bluuebunny/crossref_metadata_2025 huggingface dataset:
Taxonomy of the leafhopper genus Drabescus Stål (Hemiptera: Cicadellidae: Deltocephalinae) with description of two new species from China
Authors: XU DELIANG , ZHANG YALIN
Published: April 2023

Two new species from China, Drabescus macrocladus sp. nov. and Drabescus mucronatus sp. nov., are described and figured. An updated checklist with distributions and key to males of the species in this genus from China is given. The type specimens of these two new species are deposited in the Entomological Museum, Northwest A&F University, Yangling, Shaanxi, China (NWAFU) and in Sun Yat-Sen University (Zhongshan University, ZSU), Guangzhou, Guangdong, China.
Evaluation of Naples Score for Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Şaylık Faysal , Çınar Tufan , Selçuk Murat , Akbulut Tayyar , Hayıroğlu Mert İlker , Tanboğa İbrahim Halil
Published: April 2023

The Naples score (NS), which is a composite of cardiovascular adverse event predictors including neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, albumin, and total cholesterol, has emerged as a prognostic risk score in cancer patients. We aimed to investigate the predictive value of NS for long-term mortality in ST-segment elevation myocardial infarction patients (STEMI). A total of 1889 STEMI patients were enrolled in this study. The median duration of the study was 43 months (IQR: 32–78). Patients were divided into 2 groups according to NS as group 1 and group 2. We created 3 models as a baseline model, model 1 (baseline + NS in continuous), and model 2 (baseline + NS as categorical). Group 2 patients had higher long-term mortality rates than group 1 patients. The NS was independently associated with long-term mortality and adding NS to a baseline model improved the model performance for prediction and discrimination of long-term mortality. Decision curve analysis demonstrated that model 1 had a better net benefit probability for detecting mortality compared with the baseline model. NS had the highest contributive significant effect in the prediction model. An easily accessible and calculable NS might be used for risk stratification of long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention.
Experimental and numerical investigation of the static behavior of a 3D printed bio-based anti-trichiral sandwich
Authors: Hamrouni Anis , Rebiere Jean-Luc , El Mahi Abderrahim , Beyaoui Moez , Haddar Mohamed
Published: April 2023

In this work, the analysis of the static behavior of the composite honeycomb and anti-trichiral sandwich is studied. The objective of this paper is to estimate the effect of cellular geometrical parameters which are the ligament length and the cylindrical node radius on the static properties of the anti-trichiral structures. The core and the sandwiches were made from the same biobased material which is polylactic acid with flax fibers (Flax/PLA Material). 3D printing technology was used to manufacture the specimens. Several tensile tests were performed on the anti-trichiral core while bending tests were carried out on the sandwich structures. Several specimens with different geometric parameters of the anti-trichiral unit cell are tested to study their effect on the static properties of this material. The results show that the static properties of the anti-trichiral shaped meta-material depend on the unit cell dimensions. The Poisson’s ratio varies from 1 to −1 and from 0.5 to−0.8 respectively for one-cell and two-cell cores in width. To validate the experimental results, numerical simulations were carried out. Experimental and computational results for the Poisson’s ratio were quite similar.
Contrasting Direct Instruction in Morphological Decoding and Morphological Inquiry-Analysis Interventions in Grade 3 Children With Poor Morphological Awareness
Authors: Savage Robert , Maiorino Kristina , Gavin Kristina , Horne-Robinson Hannah , Georgiou George , Deacon Hélène
Published: April 2023

We report on a school-based randomized control trial study comparing two morphological interventions with untaught controls: one focusing on direct instruction targeting print morphological decoding (direct decoding condition) and the other on inquiry-focused pedagogy using oral morphological analysis (inquiry-analysis condition). We identified 63 Grade 3 children with below-average morphological awareness following screening (from N = 163). This sub-sample showed average pseudoword decoding but poor language and word reading abilities. Following a 13-week supplemental intervention randomized within the 63 children, results showed a statistically significant main effect of intervention on standardized reading vocabulary measures at immediate post-test in the direct decoding condition. Pre-test morphological awareness moderated reading vocabulary effects for the untaught control group. Statistically significant moderation of growth in sentence comprehension at post- by pre-test morphological awareness was also evident in the inquiry-analysis condition. Universal screening for below-average morphological awareness followed by inquiry-based or direct instruction interventions focusing on the meaning dimensions of morphemes may be modestly efficacious for supporting reading vocabulary and sentence comprehension in such at risk learners, potentially aiding school-wide literacy improvement.
In the Name of Transparency: Organizing European pharmaceutical markets through struggles over transparency devices
Authors: Geiger Susi , Bourgeron Théo
Published: April 2023

The controversies surrounding the heavily redacted contracts between the European Commission and Covid-19 vaccine producers have highlighted ‘transparency’ as a hotly debated concept in the pharmaceutical market. We combine research on transparency with literature on the organization of markets to investigate how such struggles over competing visions of transparency end up shaping markets and their politics. Focusing on the case of the European pharmaceutical market, we demonstrate how market transparency was implemented through devices that enacted specific visions of transparency and produced distinct market organizations over time: transparency for states (until about 1990), transparency for corporations (ca. 1990 to 2010) and transparency for state coalitions (since 2010). We discuss how the specific instrumentations and materializations of such visions of transparency play a crucial role in market politics. This debate also highlights why engaging in controversies over transparency has become increasingly important for those contesting the market status quo – in pharmaceutical markets and beyond.
Marital Beliefs and Concerns of Spanish Emerging Adults
Authors: Serrano Cecilia , García-Manglano Javier
Published: April 2023

Young adults’ beliefs about life-long commitment such as marriage are decisive when making decisions and setting life priorities. Using a representative sample of Spanish emerging adults (ages 18–29), we explored the relationship between beliefs about marriage and life priorities (also called ultimate concerns). Using latent class analysis, we found six different marital paradigms among the population: indifferent, reject, contextual, hesitant, convinced, and traditionalist. These groups were significantly different in their life priorities—for example, in the importance they assign to parenting or their professional career. The traits of emerging adults in each paradigm helped explain differences in risk-taking and sexual behaviors, particularly for men. In sum, marital beliefs are relevant when seeking to understand the commitments, decisions, and behaviors of emerging adults.
Narrative identity and positive youth development in Turkish emerging adults: The moderating role of cultural self-construals
Authors: Aytuglu Alp , Dost-Gözkan Ayfer , Şengül-Tığ Pınar , Buğan-Kısır Burcu , Brown Geoffrey L.
Published: April 2023

The current study examined the associations between narrative coherence, the 5Cs of positive youth development, and cultural self-construals among 91 Turkish emerging adults (48 females, 42 males, and 1 other ) aged between 18 and 29 ( Mage = 23.01, SD = .52). Emerging adults partook in a life story interview to share three important narratives involving parental interactions that were assessed for causal and thematic coherence. Participants also self-reported on their positive development (competence, confidence, character, caring, and connection) and cultural self-construals (autonomy, relatedness, and autonomy relatedness). Results of path analysis revealed that high causal coherence in narratives was associated with lower levels of competence, confidence, and connection, whereas high thematic coherence was linked to higher levels of competence, confidence, and connection. Further, we examined the role of cultural self-construals in moderating the link between narrative coherence and the 5Cs. Thematic coherence was related to decreased caring when autonomy was high and relatedness was low. Thematic coherence was also related to increased connection only when autonomy was low and relatedness was high. Moreover, causal coherence was related to decreased caring and connection for emerging adults with highly autonomous self-construals. Similarly, causal coherence was associated with lower levels of confidence for emerging adults with high autonomous-related self-construals. Implications for research with Turkish emerging adults are discussed.
Functional Anatomy of the Eustachian Tube
Authors: Cunsolo E. , Marchioni D. , Leo G. , Incorvaia C. , Presutti L.
Published: April 2023

The Eustachian tube (ET) is divided in 3 portions: a bony portion, a cartilaginous portion, and a junctional portion. From an anatomical-functional point of view, the bony portion of ET is the region of ventilation and clearance of secretions, and is lined by pseudostratified, ciliated, columnar epithelium, with an anti-gravitational direction of the drainage. The ET in the bony portion is in a state of forced opening. The cartilaginous portion is instead the heart of this dynamic system tube, because the mechanism of opening and closing of the tube is at this level. ET is normally closed, and it opens only during swallowing, being essential for good functioning of the middle ear, because it provides ventilation from the nasopharynx to the middle ear, and, at the same time, clearance of secretions from the middle ear-mastoid unit to the nasopharynx. Moreover, the ET protects the middle ear against nasopharyngeal pressure variations, ascending secretions, and microorganisms. The ability to develop all these functions makes the tube a complex organ.
Supporting the Self-Regulated Learning of Primary School Students With a Performance-Based Assessment Platform for Programming Education
Authors: Kong Siu-Cheung , Liu Bowen
Published: April 2023

This study implemented and evaluated the innovative use of a performance-based assessment platform to support the development of self-regulated learning (SRL) in senior primary students as they completed programming tasks. We embedded SRL support features into a performance-based assessment platform as scaffolding to help the students implement problem-solving strategies. A mixed-methods approach was adopted to evaluate the intervention. The students’ perceptions of their SRL skills after working through the programming tasks were measured by a survey of 45 students. The quantitative results suggested that the students benefited from the performance-based assessment platform in developing their SRL skills. A thematic analysis of interview data from 20 students further indicated that the embedded SRL scaffolding and automatic marking function helped them to solve the programming tasks. The results demonstrate that a well-designed performance-based assessment platform with embedded SRL support can be an effective tool for developing students’ SRL. The qualitative results further revealed that algorithmic thinking is an aspect of programming for which students need more SRL support.
A rare simultaneous presentation of combined occlusion and optic neuritis in a lupus erythematosus patient with anti-phospholipid antibody syndrome
Authors: Prakash Sarvesswaran , Gunderia Akruti Mayur , Khadar Syed Mohideen Abdul
Published: April 2023

Background

A known case of Systemic Lupus Erythematosus (SLE) developed sudden loss of vision (no light perception) with relative afferent pupillary defect in her right eye (RE) and fundus examination revealed cherry red spot over tomato splash background with tortuous and dilated veins suggestive of combined central retinal arterial and vein occlusion.

Analysis

Left eye (LE) had 6/6 vision but posterior segment revealed a hyperemic disc. Fundus fluorescein angiography (FFA) revealed delayed arm to retina time and increased arterial to vein transit time in RE. LE showed pooling of dye around optic disc suggestive of SLE related Optic neuritis. Patient was re-evaluated and she tested positive for Lupus anticoagulant. Patient was diagnosed to have anti-phospholipid antibody syndrome (APS) occurring secondary to SLE. She was started on intra venous steroids, anti-coagulants and disease progression in left eye was controlled.

Results

We report a rare simultaneous presentation of complete combined occlusion of central retinal artery and vein (CCRAVO) in RE and Optic neuritis in LE which has not been reported in literature so far.

Conclusion

Ocular involvement may precede other systemic symptoms in SLE, so ophthalmologist should know about this rare simultaneous presentation. Ocular activity can correlate with systemic disease activity and starting early effective treatment can prevent other systemic lesion and can be life saving.
Critical Evaluation of Drug Promotional Literature Using WHO Ethical Criteria and Perception of Clinicians at a Tertiary Care Hospital
Authors: Kaur Amanjot , Singla Shweta , Kaur Mandeep , Singh Jasninder
Published: April 2023

Objective

To evaluate the rationality of drug promotional literature (DPL) using World Health Organization (WHO) ethical criteria and to evaluate the perception of clinicians regarding DPLs using prevalidated criteria.

Methods

The promotional material was collected at a tertiary care teaching hospital over a period of 3 months. The perception of different prescribers has been changed. The data were analyzed using descriptive analysis.

Results

191 DPLs were collected from various outpatient departments at a tertiary care hospital. The information regarding brand name, generic name, and active ingredients was mentioned in 100% of the collected material. Therapeutic uses of the promotional agents were mentioned in only 60.20%; references were cited in only 15.18%. The adverse effects were listed in only 17.80% of the DPLs. The perception regarding DPLs was gathered from 27 physicians at the same institute. The percentage of clinicians who were aware of the WHO criteria used for analyzing DPL was only 37.03%. All healthcare workers have agreed on the necessity of including critical appraisal of the DPLs in the undergraduate curriculum.
A New Design Framework for Innovative Qualitative Research in HRD
Authors: Lochmiller Chad R. , Cho Yonjoo , Lester Jessica Nina
Published: April 2023

In the last few decades, there has been a proliferation of qualitative methodologies and methods. Within HRD, however, there has been a persistent use of particular kinds of qualitative methodologies and methods, with limited degrees of methodological innovation. In this article, we overview the literature on qualitative methodological innovation and the kinds of innovation that have been engaged within HRD. To move the field forward, we introduce a new design framework, which we suggest is a useful decision-making tool to guide a scholar in making research design choices as they consider innovative research designs.
Emergent Total Endovascular Arch Repair for Contained Aortic Arch Rupture: Another Tool in the Box
Authors: Kus Nicole , Robinson Justin A. , Hall Michael R. , Ghoreishi Mehrdad , Taylor Bradley , Toursavadkohi Shahab
Published: April 2023

To date, emergent total endovascular aortic arch repair has not been described in the literature. We present a 67-year-old female with a poorly differentiated posterior mediastinal sarcoma. Imaging obtained was concerning for intravascular extension of the tumor into the thoracic aorta. While awaiting radiation therapy, the patient complained of worsening chest and arm pain, vital signs demonstrating tachypnea and hypoxia. Subsequent imaging revealed an increase in vascular erosion, concerning for a contained rupture, with complete obliteration of the left mainstem bronchus. The patient was emergently taken for percutaneous endovascular repair of her aortic arch. A three-vessel physician modified fenestrated graft was created and deployed with concurrent stenting of the innominate, left carotid, and left subclavian arteries. Interval computed tomography angiography revealed patency in all stented vessels, with no endoleak and no evidence of pseudoaneurysm. The patient was able to undergo chemotherapy with favorable decrease in tumor burden. Total endovascular aortic arch repair, when planned carefully, is an attractive option in high-risk patients who are otherwise not ideally suited for open total arch replacement.
Virtual High Schools: Principal Leadership in an Underexplored Context
Authors: Partin Jeana M. , Derrington Mary Lynne
Published: April 2023

Principal Wilson is a first-year leader of a virtual high school. Following four years as an assistant principal in the brick-and-mortar school, she encounters unanticipated leadership challenges and policy dilemmas. Although discipline issues are nearly nonexistent, remote testing presents an ethical challenge. Moreover, she discovers that implementing the tenants of social presence is an unconditional requirement of a virtual school. In this case, the principal faces tough decisions when considering discipline for cheating, the lack of professional development for part-time teachers, and the potential effects of trauma-influenced behavior. This case explores the emerging field of virtual school principal leadership in the context of increasing online K–12 learning post-pandemic.
A Rare Presentation of Multiple Hepatic Masses Due to Hepatic Adenoma: A Case Report
Authors: Shah Shivam , Meka Omsai , Reddy Adisesha , Neelam Sphurti , Wilcox Charles
Published: April 2023

Hepatic adenomas (HAs) are rare but benign neoplasms of the liver which predominantly present as solitary lesions in women of reproductive age. The incidence of HAs has increased dramatically since the introduction of oral contraceptive pills (OCPs) along with the rising incidence of obesity. Discontinuation of OCPs and lifestyle modifications, including weight loss regimens, are considered as conservative treatment options for HAs. Large lesions may result in malignant transformation with a higher propensity for hemorrhage. Importantly, larger lesions that do not respond to conservative management require surgical excision. We report a case of a patient presenting with multiple hepatic lesions that were subsequently confirmed as HAs.
High peak inspiratory pressure may be associated with intraoperative coughing during neurosurgery under general anesthesia without neuromuscular blockade: a retrospective study
Authors: Oh Hyongmin , Sohn Jin Young , Ma Seoyoung , Choi Seungeun , Kim Yoon Jung , Lee Hyung-Chul , Lee Chang-Hyun , Kim Chi Heon , Chung Chun Kee , Park Hee-Pyoung
Published: April 2023

Background

The endotracheal cuff pressure depends on the airway pressure during positive-pressure ventilation. A high endotracheal cuff pressure may be related to intraoperative coughing, which can be detrimental during neurosurgery. We investigated the incidence of intraoperative coughing and its association with peak inspiratory pressure (PIP) during neurosurgery under general anesthesia without neuromuscular blockade.

Methods

This retrospective study divided 1656 neurosurgical patients who underwent total intravenous anesthesia without additional neuromuscular blockade after tracheal intubation into high (PIP > 21.6 cmH2O, n = 318) and low (PIP ≤ 21.6 cmH2O, n = 1338) PIP groups. After propensity score matching, 206 patients were selected in each group. Demographic, preoperative, surgical, and anesthetic data were collected retrospectively from electronic medical records and continuous ventilator, infusion pump, and bispectral index data from a data registry.

Results

Intraoperative coughing occurred in 30 (1.8%) patients, including 9 (0.5%) during the main surgical procedure. Intraoperative coughing was more frequent in the high PIP group than in the low PIP group before (14/318 [4.4%] vs. 16/1338 [1.2%], P < 0.001) and after (13/206 [6.3%] vs. 1/206 [0.5%], P = 0.003) propensity score matching. In multivariable logistic regression analysis after propensity score matching, a high PIP (odds ratio [95% confidence interval] 14.22 [1.81-111.73], P = 0.012), tidal volume divided by predicted body weight (mL/kg, 1.36 [1.09–1.69], P = 0.006), and surgical duration (min, 1.01 [1.00–1.01], P = 0.025) predicted intraoperative coughing.

Conclusion

The incidence of intraoperative coughing was 1.8% in neurosurgical patients undergoing general anesthesia without neuromuscular blockade and might be associated with a high PIP.
A smartphone application as a personalized treatment tool for adolescents with overweight: an explorative qualitative study
Authors: Desmet Maurane , Franssen Sieske , Varol Tugce , Fillon Alicia , Thivel David , Roefs Anne , Braet Caroline
Published: April 2023

Background

The present study is the first step of a 3-year European project in which a tailored smartphone application will be developed and tested as a potential tool in the personalized treatment of children and adolescents with overweight.

Methods

In this study, 10 focus groups (n = 48 participants) were conducted in Belgium, The Netherlands and France with adolescents with overweight (12–16 years; n = 30) and parents of adolescents with overweight (n = 18) to investigate their perceptions on (un)healthy behavior, the drivers of these behaviors, and the needs of an eHealth application for weight loss. A thorough thematic analysis was performed using Nvivo12.

Results

Results show that adolescents with overweight have a well-articulated perspective on (un)healthy behavior and their needs. Parents underestimate their own influence on the (un)healthy behavior of their children and report difficulties in healthy lifestyle parenting, which makes their role as a coach rather ambiguous. Concerning the needs of an eHealth application, both parents and adolescents formulated some challenging expectations regarding the content and the format including information, a monitoring feature and features that increase participants’ motivation to behave healthy. The results of this analysis will form the basis for designing a personalized eHealth application, which will be tested in a next phase.

Conclusion

We can conclude that adolescents have a well-articulated perspective on healthy and unhealthy behavior and their needs, whereby a new app could be of great help. It could function as a day-by-day diary and as a supportive coach.
Laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF): a case-series study
Authors: Peng Wei , Yan Shangcheng , Huang Yikai , Cheng Ming , Liu Tianhua , Ren Rui , Chen Qiang , Zhang Jingyu , Gong Wei , Xing Chungen , Wu Yongyou
Published: April 2023

Background

There is no standard reconstruction method following proximal gastrectomy, of which gastroesophageal reflux and anastomotic complications are of great concern. Though several techniques have been devised to overcome these postoperative complications, such as double tract reconstruction, double-flap technique and side overlap fundoplication by Yamashita, none of them is considered a perfect solution. Herein, we designed a novel method of esophagogastrostomy after laparoscopic proximal gastrectomy (LPG), named right-sided overlap and single-flap valvuloplasty (ROSF).

Methods

Between March 2021 and December 2021, 20 consecutive patients underwent LPG-ROSF at Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University. Surgical outcomes and postoperative complications were recorded. All patients were followed-up until December 2022. Endoscopy and assessment of gastrointestinal symptoms were performed 1 year after surgery. Nutrition-related parameters including total body weight, hemoglobin, lymphocyte count, serum total protein, serum albumin and serum prealbumin were evaluated 1 year after surgery and compared with those before surgery.

Results

The mean surgery time and anastomosis time was 285.3 ± 71.3 and 61.3 ± 11.2 min respectively. None of the patients had gastrointestinal early postoperative complications. Symptomatic reflux was observed in one patient (5%) while reflux esophagitis (Los Angeles Grade A) was observed in another patient (5%). Four patients (20%) had mild dysphagia (Visick score = II) but none of them had anastomotic stenosis. There were no significant changes in nutritional status postoperatively.

Conclusions

ROSF can be safely performed after LPG and has satisfactory outcomes in preventing reflux and stenosis, and maintaining nutritional status. This technique requires further validation.
Disparity in access for people with disabilities to outpatient dental care services: a retrospective cohort study
Authors: Park Bo-Young , Cho Han-A , Shin Hosung
Published: April 2023

Background

People with disabilities face difficulties in oral health management and gaining access to dental care. The availability of a regular source of dental care (RSDC) is an important factor that influences the access to health services and care management. The purpose of this study was to determine the effect of the availability of RSDC on the number of annual dental visits and dental expenses per visit among people with disabilities.

Methods

Data of 7,896,251 patients with dental problems in South Korea were analyzed using the 2002–2018 National Health Insurance claims data. A generalized estimating equation was applied to analyze the repeated-measurement data, and the interaction effect between RSDC and the disability severity was evaluated.

Results

The number of annual dental visits was higher among people with (2.62) than among those without (2.23) disabilities. Despite their increased dental needs, both annual dental visits and dental expenses per visit were low among older individuals (p < 0.001). The proportion and frequency of annual dental visits was lower among women than among men with disabilities. RSDC had differential effects on the severity of disability. Compared to people without disabilities, RSDC increased the number of annual dental visits (p = 0.067) and the dental expenses per visit (p < 0.05) among those with severe disabilities, but the effect on the number of annual dental visits was not significant among those with mild disabilities (p = 0.698).

Conclusions

Our results suggest a need for a special dental care system for people with disabilities, to ensure an RSDC, particularly for women and for older people with disabilities.
Anti-proliferative activity of Artemisia marschalliana on cancerous cell lines
Authors: Forouhandeh Haleh , Tarhriz Vahideh , Zadehkamand Masoumeh , Asgharian Parina
Published: April 2023

Background

The genusArtemisiaof theAsteraceaefamily has different species that are used in the treatment of a wide range of diseases, including cancers due to the presence of valuable compounds and important medicinal properties. Various studies on the anti-tumor effect of different species ofArtemisiahave proven the cytotoxic properties of these plants in cancer treatment, and several anti-cancer compounds of this genus have been purified.

Objective

The objective of this study was to investigate the cytotoxicity and related mortality mechanisms ofArtemisia marschallianaessential oil and extracts.

Methods

The essential oil and various extracts ofArtemisia marschallianawere elicited using a Soxhlet extractor. Anti-cancer to anti-proliferative activity as MTT assay is measuring cancerous and non-cancerous cell viability. In the next step, the strongest extract fractions were obtained by using the vacuum liquid chromatography method. Flow cytometry was applied to identify the mechanism of cell death, and a Real-time polymerase chain reaction test of apoptosis genes, which encode apoptosis-regulating proteins, was measured to confirm the flow cytometry results.

Results

The strongest extract belonged to dichloromethane extract 60% fraction of the extract on breast cancer cells and 80% fraction on liposarcoma cancer cells showed the most cytotoxicity within 48 h, while, the fractions did not notable cytotoxicity of non-cancerous cells cell. Flow cytometry analysis illustrated the mentioned extract and its fractions kill cancer cell lines through the apoptosis mechanism. Our findings confirmed the flow cytometry results. In addition, the essential oil ofArtemisia marschallianashowed a considerable cytotoxic property.

Conclusion

Dichloromethane extract ofArtemisia marschallianashoot and its 60 and 80% fraction selectively inhibited the growth of cancer cells by inducing the apoptosis mechanism. Regarding obtained results, 60 and 80% fractions of dichloromethane extract can be a good candidate for future studies in the field of identification and separation of pure cytotoxic compounds.
Prevotella histicola suppresses ferroptosis to mitigate ethanol-induced gastric mucosal lesions in mice
Authors: Wang Sisi , Wu Du , Wu Fangquan , Sun Hongxia , Wang Xinyu , Meng Hongbing , Lin Qingqing , Jin Keke , Wang Fangyan
Published: April 2023

Background

Ethanol-induced gastric mucosal lesions (EGML) is one of the most common digestive disorders for which current therapies have limited outcomes in clinical practice. Prevotella histicola (P. histicola) has shown probiotic efficacy against arthritis, multiple sclerosis and oestrogen deficiency-induced depression in mice; however, its role in EGML remains unclear in spite of its extensive colonisation of the stomach. Ferroptosis, which is characterised by lipid peroxidation, may be involved in EGML. Herein, we aimed to investigate the effects and underlying mechanism of action of P. histicola on EGML in the ferroptosis-dependent pathway.

Methods

P. histicola was intragastrically administered for a week, and deferoxamine (DFO), a ferroptosis inhibitor, was intraperitoneally injected prior to oral ethanol administration. The gastric mucosal lesions and ferroptosis were assessed via histopathological examinations, quantitative real-time PCR, Western blot, immunohistochemistry and immunofluorescence.

Results

P. histicola was originally found to attenuate EGML by reducing histopathological changes and lipid reactive oxygen species (ROS) accumulation. The pro-ferroptotic genes of Transferrin Receptor (TFR1), Solute Carrier Family 39 Member 14 (SLC39A14), Haem Oxygenase-1 (HMOX-1), Acyl-CoA Synthetase Long-chain Family Member 4 (ACSL4), Cyclooxygenase 2 (COX-2) and mitochondrial Voltage-dependent Anion Channels (VDACs) were up-regulated; the anti-ferroptotic System Xc-/Glutathione Peroxidase 4 (GPX4) axis was inhibited after ethanol administration. However, the changes of histopathology and ferroptosis-related parameters induced by ethanol were reversed by DFO. Furthermore, P. histicola treatment significantly downregulated the expression of ACSL4, HMOX-1 and COX-2, as well as TFR1 and SLC39A14, on mRNA or the protein level, while activating the System Xc-/GPX4 axis.

Conclusions

We found that P. histicola reduces ferroptosis to attenuate EGML by inhibiting the ACSL4- and VDAC-dependent pro-ferroptotic pathways and activating the anti-ferroptotic System Xc-/GPX4 axis.
Traditional medicine users in a treated chronic disease population: a cross-sectional study in Indonesia
Authors: Pradipta Ivan Surya , Aprilio Kevin , Febriyanti Raden Maya , Ningsih Yozi Fiedya , Pratama Mochammad Andhika Aji , Indradi Raden Bayu , Gatera Vesara Ardhe , Alfian Sofa Dewi , Iskandarsyah Aulia , Abdulah Rizky
Published: April 2023

Background

Traditional medicine (TM) is commonly used as a treatment in Indonesia. This raises the need for an analysis of its potential development and irrational use. Therefore, we analyze the proportion of TM users among chronic disease patients and its associated characteristics to optimize the use of TM in Indonesia.

Methods

A cross-sectional study of treated adult chronic disease patients was conducted using the fifth Indonesian Family Life Survey (IFLS-5) database. Descriptive analysis was used to identify the proportion of TM users, while a multivariate logistic regression was used to analyze their characteristics.

Results

This study included 4901 subjects and identified 27.1% as TM users. The highest TM use was in subjects with cancer (43.9%), liver issues (38.3%), cholesterol issues (34.3%), diabetes (33.6%), and stroke (31.7%). Characteristics associated with TM users were a perception of one's current health as unhealthy (OR 2.59, 95% CI 1.76–3.81), low medication adherence (OR 2.49, 95% CI 2.17–2.85), age above 65 years (OR 2.17, 95% CI 1.63–2.90), having higher education (OR 1.64, 95% CI 1.17–2.29), and residence outside of Java (OR 1.27, 95% CI 1.11–1.45).

Conclusions

Low medication adherence among TM users highlights the potentially irrational use of treatment in chronic diseases. Nevertheless, the longstanding use of TM users indicates the potential for its development. Further studies and interventions are needed to optimize TM use in Indonesia.
A comprehensive framework to estimate the frequency, duration, and risk factors for diagnostic delays using bootstrapping-based simulation methods
Authors: Miller Aaron C , Cavanaugh Joseph E , Arakkal Alan T , Koeneman Scott H , Polgreen Philip M
Published: April 2023

Background

The incidence of diagnostic delays is unknown for many diseases and specific healthcare settings. Many existing methods to identify diagnostic delays are resource intensive or difficult to apply to different diseases or settings. Administrative and other real-world data sources may offer the ability to better identify and study diagnostic delays for a range of diseases.

Methods

We propose a comprehensive framework to estimate the frequency of missed diagnostic opportunities for a given disease using real-world longitudinal data sources. We provide a conceptual model of the disease-diagnostic, data-generating process. We then propose a bootstrapping method to estimate measures of the frequency of missed diagnostic opportunities and duration of delays. This approach identifies diagnostic opportunities based on signs and symptoms occurring prior to an initial diagnosis, while accounting for expected patterns of healthcare that may appear as coincidental symptoms. Three different bootstrapping algorithms are described along with estimation procedures to implement the resampling. Finally, we apply our approach to the diseases of tuberculosis, acute myocardial infarction, and stroke to estimate the frequency and duration of diagnostic delays for these diseases.

Results

Using the IBM MarketScan Research databases from 2001 to 2017, we identified 2,073 cases of tuberculosis, 359,625 cases of AMI, and 367,768 cases of stroke. Depending on the simulation approach that was used, we estimated that 6.9–8.3% of patients with stroke, 16.0-21.3% of patients with AMI and 63.9–82.3% of patients with tuberculosis experienced a missed diagnostic opportunity. Similarly, we estimated that, on average, diagnostic delays lasted 6.7–7.6 days for stroke, 6.7–8.2 days for AMI, and 34.3–44.5 days for tuberculosis. Estimates for each of these measures was consistent with prior literature; however, specific estimates varied across the different simulation algorithms considered.

Conclusions

Our approach can be easily applied to study diagnostic delays using longitudinal administrative data sources. Moreover, this general approach can be customized to fit a range of diseases to account for specific clinical characteristics of a given disease. We summarize how the choice of simulation algorithm may impact the resulting estimates and provide guidance on the statistical considerations for applying our approach to future studies.
The impact of COVID-19 on relationships between family/friend caregivers and care staff in continuing care facilities: a qualitative descriptive analysis
Authors: Dymchuk Emily , Mirhashemi Bita , Chamberlain Stephanie , Beeber Anna , Hoben Matthias
Published: April 2023

Background

The COVID-19 pandemic and related public health measures added a new dynamic to the relationship between caregivers and care staff in congregate care settings. While both caregivers and staff play an important role in resident quality of life and care, it is common for conflict to exist between them. These issues were amplified by pandemic restrictions, impacting not only caregivers and care staff, but also residents. While research has explored the relationship between caregivers and care staff in long-term care and assisted living homes, much of the research has focused on the caregiver perspective. Our objective was to explore the impact of COVID-19-related public health measures on caregiver-staff relationships from the perspective of staff in long-term care and assisted living homes.

Methods

We conducted 9 focus groups and 2 semi-structured interviews via videoconference.

Results

We identified four themes related to caregiver-staff relationships: (1) pressure from caregivers, (2) caregiver-staff conflict, (3) support from caregivers, and (4) staff supporting caregivers.

Conclusions

The COVID-19 pandemic disrupted long-standing relationships between caregivers and care staff, negatively impacting care staff, caregivers, and residents. However, staff also reported encouraging examples of successful collaboration and support from caregivers. Learning from these promising practices will be critical to improving preparedness for future public health crises, as well as quality of resident care and life in general.
Clinician acceptability of an antibiotic prescribing knowledge support system for primary care: a mixed-method evaluation of features and context
Authors: Hurley Ruth , Jury Francine , van Staa Tjeerd P. , Palin Victoria , Armitage Christopher J.
Published: April 2023

Background

Overprescribing of antibiotics is a major concern as it contributes to antimicrobial resistance. Research has found highly variable antibiotic prescribing in (UK) primary care, and to support more effective stewardship, the BRIT Project (Building Rapid Interventions to optimise prescribing) is implementing an eHealth Knowledge Support System. This will provide unique individualised analytics information to clinicians and patients at the point of care. The objective of the current study was to gauge the acceptability of the system to prescribing healthcare professionals and highlight factors to maximise intervention uptake.

Methods

Two mixed-method co-design workshops were held online with primary care prescribing healthcare professionals (n = 16). Usefulness ratings of example features were collected using online polls and online whiteboards. Verbal discussion and textual comments were analysed thematically using inductive (participant-centred) and deductive perspectives (using the Theoretical Framework of Acceptability).

Results

Hierarchical thematic coding generated three overarching themes relevant to intervention use and development. Clinician concerns (focal issues) were safe prescribing, accessible information, autonomy, avoiding duplication, technical issues and time. Requirements were ease and efficiency of use, integration of systems, patient-centeredness, personalisation, and training. Important features of the system included extraction of pertinent information from patient records (such as antibiotic prescribing history), recommended actions, personalised treatment, risk indicators and electronic patient communication leaflets. Anticipated acceptability and intention to use the knowledge support system was moderate to high. Time was identified as a focal cost/ burden, but this would be outweighed if the system improved patient outcomes and increased prescribing confidence.

Conclusion

Clinicians anticipate that an eHealth knowledge support system will be a useful and acceptable way to optimise antibiotic prescribing at the point of care. The mixed method workshop highlighted issues to assist person-centred eHealth intervention development, such as the value of communicating patient outcomes. Important features were identified including the ability to efficiently extract and summarise pertinent information from the patient records, provide explainable and transparent risk information, and personalised information to support patient communication. The Theoretical Framework of Acceptability enabled structured, theoretically sound feedback and creation of a profile to benchmark future evaluations. This may encourage a consistent user-focused approach to guide future eHealth intervention development.
Long-term exposure to particulate matter and risk of Alzheimer’s disease and vascular dementia in Korea: a national population-based Cohort Study
Authors: Shim Jung-Im , Byun Garam , Lee Jong-Tae T.
Published: April 2023

Background

The prevalence of age-related neurodegenerative diseases has risen in conjunction with an increase in life expectancy. Although there is emerging evidence that air pollution might accelerate or worsen dementia progression, studies on Asian regions remains limited. This study aimed to investigate the relationship between long-term exposure to PM10 and the risk of developing Alzheimer’s disease and vascular dementia in the elderly population in South Korea.

Methods

The baseline population was 1.4 million people aged 65 years and above who participated in at least one national health checkup program from the National Health Insurance Service between 2008 and 2009. A nationwide retrospective cohort study was designed, and patients were followed from the date of cohort entry (January 1, 2008) to the date of dementia occurrence, death, moving residence, or the end of the study period (December 31, 2019), whichever came first. Long-term average PM10 exposure variable was constructed from national monitoring data considering time-dependent exposure. Extended Cox proportional hazard models with time-varying exposure were used to estimate hazard ratios (HR) for Alzheimer’s disease and vascular dementia.

Results

A total of 1,436,361 participants were selected, of whom 167,988 were newly diagnosed with dementia (134,811 with Alzheimer’s disease and 12,215 with vascular dementia). The results show that for every 10 µg/m3 increase in PM10, the HR was 0.99 (95% CI 0.98-1.00) for Alzheimer’s disease and 1.05 (95% CI 1.02–1.08) for vascular dementia. Stratified analysis according to sex and age group showed that the risk of vascular dementia was higher in men and in those under 75 years of age.

Conclusion

The results found that long-term PM10 exposure was significantly associated with the risk of developing vascular dementia but not with Alzheimer’s disease. These findings suggest that the mechanism behind the PM10-dementia relationship could be linked to vascular damage.
“As long as that place stays open, I’ll stay alive”: Accessing injectable opioid agonist treatment during dual public health crises
Authors: Jaffe Kaitlyn , Blawatt Sarin , Lehal Eisha , Lock Kurt , Easterbrook Adam , MacDonald Scott , Harrison Scott , Lajeunesse Julie , Byres David , Schechter Martin , Oviedo-Joekes Eugenia
Published: April 2023

Background

Since the onset of the COVID-19 pandemic, overdose rates in North America have continued to rise, with more than 100,000 drug poisoning deaths in the past year. Amidst an increasingly toxic drug supply, the pandemic disrupted essential substance use treatment and harm reduction services that reduce overdose risk for people who use drugs. In British Columbia, one such treatment is injectable opioid agonist treatment (iOAT), the supervised dispensation of injectable hydromorphone or diacetylmorphine for people with opioid use disorder. While evidence has shown iOAT to be safe and effective, it is intensive and highly regimented, characterized by daily clinic visits and provider–client interaction—treatment components made difficult by the pandemic.

Methods

Between April 2020 and February 2021, we conducted 51 interviews with 18 iOAT clients and two clinic nurses to understand how the pandemic shaped iOAT access and treatment experiences. To analyze interview data, we employed a multi-step, flexible coding strategy, an iterative and abductive approach to analysis, using NVivo software.

Results

Qualitative analysis revealed the ways in which the pandemic shaped clients’ lives and the provision of iOAT care. First, client narratives illuminated how the pandemic reinforced existing inequities. For example, socioeconomically marginalized clients expressed concerns around their financial stability and economic impacts on their communities. Second, clients with health comorbidities recognized how the pandemic amplified health risks, through potential COVID-19 exposure or by limiting social connection and mental health supports. Third, clients described how the pandemic changed their engagement with the iOAT clinic and medication. For instance, clients noted that physical distancing guidelines and occupancy limits reduced opportunities for social connection with staff and other iOAT clients. However, pandemic policies also created opportunities to adapt treatment in ways that increased patient trust and autonomy, for example through more flexible medication regimens and take-home oral doses.

Conclusion

Participant narratives underscored the unequal distribution of pandemic impacts for people who use drugs but also highlighted opportunities for more flexible, patient-centered treatment approaches. Across treatment settings, pandemic-era changes that increase client autonomy and ensure equitable access to care are to be continued and expanded, beyond the duration of the pandemic.
Psychological distress of adult patients consulting a center for rare and undiagnosed diseases: a cross-sectional study
Authors: Mund Meike , Uhlenbusch Natalie , Rillig Franziska , Weiler-Normann Christina , Herget Theresia , Kubisch Christian , Löwe Bernd , Schramm Christoph
Published: April 2023

Background

Centers for rare diseases serve as contact points for patients with complex, often undiagnosed complaints and persistent somatic symptoms of heterogeneous origin. Little is known about psychological distress of patients consulting these centers.

Objectives

To better understand psychological distress of adult patients presenting at a center for rare diseases by determining the proportion of patients screening positive for depressive, anxiety, and somatic symptom disorders (SSD) and to identify factors associated with increased psychopathology.

Methods

Cross-sectional data from the routine care registry of the Martin Zeitz Center for Rare Diseases (MZCSE) at the University Medical Center Hamburg-Eppendorf in Germany was retrieved and analyzed. We included all adult patients presenting between October 01,2020 and September 30,2021, who gave written informed consent.

Measures

Sociodemographic variables, medical history and healthcare utilization, as well as validated measures to screen for a depressive disorder (PHQ-8), an anxiety disorder (GAD-7), and SSD (PHQ-15, SSD-12).

Results

N = 167 patients were included (age 44.5 ± 14.3 years, 64.7% female). A total of 40.7% of the patients screened positive for a depressive disorder (PHQ-8 ≥ 10), 27.5% for an anxiety disorder (GAD-7 ≥ 10) and 45.0% screened positive for SSD (PHQ-15 ≥ 9 & SSD-12 ≥ 23). Factors associated with increased psychopathology included the number of symptoms, the number of different specialties consulted before and past psychotherapy.

Conclusions

Patients presenting at centers for rare diseases are likely to experience high rates of psychological distress. Systematically screening patients with rare and undiagnosed diseases for mental disorders can help to detect those at risk at an early stage and initiate adequate psychological care.