bluuebunny/crossref_metadata_2025 huggingface dataset:
A Heuristic Analysis of Covid-19 At-Home Test Kits’ Usability
Authors: DiBello Alexis M. , Thai Phuoc , Pavlov Kathren , Montalvo Fernando , McConnell Daniel S. , Smither Janan A.
Published: June 2023

As COVID-19 cases continue to be prevalent, at-home testing for the illness will continue to be in demand. At-home testing is convenient as results are obtained quickly and often at a lower cost. This study utilized Nielsen’s Ten Usability Heuristics to evaluate at-home COVID-19 test kits, with consideration given to older users when applicable. Understanding whether users can correctly use and interpret these tests is critical to ensure the kits provide accurate results and to ensure user trust. Results of our analysis showed that there is a need for at-home COVID-19 test kits to improve the way results are presented and implement more error prevention techniques. In regards to older users, the kits would benefit from clearing up ambiguities which require reference materials, accommodating users with contrast sensitivity difficulties, and ensuring that the test kit products are easy to manually handle. While the kits have acceptable usability, improvements to the usability of COVID-19 at-home test kits will lead to lower user errors and improved result accuracy.
Sport and Exercise Activity After Isolated Ankle Arthrodesis for Advanced-Stage Ankle Osteoarthritis: A Single-Center Retrospective Analysis
Authors: Chuckpaiwong Bavornrit , Reingrittha Pissanu , Harnroongroj Thos , Mawhinney Chris , Tharmviboonsri Theerawoot
Published: June 2023

Background:

Ankle arthrodesis, a recognized operative treatment for advanced-stage ankle osteoarthritis (OA), is recommended when conservative treatment proves unsuccessful. This single-center retrospective analysis examined the change in functional outcomes and the type of sport/exercise activity performed by advanced-stage ankle OA patients after ankle arthrodesis treatment.

Methods:

A total of 61 advanced-stage ankle OA patients (age, 63.1 ± 12.6 years) who had undergone ankle arthrodesis were included in this single-center retrospective study. The patients had functional outcomes evaluated via American Orthopaedic Foot & Ankle Society Score (AOFAS), Foot Function Index (FFI), Tegner Activity Level Scale (TAS), and High-Activity Arthroplasty Score (HAAS) questionnaires. Clinical status was compared across prearthritic, arthritic, and postarthrodesis periods, and satisfaction with return to sport/exercise activity was recorded.

Results:

Patients’ tarsal sagittal ROM (mean [95% CI]: 22.7 degrees [21.4-24.0]); time to union (15.7 weeks [11.8-19.6]); time to walk without gait aid (14.4 weeks [11.0-17.7]); time to return to work (17.9 weeks [15.1-20.8]); and time to exercise activity (20.6 weeks [17.9-23.4]) were recorded postarthrodesis. Hindfoot alignment angle toward a neutral position (difference: 11.4 degrees [9.2-13.6], P < .001) and functional outcomes ( P < .001) significantly improved after arthrodesis surgery; however, only the TAS questionnaire indicated patients returned to their prearthritic activity level ( P > .99). Patients generally reported “good” satisfaction with their recovery from ankle arthrodesis surgery, with 64% of patients returning to high-impact-type activity.

Conclusion:

Advanced-stage ankle OA patients had improved functional outcomes at ~1 year postarthrodesis surgery, enabling the majority of patients to return to high-impact-type activity.

Level of Evidence:

Level III, retrospective cohort study.
Optimized vitamin D repletion with oral thin film cholecalciferol in patients undergoing stem cell transplant
Authors: Bartlett Allison L. , Zhang Grace , Wallace Gregory , McLean Stacie , Myers Kasiani C. , Teusink-Cross Ashley , Taggart Cynthia , Patel Bhaumik , Davidson Robert , Davies Stella M. , Jodele Sonata
Published: June 2023

Vitamin D deficiency is common in childhood, pervasive before and after bone marrow transplant, and is associated with increased incidence of graft-versus-host disease (GVHD) and decreased survival in patients undergoing hematopoietic stem cell transplant (HSCT). Numerous barriers impede replacement, including malabsorption secondary to gut GVHD, mucositis, inability to take capsules, kidney disease, liver disease, and infection; many patients remain refractory despite vitamin D therapy. We hypothesized that a different formulation of cholecalciferol, administered on the tongue as a readily dissolving oral thin film (OTF), would ease administration and facilitate therapeutic vitamin D levels (>35 ng/mL) in patients who are refractory. In this prospective pilot study, we evaluated 20 patients after HSCT (range, day +21 - day +428 at enrollment) with serum vitamin D levels ≤35 ng/mL. Cholecalciferol OTF strips were administered for 12 weeks. Dosing was based on patient body weight and titrated per individual pharmacokinetics. Wilcoxon matched-pairs signed-rank test demonstrated marked improvement in all 20 patients who were formerly refractory, increasing from a median baseline vitamin D level of 29.2 ng/mL to 58 ng/mL at end of study (P < .0001). All patients demonstrated improvement in serum vitamin D level by week 4 on study, some of whom had been refractory for years prior. Median dose was 1 OTF strip (40 000 IU) per week. No toxicity was observed. This formulation proved to be safe, effective, efficient, and well received. We are eager to explore other patient populations, which might benefit from this promising development, and other therapeutics that might be optimized using this mode of delivery. This trial was registered at www.clinicaltrials.gov as #NCT04818957.
Deep learning for pneumothorax diagnosis: a systematic review and meta-analysis
Authors: Sugibayashi Takahiro , Walston Shannon L. , Matsumoto Toshimasa , Mitsuyama Yasuhito , Miki Yukio , Ueda Daiju
Published: June 2023

Background

Deep learning (DL), a subset of artificial intelligence (AI), has been applied to pneumothorax diagnosis to aid physician diagnosis, but no meta-analysis has been performed.

Methods

A search of multiple electronic databases through September 2022 was performed to identify studies that applied DL for pneumothorax diagnosis using imaging. Meta-analysisviaa hierarchical model to calculate the summary area under the curve (AUC) and pooled sensitivity and specificity for both DL and physicians was performed. Risk of bias was assessed using a modified Prediction Model Study Risk of Bias Assessment Tool.

Results

In 56 of the 63 primary studies, pneumothorax was identified from chest radiography. The total AUC was 0.97 (95% CI 0.96–0.98) for both DL and physicians. The total pooled sensitivity was 84% (95% CI 79–89%) for DL and 85% (95% CI 73–92%) for physicians and the pooled specificity was 96% (95% CI 94–98%) for DL and 98% (95% CI 95–99%) for physicians. More than half of the original studies (57%) had a high risk of bias.

Conclusions

Our review found the diagnostic performance of DL models was similar to that of physicians, although the majority of studies had a high risk of bias. Further pneumothorax AI research is needed.
Sparse Phenotyping and Haplotype-Based Models for Genomic Prediction in Rice
Authors: He Sang , Liang Shanshan , Meng Lijun , Cao Liyong , Ye Guoyou
Published: June 2023

The multi-environment genomic selection enables plant breeders to select varieties resilient to diverse environments or particularly adapted to specific environments, which holds a great potential to be used in rice breeding. To realize the multi-environment genomic selection, a robust training set with multi-environment phenotypic data is of necessity. Considering the huge potential of genomic prediction enhanced sparse phenotyping on the cost saving of multi-environment trials (MET), the establishment of a multi-environment training set could also benefit from it. Optimizing the genomic prediction methods is also crucial to enhance the multi-environment genomic selection. Using haplotype-based genomic prediction models is able to capture local epistatic effects which could be conserved and accumulated across generations much like additive effects thereby benefitting breeding. However, previous studies often used fixed length haplotypes composed by a few adjacent molecular markers disregarding the linkage disequilibrium (LD) which is of essential role in determining the haplotype length. In our study, based on three rice populations with different sizes and compositions, we investigated the usefulness and effectiveness of multi-environment training sets with varying phenotyping intensities and different haplotype-based genomic prediction models based on LD-derived haplotype blocks for two agronomic traits, i.e., days to heading (DTH) and plant height (PH). Results showed that phenotyping merely 30% records in multi-environment training set is able to provide a comparable prediction accuracy to high phenotyping intensities; the local epistatic effects are much likely existent in DTH; dividing the LD-derived haplotype blocks into small segments with two or three single nucleotide polymorphisms (SNPs) helps to maintain the predictive ability of haplotype-based models in large populations; modelling the covariances between environments improves genomic prediction accuracy. Our study provides means to improve the efficiency of multi-environment genomic selection in rice.
Rescuing biologically relevant consensus regions across replicated samples
Authors: Jalili Vahid , Cremona Marzia A. , Palluzzi Fernando
Published: June 2023

Background

Protein-DNA binding sites of ChIP-seq experiments are identified where the binding affinity is significant based on a given threshold. The choice of the threshold is a trade-off between conservative region identification and discarding weak, but true binding sites.

Results

We rescue weak binding sites using MSPC, which efficiently exploits replicates to lower the threshold required to identify a site while keeping a low false-positive rate, and we compare it to IDR, a widely used post-processing method for identifying highly reproducible peaks across replicates. We observe several master transcription regulators (e.g., SP1 and GATA3) and HDAC2-GATA1 regulatory networks on rescued regions in K562 cell line.

Conclusions

We argue the biological relevance of weak binding sites and the information they add when rescued by MSPC. An implementation of the proposed extended MSPC methodology and the scripts to reproduce the performed analysis are freely available at https://genometric.github.io/MSPC/; MSPC is distributed as a command-line application and an R package available from Bioconductor (https://doi.org/doi:10.18129/B9.bioc.rmspc).
Electrocardiogram-based deep learning algorithm for the screening of obstructive coronary artery disease
Authors: Choi Seong Huan , Lee Hyun-Gye , Park Sang-Don , Bae Jang-Whan , Lee Woojoo , Kim Mi-Sook , Kim Tae-Hun , Lee Won Kyung
Published: June 2023

Background

Information on electrocardiogram (ECG) has not been quantified in obstructive coronary artery disease (ObCAD), despite the deep learning (DL) algorithm being proposed as an effective diagnostic tool for acute myocardial infarction (AMI). Therefore, this study adopted a DL algorithm to suggest the screening of ObCAD from ECG.

Methods

ECG voltage-time traces within a week from coronary angiography (CAG) were extracted for the patients who received CAG for suspected CAD in a single tertiary hospital from 2008 to 2020. After separating the AMI group, those were classified into ObCAD and non-ObCAD groups based on the CAG results. A DL-based model adopting ResNet was built to extract information from ECG data in the patients with ObCAD relative to those with non-ObCAD, and compared the performance with AMI. Moreover, subgroup analysis was conducted using ECG patterns of computer-assisted ECG interpretation.

Results

The DL model demonstrated modest performance in suggesting the probability of ObCAD but excellent performance in detecting AMI. The AUC of the ObCAD model adopting 1D ResNet was 0.693 and 0.923 in detecting AMI. The accuracy, sensitivity, specificity, and F1 score of the DL model for screening ObCAD were 0.638, 0.639, 0.636, and 0.634, respectively, while the figures were up to 0.885, 0.769, 0.921, and 0.758 for detecting AMI, respectively. Subgroup analysis showed that the difference between normal and abnormal/borderline ECG groups was not notable.

Conclusions

ECG-based DL model showed fair performance for assessing ObCAD and it may serve as an adjunct to the pre-test probability in patients with suspected ObCAD during the initial evaluation. With further refinement and evaluation, ECG coupled with the DL algorithm may provide potential front-line screening support in the resource-intensive diagnostic pathways.
Decision-making on the fly: a qualitative study of physicians in out-of-hospital emergency medical services
Authors: Karmelić Ema , Lindlöf Henrik , Luckhaus Jamie Linnea , Castillo Moa Malmqvist , Vicente Veronica , Härenstam Karin Pukk , Savage Carl
Published: June 2023

Background

Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors.

Methods

Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis.

Results

Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries.

Conclusions

The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians’ journey from novice to expert.
Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study
Authors: Kawuki Joseph , Gatasi Ghislaine , Sserwanja Quraish , Mukunya David , Musaba Milton W.
Published: June 2023

Background

Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda.

Methods

We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25).

Results

Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2–55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13–3.20), health insurance (AOR = 1.39, 95% CI: 1.12–1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04–1.52), exposure to television (AOR = 1.23, 95% CI: 1.05–1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07–1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49–0.87) and Northern (AOR = 0.75, 95% CI: 0.59–0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68–0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion.

Conclusions

To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.
Acute pancreatitis associated with diabetic ketoacidosis in a child with COVID-19 infection
Authors: Liu Xiaoyan , Yu Qingle , Li Lanying , Wei Songqing , Zeng Jin , Jiang Jie
Published: June 2023

Background

There is a mutual influence between COVID-19, diabetes ketoacidosis, and acute pancreatitis, with clinical manifestations overlapping each other, which can lead to misdiagnosis and delayed treatment that could aggravate the condition and affect the prognosis. COVID-19-induced diabetes ketoacidosis and acute pancreatitis are extremely rare, with only four case reports in adults and no cases yet reported in children.

Case presentation

We reported a case of acute pancreatitis associated with diabetic ketoacidosis in a 12-year-old female child post novel coronavirus infection. The patient presented with vomiting, abdominal pain, shortness of breath, and confusion. Laboratory findings showed elevated levels of inflammatory markers, hypertriglyceridemia, and high blood glucose. The patient was treated with fluid resuscitation, insulin, anti-infection treatments, somatostatin, omeprazole, low-molecular-weight heparin, and nutritional support. Blood purification was administered to remove inflammatory mediators. The patient's symptoms improved, and blood glucose levels stabilized after 20 days of admission.

Conclusion

The case highlights the need for greater awareness and understanding of the interrelated and mutually promoting conditions of COVID-19, diabetes ketoacidosis, and acute pancreatitis among clinicians, to reduce misdiagnosis and missed diagnoses.
The perfect birth: a content analysis of midwives’ posts about birth on Instagram
Authors: Marsh Anna , Hundley Vanora A. , Luce Ann , Richens Yana
Published: June 2023

Background

There is limited research into how midwives use social media within their professional role. Small pilot studies have explored the introduction of social media into maternity practice and teaching but there is little evidence around how midwives use social media professionally. This is important as 89% of pregnant women turn to social media for advice during pregnancy, and how midwives use social media could be influencing women, their perception of birth and their decision making.

Methods

Aim

To analyse how popular midwives portray birth on the social media platform Instagram.

This is an observational mixed methods study using content analysis. Five ‘popular’ midwives from each country (UK, New Zealand, USA and Australia) were identified and their posts about birth collated from a one-year period (2020–21). Images/videos were then coded. Descriptive statistics enabled comparison of the posts by country. Categorisation was used to analyse and understand the content.

Results

The study identified 917 posts from the 20 midwives’ accounts, containing 1216 images/videos, with most coming from USA (n = 466), and UK (n = 239), Australia (n = 205) and New Zealand (n = 7) respectively. Images/videos were categorised into ‘Birth Positivity’, ‘Humour’, ‘Education’, ‘Birth Story’ and ‘Advertisement’. Midwives’ portrayals of birth represented a greater proportion of vaginal births, waterbirths and homebirths than known national birth statistics.

The most popular midwives identified mainly had private businesses (n = 17). Both the midwives and women portrayed in images were primarily white, demonstrating a disproportionate representation.

Conclusion

There is a small midwifery presence on Instagram that is not representative of the broader profession, or the current picture of midwifery care. This paper is the first study to explore how midwives are using the popular social media platform Instagram to portray birth. It provides insight into how midwives post an un-medicalised, low risk representation of birth. Further research is recommended to explore midwives’ motivation behind their posts, and how pregnant and postnatal women engage with social media.
Postnatal care service utilisation for babies within the first two months after childbirth: an analysis of rural-urban differences in eleven Sub-Saharan African countries
Authors: Dickson Kwamena Sekyi , Ayebeng Castro , Adu-Gyamfi Addae Boateng , Okyere Joshua
Published: June 2023

Background

The World Health Organisation recommends that all mothers seek postnatal care (PNC) within the first two months after childbirth. This study examined PNC utilisation for babies within the first two months after childbirth.

Methods

We used data from the most recent Demographic and Health Surveys (DHS) (2018–2020) of eleven countries in SSA. Descriptive and a multivariate analysis were carried out, and presented in adjusted odds ratios. The explanatory variables included: age, place of residence, level of formal education, wealth quintile, antenatal care visits, marital status, frequency of watching TV, listening to radio and reading newspaper, getting permission to go medical help for self, getting money needed for treatment, and distance to facility.

Results

PNC utilisation was 37.5% and 33% in urban and rural residences, respectively. Higher level of education (Urban: AOR = 1.39, CI = 1.25, 1.56; Rural: AOR = 1.31, CI = 1.10, 1.58), 4 or more ANC visits (Urban: AOR = 1.32, CI = 1.23, 1.40; Rural: AOR = 1.49, CI = 1.43, 1.56 0.86), requiring permission to go to the health facility (Urban: AOR = 0.67, CI = 0.61, 0.74; Rural: AOR = 0.86, CI = 0.81, 0.91), listening to the radio at least once a week (Urban: AOR = 1.32, CI = 1.23, 1.41; Rural: AOR = 0.86, CI = 0.77, 0.95), and watching television at least once a week (Urban: AOR = 1.11, CI = 1.03, 1.21; Rural: AOR = 1.15, CI = 1.07, 1.24) were significantly associated with PNC service utilisation in both rural and urban areas. However, belonging to a richer wealth status (AOR = 1.11, CI = 1.02, 1.20) and having a problem with distance (AOR = 1.13, CI = 1.07, 1.18) were significant in only rural areas, while having a problem with money for treatment was significant only in urban areas (AOR = 1.15, CI = 1.08, 1.23).

Conclusion

In this study, we conclude that the PNC service utilisation within the first 2 months after delivery was low across rural and urban residences. There is, therefore, a need for SSA countries to develop population tailored interventions such as advocacy and health education targeted at women with no formal education in both rural and urban areas. Our study also suggests that SSA countries must intensify radio programs and advertisements on the health benefits of PNC to improve maternal and child health.
Clinical evaluation and management of badminton-related eye injuries: a retrospective case series
Authors: Guo Tingting , Shi Wanru , Yi Xiuqian , Huang Tianrui , Huang Peijie , Xue Kang
Published: June 2023

Background

To describe the clinical features, visual outcomes, management, and complications of ocular injury in badminton and investigate risk factors associated with visual impairment.

Methods

Data on patients injured while playing badminton admitted to Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital, Fudan University between January 2018 to December 2020.The relationship between visual acuity (VA) and demographic and clinical variables was also analyzed. Patients were managed medically or surgically as per their needs, followed up for at least 18 months. The visual outcomes were predicted using ocular trauma score (OTS), predicted outcomes were compared with actual outcomes using statistical tests.

Results

This study involved 102 patients (78 men, 24 women) with a mean age of 43.8 ± 16.1 years (7–71 years). Of these, 93 patients had closed-globe injuries and 9 had open-globe injuries. Vision-threatening findings included lens subluxation(31.4%),retinal detachment(13.7%),hyphema(12.7%). Open-globe injury had significantly lower presenting VA and final VA (P= 0.0164, 0.0053).Final VA was found to be correlated with presenting VA, maculopathy, retinal detachment, and OTS (P=0.0000, 0.0494, 0.0001, 0.0000 respectively), it was worse in patients who were under 20 years of age and were female. OTS prediction was not significantly different when compared with actual visual outcomes postoperatively in OTS3, OTS4, and OTS5 (P > 0.05),while the prognosis of patients with OTS1 and OTS2 was better than OTS study (P=0.001, 0.007, respectively).

Conclusion

Badminton-related closed-globe injuries were more frequent; open-globe injuries were usually more serious. Younger and female patients have poorer visual recovery prognoses. OTS was found to be a reliable tool for predicting visual outcomes.
One-way or two-way sweet link between theobromine and depression?
Authors: Franco Rafael , Martínez-Pinilla Eva
Published: June 2023

Theobromine is an abundant methylxanthine in cocoa/chocolate. A recent article in BMC Psychiatry concludes that theobromine consumption increases the risk of depression. In our opinion, it is difficult to make a correlation between dietary habits and the risk of depression, the diagnosis of which is not simple to make. Also, it is not easy to assess the amount of theobromine because it varies from one brand of chocolate to another and/or depending on the percentage of cocoa it has. Assuming that there is a correlation, we postulate that the conclusion may be the opposite, that is, that depressed individuals benefit from the intake of products containing theobromine. Since some antidepressant drugs alter the craving for sweet products, it would be interesting to try to correlate the data on theobromine intake with the kind of therapy used in depressed individuals.
Inequalities in the receipt of healthcare practitioner counseling for adults after COVID-19 in southern Brazil
Authors: Rocha Juliana Quadros Santos , Dutra Rinelly Pazinato , Vieira Yohana Pereira , Duro Suele Manjourany Silva , de Oliveira Saes Mirelle
Published: June 2023

Health counseling is a prevention and health promotion action, especially in the context of a pandemic, for both preventing disease and maintaining health. Inequalities may affect receipt of health counseling. The aim was to provide an overview of the prevalence of receiving counseling and to analyze income inequality in the receipt of health counseling. Methods: This was a cross-sectional telephone survey study with individuals aged 18 years or older with diagnosis of symptomatic COVID-19 using RT-PCR testing between December 2020 and March 2021. They were asked about receipt of health counseling. Inequalities were assessed using the Slope Index of Inequality (SII) and Concentration Index (CIX) measures. We used the Chi-square test to assess the distribution of outcomes according to income. Adjusted analyses were performed using Poisson regression with robust variance adjustment. Results: A total of 2919 individuals were interviewed. Low prevalence of health counseling by healthcare practitioner was found. Participants with higher incomes were 30% more likely to receive more counseling. Conclusions: These results serve as a basis for aggregating public health promotion policies, in addition to reinforcing health counseling as a multidisciplinary team mission to promote greater health equity.
Care seek behavior for low back pain in southern Brazil during the COVID-19 pandemic: a panel data analysis
Authors: Caputo Eduardo L , Feter Natan , Pinto Ricardo N C , Delpino Felipe Mendes , Cassuriaga Júlia , da Silva Carine N , Leite Jayne S , Jerônimo Jeferson S , da Silva Sophia D P , Reichert Felipe F , Rombaldi Airton J , da Silva Marcelo C
Published: June 2023

Background

During the COVID-19 pandemic, people with low back pain (LBP) might have avoided seeking care for their pain. We aimed to investigate how the COVID-19 pandemic has affected LBP care seeking behavior among adults.

Methods

Data from four assessments of the PAMPA cohort were analyzed. Participants who reported experiencing LBP during wave one both before and during social restrictions (n = 1,753 and n = 1,712, respectively), wave two (n = 2,009), and wave three (n = 2,482) were included. We asked participants about sociodemographic, behavioral, and health factors and outcomes related to LBP. Poisson regression analyses were conducted, and data are presented as prevalence ratios (PR) and respective 95% confidence interval (95%CI).

Results

Overall, care seeking behavior decreased by half in the first months of restrictions, from 51.5% to 25.2%. Although there was an increase in care seeking behavior observed in the other two assessments (nearly 10 and 16 months after restrictions), it was insufficient to reach pre-pandemic levels. In the first months of restrictions, a similar scenario was observed for specific care, such as general practitioner and exercise professional care, with proportions of pre-pandemic levels reached after 10 and 16 months. Women were more likely to seek care for LBP 10 and 16 months after restrictions (PR 1.30 95%CI 1.11; 1.52, PR 1.22 95%CI 1.06; 1.39, respectively). Also, those participants who worked, were physically active, and reported pain-related disability and high pain levels were more likely to seek care at all time points assessed.

Conclusion

Overall, care-seeking behavior for LBP significantly decreased in the first months of restrictions and increased in the following months; however, this behavior remained lower than pre-pandemic levels.
Can pelvic diameter measurement have an effect on surgical outcomes in radical cystectomy?
Authors: Erdik Anil , Cimen Haci Ibrahim , Kose Osman , Ates Omer Faruk , Taydas Onur , Gul Deniz , Saglam Hasan Salih
Published: June 2023

Objective

To determine the effectiveness of pelvis diameters in determining postoperative outcomes in men who underwent open radical cystectomy + urinary diversion, it is aimed to predict the factors that may affect the operative difficulty and possible surgical outcomes before the operation.

Methods

A total of 79 radical cystectomy patients operated in our institution with preoperative computed tomography (CT) were included the study. Pelvic dimensions; symphysis angle (SA), upper conjugate, lower conjugate, pelvic depth, apical depth (AD), interspinous distance (ISD), bone femoral width and soft tissue width were measured by preoperative CT. ISD index were defined as ISD/AD. Postoperative outcomes and indicators of operative difficulty were recorded. Regression analyses were used to predict perioperative and postoperative outcomes.

Results

Total of 96 complications were observed in 52 of the 79 patients in ninety days (65,8%) with a mean age of 68.25 years. There were significant correlations between SA and body mass index (BMI) with operative time (p = 0.006, p < 0.001; respectively). For estimated blood loss, there were significant correlations between preoperative hematocrit (p = 0,031). Analysis of multivariate logistic regression revealed that higher Charlson comorbidity index (CCI) and BMI were found to be significant predictors for major complications while CCI, pathological T stage and ISD index are prominent predictors for surgical margin positivity.

Conclusions

Pelvic dimensions are not significant with minor or major complications. However, operative time may be associated with SA. Also, narrow and deep pelvis may increase the risk of positive surgical margins.
Impact of the Medicare Benefits Schedule Rebate (MBSR) freeze on General Practice (GP) use: multivariable regression analysis
Authors: Mudiyanselage Shalika Bohingamu , Dona Sithara Wanni Arachchige , Abimanyi-Ochom Julie , Watts Jennifer J
Published: June 2023

Background

In 2015, the Australian government froze the Medicare Benefits Schedule Rebate (MBSR) for General Practitioner (GP) service use. This paper aimed to explore the impact of the MBSR freeze on the demand for GP services in Victoria, Australia, for three years, from 2014 to 2016.

Method

Annual data on GP service utilisation by the Victorian State Statistical Area Level 3 (SA3) were analysed using 2015 as the reference year (MBSR freeze year). We compared annual per-person GP service use before and after the MBSR freeze for each SA3. Socioeconomic Indexes for Areas (SEIFA) scores and regions of Victoria (Greater Melbourne and the Rest of Victoria) were used to identify the most disadvantaged SA3s in Victoria. We conducted a multivariable regression analysis for the number of GP services per patient by SA3, controlling for regions of Victoria, the number of GP services, the proportion of bulk-billed visits, age group, gender and year.

Findings

After adjusting for age group, gender, region, SEIFA, the number of GPs and the proportion of bulk-billed GP visits, mean GP services per person per year declined steadily between 2014 and 2016, with a 3% or 0.11 visit (-0.114, 95%CI: -0.134; -0.094, P = < 0.001) reduction in mean utilisation in 2016 compared to 2014. In disadvantaged SA3s, there was a fall in the number of GP services that were bulk-billed during and after the MBSR freeze compared to 2014, and this fall was large in LOW SEIFA SA3s, with a reduction in 17% of mean bulk-billed GP services.

Conclusion

The MBSR freeze for GP consultations in 2015 resulted in a reduction in the annual per capita demand for GP visits, with the impact of reduced demand more significant in lower socioeconomic and regional/rural areas. The GP funding policies must consider the demand differences by social-economic status and location.
Multiple heteroresistance to tigecycline and colistin in Acinetobacter baumannii isolates and its implications for combined antibiotic treatment
Authors: Jo Jeongwoo , Kwon Ki Tae , Ko Kwan Soo
Published: June 2023

Background

We investigated the presence of heteroresistance against both tigecycline and colistin in Acinetobacter baumannii and then evaluated the effectiveness of combined antibiotic treatment given the existence of discrete tigecycline- and colistin-resistant subpopulations.

Methods

We performed population analysis profiling (PAP) to evaluate the degree of composite heteroresistance in A. baumannii isolates, with the extent of this resistance quantified using subsequent antibiotic susceptibility testing. We then evaluated the amino acid sequence of PmrBAC and the relative mRNA expression levels of pmrB. Finally, we investigated the combined antibiotic efficacy of tigecycline and colistin in multiple-heteroresistant isolates using dual PAP and in vitro time-killing assays.

Results

All tigecycline-heteroresistant A. baumannii isolates, with the exception of one colistin-resistant isolate, were also heteroresistant to colistin. Evaluations of the colistin-resistant subpopulations revealed amino acid alterations in PmrA and PmrB and increased expression of pmrB. All tigecycline-resistant subpopulations were susceptible to colistin, and all colistin-resistant subpopulations were susceptible to tigecycline. Dual PAP analysis using tigecycline and colistin showed no heteroresistance, and in vitro time-killing assays revealed that a combination of these two antibiotics effectively eliminated the bacterial cells.

Conclusion

Our results suggest that multiple heteroresistance to tigecycline and colistin is highly prevalent among A. baumannii clinical isolates and that these resistant subpopulations exist independently in single multiple heteroresistant isolates. Therefore, our findings may explain the success of combined antibiotic therapies in these infections.
Improving therapeutic protein secretion in the probiotic yeast Saccharomyces boulardii using a multifactorial engineering approach
Authors: Durmusoglu Deniz , Al’Abri Ibrahim , Li Zidan , Islam Williams Taufika , Collins Leonard B. , Martínez José L. , Crook Nathan
Published: June 2023

The probiotic yeastSaccharomyces boulardii(Sb) is a promising chassis to deliver therapeutic proteins to the gut due toSb’s innate therapeutic properties, resistance to phage and antibiotics, and high protein secretion capacity. To maintain therapeutic efficacy in the context of challenges such as washout, low rates of diffusion, weak target binding, and/or high rates of proteolysis, it is desirable to engineerSbstrains with enhanced levels of protein secretion. In this work, we explored genetic modifications in bothcis-(i.e. to the expression cassette of the secreted protein) andtrans-(i.e. to theSbgenome) that enhanceSb’s ability to secrete proteins, taking aClostridioides difficileToxin A neutralizing peptide (NPA) as our model therapeutic. First, by modulating the copy number of the NPA expression cassette, we found NPA concentrations in the supernatant could be varied by sixfold (76–458 mg/L) in microbioreactor fermentations. In the context of high NPA copy number, we found a previously-developed collection of native and synthetic secretion signals could further tune NPA secretion between 121 and 463 mg/L. Then, guided by prior knowledge ofS. cerevisiae’s secretion mechanisms, we generated a library of homozygous single gene deletion strains, the most productive of which achieved 2297 mg/L secretory production of NPA. We then expanded on this library by performing combinatorial gene deletions, supplemented by proteomics experiments. We ultimately constructed a quadruple protease-deficientSbstrain that produces 5045 mg/L secretory NPA, an improvement of > tenfold over wild-typeSb. Overall, this work systematically explores a broad collection of engineering strategies to improve protein secretion inSband highlights the ability of proteomics to highlight under-explored mediators of this process. In doing so, we created a set of probiotic strains that are capable of delivering a wide range of protein titers and therefore furthers the ability ofSbto deliver therapeutics to the gut and other settings to which it is adapted.
Optimization of tumor-treating field therapy for triple-negative breast cancer cells in vitro via frequency modulation
Authors: Smothers Austin R. , Henderson Jason R. , O’Connell John J. , Stenbeck Jonathan M. , Dean Delphine , Booth Brian W.
Published: June 2023

Purpose

Currently, tumor-treating field (TTField) therapy utilizes a single “optimal” frequency of electric fields to achieve maximal cell death in a targeted population of cells. However, because of differences in cell size, shape, and ploidy during mitosis, optimal electric field characteristics for universal maximal cell death may not exist. This study investigated the anti-mitotic effects of modulating electric field frequency as opposed to utilizing uniform electric fields.

Methods

We developed and validated a custom device that delivers a wide variety of electric field and treatment parameters including frequency modulation. We investigated the efficacy of frequency modulating tumor-treating fields on triple-negative breast cancer cells compared to human breast epithelial cells.

Results

We show that frequency-modulated (FM) TTFields are as selective at treating triple-negative breast cancer (TNBC) as uniform TTFields while having a greater efficacy for combating TNBC cell growth. TTField treatment at a mean frequency of 150 kHz with a frequency range of ± 10 kHz induced apoptosis in a greater number of TNBC cells after 24 h as compared to unmodulated treatment which led to further decreased cell viability after 48 h. Furthermore, all TNBC cells died after 72 h of FM treatment while cells that received unmodulated treatment were able to recover to cell number equivalent to the control.

Conclusion

TTFields were highly efficacious against TNBC growth, FM TTFields showed minimal effects on epithelial cells similar to unmodulated treatment.
Genetic variants of TLR4, including the novel variant, rs5030719, and related genes are associated with susceptibility to clinical malaria in African children
Authors: Ariff Amir , Song Yong , Aguilar Ruth , Nhabomba Augusto , Manaca Maria Nelia , Khoo Siew-Kim , Wiertsema Selma , Bassat Quique , Barbosa Arnoldo , Quintó Llorenç , Laing Ingrid A. , Guinovart Caterina , Alonso Pedro L. , Dobaño Carlota , Le Souëf Peter , Zhang Guicheng
Published: June 2023

Background

Malaria is a deadly disease caused by Plasmodium spp. Several blood phenotypes have been associated with malarial resistance, which suggests a genetic component to immune protection.

Methods

One hundred and eighty-seven single nucleotide polymorphisms (SNPs) in 37 candidate genes were genotyped and investigated for associations with clinical malaria in a longitudinal cohort of 349 infants from Manhiça, Mozambique, in a randomized controlled clinical trial (RCT) (AgeMal, NCT00231452). Malaria candidate genes were selected according to involvement in known malarial haemoglobinopathies, immune, and pathogenesis pathways.

Results

Statistically significant evidence was found for the association of TLR4 and related genes with the incidence of clinical malaria (p = 0.0005). These additional genes include ABO, CAT, CD14, CD36, CR1, G6PD, GCLM, HP, IFNG, IFNGR1, IL13, IL1A, IL1B, IL4R, IL4, IL6, IL13, MBL, MNSOD, and TLR2. Of specific interest, the previously identified TLR4 SNP rs4986790 and the novel finding of TRL4 SNP rs5030719 were associated with primary cases of clinical malaria.

Conclusions

These findings highlight a potential central role of TLR4 in clinical malarial pathogenesis. This supports the current literature and suggests that further research into the role of TLR4, as well as associated genes, in clinical malaria may provide insight into treatment and drug development.
Biomedical application of 2D nanomaterials in neuroscience
Authors: Li Kangchen , Ji Qianting , Liang Huanwei , Hua Zixuan , Hang Xinyi , Zeng Linghui , Han Haijun
Published: June 2023

Two-dimensional (2D) nanomaterials, such as graphene, black phosphorus and transition metal dichalcogenides, have attracted increasing attention in biology and biomedicine. Their high mechanical stiffness, excellent electrical conductivity, optical transparency, and biocompatibility have led to rapid advances. Neuroscience is a complex field with many challenges, such as nervous system is difficult to repair and regenerate, as well as the early diagnosis and treatment of neurological diseases are also challenged. This review mainly focuses on the application of 2D nanomaterials in neuroscience. Firstly, we introduced various types of 2D nanomaterials. Secondly, due to the repairment and regeneration of nerve is an important problem in the field of neuroscience, we summarized the studies of 2D nanomaterials applied in neural repairment and regeneration based on their unique physicochemical properties and excellent biocompatibility. We also discussed the potential of 2D nanomaterial-based synaptic devices to mimic connections among neurons in the human brain due to their low-power switching capabilities and high mobility of charge carriers. In addition, we also reviewed the potential clinical application of various 2D nanomaterials in diagnosing and treating neurodegenerative diseases, neurological system disorders, as well as glioma. Finally, we discussed the challenge and future directions of 2D nanomaterials in neuroscience.

Graphical Abstract
Prognostic impact of R1 resection margin in synchronous and simultaneous colorectal liver metastasis resection: a retrospective cohort study
Authors: Kim Na Reum , Alhothaifi Essam Dhafer , Han Dai Hoon , Choi Jin Sub , Choi Gi Hong
Published: June 2023

Background

A margin ≥ 1 mm is considered a standard resection margin for colorectal liver metastasis (CRLM). However, microscopic incomplete resection (R1) is not rare since aggressive surgical resection has been attempted in multiple and bilobar CRLM. This study aimed to investigate the prognostic impact of resection margins and perioperative chemotherapy in patients with CRLM.

Methods

A total of 368 of 371 patients who underwent simultaneous colorectal and liver resection for synchronous CRLM between 2006 and June 2017, excluding three R2 resections, were included in this study. R1 resection was defined as either abutting tumor on the resection line or involved margin in the pathological report. The patients were divided into R0 (n = 304) and R1 (n = 64) groups. The clinicopathological characteristics, overall survival, and intrahepatic recurrence-free survival were compared between the two groups using propensity score matching.

Results

The R1 group had more patients with ≥ 4 liver lesions (27.3 vs. 50.0%, P < 0.001), higher mean tumor burden score (4.4 vs. 5.8%, P = 0.003), and more bilobar disease (38.8 vs. 67.2%, P < 0.001) than the R0 group. Both R0 and R1 groups showed similar long-term outcomes in the total cohort (OS, P = 0.149; RFS, P = 0.414) and after matching (OS, P = 0.097, RFS: P = 0.924). However, the marginal recurrence rate was higher in the R1 group than in the R0 group (26.6 vs. 16.1%, P = 0.048). Furthermore, the resection margin did not have a significant impact on OS and RFS, regardless of preoperative chemotherapy. Poorly differentiated, N-positive stage colorectal cancer, liver lesion number ≥ 4, and size ≥ 5 cm were poor prognostic factors, and adjuvant chemotherapy had a positive impact on survival.

Conclusions

The R1 group was associated with aggressive tumor characteristics; however, no effect on the OS and intrahepatic RFS with or without preoperative chemotherapy was observed in this study. Tumor biological characteristics, rather than resection margin status, determine long-term prognosis. Therefore, aggressive surgical resection should be considered in patients with CRLM expected to undergo R1 resection in this multidisciplinary approach era.