bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamics of Perceived Barriers to Change Physical Activity and Eating Habits in Adults Before and During a Lifestyle Intervention in a Primary Care Setting: A Mixed Methods Approach
Authors: Kadi Fawzi , Nilsson Andreas
Published: August 2024

Background:

There is scarcity of data exploring the dynamics of barriers to changing physical activity (PA) and eating habits during a lifestyle intervention in a primary care setting. The aim of the present study was to investigate barriers to lifestyle change before and during a primary care lifestyle intervention in adults with different sociodemographic backgrounds.

Methods:

Barriers to healthy eating and PA were assessed in 114 adults (age = 55 ± 9 years) using a questionnaire before inclusion in the intervention. During the lifestyle intervention, factors perceived as obstacles to reach goals for PA and healthy eating habits were collected using focus group interviews in a sub-sample of 25 adults and analyzed using thematic analysis.

Results:

At least 1 barrier to changing eating and PA habits was reported in 65% and 67% of the population, respectively, without differences due to sex, place of birth, and educational level. Before entering the lifestyle intervention, intrapersonal factors including lack of willpower and lack of enjoyment were the dominant barriers to PA and healthy eating, irrespective of place of birth, sex, and education level. In contrast, environmental factors such as lack of support from family and work-related constraints emerged as important barriers to overcome during the action phase of the lifestyle intervention.

Conclusions:

The present study highlights the dynamics of barriers to changing PA and eating habits in a primary care lifestyle intervention, emphasizing the need for barrier assessment during the different phases of an intervention to tailor support activities for successful lifestyle behavioral change.
Elder Abuse in the Orthopaedic Patient: An Updated Review of Prevalence, Identification, and Screening Tools for Orthopaedic Surgeons
Authors: Scott Sophia , Brameier Devon T. , Tryggedsson Ida , Suneja Nishant , Stenquist Derek S. , Weaver Michael J. , von Keudell Arvind
Published: August 2024

Introduction

Elder abuse is a prevalent, though often overlooked and underreported, cause of musculoskeletal injury in the elderly population. The purpose of this review is to provide an updated overview of the prevalence of elder abuse, its association with musculoskeletal injuries, and the available resources to aid orthopaedic surgeons in early detection and intervention.

Significance

Improved training on this topic is needed throughout the medical education of orthopaedic surgeons to effectively recognize and address elder abuse. Our findings reveal an urgent need for increased awareness, education, and collaboration among healthcare professionals to address this significant public health concern. As the aging population continues to grow, understanding the connection between elder abuse and musculoskeletal injuries is essential for providing comprehensive care to older adults.

Results

This review offers practical recommendations for identifying individuals at risk of elder abuse and outlines strategies for intervention. Indicators of abuse range from obvious signs like dirty clothes, neglect, and unattended injuries from falls, to more subtle cues requiring careful observation and questioning, such as mental health symptoms and family histories of abuse.

Conclusion

By shedding light on this often-overlooked issue, this review advocates for a proactive approach to identifying and addressing elder abuse to safeguard the well-being and quality of life of older individuals.
The Impact of Improved Compliance With Enhanced Recovery After Surgery on Frail Patients Undergoing Multi-Level Posterior Lumbar Fusion Surgery for Degenerative Lumbar Diseases
Authors: Zhang Xiaoying , Dong Xuewei , Luo Huili , Song Yanli , Chen Shengmin
Published: August 2024

Background

Patients with frailty are more prone to have perioperative adverse events, and enhanced recovery after surgery (ERAS) has been widely adopted to improve perioperative outcomes. The purpose of this study was to assess the impact of improved compliance with ERAS on perioperative outcomes in frail patients.

Methods

Geriatric patients (over 65 years) who underwent multi-level lumbar fusion surgery between June 2017 and June 2022 were included. The patients were divided into two groups according to their degree of compliance with the ERAS. Stepwise nearest-neighbor propensity score matching 1:1 cohorts for age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classfication and Charlson Comorbidity Index (CCI) was performed between groups, namely frail-compliant (FC), frail-noncompliant (FN). Further length of stay (LOS), complications and clinical efficacy were compared between groups.

Results

There were 83 pairs of well-balanced patients with comparable clinical baseline data. It was worth noting that patients in FC group has significant lower overall complications (20.5% in the FC group vs 39.8% in the FN group, P = 0.007), major complications (7.2% in the FC group vs 19.3% in the FN group, P = 0.022) and shorter LOS (11.18 ± 5.32 in the FC group vs 14.45 ± 4.68 in the FN group, P < 0.001) than patients in FN group. In addition, the initial occurrence of ambulation (2.14 ± 1.21 in FC group vs 3.18 ± 1.73 in FN group, P = 0.012) and bowel movement (3.68 ± 1.24 in FC group vs 4.17 ± 1.32 in FN group, P = 0.031) were earlier for patients in FC group than patients in FN group. With regard to clinical efficacy, there were no significant difference between FC and FN group in terms of patients who meet minimal clinical important difference (MCID) for Oswestry Disability Index (ODI) at postoperative day (POD) 30, Visual Analog Scale (VAS) for back at POD 30-90 and VAS for legs at POD 30, 90, and 180 follow-up intervals. However, there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 between FC and FN group.

Conclusions

In this retrospective cohort study, we found that frail patients with higher ERAS adherence group had a lower incidence of overall complication, mjor complications, and a shorter LOS than their lower ERAS adherence counterparts. In addition, frail patients with higher ERAS adherence had earlier ambulatioin and bowel movement. More importantly, we found there were significant more patients meeting MCID for ODI at POD 90 and180, and VAS for back at POD 180 in higher ERAS adherence than their lower counterparts.
Barriers to Discharge of Hip Fracture Patients From An Academic Hospital: A Retrospective Data Analysis
Authors: Backman Chantal , Engel Franciely D. , Webber Colleen , Harley Anne , Tanuseputro Peter , de Mello Ana Lúcia Schaefer Ferreira , Lanzoni Gabriela Marcellino de Melo , Papp Steve
Published: August 2024

Introduction

Adherence to best practices for care of hip fracture patients is fundamental to decreasing morbidity and mortality in older adults. This includes timely transfer from the hospital to rehabilitation soon after their surgical care. Hospitals experience challenges in implementing several best practices. We examined the potential barriers associated with timely discharge for patients who underwent a hip fracture surgery in an academic hospital in Ontario, Canada.

Methods

We conducted a retrospective cross-sectional review of a local database. We used descriptive statistics to characterize individuals according to the time of discharge after surgery. Multivariable binary logistic regression was used to evaluate factors associated with delayed discharge (>6 days post-surgery).

Results

A total of 492 patients who underwent hip fracture surgery between September 2019 and August 2020 were included in the study. The odds of having a delayed discharge occurred when patients had a higher frailty score (odds ratios [OR] 1.19, 95% confidence interval [CI] 1.02;1.38), experienced an episode of delirium (OR 2.54, 95% CI 1.35;4.79), or were non-weightbearing (OR 3.00, 95% CI 1.07;8.43). Patients were less likely to have a delayed discharge when the surgery was on a weekend (OR .50, 95% CI .32;.79) compared to a weekday, patients had a total hip replacement (OR .28, 95% CI .10;.80) or dynamic hip screw fixation (OR .49, 95% CI .25;.98) compared to intramedullary nails, or patients who were discharged to long-term care (OR .05, 95% CI .02;.13), home (OR .26, 95% CI .15;.46), or transferred to another specialty in the hospital (OR .49, 95% CI .29;.84) compared to inpatient rehabilitation.

Conclusions

Clinical and organizational factors can operate as potential barriers to timely discharge after hip fracture surgery. Further research is needed to understand how to overcome these barriers and implement strategies to improve best practice for post-surgery hip fracture care.
A Study on the Impact of Personality Traits on Behavior of Game Players Toward Spending on In-game Microtransactions
Authors: Dai Qi , Huang Linzhang , Nagasawa Hana , Sawada Masato , Oshio Atsushi
Published: August 2024

This study examined how personality influences consumer behavior of electronic game players. Participants ( N = 479) were respectively placed into four groups called microtransaction group (if they had made any in-game microtransactions, n = 192), free-game group (if they had only played entirely free games, n = 124), pay-to-play group (if they had only played games that needed just one-time payment upon purchase, n = 19), and non-microtransaction group (if they had not made any in-game microtransactions although the games provided such services, n = 144). The results indicated that the microtransaction group had higher levels of extraversion and openness than the non-microtransaction group. Additionally, the microtransaction group showed higher levels of dispositional greed and narcissism than all other groups. However, there were no significant differences in agreeableness, conscientiousness, neuroticism, or self-control among the groups. The study also found that the possibility of making in-game microtransactions decreased with age. These findings have important implications for game developers and marketers, who may use this information to tailor their products and marketing strategies to specific personality types and age groups.
Linking Person Supervisor Fit With Employee Performance and Work Engagement: The Mediating Role of LMX
Authors: Zakiy Muhammad
Published: August 2024

Leaders have become a key factor in determining the future of an organization. For this reason, support from leaders is very influential on work engagement and employee performance in the organization. Leaders can form a conducive work atmosphere so that employees can be motivated to work. This study aims to link person supervisor fit to employee performance and work engagement mediated by a leader-member exchange. Respondents in this study were employees of six Islamic banks in the province of DIY. Collecting data through questionnaires were distributed online and offline to 158 employees of Islamic Banks. Data were analyzed through SEM-PLS using SMART-PLS software. The results of this study prove that PS-Fit can have a positive effect on employee performance and work engagement. In addition, this study can also examine the role of LMX as a mediating variable that connects PS-Fit to employee performance and employee work engagement. For this reason, managers at Islamic Banks need to optimize the role of leaders in the company, such as improving interpersonal relationships with employees in order to improve employee performance and employee work engagement.
The Influence of Zombie Enterprises on Quantity and Quality of Entrepreneurship: Does Banking Competition Matter
Authors: He Xiangmin , Yan Shenrun , Miao Jingyun
Published: August 2024

Entrepreneurship plays a pivotal role in driving economic development and social progress. In contrast to existing literature that primarily focuses on the impact of zombie enterprises on innovation, resource distortion, and environmental pollution, this study aims to investigate the influence of zombie enterprises on entrepreneurship by utilizing data from prefecture cities in China. Additionally, we explore how banking competition moderates this relationship. Employing the system GMM estimator, our findings reveal that zombie enterprises significantly hampers urban entrepreneurship quantity and diminishes entrepreneurship quality. Furthermore, the inhibitory effect of zombie enterprises on entrepreneurship quality is greater than that of entrepreneurship quantity. In addition, we observe that state-owned zombie enterprises have a more pronounced negative impact compared to private zombie enterprises. Notably, banking competition exhibits a nonlinear moderating effect on the association between zombie firms and entrepreneurship; joint-stock banks and city commercial banks play prominent roles in shaping this effect. Threshold model regression analysis confirms these nonlinear effects. Overall, our conclusions offer important policy implications for accelerating the disposal of zombie firms as well as enhancing entrepreneurship quantity /quality to promote high-quality urban development.
Exploring Global Entrepreneurship Issues on Twitter
Authors: Chen Mei-Hui , Yuan Chih-Hung , Tsai Kune-Muh
Published: August 2024

Entrepreneurship benefits economic development and innovation, and provides competitive advantages. Thus, entrepreneurship issues have received widespread attention from both academia and governments. However, there is relatively scarce research on the issues or topics that concern most people when talking about entrepreneurship on social media platforms. This study explores global entrepreneurship issues on Twitter. It adopts a text-mining technique followed by a social network analysis to analyze global, real-time longitudinal, and qualitative data from Twitter using 138,089 tweets related to entrepreneurship from 28,592 Twitter users. We observe that the startup phase is the most critical issue when talking about entrepreneurship because most people are interested in acquiring information on how to start a new venture. We also find that busy entrepreneurs prefer obtaining tips to help them work smart. Finally, the four most discussed topics are starting a business, success tips, startup, and team building. The research period is not long enough and all samples in the study are from Twitter Although they are representative, future research can improve the academic and practical implications with extended data collection periods and cross-platforms.
Women’s Struggle for a Voice in Gaming Culture Among Youth in Türkiye
Authors: Demir Zuhal Gök , Sümer Fulya Erendağ , Karakaya Çiğdem , Aydın Şükrü
Published: August 2024

It is important to examine how video games affect gender-based dynamics in society as their popularity continues to rise. Video games can be a powerful force in shaping perceptions of social reality, including teenage gamers’ perceptions of gender roles. The impact of video games may be more influential for teenagers who are maturing their expectations, thoughts, and attitudes by providing images and messages that can shape the perceptions of gender roles and societal expectations of appearances. Thus, the paper aims to introduce the gender insights of teenage gamers in Türkiye by conducting separate focus group discussions for male and female teenage gamers via the Zoom platform in June 2021. Data were analyzed using thematic analysis under seven themes; representation of game style; depiction of characters in video games; reflection about stereotypes towards gamers; equality of characters in video games; bullying in video games; representation of others in video games; and perspective on gender equality. The findings suggest that both male and female teenagers are more open-minded about gender equality and aware of the struggles of change. However, when their insights are researched in detail it is clear that male gamers still perceive stereotypic gender roles whereas female gamers naturalized gender equality.
Influence of Lead Knee Extension on Ball Velocity and Elbow Varus Torque in Professional and High School Baseball Pitchers
Authors: Dowling Brittany , Hodakowski Alexander , Brusalis Christopher M. , Luera Micheal J. , Smith Calvin D. , Verma Nikhil N. , Garrigues Grant E.
Published: August 2024

Background:

When the lead leg of a pitcher contacts the ground, the knee braces and then rapidly extends, initiating energy transfer to begin pelvis and trunk rotation.

Purpose:

To investigate the relationship of lead knee extension during the pitching delivery with peak lead knee extension velocity, ball velocity, and elbow varus torque in high school and professional pitchers.

Study Design:

Descriptive laboratory study.

Methods:

Data from 50 professional (PRO) and 50 high school (HS) pitcher groups were retrospectively analyzed. Pitchers threw 8 to 12 fastballs under 3-dimensional motion analysis (480 Hz). The groups were divided according to high or low lead knee extension: PRO-high (n = 18), PRO-low (n = 16), HS-high (n = 16), and HS-low (n = 17). Lead knee flexion, lead knee extension velocity, ball velocity, and elbow varus torque were analyzed between groups. Regression analyses were performed to quantify associations between lead knee extension and ball velocity and elbow varus torque for all pitchers.

Results:

At foot contact, all pitchers landed with similar knee flexion. PRO-high and HS-high pitchers had significantly greater lead knee extension through remaining pitching time points compared with the PRO-low and HS-low pitchers. PRO-high pitchers had faster ball velocity than PRO-low pitchers (39.8 ± 1.1 vs 39.3 ± 1.3 m/s, respectively), and HS-high pitchers had faster ball velocity than HS-low pitchers (34.1 ± 2.6 vs 31.2 ± 1.8 m/s, respectively) ( P < .05). PRO-high pitchers had decreased elbow varus torque compared with PRO-low pitchers (85.3 ± 10.7 vs 95.4 ± 13.3 N·m, respectively); conversely, HS-high pitchers had greater elbow varus torque than HS-low pitchers (64.2 ± 14.7 vs 56.3 ± 12.2 N·m, respectively). For every 1° increase in lead knee extension, ball velocity increased by 0.47 m/s ( P < .001) and elbow varus torque increased by 0.27 N·m ( P = .025).

Conclusion:

Proper lead knee extension allowed efficient energy transfer through the kinetic chain to produce optimal ball velocity and minimize elbow varus torque in professional pitchers. Conversely, while proper lead knee extension improved ball velocity among high school pitchers, this did not minimize elbow varus torque.

Clinical Relevance:

Professional pitchers can extend their lead knee with minimal impact at the elbow. In high school pitchers, cognizance of proper full-body pitching mechanics remains a priority over increased velocity.
Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion
Authors: Moran Ryan N. , Guin J. Russell , Roehmer Christian , Murray Nicholas G.
Published: August 2024

Background:

Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation.

Purpose:

To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 61 college-aged individuals (21 HC-using women, 21 non–HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores.

Results:

Significant differences were reported on HIT-6, with the highest headache reporting in the HC group ( P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group ( P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms ( P < .001), symptom severity ( P < .001), and vestibular-somatic ( P = .024), cognitive-sensory ( P = .004), sleep-arousal ( P = .001), and affective ( P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups ( P = .003), with the HC group having greater provocation compared with non-HC users ( P = .020).

Conclusion:

HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.
The 25 Most Cited Articles in Pediatric Orthopaedic Sports Medicine
Authors: DiCenso Stefano , Mistovich R. Justin
Published: August 2024

Background:

Citation analysis reflects the influence a work has on a field of research and can be used to identify “classic” works and their qualities in medical specialties. By analyzing the characteristics of these works, we intended to determine what qualities make for a highly cited work in pediatric orthopaedic sports medicine.

Purpose:

To identify the top 25 most cited articles in the field of pediatric orthopaedic sports medicine.

Study Design:

Cross-sectional study.

Methods:

The Science Citation Index Expanded feature within the Web of Science database was searched using a Boolean string, generating 2008 pediatric orthopaedic sports medicine articles arranged by number of citations. The top 25 most cited articles were reviewed for authors, year of publication, source journal, country of origin, region of origin, diagnosis or condition of focus, and level of evidence (LOE).

Results:

Most of the articles were published in the 2000s (range, 1992-2016). The mean number of citations was 166 (range, 119-329), and the mean citation density was 13.25 (range, 4.25-29.57). There were 18 of 25 studies performed in the United States. A plurality of the articles were published in the American Journal of Sports Medicine. The LOE ranged from 2 to 4, with the most common being level 2 (11/25). Anterior cruciate ligament (ACL) injury management (14/25) and epidemiological studies on the incidence of various sports injuries (6/25) were the most represented topics of study. Since the 1990s, the mean citation density for articles related to ACL injuries in young athletes and the epidemiology of sports injuries has been increasing.

Conclusion:

This evaluation demonstrated that ACL injuries and the epidemiology of sports injuries had the highest citation density of the most influential studies in pediatric orthopaedic sports medicine. We identified attributes such as country of publication, journal of publication, and LOE that make for a highly cited pediatric orthopaedic sports medicine article. Overall, citation density in pediatric sports medicine is increasing. Nonetheless, the most represented LOE in the most cited works is level 2, with no level 1 studies being represented in the top 25. In terms of both topics and LOE, this study allows surgeons to identify deficiencies in the existing literature and meaningfully design future studies to improve on these.
Fluid excess on intensive care unit after mechanical thrombectomy after acute ischemic stroke is associated with unfavorable neurological and functional outcomes: An observational cohort study
Authors: Schell Maximilian , Mayer Christina , Woo Marcel Seungsu , Leischner Hannes , Fischer Marlene , Grensemann Jörn , Kluge Stefan , Czorlich Patrick , Gerloff Christian , Fiehler Jens , Thomalla Götz , Flottmann Fabian , Schweingruber Nils
Published: August 2024

Introduction:

Endovascular thrombectomy stands as a pivotal component in the standard care for patients experiencing acute ischemic stroke with large vessel occlusion. Subsequent care for patients often extends to a neurological intensive care unit. While fluid management is integral to intensive care, the association between early fluid balance and neurological and functional outcomes post-thrombectomy has not yet been thoroughly investigated.

Methods:

In a retrospective analysis of an observational, single-center study spanning from 2015 to 2021 at the University Medical Center Hamburg-Eppendorf, Germany, we enrolled stroke patients who underwent thrombectomy and received subsequent treatment in the ICU. Unfavorable functional and neurological outcome was defined as a mRS > 2 on day 90 after admission (mRS d90) or NIHSS > 5 at discharge, respectively. A multivariate regression model, adjusting for confounders, utilized the average fluid balance in the first 5 days to predict outcomes. Patients were dichotomized by their average fluid balance (>1 L vs <1 L) within the first 5 days, and a multivariate mRS d90 shift analysis was conducted after adjusting for covariates.

Results:

Between 2015 and 2021, 1252 patients underwent thrombectomy, and 553 patients met the inclusion criteria (299 women [54%]). Unfavorable functional outcome was significantly associated with a higher daily average fluid balance in the first 5 days in the ICU (mRS d90 ⩽ 2: 0.3 ± 0.5 L, mRS d90 > 2: 0.7 ± 0.7 L, p = 0.02). The same association was observed for the NIHSS at discharge (NIHSS ⩽ 5: 0.3 ± 0.5 L; NIHSS > 5: 0.6 ± 0.6 L; p = 0.03). The mRS d90 shift analysis revealed significance for patients with an average fluid balance <1 L for better functional outcomes (adjusted odds ratio [AOR] 2.17; 95% confidence interval [CI] 1.54–3.07; p < 0.01).

Discussion:

Fluid retention in post-thrombectomy stroke patients in the ICU is associated with poorer functional and neurological outcomes. Consequently, fluid retention emerges as an additional potential predictor for post-intervention stroke outcomes. Our findings provide an initial indication that preventing excessive fluid retention in stroke patients after endovascular thrombectomy could be beneficial for both functional and neurological recovery. Therefore, fluid retention might be an element to consider in optimizing fluid management for stroke patients.
A suggested eco-friendly procedure for the recovery of uranium from Egyptian Abu Tartur phosphorites before industrial processing
Authors: Abdellah Walid M.
Published: August 2024

The manufacture of phosphate fertilizers without prior uranium extraction leads to widespread dispersal of uranium compounds across agricultural fields, posing significant cumulative environmental and health risks. Furthermore, this represents a wasteful loss of a critical global energy resource. Against this backdrop, we propose an environmentally friendly method for extracting uranium from Egyptian Abu Tartur phosphate rocks using humic acid (HA). Almost complete dissolution of uranium with a 3% HA concentration, solid-to-liquid ratio of 1/2, and a leaching temperature of 60°C. The uranium was then effectively adsorbed from the HA solution, with a concentration of 0.026 g/L, onto activated carbon, influenced by variables such as: pH, contact time, and adsorbent amount per leach solution volume. Subsequent uranium regeneration from the activated carbon was accomplished using 0.5 M ammonium bicarbonate, achieving a desorption efficiency of 98.7%. This process culminated in the production of a sodium diuranate concentrate following uranium precipitation with NaOH solution.
‘There is no such word as palliative care for us at the moment’: A mixed-method study exploring the perceptions of healthcare professionals on the need for palliative care in Bhutan
Authors: Laabar Tara Devi , Saunders Christobel , Auret Kirsten , Johnson Claire E.
Published: August 2024

Background:

The need for palliative care is ever-increasing globally. However, it is least developed or not available in most low-and-middle-income-countries including Bhutan.

Objective:

This study was aimed at exploring the perspectives of Bhutanese healthcare professionals on the need for palliative care in the country.

Design:

This is a cross-sectional, mixed-method study.

Setting/subjects:

The study sites included all levels of healthcare in Bhutan and involved doctors, nurses, physiotherapists, pharmacists, health assistants and Drungtshos (traditional physicians). Data were collected through surveys, focus group discussions and in-depth interviews.

Results:

While the majority of the participants were directly involved in taking care of terminally ill and dying patients, only 14% had received some form of palliative care training for a duration ranging from 1 day to 6 weeks. Ninety-five percent of the participants reported that they faced challenges related to lack of palliative care knowledge and skills; limited resources including analgesics; shortage of doctors and nurses and lack of a palliative care team; issues with low illiteracy and financial challenges among patients; and policies and other systemic issues. The qualitative data generated four major themes: past adverse experiences; unique and complex needs for palliative care; challenges faced while caring for terminally ill and dying patients; and the urgent need for palliative care in Bhutan.

Conclusion:

Bhutanese healthcare professionals had very limited exposure to palliative care. This study identified a crucial need for palliative care and informs the development of an appropriate palliative care model for Bhutan.
Black ecological relations and methodologies
Authors: Bruno Tianna
Published: August 2024

Black environmental geographies scholarship has made significant strides in expanding the ways we understand ecologies and ecological relationships interweaving the lives of black communities across the black diaspora. In this article, I review the analytical interventions in this field that press the bounds of traditional environmental injustice framings of black ecological experiences and relations. Drawing on black studies, this literature, first, helps us to position present racial ecological landscapes within historical and long-standing logics of race, colonialism, and imperialism. Moreover, it breathes nuance and life into discourse that overrepresents black ecological relationships as lack, decay, and containers of pollution and death, with very little everyday living. Building on these interventions and understanding the dialectic relationship between death-dealing and life-affirming socio-ecological processes at work in black environmental geographies, I call attention to interdisciplinary methodological approaches that bring together black environmental geographies and critical environmental science to behold the complex enmeshment of social and biophysical relations and the entanglement of life and degradation that interweave the two.
Gender-specific factors influencing the glenoid version and reference values for it
Authors: Fischer Cornelius Sebastian , Floß Matthias , Ittermann Till , Gonser Christoph Emanuel , Giordmaina Ryan , Bülow Robin , Schmidt Carsten-Oliver , Lange Jörn
Published: August 2024

Background

Glenoid version is an important factor in the evaluation of shoulder stability and shoulder pathologies. However, there are neither established reference values nor known factors that influence the glenoid version, even though valid reference values are needed for diagnostic and orthopaedic surgery like corrective osteotomy and total or reverse shoulder arthroplasty (TSA/RSA). The aim of our population-based study was to identify factors influencing the glenoid version and to establish reference values from a large-scale population cohort.

Results

Our study explored the glenoid versions in a large sample representing the general adult population. We investigated 3004 participants in the population-based Study of Health in Pomerania (SHIP). Glenoid version was measured for both shoulders via magnetic resonance imaging (MRI). Associations with the glenoid version were calculated for sex, age, body height, body weight and BMI. The reference values for glenoid version in the central European population range between −9° and 7.5°, while multiple factors are associated with the glenoid version.

Conclusion

To achieve a reliable interpretation prior to orthopaedic surgery, sex- and age-adjusted reference values are proposed.
Clinical utility of ambulatory ECG monitoring and 2D-ventricular strain for evaluation of post-COVID-19 ventricular arrhythmia
Authors: Hamdy Rehab M. , Samy Mohammed , Mohamed Huda Shaban
Published: August 2024

Background

A relatively common complication of COVID -19 infection is arrhythmia. There is limited information about myocardial deformation and heart rate variability (HRV) in symptomatic post COVID patients presented by ventricular arrhythmia.

Aim of the study

Our goal was to assess 2D-ventricular strain and heart rate variability indices (evaluated by ambulatory ECG monitoring) in post-COVID-19 patients suffering from ventricular arrhythmia.

Methods

The current observational case–control study performed on 60 patients one month after they had recovered from the COVID-19 infection. Thirty healthy volunteers served as the control group. Each participant had a full medical history review, blood tests, a 12-lead surface electrocardiogram (ECG), 24-h ambulatory ECG monitoring, and an echo-Doppler examination to evaluate the left ventricular (LV) dimensions, tissue Doppler velocities, and 2D-speckle tracking echocardiography (2D-STE) for both the LV and right ventricular (RV) strain.

Results

Symptomatic post-COVID patients with monomorphic premature ventricular contractions (PVCs) showed a substantial impairment of LV/RV systolic and diastolic functions, LV/RV myocardial performance (MPI) with reduced indices of HRV. Patients with higher versus lower ventricular burden had poorer functional status, higher levels of inflammatory biomarkers and reduced parameters of HRV (New York Heart Association (NYHA) class: 2.1 ± 0.9 vs. 1.5 ± 0.6, p < 0.001, C-reactive protein (CRP): 13.3 ± 4.1 vs. 8.3 ± 5.9 mg/L, p < 0.0001, low frequency/high frequency (LF/HF): 3.6 ± 2.4 vs. 2.2 ± 1.2, p < 0.002, the root mean square of the difference between successive normal intervals (rMSSD): 21.8 ± 4.7 vs. 29.3 ± 14.9 ms, p < 0.039 and the standard deviation of the RR interval (SDNN): 69.8 ± 19.1 vs.108.8 ± 37.4 ms, p < 0.0001). The ventricular burden positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.33, p < 0.001), CRP (r = 0.60, p < 0.0001), while it negatively correlated with LV-global longitudinal strain (GLS) (r = -0.38, p < 0.0001), and RV-GLS (r = -0.37, p < 0.0001).

Conclusions

Patients with post-COVID symptoms presented by ventricular arrhythmia had poor functional status. Patients with post-COVID symptoms and ventricular arrhythmia had subclinical myocardial damage, evidenced by speckle tracking echocardiography while having apparently preserved LV systolic function. The burden of ventricular arrhythmia in post-COVID patients significantly correlated with increased inflammatory biomarkers and reduced biventricular strain.
Variability of urinary albumin to creatinine ratio and eGFR are independently associated with eGFR slope in Japanese with type 2 diabetes: a three-year, single-center, retrospective cohort study
Authors: Matsuda Takaaki , Osaki Yoshinori , Maruo Kazushi , Matsuda Erika , Suzuki Yasuhiro , Suzuki Hiroaki , Mathis Bryan J. , Shimano Hitoshi , Mizutani Masakazu
Published: August 2024

Background

To evaluate the seasonal variability of urinary albumin to creatinine ratio (UACR) and eGFR and these effects on three-year eGFR slope in persons with type 2 diabetes (T2D).

Methods

A total of 1135 persons with T2D were analyzed in this single-center, retrospective cohort study in Japan. The standard deviation (SD) of UACR (SD [UACR]) and SD of eGFR (SD [eGFR]) were calculated for each person’s 10-point data during the three years, and a multiple linear regression analysis was performed to evaluate associations with eGFR slope. A sensitivity analysis was performed in a group with no medication changes (n = 801).

Results

UACR exhibited seasonal variability, being higher in winter and lower in spring, early summer, and autumn especially in the UACR ≥ 30 mg/g subgroup, while eGFR showed no seasonal variability. The eGFR slope was significantly associated with SD (eGFR) (regression coefficient -0.170 [95% CI -0.189–-0.151]) and SD (UACR) (0.000 [-0.001–0.000]). SGLT-2 inhibitors, baseline eGFR, and baseline systolic blood pressure (SBP) were also significantly associated. These associated factors, except baseline SBP, were still significant in the sensitivity analysis.

Conclusions

The UACR showed clear seasonal variability. Moreover, SD (UACR) and SD (eGFR) were independently associated with a three-year eGFR slope in persons with T2D.

Trial registration

This study was not registered for clinical trial registration because it was a retrospective observational study.
Associations of fruit intake with adiposity and cardiometabolic biomarkers in UK Biobank
Authors: Trichia Eirini , MacLean Fiona , Perez-Cornago Aurora , Tong Tammy Y. N. , Emberson Jonathan R. , Key Timothy J. , Lewington Sarah , Carter Jennifer L.
Published: August 2024

Background

Fruit consumption has been associated with a lower cardiovascular disease (CVD) risk but the underlying mechanisms are unclear. We investigated the cross-sectional and prospective associations of fruit consumption with markers of adiposity, blood pressure, lipids, low-grade inflammation, glycaemia, and oxidative stress.

Methods

The main analyses included 365 534 middle-aged adults from the UK Biobank at baseline, of whom 11 510, and 38 988 were included in the first and second follow-up respectively, free from CVD and cancer at baseline. Fruit consumption frequency at baseline was assessed using a questionnaire. We assessed the cross-sectional and prospective associations of fruit with adiposity (body mass index, waist circumference and %body fat), systolic and diastolic blood pressure, lipids (low-density and high-density lipoproteins, triglycerides and apolipoprotein B), glycaemia (haemoglobin A1c), low-grade inflammation (C-reactive protein) and oxidative stress (gamma-glutamyl-transferase) using linear regression models adjusted for socioeconomic and lifestyle factors. Analyses were repeated in a subset with two to five complete 24-h dietary assessments (n = 26 596) allowing for adjustment for total energy intake.

Results

Fruit consumption at baseline generally showed weak inverse associations with adiposity and biomarkers at baseline. Most of these relationships did not persist through follow-up, except for inverse associations with diastolic blood pressure, C-reactive protein, gamma-glutamyl transferase and adiposity. However, for most mechanisms, mean levels varied by less than 0.1 standard deviations (SD) between high and low fruit consumption (> 3 vs < 1 servings/day) in further adjusted models (while the difference was < 0.2 SD for all of them). For example, waist circumference and diastolic blood pressure were 1 cm and 1 mmHg lower in high compared to low fruit intake at the first follow-up (95% confidence interval: -1.8, -0.1 and -1.8, -0.3, respectively). Analyses in the 24-h dietary assessment subset showed overall similar associations.

Conclusions

We observed very small differences in adiposity and cardiometabolic biomarkers between those who reported high fruit consumption vs low, most of which did not persist over follow-up. Future studies on other mechanisms and detailed assessment of confounding might further elucidate the relevance of fruit to cardiovascular disease.
Production and bioprocessing of epothilone B from Aspergillus niger, an endophyte of Latania loddegesii, with a conceivable biosynthetic stability: anticancer, anti-wound healing activities and cell cycle analysis
Authors: Refaat Sara , Fikry Eman , Tawfeek Nora , El-Sayed Ashraf S. A. , El-Domiaty Maher M. , El-Shafae Azza M.
Published: August 2024

Epothilones are one of the common prescribed anticancer drugs for solid tumors, for their exceptional binding affinity with β-tubulin microtubule, stabilizing their disassembly, causing an ultimate arrest to the cellular growth. Epothilones were initially isolated from Sornagium cellulosum, however, their extremely slow growth rate and low yield of epothilone is the challenge. So, screening for a novel fungal endophyte dwelling medicinal plants, with higher epothilone productivity and feasibility of growth manipulation was the objective. Aspergillus niger EFBL-SR OR342867, an endophyte of Latania loddegesii, has been recognized as the heady epothilone producer (140.2 μg/L). The chemical structural identity of the TLC-purified putative sample of A. niger was resolved from the HPLC, FTIR and LC–ESI–MS/MS analyses, with an identical molecular structure of the authentic epothilone B. The purified A. niger epothilone B showed a resilient activity against MCF-7 (0.022 μM), HepG-2 (0.037 μM), and HCT-116 (0.12 μM), with selectivity indices 21.8, 12.9 and 4, respectively. The purified epothilone B exhibited a potential anti-wound healing activity to HepG-2 and MCF-7 cells by ~ 54.07 and 60.0%, respectively, after 24 h, compared to the untreated cells. The purified epothilone has a significant antiproliferative effect by arresting the cellular growth of MCF-7 at G2/M phase by ~ 2.1 folds, inducing the total apoptosis by ~ 12.2 folds, normalized to the control cells. The epothilone B productivity by A. niger was optimized by the response surface methodology, with ~ 1.4 fold increments (266.9 μg/L), over the control. The epothilone productivity by A. niger was reduced by ~ 2.4 folds by 6 months storage as a slope culture at 4 °C, however, the epothilone productivity was slightly restored with ethylacetate extracts of L. loddegesii, confirming the plant-derived chemical signals that partially triggers the biosynthetic genes of A. niger epothilones. So, this is the first report emphasizing the metabolic potency of A. niger, an endophyte of L. loddegesii, to produce epothilone B, that could be a new platform for industrial production of this drug.
Application of multivariate binary logistic regression grouped outlier statistics and geospatial logistic model to identify villages having unusual health-seeking habits for childhood malaria in Malawi
Authors: Hamuza Gracious A. , Singogo Emmanuel , Kaombe Tsirizani M.
Published: August 2024

Background

Early diagnosis and prompt treatment of malaria in young children are crucial for preventing the serious stages of the disease. If delayed treatment-seeking habits are observed in certain areas, targeted campaigns and interventions can be implemented to improve the situation.

Methods

This study applied multivariate binary logistic regression model diagnostics and geospatial logistic model to identify traditional authorities in Malawi where caregivers have unusual health-seeking behaviour for childhood malaria. The data from the 2021 Malawi Malaria Indicator Survey were analysed using R software version 4.3.0 for regressions and STATA version 17 for data cleaning.

Results

Both models showed significant variability in treatment-seeking habits of caregivers between villages. The mixed-effects logit model residual identified Vuso Jere, Kampingo Sibande, Ngabu, and Dzoole as outliers in the model. Despite characteristics that promote late reporting of malaria at clinics, most mothers in these traditional authorities sought treatment within twenty-four hours of the onset of malaria symptoms in their children. On the other hand, the geospatial logit model showed that late seeking of malaria treatment was prevalent in most areas of the country, except a few traditional authorities such as Mwakaboko, Mwenemisuku, Mwabulambya, Mmbelwa, Mwadzama, Zulu, Amidu, Kasisi, and Mabuka.

Conclusions

These findings suggest that using a combination of multivariate regression model residuals and geospatial statistics can help in identifying communities with distinct treatment-seeking patterns for childhood malaria within a population. Health policymakers could benefit from consulting traditional authorities who demonstrated early reporting for care in this study. This could help in understanding the best practices followed by mothers in those areas which can be replicated in regions where seeking care is delayed.
The Greenhouse gas Observations of Biospheric and Local Emissions from the Upper sky (GOBLEU): a mission overview, instrument description, and results from the first flight
Authors: Suto Hiroshi , Kuze Akihiko , Matsumoto Ayako , Oda Tomohiro , Mori Shigetaka , Miyashita Yohsuke , Hoshino Chiharu , Shigetoh Mayumi , Kataoka Fumie , Tsubakihara Yasuhiro
Published: August 2024

Background

The Greenhouse gas Observations of Biospheric and Local Emissions from the Upper sky (GOBLEU) is a new joint project by Japan Aerospace Exploration Agency (JAXA) and ANA HOLDING INC. (ANAHD), which operates ANA flights. GOBLEU aims to visualizes our climate mitigation effort progress in support of subnational climate mitigation by collecting greenhouse gas (GHG) data as well as relevant data for emissions (nitrous dioxide, NO2) and removals (Solar-Induced Fluorescence, SIF) from regular passenger flights. We developed a luggage-sized instrument based on the space remote-sensing techniques that JAXA has developed for Japan’s Greenhouse gas Observing SATellite (GOSAT). The instrument can be conveniently installed on a coach-class passenger seat without modifying the seat or the aircraft.

Results

The first GOBLEU observation was made on the flight from the Tokyo Haneda Airport to the Fukuoka Airport, with only the NO2 module activated. The collected high-spatial-resolution NO2 data were compared to that from the TROPOspheric Monitoring Instrument (TROPOMI) satellite and surface NO2 data from ground-based air quality monitoring stations. While GOBLEU and TROPOMI data shared the major concentration patterns largely driven by cities and large point sources, regardless of different observation times, we found fine-scale concentration pattern differences, which might be an indication of potential room for GOBLEU to bring in new emission information and thus is worth further examination. We also characterized the levels of NO2 spatial correlation that change over time. The quickly degrading correlation level of GOBLEU and TROPOMI suggests a potentially significant impact of the time difference between CO2 and NO2 as an emission marker and, thus, the significance of co-located observations planned by future space missions.

Conclusions

GOBLEU proposes aircraft-based, cost-effective, frequent monitoring of greenhouse emissions by GOBLEU instruments carried on regular passenger aircraft. Theoretically, the GOBLEU instrument can be installed and operated in most commercially used passenger aircraft without modifications. JAXA and ANAHD wish to promote the observation technique by expanding the observation coverage and partnership to other countries by enhancing international cooperation under the Paris Agreement.