studies on idioms of resilience, the study also makes a theoretical contribution to international resilience research.
Trapped: Experiences of unpaid carers of clinically vulnerable people “shielding” during the coronavirus disease 2019 pandemic
Authors: Burrows Daniel , Lyttleton-Smith Jen , Sheehan Lucy , Jones Siôn , Kyle Richard
Published: September 2023

Unpaid carers were profoundly impacted by the coronavirus disease 2019 pandemic and public health responses. In the UK, in March 2020, people identified as clinically extremely vulnerable and their household members were advised to “shield” for an initial 12-week period, which meant minimizing all contacts from outside the household and not leaving the house at all, unless in an emergency. In a modified form, shielding guidance remained in place until August 2020 and was reinstituted from December 2020 until April 1, 2021. This article, reporting on qualitative interviews with 47 unpaid carers in Wales, thematically analyzed using a coding framework, explores the experiences of unpaid carers affected by this shielding guidance and their wider implications for social work with unpaid carers in the future.

Findings

Participants in our study described ways in which their caring role expanded, due to the need to provide additional practical and emotional support for loved ones who were shielding, and who lost access to other avenues of support. Some also described their caring role as becoming more involved and complex due to the declining health or self-care capacity of the person cared-for as a direct consequence of shielding restrictions. Alongside the increase in their caring responsibilities, carers reported losing access to important avenues of support for their own well-being.

Applications

We draw on ecological systems theory to highlight the importance during care planning and management of exploring the carer's mesosystem to identify and optimize sustaining forces, and of attending to the microsystem involving the carer and person cared-for.
The Relationship Between the Global Limb Anatomic Staging System and Midterm Outcomes of Subintimal Angioplasty of Superficial Femoral Artery Atherosclerotic Disease in Chronic Limb Threatening Ischemia
Authors: Shahat Mohammed , Atalla Khaled , Abdelmonem Mostafa , Khairy Ahmed
Published: September 2023

Background:

Superficial femoral artery (SFA) is commonly affected with atherosclerotic peripheral arterial disease leading to chronic limb-threatening ischemia (CLTI). Subinitimal angioplasty (SIA) is a minimally invasive option. We aimed to examine the relationship between the Global Limb Anatomic Staging System and SIA midterm limb and survival-related outcomes.

Method:

A prospective observational study was conducted on all patients with CLTI (Rutherford 4–6 or WIFI stages 2–4), with diseased femoropopliteal segment underwent SIA from August 2020 to September 2021. Patients with non-atherosclerotic SFA occlusion and those requiring primary major amputation were excluded. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan-Meier survival curves were used to estimate limb-based patency (LBP), limb salvage, amputation-free survival (AFS), and overall survival.

Results:

The study included 138 patients with CLTI due to chronic total occlusion of the SFA and underwent SIA ± treatment of associated ipsilateral hemodynamically significant inflow/outflow disease. Primary technical success was achieved in 116 cases (84%), with primary patency at 1, 6, and 12 months being 100%, 84%, and 79% respectively, while the limb-salvage rate at 6 and 12 months was 100% and 94%, respectively. The result of the comparison between CLASS 1 and Global Limb Anatomic Staging System III (GLASS III) revealed significantly worse patency with GLASS III (p=0.005), and better overall survival (p=0.037), limb salvage (p=0.021), and AFS (p<0.001) with GLASS I.

Conclusion:

Subinitimal angioplasty is a safe, effective, and minimally invasive treatment option for lengthy SFA lesions by avoiding the patients’ anesthesia and operative risk. Our study suggests that the GLASS stage may be a useful predictor of midterm limb and survival-related outcomes of this approach. GLASS III anatomy in comparison with GLASS I is associated with a statistically significantly worse LBP, limb salvage, AFS, and overall survival.

Clinical Impact

This study is discussing a very hot interesting challenging topic in vascular surgery and its management as SFA atherosclerotic lesion is the most common lesion faced by vascular surgeons subintimal angioplasty SIA is considered feasible and effective method in dealing with this lesion with accepted durability and lower rates of complications.The subintimal angioplasty is made by opening an extraluminal track behind the intimal layer and between the media and intima of the artery surrounding atherosclerotic plaque and thrombus. Hence, the track has a low thrombus or plaque burden content, making the SIA easier than intraluminal angioplasty and with comparable results. GLASS stage III was an independent predictor of loss of LBP, worse AFS, and major amputation.
Introduction to the special issue: Genres of Rape and Putting Rape Into Genre: Sexual Violence and TV After #MeToo
Authors: Dango Michael
Published: September 2023

This introduction to the “Rape, Genre, and TV after #MeToo” special issue articulates the importance of genre for understanding shifting affective and political norms related to sexual violence. Recent TV from the U.S. and the U.K. has worked to expand the public’s understanding of what counts in the genre of rape, bringing into view less discussed harms like nonconsensual condom removal. At the same time, public discussions of rape have put pressure on the conventions of genres, including the genres explored in this special issue: the procedural, stand-up comedy, the Western, and the situation comedy.
The Most Glorified Day: Memory and Narratives on the Normandy Landings in the Italian Daily Press
Authors: Pipitone Daniele
Published: September 2023

The article focuses on the memory of the Normandy landings in post-war Italy, as a case study for investigating the wider subject of the memory of World War II in the country. It is based on two main assumptions: that memories of World War II were by no means limited to the national level (i.e. to the aspects of the conflict that directly involved Italy) and necessarily included a representation of the global features of the war and that memories often have a transnational nature and undergo a continuous process of importation and exportation beyond national boundaries. In order to investigate the issue, a corpus of sources has been collected, made up of articles published on five Italian newspapers of different political allegiance, roughly in the first two decades after the war, from 1945 to 1968. The results of the analysis show how the memory of the landings was paid very different attention, depending on the cultural and political stance of the daily: while the right- and left-wing press seldom focused on it, the moderate and pro-governmental newspapers showed a greater interest. Two other key elements emerge from the analysis: the transnational character of the memories and their strongly celebratory nature. In fact, many articles on the D-Day drew upon foreign sources (of Anglo-American, but also of German origin) in different ways, and almost all of them depicted the landings as the turning point of the war, the moment when Europe was freed and the final triumph of the good against the evil. In conclusion, it is outlined how the memory of the landings played a key role in making the global war known, in importing to Italy the (western) idea of the ‘good war’ and in spreading in Italy the ‘western’ set of values, thus strengthening the bonds of the country with its Cold War allies.
Real-time marine target recognition method of underwater inspection robot based on computer vision
Authors: Yang Qing , Zhou Jili , Meng Huijuan , Gao Dexin
Published: September 2023

In the complex marine environment, target recognition is difficult, and the real-time detection has a slow speed. In this article, a target recognition method combining underwater generative adversarial network and improved YOLOv4 is proposed, which is named M-YOLOv4. Firstly, the images collected by the underwater inspection robot are enhanced using the underwater generative adversarial network algorithm to obtain the training datasets. Secondly, the YOLOv4 target detection algorithm combines the feature extraction network of MoblieNetv3 for lightweight processing, which reduces the network model size, and reduces the number of algorithm calculations and parameters. Then, change the size of the spatial pyramid pooling module pooling kernel, which can enlarge receptive field and integrate characteristics of different receptive fields. Finally, the processed datasets are transferred to the improved M-YOLOv4 algorithm for training, and the trained model is transplanted to the Jetson Nano hardware device for real-time detection. The results of experiments show that the mean average precision value of the improved M-YOLOv4 recognition is 90.77%, which is 2.02% higher than that of the unimproved one. The frame per second value of the lightweight YOLOv4 algorithm with MobileNetv3 is 27, an increase of 12 compared with YOLOv4. The improved M-YOLOv4 algorithm can perform accurate detection of marine multi-targets on embedded devices.
Eye trauma
Authors: Shah Dr Iffat , Goyal Dr Aaliya
Published: September 2023

When a patient presents with eye trauma, it can be a daunting prospect for the GP, particularly with the potential risks, including of irreversible sight loss. It may be tempting to send patients to the nearest eye emergency service when hearing the patient's presenting complaint. This is understandable given limited access to ophthalmic equipment in primary care, including, for example, a slit lamp or even a working ophthalmoscope. However, taking a relevant and accurate history with a subsequent focussed examination to assess the extent of damage is both useful and vital to ensure the patient is seen by the ophthalmologist within the appropriate timeframe. However, for some types of eye trauma, such as chemical burns, it is best to treat in tandem with history taking.
Creating Alignment: How the Humanities Can Help Heal Physicians and Patients
Authors: Cerceo Elizabeth , Vasan Nagaswami
Published: September 2023

The medical humanities, an umbrella term for the fields of ethics, social science, and fine arts, are increasingly recognized as an important component of medical education. Since the Flexner report, the primacy of science and evidence-based medicine has replaced subjectivity and nuance. While this has been critical for standardization of care and patient safety, an exclusive emphasis on science in undergraduate medical education can devalue more humanistic pursuits. Modern medicine is now plagued with burnout, pandemics, and societal ills that permeate into medicine. Addressing these requires a thoughtful, holistic approach where we extend our sights beyond strict evidence-based medicine.
Agential possibilities
Authors: List Christian
Published: September 2023

We ordinarily think that we human beings have agency: we have control over our choices and make a difference to our environments. Yet it is not obvious how agency can fit into a physical world that is governed by exceptionless laws of nature. In particular, it is unclear how agency is possible if those laws are deterministic and the universe functions like a mechanical clockwork. In this short paper, I first explain the apparent conflict between agency and physical determinism (referring to recent work by Helen Steward), then review some salient responses one might give to this conflict, and finally sketch a response that rests on a distinction between “physical” and “agential possibilities.” Agency, I suggest, is a higher-level phenomenon, which comes with its own level-specific notion of possibility, and it cannot be adequately analyzed in physical terms alone or just through the lens of physical possibility.
A human genome editing–based MLL::AF4 ALL model recapitulates key cellular and molecular leukemogenic features
Authors: Bueno Clara , Torres-Ruiz Raul , Velasco-Hernandez Talia , Molina Oscar , Petazzi Paolo , Martinez Alba , Rodriguez Virginia , Vinyoles Meritxell , Cantilena Sandra , Williams Owen , Vega-Garcia Nerea , Rodriguez-Perales Sandra , Segovia Jose C. , Quintana-Bustamante Oscar , Roy Anindita , Meyer Claus , Marschalek Rolf , Smith Alastair L. , Milne Thomas A. , Fraga Mario F. , Tejedor Juan Ramón , Menéndez Pablo
Published: September 2023

Cellular ontogeny and MLL breakpoint site influence the capacity of MLL-edited CD34+ hematopoietic cells to initiate and recapitulate infant patients' features in pro–B-cell acute lymphoblastic leukemia (B-ALL). We provide key insights into the leukemogenic determinants of MLL-AF4+ infant B-ALL.
Phylogenetic analysis of museum specimens of houting Coregonus oxyrinchus shows the need for a revision of its extinct status
Authors: Kroes R. , Winkel Y. , Breeuwer J. A. J. , van Loon E. E. , Loader S. P. , Maclaine J. S. , Verdonschot P. F. M. , van der Geest H. G.
Published: September 2023

According to the IUCN Red List the anadromous houtingCoregonus oxyrinchusis categorized as ‘extinct’. However, this extinct status might be incorrect because taxonomic difference betweenC. oxyrinchusand the closely related C. lavaretusis based on a disputable morphological comparison. Also, phylogenetic studies on mtDNA only focused on recent obtained coregonids. We are the first to perform a mtDNA analysis on both historic and recent specimens, including the syntype specimen which was used for species description by Linnaeus originally. Two primer pairs for mitochondrialCytBandND3were used to extract sequences for phylogenetic analysis. Sequences from 14 out of 21C. oxyrinchusmuseum specimens were successfully obtained and compared with sequences from recent obtainedC. lavaretus. The sequences were combined with GenBank data from a previous phylogenetic study on houting to create a phylogenetic tree and two minimum spanning haplotype networks. Results show thatC. oxyrinchusandC. lavaretusform a clade with limited genetic variation. Low bootstrap values also show weak support for geographical patterns in distribution of mitochondrial haplotypes. Statistical analysis of the haplotype networks also shows that historic and recent specimens are similar species. Our results suggest thatC. oxyrinchusis a junior synonym ofC. lavaretus. A definitive taxonomic revision could not be made because onlyCytBsequencing was successful for the syntype specimen. We discuss taxonomic consequences and the species-specific focus in nature conservation. We propose a shift in nature conservation to a more functional approach based on traits rather than species.
Point-of-care ultrasound in geriatrics: a national survey of VA medical centers
Authors: Gogtay Maya , Choudhury Ryan S. , Williams Jason P. , Mader Michael J. , Murray Kevin J. , Haro Elizabeth K. , Drum Brandy , O’Brien Edward , Khosla Rahul , Boyd Jeremy S. , Bales Brain , Wetherbee Erin , Sauthoff Harald , Schott Christopher K. , Basrai Zahir , Resop Dana , Lucas Brian P. , Sanchez-Reilly Sandra , Espinosa Sara , Soni Nilam J. , Nathanson Robert
Published: September 2023

Background

Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care (“geriatric”) clinics at Veterans Affairs Medical Centers (VAMCs).

Methods

We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics.

Results

All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics (“chiefs”) at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers.

Conclusions

POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.
Incidence and predictors of mortality among low birth weight neonates in the first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia comprehensive specialized hospitals, 2022. Multi-center institution-based retrospective follow-up study
Authors: Wondie Wubet Tazeb , Zeleke Kassaye Ahmed , Wubneh Chalachew Adugna
Published: September 2023

Background

Globally, a high number of neonatal mortalities occurs in the first week of life, particularly among low birth weight neonates in low-income countries, including Ethiopia. However, there is limited evidence on the early neonatal mortality of low-birth-weight neonates in Ethiopia. Therefore, this study aimed to assess incidence and predictors of mortality among low-birth-weight neonates in their first week of life admitted to the neonatal intensive care unit in Northwestern Ethiopia Comprehensive Specialized Hospitals, 2022.

Methods

A multi-center retrospective follow-up study was conducted from March 21, 2020 to March 1, 2022, among 761 early neonates with low birth weight admitted in Northwestern Ethiopia Comprehensive Specialized Hospitals. The study participants were selected using simple random sampling technique. Data were collected using a data abstraction checklist ,and checked for completeness and entered into EPI data version 4.6, then exported to STATA 14 for analysis. Kaplan Meier failure curve and log-rank test were used to estimate and compare the probability of death. Both bivariable and multivariable Weibull regression models were fitted to identify predictors of mortality. Finally, a hazard ratio with 95% CI was computed, and variables having a p-value < 0.05 were considered as a significant predictor of mortality.

Results

The incidence of mortality among low birth weight neonates in their first week of life was 75.63 per 1000 neonate day observation (95% CI: 66.76–85.67), preeclampsia (AHR = 1.77;95% CI:1.32-2.36s), perinatal asphyxia (AHR = 1.64; 95% CI:1.14–2.36), respiratory distress syndrome (AHR = 1.76 95% CI;1.31–2.34), necrotizing enterocolitis (AHR = 2.78 95% CI;1.79–4.32), prematurity (AHR = 1.86; 95% CI:1.30–2.67), and birth weight < 1000gram (AHR = 3.13;95% CI: 1.91–5.12) and 1000–1499 gram (AHR = 1.99; 95% CI:1.47–2.68) were predictors.

Conclusion

The incidence of early neonatal mortality in low birth weight neonates was incredibly higher than the overall early neonatal mortality in Northwest Ethiopia (Amhara region). Preeclampsia, perinatal asphyxia, respiratory distress syndrome, necrotizing enterocolitis, prematurity, and birth weight were predictors of mortality. Therefore, stakeholders shall give early identification and emphasis on preventable and treatable predictors. Furthermore, the health care provider shall give education about the importance of breastfeeding, and Antenatal and postnatal care.
Transgender Attitudes and Beliefs Scale-Greek (TABS-Gr) version: translation and initial evaluation of psychometric properties among medical students
Authors: Voultsos Polychronis , Papana Angeliki , Alexandri Stella , Zymvragou Christina-Erato
Published: September 2023

Background

Transgender people face significantly greater discrimination and health disparities in health care settings than cisgender people. The role of education in eliminating this phenomenon has been increasingly recognized by many medical schools. However, transgender health content is sparse or lacking in the medical curricula of many countries.

Method

This study was designed to validate the Greek version of the Transgender Attitudes and Beliefs Scale (TABS-Gr). The study adopted a cross-sectional, comparative-descriptive research design. Participants (N = 203) were contacted through online recruitment and invited to complete an anonymous web-based survey. The data were collected between December 2022 and February 2023.

Results

The overall reliability of the TABS-Gr questionnaire was high (Cronbach’s α = 0.961, p. from Hotelling’s T-squared test < 0.000). High Cronbach’s alpha values were estimated for the three subscales, with α = 0.958 for Interpersonal Comfort, α = 0.906 for Gender Beliefs, and α = 0.952 for Human Values. Hotelling’s T-squared test confirmed that all items on the scale had the same mean (p < 0.001 for all subgroups). Explanatory factor analysis (EFA) demonstrated adequate fit. Convergent and discriminant validity were validated based on the estimated correlations. The three-factor structure of the Greek TABS version was confirmed. The mean total score was 155.95 (SD = 30.63), indicating that medical students had a moderately positive attitude towards transgender people. Participants showed significantly less biased (more tolerant, positive) attitudes towards transgender people on the Interpersonal Comfort (IC) and Human Value (HV) subscales than on the Sex/Gender Beliefs (SGB) subscale. A demographic comparison was conducted and demonstrated a correlation between scores and sociodemographics, except for place of origin. A statistically significant increase in the total mean score was estimated for women compared to men.

Conclusion

The overall psychometric findings provide some evidence to support the validity of the Greek version of the TABS. However, we call for further validation research in Greek medical schools. Since our claims for validity are based in part on an exploratory factor analysis, a future confirmatory factor analysis (CFA) is part of our call for further validation research. While the results of this study are mostly in line with the results of previous research, some nuances were identified. These results may inform educators, medical school curricula and education policy-makers.
A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study
Authors: Salim Hani , Cheong Ai Theng , Sharif-Ghazali Sazlina , Lee Ping Yein , Lim Poh Ying , Khoo Ee Ming , Hussein Norita , Harrun Noor Harzana , Ho Bee Kiau , Pinnock Hilary ,   RESPIRE Collaboration
Published: September 2023

Background

Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes.

Methods

We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively.

Results

We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members.

Conclusions

An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.
Trajectory analysis of the work and life experience of healthcare workers during the COVID-19 pandemic: a longitudinal qualitative study
Authors: Zhu Pingting , Qian Meiyan , Lee Amanda , Hayter Mark , Wang Wen , Shi Guanghui , Wu Qiwei , Ji Qiaoying , Gu Xinyue , Zhang Hui , Ding Yinwen
Published: September 2023

Background

The COVID-19 pandemic has posed a global health threat and has had a profoundly negative impact on the work and lives of healthcare workers. However, few people know how their experiences have evolved over time.

Aims

To describe healthcare workers’ experiences during clinical responses to COVID-19 and how they changed over time.

Design

A longitudinal qualitative study.

Methods

We undertook a series of four semi-structured qualitative interviews of 14 healthcare workers called as 1st responders to the COVID-19 pandemic. Participants were recruited through purposive snowball sampling. Interviews were undertaken between May 2020 and May 2022 and trajectory approach was used to reveal individual experiences over time. This paper follows the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

Results

Data analysis yielded the following four themes: (1) Changes in emotions; (2) Changes in organization and management of care; (3) Changes in knowledge and capabilities; and (4) Changes in outlook on life and career.

Conclusion

Healthcare workers have become stronger in the pandemic and have demonstrated a high degree of professional loyalty and responsibility. However, there is a need to focus on the issue of jealousy and create a harmonious and safe work environment to reduce harm to healthcare workers. Additionally, human resource management strategies must support well-being of healthcare workers and maximize the efficiency of human resource utilization to enable them to respond to current and future needs and emergencies.
The spillover effect of after-hours electronic communication on nurses’ cyberloafing: the mediating role of psychological contract breach
Authors: Zhang Na , Liu Xiaoyun , Li Jingjing , Xu Zhen
Published: September 2023

Background

Considerable research has investigated the influencing factors of cyberloafing in the workplace. However, few studies have focused on the antecedents in non-work fields, especially for nurses. According to the effort-reward imbalance theory, this study aims to explore the spillover effect of after-hours electronic communication on nurses’ cyberloafing, and the mediating role of psychological contract breach.

Methods

A total of 282 nurses completed the online survey. PROCESS macro for SPSS was used to test how after-hour electronic communication affect nurses’ cyberloafing.

Results

After-hours electronic communication has a significant positive impact on nurses’ cyberloafing, and psychological contract breach plays a mediating role in the relationship.

Conclusion

Psychological contract breach was the linchpin linking after-hours electronic communication to nurses’ cyberloafing in workplace. This study provides a guide for healthcare organizations to reduce or manage inappropriate telework arrangements and strengthen nurses’ psychological contracts.
A biphasic effect of age on CPAP adherence: a cross-sectional study of 26,343 patients
Authors: Prigent Arnaud , Blanloeil Clément , Serandour Anne-Laure , Barlet Franck , Gagnadoux Frédéric , Jaffuel Dany
Published: September 2023

Background

As the prevalence of OSA increases in older patients, the proportion of elderly patients treated with CPAP is expected to become even higher. We studied CPAP-adherence in a real-life cohort involving a large population of elderly patients with OSA.

Methods

eQUALISAS is a cross-sectional study of CPAP treated OSA patients for at least 4 months who received remote monitoring during 2021. CPAP adherence, device-reported residual AHI (AHICPAP) and 95th percentile non-intentional leaks were software collected during January 2021. Age and sex were also collected.

Results

Data from 26,343 patients including 1656 patients aged [80–85] years and 639 patients aged ≥ 85 years were analysed. Median CPAP adherence increases from 6.3 h (< 50 years) to 7 h (75–80 years) and decreases after this age (p < 0.001). The decrease in CPAP adherence observed after the age of 80 was associated with an increase in the proportion of patients with a CPAP-adherence < 4 h/day (p < 0.001). Proportion of CPAP treated female, patients having AHICPAP mean ≥ 10 events per hour or 95th percentile non-intentional leaks mean over 24 l/min increase with aging of the population. However, for patients over 80 years old, Chi square test showed no association of adherence with gender, AHICPAP and leaks (p > 0.05).

Conclusion

This study demonstrates that adherence gradually increases with age until 80 years. The proportion of non-adherent patients grows with age after 80 years old. No significative relationship was found between adherence after 80 years old and gender, leaks and AHICPAP.

Trial registration: The study is registered on Health Data Hub platform (No. F20220715144543).
Plant-based dietary patterns, genetic predisposition and risk of colorectal cancer: a prospective study from the UK Biobank
Authors: Liu Fubin , Lv Yanling , Peng Yu , Qiao Yating , Wang Peng , Si Changyu , Wang Xixuan , Gong Jianxiao , Zhou Huijun , Zhang Ming , Chen Liangkai , Song Fangfang
Published: September 2023

Background

Plant-based dietary patterns may affect colorectal cancer (CRC) related outcomes, while risks differ in the quality of plant foods. We aimed to examine the association of plant-based diet quality with risks of CRC incidence and mortality and whether this association was modified by genetic risk.

Methods

This prospective cohort study included 186,675 participants free of cancer when the last dietary recall was completed. We calculated three plant-based diet indices (PDIs), i.e., the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI) representing adherence to plant-based diets with diverse quality. Genetic risk was characterized using a weighted polygenic risk score (PRS), capturing overall risk variants associated with CRC. Hazard ratios (HR) and 95% confidential intervals (CI) were estimated by the cause-specific Cox proportional hazards model.

Results

Over a follow-up of 9.5 years, 2163 cases and 466 deaths from CRC were documented. The HR of CRC incidence was 0.88 (95% CI, 0.81–0.96) and 0.91 (95% CI, 0.84–0.99) per 10-score increase in PDI and hPDI, respectively. Compared to the lowest quartile, PDI, hPDI, and uPDI in the highest quartile were associated with a 13% decrease, a 15% decrease, and a 14% increase in risk of incident CRC, respectively. We found a joint association of genetic risk and PDIs with incident CRC, with the highest hazard observed in those carrying higher PRS and adhering to lower-quality PDIs. The inverse association of PDI and hPDI with CRC mortality was pronounced in males.

Conclusions

Our results suggested that better adherence to overall and healthful plant-based diets was associated with a lower risk of CRC, whereas an unhealthful plant-based diet was associated with a higher CRC risk. Consumption of a higher-quality plant-based diet combined with decreased genetic risk conferred less susceptibility to CRC. Our findings highlighted the importance of food quality when adhering to a plant-based dietary pattern for CRC prevention in the general population.
Glycolytic shift during West Nile virus infection provides new therapeutic opportunities
Authors: Mingo-Casas Patricia , Blázquez Ana-Belén , Gómez de Cedrón Marta , San-Félix Ana , Molina Susana , Escribano-Romero Estela , Calvo-Pinilla Eva , Jiménez de Oya Nereida , Ramírez de Molina Ana , Saiz Juan-Carlos , Pérez-Pérez María-Jesús , Martín-Acebes Miguel A.
Published: September 2023

Background

Viral rewiring of host bioenergetics and immunometabolism may provide novel targets for therapeutic interventions against viral infections. Here, we have explored the effect on bioenergetics during the infection with the mosquito-borne flavivirus West Nile virus (WNV), a medically relevant neurotropic pathogen causing outbreaks of meningitis and encephalitis worldwide.

Results

A systematic literature search and meta-analysis pointed to a misbalance of glucose homeostasis in the central nervous system of WNV patients. Real-time bioenergetic analyses confirmed upregulation of aerobic glycolysis and a reduction of mitochondrial oxidative phosphorylation during viral replication in cultured cells. Transcriptomics analyses in neural tissues from experimentally infected mice unveiled a glycolytic shift including the upregulation of hexokinases 2 and 3 (Hk2 and Hk3) and pyruvate dehydrogenase kinase 4 (Pdk4). Treatment of infected mice with the Hk inhibitor, 2-deoxy-D-glucose, or the Pdk4 inhibitor, dichloroacetate, alleviated WNV-induced neuroinflammation.

Conclusions

These results highlight the importance of host energetic metabolism and specifically glycolysis in WNV infection in vivo. This study provides proof of concept for the druggability of the glycolytic pathway for the future development of therapies to combat WNV pathology.
Towards a better preclinical cancer model – human immune aging in humanized mice
Authors: Tan Joel H. L. , Hwang You Yi , Chin Hui Xian , Liu Min , Tan Sue Yee , Chen Qingfeng
Published: September 2023

Background

Preclinical models are often used for cancer studies and evaluation of novel therapeutics. The relevance of these models has vastly improved with mice bearing a human immune system, especially in the context of immunotherapy. Nonetheless, cancer is an age-related disease, and studies often overlook the effects of aging. Here we have established a humanized mouse model of human immune aging to investigate the role of this phenomenon on liver tumor dynamics.

Methods

Multiple organs and tissues (blood, thymus, lung, liver, spleen and bone marrow) were harvested from NOD-scid IL2rγ−/− (NIKO) mice reconstituted with human immune cells, over a period of 60 weeks post-birth, for immune profiling. Young and aging immune cells were compared for transcriptomic changes and functional differences. Effect of immune aging was investigated in a liver cancer humanized mouse model.

Results

Focusing on the T cell population, which is central to cancer immunosurveillance and immunotherapy, we showed that the proportion of naïve T cells declined while memory subsets and senescent-like cells increased with age. RNA-sequencing revealed that downregulated genes were related to immune responses and processes, and this was corroborated by reduced cytokine production in aging T cells. Finally, we showed faster liver tumor growth in aging than younger humanized mice, which could be attributed to specific pathways of aging T cell exhaustion.

Conclusion

Our work improves on existing humanized (immune) mouse model and highlights the importance of considering immune aging in liver cancer modeling.
Long non-coding HOXA-AS3 contributes to osteosarcoma progression through the miR-1286/TEAD1 axis
Authors: Xiao Xiangjun , Liu Mingjiang , Xie Songlin , Liu Changxiong , Huang Xinfeng , Huang Xiongjie
Published: September 2023

Long non-coding RNA (lncRNA) HOXA cluster antisense RNA 3 (HOXA-AS3) regulates the progression of several types of human malignancy. However, the role and potential mechanism of HOXA-AS3 in osteosarcoma (OS) remain unknown. In this study, upregulation of HOXA-AS3 was observed in OS tissues and cell lines and associated with poor clinical outcomes. Silencing of HOXA-AS3 significantly inhibited the proliferation, migration and invasion of OS cells in vitro and suppressed the tumorigenesis of OS cells in vivo. Furthermore, knockdown of HOXA-AS3 inhibited the proliferation and migration of human umbilical vein endothelial cells (HUVECs) and epithelial-to-mesenchymal transition (EMT) in OS. Further investigation of this mechanism revealed that HOXA-AS3 could directly upregulate the expression of TEAD1 via its competing endogenous RNA (ceRNA) activity on miR-1286. This study clarified the oncogenic roles of the HOXA-AS3/miR-1286/TEAD1 axis in OS progression, suggesting a novel therapeutic target for OS.
Destruction, disruption and disaster: Sudan’s health system amidst armed conflict
Authors: Dafallah Alaa , Elmahi Osman K. O. , Ibrahim Maisoon Elbukhari , Elsheikh Rania Elfatih , Blanchet Karl
Published: September 2023

The ongoing armed conflict in Sudan has resulted in a deepening humanitarian crisis with significant implications for the country's health system, threatening its collapse. This article examines the destruction, disruption, and disastrous consequences inflicted upon Sudan's health system. The conflict has led to the severe compromise of healthcare facilities, with only one-third of hospitals in conflict zones operational. Artillery attacks, forced militarization, power outages, and shortages of medical supplies and personnel have further crippled the health system. The exodus of health workers and escalating violence have exacerbated the crisis. Disrupted service delivery has resulted in the interruption of essential health services, including obstetric care, emergency services, and dialysis. Financial losses to the health system are estimated at $700 million, impacting an already underfunded sector. We identify that in addition to restoration of peace and mobilization of urgent aid, immediate prioritization of the reconstruction of the health system is crucial to mitigate the long-term consequences of the war. Rebuilding a resilient health system is sine qua non for Sudan's progress towards universal health.
Synchronic development of hydrocele and groin hernia during pregnancy: a case report
Authors: Rasmussen Lise , Farooqui Waqas , Ries Annedorte , Stadeager Morten Willer
Published: September 2023

Introduction

Hydroceles of the canal of Nuck are rare, and have not been described in relation to pregnancy.

Case presentation

A 34-year-old Caucasian female patient had bilateral groin swelling debuted during her pregnancy. A preoperative magnetic resonance imaging scan found bilateral hydroceles of the canal of Nuck. Operative findings and histological examinations revealed a left-sided inguinal hernia and a right-sided hydrocele. The patient was discharged well and without signs of postoperative complications or hernia recurrence.

Discussion

In this case, a hydrocele and a hernia sac were morphologically identical in terms of preoperative appearance and development. Given the morphological correlation, it was surprising to find different operative findings confirmed by the histopathological examination.

Conclusion

This is the first ever report of the synchronic development of two morphologically identical cystic processes, with one being a hydrocele and the other a hernia sac. In addition, the hydrocele developed during pregnancy, making this case even more unique.
Human osteoarthritic articular cartilage stem cells suppress osteoclasts and improve subchondral bone remodeling in experimental knee osteoarthritis partially by releasing TNFAIP3
Authors: Li Zhi-Ling , Li Xiao-Tong , Hao Rui-Cong , Wang Fei-Yan , Wang Yu-Xing , Zhao Zhi-Dong , Li Pei-Lin , Yin Bo-Feng , Mao Ning , Ding Li , Zhu Heng
Published: September 2023

Background

Though articular cartilage stem cell (ACSC)-based therapies have been demonstrated to be a promising option in the treatment of diseased joints, the wide variety of cell isolation, the unknown therapeutic targets, and the incomplete understanding of the interactions of ACSCs with diseased microenvironments have limited the applications of ACSCs.

Methods

In this study, the human ACSCs have been isolated from osteoarthritic articular cartilage by advantage of selection of anatomical location, the migratory property of the cells, and the combination of traumatic injury, mechanical stimuli and enzymatic digestion. The protective effects of ACSC infusion into osteoarthritis (OA) rat knees on osteochondral tissues were evaluated using micro-CT and pathological analyses. Moreover, the regulation of ACSCs on osteoarthritic osteoclasts and the underlying mechanisms in vivo and in vitro were explored by RNA-sequencing, pathological analyses and functional gain and loss experiments. The one-way ANOVA was used in multiple group data analysis.

Results

The ACSCs showed typical stem cell-like characteristics including colony formation and committed osteo-chondrogenic capacity. In addition, intra-articular injection into knee joints yielded significant improvement on the abnormal subchondral bone remodeling of osteoarthritic rats. Bioinformatic and functional analysis showed that ACSCs suppressed osteoarthritic osteoclasts formation, and inflammatory joint microenvironment augmented the inhibitory effects. Further explorations demonstrated that ACSC-derived tumor necrosis factor alpha-induced protein 3 (TNFAIP3) remarkably contributed to the inhibition on osteoarhtritic osteoclasts and the improvement of abnormal subchondral bone remodeling.

Conclusion

In summary, we have reported an easy and reproducible human ACSC isolation strategy and revealed their effects on subchondral bone remodeling in OA rats by releasing TNFAIP3 and suppressing osteoclasts in a diseased microenvironment responsive manner.

Graphical abstract
MRE11:p.K464R mutation mediates olaparib resistance by enhancing DNA damage repair in HGSOC
Authors: Zhuang Xucui , Xiao Rourou , Fu Yu , Yang Bin , Fan Junpeng , Lu Funian , Qin Tianyu , Yang Xiaohang , Hu Xingyuan , Yin Jingjing , Li Wenting , Kang Xiaoyan , Chen Gang , Hu Dianxing , Sun Chaoyang
Published: September 2023

Background

Although the clinical application of PARP inhibitors has brought hope to ovarian cancer, the problem of its resistance has become increasingly prominent. Therefore, clinical experts have been focused on finding specific indicators and therapeutic targets that can be used for resistance monitoring of PARP inhibitors.

Results

By cfDNA detecting during Olaparib maintenance therapy in platinum-sensitive relapsed ovarian cancer, we found the presence of MRE11:p.K464R mutation was strongly associated with acquired Olaparib resistance. Structural analysis revealed that the MRE11:p.K464R mutation is situated at a critical site where the MRE11 protein interacts with other biomolecules, leading to potential structural and functional abnormalities of MRE11 protein. Functionally, MRE11:p.K464R mutation enhanced the tolerance of Olaparib by reducing the DNA damage. Mechanistically, MRE11:p.K464R mutation improved the efficiency of DNA damage repair and induce Olaparib resistance by enhancing its binding activity with the interacting proteins (including RAD50 and RPS3). Among them, the enhanced binding of MRE11:p.K464R mutation to RAD50/RPS3 facilitated non-homologous end joining (NHEJ) repair in tumor cells, thereby expanding the scope of research into acquired resistance to PARP inhibitors.

Conclusions

Our findings provide a theoretical basis for MRE11:p.K464R mutation as a specific indicator of resistance monitoring in Olaparib treatment, and the exploration of its resistance mechanism provides a novel insights for the formulation of combination ther therapies after Olaparib resistance.