bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety exacerbation in a patient with chronic myeloid leukemia receiving dasatinib and venlafaxine
Authors: Bell Christopher , Signorelli Jessie , Hobbs Gabriela
Published: June 2023

Introduction

Tyrosine kinase inhibitor (TKI) use leads to near-normal life expectancy in patients with chronic myeloid leukemia (CML); unfortunately for some patients, adverse drug effects (ADEs) and medication burden associated with TKI therapy can lead to decreased quality of life. Additionally, TKIs have drug interactions that may negatively impact patients’ management of co-morbidities or lead to increased ADEs.

Case report

A 65-year-old female with a history of anxiety treated and controlled with venlafaxine experienced increased and resistant anxiety and insomnia after starting dasatinib for CML.

Management and outcome

On dasatinib, the patient experienced worsening anxiety and insomnia. The stress of a new leukemia diagnosis, drug interactions, and ADEs from dasatinib were considered possible causes. Dose adjustments to dasatinib and venlafaxine were made to control the patient’s symptoms. However, the patient’s symptoms did not resolve. After being on dasatinib for 2.5 years, the patient discontinued TKI therapy due to being in a deep molecular remission and given ongoing challenges managing anxiety. Within 4 months of stopping dasatinib, the patient reported an improvement in anxiety and overall emotional wellbeing. She continues to feel better and remains in a complete molecular remission 20 months off treatment.

Discussion

This case demonstrates a possible previously unknown drug interaction with dasatinib as well as a possible rarely reported ADE of dasatinib. Additionally, it highlights the difficulties patients with psychiatric disorders may face on TKI therapy and challenges providers may have in identifying rare psychiatric ADEs, thus emphasizing the need for documentation of these types of cases.
Research Compensation and Enhanced Contacts in Studies With Persons Who Use Drugs: Lessons From the COVID-19 Pandemic Demand a Reset
Authors: Lemansky Matthew G , Martin Anna K , Bernstein Judith A , Assoumou Sabrina A
Published: June 2023

Policy changes resulting from the coronavirus 2019 (COVID-19) pandemic have had a substantial and positive impact on the clinical care of persons with opioid use disorder. These innovative paradigm shifts created a ripe environment for re-evaluating traditional approaches to recruiting and retaining persons who use drugs into research studies. For example, changes to methadone prescribing requirements and authorization of buprenorphine prescriptions via telehealth have both increased access to medications. In this commentary, we contribute to ongoing conversations about the ethics of compensation for participants in addiction-related clinical research and share methods of payment that proved successful in research performed during the pandemic. We also discuss approaches to enrollment and follow-up that were implemented during the height of COVID restrictions. These approaches may mutually benefit both participants and researchers in a post-pandemic era.
Visual localization with a monocular camera for unmanned aerial vehicle based on landmark detection and tracking using YOLOv5 and DeepSORT
Authors: Ma Liqun , Meng Dongyuan , Zhao Shuaihe , An Binbin
Published: June 2023

Absolute visual localization is of significant importance for unmanned aerial vehicles when the satellite-based localization system is not available. With the rapid evolution in the field of deep learning, the real-time visual detection and tracking of landmarks by an unmanned aerial vehicle could be implemented onboard. This study demonstrates a landmark-based visual localization framework for unmanned aerial vehicles flying at low altitudes. YOLOv5 and DeepSORT are used for multi-object detection and tracking, respectively. The unmanned aerial vehicle localization is achieved according to the geometric similarity between the geotagged transmission towers and the annotated images captured by a monocular camera. The validation is accomplished both in the Rflysim-based simulation and the quadrotor-based real flight. The localization precision is about 10 m, and the location update frequency reaches 5 Hz with a commercially available entry-level edge artificial intelligence platform. The proposed visual localization strategy needs no satellite image as a reference map, which saves a significant amount of the GPU memory and makes possible the end-to-end implementation on small unmanned aerial vehicles.
Relationship of Precrisis Financial Decisions With the Financial Distress and Performance of Small- and Medium-Sized Restaurants During COVID-19
Authors: Sharma Amit , Lee Seoki , Lin Michael S.
Published: June 2023

Based on the trade-off theory of capital structure and the information asymmetry theory of business financing, we evaluated the association of informal financing with the financial performance of small- and medium-sized enterprises (SMEs) in the restaurant industry. This study collected survey responses directly from small- and medium-sized restaurant owners ( n = 178) during the COVID-19 pandemic. The findings of the study suggested that reliance on “family, friends, relatives, and third-party lenders” for financing was associated with lower financial performance during a crisis for restaurants. Results were robust when controlled for the owner’s gender, business affiliation, firm age, and relative firm size. Furthermore, we also found that the relative firm size of SMEs moderated this relationship such that, for mid-sized firms ($2–5 million annual revenues), the negative association with financial performance was lower than that for smaller firms (<$2 million annual revenue) and larger firms (>$5 million annual revenues). This article theoretically contributes to the literature by investigating the influence of informal financing on a firm’s performance, and the role of relative firm size within the category of SMEs in this relationship. Findings from the study provide practical guidance for SMEs and informal lenders.
Real-world considerations for the rapid prototyping and manufacture of a ventilator for the COVID-19 pandemic
Authors: Wong Judith Ju Ming , Loke Fiona Wei Ling , Tan Herng Lee , Quah Jessica Lishan , Cheong Wai Chye , Khan Shariq Ali , Thomas Biju , Phua Ghee Chee , Chan Derrick Wei Shih
Published: June 2023

Background

In the COVID-19 pandemic, ventilators vital to keeping infected patients alive, were in short supply globally. Our aim was to rapidly prototype and implement production of basic ventilators to serve the local and regional needs in this emergency situation.

Methods

We adopted a supply-to-design approach, estimating the potential demand for ventilator units and sourcing for common off-the-shelf components available in the estimated quantities, to assemble ventilator units which met the essential requirements for clinical use. We determined the minimum requirements of a basic ventilator based on published specifications and clinician input. Building the ventilator involved interdisciplinary collaboration (between clinicians, industry, hospital innovation engineers and government partners), prototyping and repeated iterations, bench testing, animal testing, regulatory processes, ISO13485 quality management processes, licensing and user acceptability testing.

Results

We prototyped a limited feature ventilator to supplement hospital ventilators which could be manufactured in sufficient numbers within a short span of time from easily available component parts. Developed with close attention to clinician user input with compliance to ISO standards and quality management processes where possible, this ventilator system was composed of coupled resuscitation bags, motor systems, and pressure and flow sensors capable of delivering ventilator breaths within safe and clinically important targets. This system is functional on ambient air with or without low pressure oxygen supplementation. User feedback cited size, alarms and intuitiveness of controls as potential areas for improvement.

Conclusions

Further modification based on user acceptability testing results are needed to refine the usability of this limited feature ventilator.
Developing and Testing the Negative Mentoring Experience Questionnaire (NMEQ) for Nurses
Authors: Huang Ching-Yuan , Wu Tsung-Chin , Weng Rhay-Hung , Hsia Hung Chiu- , Lin Tzu-En , Tsai Yu-Chen
Published: June 2023

Many nurse managers actively developed mentoring programs to shorten the acclimation period of new nurses in hospitals. The main aim was to develop a negative mentoring experience questionnaire (NMEQ) and test its validity and reliability. A cross-sectional study was employed. This study adopted questionnaire-survey method with new nurses of Taiwanese hospitals. In the main study, this study adopted reliability analysis, content, validity, construct validity and criterion-related validity analysis. 255 participants were collected, with 87.93% response rate. A total of 29 items of five-dimension scale of NMEQ were proposed: four nursing manager items, four institutional items, three other medical staff items, 12 mentor items, and six mentee items. Each dimension demonstrated a reliability of 0.72 to 0.96. Exploratory factor analysis and Confirmatory factor analysis results indicated that NMEQ had acceptable convergent and discriminate validity. Correlation analysis indicated this scale and mentoring function scale exhibited a significantly negative correlation ( p < .05). NMEQ is reliable and valid for hospital nurses. It also can help clinical nursing managers to clarify the possible negative experiences and strengthen the adaptability and mental health of new staff nurses in mentoring programs. Nursing policy planners can use NMEQ to measure the negative experience of new nurses, monitor the performance of mentoring program, and further revise mentoring policies.
Applications of Extended Reality (XR) in obtaining informed consent: A narrative review
Authors: Lai Michelle , (Hongbo) Chen Rob , Evanyshyn Andrew , Shaltout Zeina , Alfred Myrtede
Published: June 2023

Informed consent in healthcare requires patients to have a sufficient understanding of their upcoming procedure before deciding to proceed. Unfortunately, education prior to a surgical procedure is constrained by barriers including poor health literacy, language barriers, one-sided dialogue during consultations, anxiety, and knowledge retention. Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR) has the potential to improve informed consent processes by creating an immersive, interactive, and multimodal sensory experience that supports patient education. The purpose of the study was to review the extant literature on the effectiveness of XR technology in improving patient education, a vital component of informed consent. We screened fifty-two articles and ten relevant papers from PubMed, Scopus, and Compendex, which were included in the review based on our eligibility criteria. We found that VR and AR proved effective in enhancing patient education in eight studies, and thus improving informed consent processes. MR was not utilized in the studies reviewed. The studies were conducted in several countries and positives findings were reported from a broad range of clinical settings and procedures. Though further investigation is needed, this is a promising finding that may encourage health systems to implement similar interventions prior to procedures. The review also provided an overview of the existing XR technology utilized for patient education such as a downloadable mobile application with a virtual chatbot character, and an environment designed to simulate the MRI patient’s perspective. These applications provide immersive and interactive experiences when paired with a head mounted headset such as Google VR Cardboard. The findings also revealed that XR tools are customizable and can be tailored to specific surgical procedures, which makes the potential of implementation applicable to a broader range of settings.
A celebration of the work of Richard Cook, MD: A pioneer in understanding accidents, safety, human factors, and resilience
Authors: O'Connor Michael F. , Woods David , Perry Shawna J. , Patterson Emily S. , Nunnally Mark E. , Nemeth Christopher , Fairbanks Rollin J. (Terry) , Donchin Yoel , Bitan Yuval
Published: June 2023

Dr. Richard Cook was a physician, educator, scholar, and researcher. He was a brilliant thinker and writer. Richard's CV lists 41 peer reviewed publications, 39 conference proceedings, 6 technical reports, 30 books/book chapters that were cited about 10,000 times (as of September 2022). Richard has excelled in multiple careers and was remarkably giving of his time, devoting 100s of thousands of hours of his life presenting, debating, corresponding, mentoring, and challenging the world, in formal and informal settings, to mature toward more complex, realistic thinking about the world as a sociotechnical entity. Our community recognizes him mainly for his key role in the start and expansion of the patient safety movement.

This paper presents quintessence from a panel session that honors Richard’s work. The 7 panelists and moderator present Richard’s legacy, introduce varied aspects of his work, and consider how we can take his legacy forward to cope with future challenges. It is a moment to step back, remind ourselves of patient safety’s evolution from the 90’s until today, the power of resilience for the future of healthcare complex systems, and how to build momentum that can succeed at scale.
Preliminary Usability Evaluation of Personal Medical Devices towards Better Home Healthcare
Authors: Ranjan Jha Prameet , Chen Xiaoyu , Wang Xiaomei
Published: June 2023

Portable medical devices have been playing an important role in improving health outcomes across the socio-economic spectrum. In the recent decades, substantial population have started using such devices to monitor important vital signs. Significant proportion of these users are older patients with chronic diseases, declined physical and/or cognitive capabilities. Furthermore, these portable devices are often used in unguided environments, that can present unpredictable use contexts. In this preliminary study, we conducted usability inspection on five portable medical devices. Cognitive walkthrough followed by Nielson’s ten Usability Heuristic evaluation method were utilized for the purpose of usability inspection. Sixteen usability concerns were uncovered in such evaluation study. We also recorded the elapsed time of measuring vital signs with all five devices on a daily basis in a month. The average total completion time after familiarization (after the first week) was 5.17 minutes. Results suggest that ‘non-expert’, independent users may face challenges when using portable medical devices in home care settings. Further, the study results also indicate that unsatisfactory usability of portable medical devices could pose hinderances in technology adoption among low eHealth literate users.
Prediction of Breast Self-Examination Behavior Among Omani Undergraduate Students Using Champion's Health Belief Model
Authors: Mohanmmed Wali Shakhman Lina , Arulappan Judie
Published: June 2023

Introduction

Breast cancer (BC) is a most common and frequently occurring malignancy of women worldwide. Breast self-examination (BSE) is important for the early detection and prevention of BC and to limit the morbidity and mortality. Young students are ideal people to understand and motivate other women to perform BSE.

Objective

BSE behavior of undergraduate students was predicted using Champion's Health Belief Model Scale (CHBMS).

Methods

A descriptive cross-sectional design was adopted. This study was conducted in all nine colleges of Sultan Qaboos University, , Oman. Three-hundred eighty-one female undergraduate students were selected through convenient sampling technique. The health belief towards BSE was predicted using CHBMS.

Results

The mean and SD of beliefs about the benefits of performing BSE showed 10.84 and 3.2, respectively. Mean and SD of confidence in performing BSE indicated 56.24 and 10.8. Likewise, the mean and SD of barriers in performing BSE are 13.58 and 4.2. Source of information is found to be a statistically significant predictor of barrier in performing BSE at p < .05.

Conclusion

If the self- confidence of women in performing BSE improves, the women will uptake BSE more frequently thereby they can be prevented from developing the adverse consequences of advanced stages of breast cancer.
Identifying sinks and sources of human flows: A new approach to characterizing urban structures
Authors: Aoki Takaaki , Fujishima Shota , Fujiwara Naoya
Published: June 2023

Human flow data are rich behavioral data relevant to people’s decision-making regarding where to live, work, go shopping, etc., and provide vital information for identifying city centers. However, it is not as easy to understand massive relational data, and datasets have often been reduced merely to the statistics of trip counts at destinations, discarding relational information from origin to destination. In this study, we propose an alternative center identification method based on human mobility data. This method extracts the scalar potential field of human trips based on combinatorial Hodge theory. It detects not only statistically significant attractive locations as the sinks of human trips but also significant origins as the sources of trips. As a case study, we identify the sinks and sources of commuting and shopping trips in the Tokyo metropolitan area. This aim-specific analysis leads to a combinatorial classification of city centers based on the distinct aspects of human mobility. The proposed method can be applied to other mobility datasets with relevant properties and helps us examine the complex spatial structures in contemporary metropolitan areas from the multiple perspectives of human mobility.
The role of hydrosocial heritages produced by hydrosocial territories in understanding environmental conflicts: The case of Sélune dam removals (France)
Authors: Drapier Ludovic , Germaine Marie-Anne , Lespez Laurent
Published: June 2023

Dam removal has become one of the most widespread tools for river restoration; however, these projects can be conflictual. Our aim in this paper is to question the disconnection between the ecological project and the territorial project and to evaluate its role in the emergence of conflicts. Conceptually, we draw on a hydrosocial territory perspective to link the sociopolitical and economic context to the production of a new materiality sustained by power relationships. We focus on the removal of two large dams on the Sélune River in Normandy, France, which has fueled a conflict that has lasted for a decade. By combining multiple data sources (semi-directive interviews, focus group, archives), we highlight five successive and overlapping phases since the dams’ construction at the beginning of the 20th century. Each of these periods are characterized by the (dis)empowerment of certain stakeholders, the evolution of the material environment, and the fluctuation of the hydrosocial territory scales. The case of the Sélune highlights the importance of including long-term historical perspectives in the concept of hydrosocial territory, i.e. thinking about hydrosocial heritages. Hydrosocial heritages constitute a new way to approach non-human actors by taking the historical and contemporary relationships between humans and non-humans into account. It also helps situate the dynamics of a conflict in a deeper historical process, revealing how past dynamics shape contemporary situations.
The creativity ethos: A palette of benevolent processes and outcomes
Authors: Kaufman James C , Glăveanu Vlad P
Published: June 2023

Is creativity good, bad, or neutral? Although creative outcomes can serve malevolent purposes, we argue the underlying processes that support creative expression—what we call here the Creativity Ethos—lean toward the good in human nature. The dimensions of this Ethos can be metaphorically grouped under three main colors, Blue, Yellow and Red, related to cognition and personality, socioemotional interactions, and motivation, respectively. Blue processes are flexibility and openness, Yellow processes are perspective-taking and compassion, and Red processes are passion and inspiration. In the end, a well-developed Creativity Ethos can be compared to a rainbow that showcases how different colors valorize each other; further, they can all be enhanced through co-creation, leading to emergent changes in the world. However, there are also cases in which these components are underdeveloped, which may lead to less benevolent outcomes via profiles we call the “idle activist,” “selfish CEO,” and the “potential fanatic.” We end with reflections on why discussions of the Creativity Ethos are important not only for positive and humanistic psychology, but for any discipline, including Possibility Studies, interested in developing wise and humanizing forms of creativity.
Urban inequality revisited: From the corrugated city to the lopsided city
Authors: DeVerteuil Geoffrey
Published: June 2023

In this forum paper, I revisit the rich and coherent literature on inequality from the 1990s, immersed in radical urban studies and Marxist political economy, and apply it to recent transitions in city fabrics, that is the built environment and the social worlds around it. Some city fabrics reflect powerful interests, while others are more everyday and mundane. Recently, there has been the sense that powerful fabrics have increasingly encroached upon or erased everyday ones. I use urban vignettes to visualize the shift from the corrugated city, where there was a rough balance between powerful and everyday fabrics, and the lopsided city, where powerful fabrics seek to displace and dominate. This transition requires a more robustly class-driven analysis than what is currently used in urban studies, itself fragmented. In response, I articulate a focused yet balanced analysis of the lopsided city in conversation with certain key legacies of the 1990s literature on inequality: studying the extremes, building theory on empirical richness, paying attention to the city fabric, a concern for social justice, the importance of formal mechanisms in the city (e.g. the state and developers), and balancing fragmented and totalizing views of the city. However, certain aspects of the 1990s literature have aged less well, such as the obsession with the dystopic, the narrow focus on global cities of the Global North, and the ‘all-or-nothing’ (universalistic) notions that class should dominate urban analysis.
Evaluation of Schlemm’s canal with swept-source optical coherence tomography in primary angle-closure disease
Authors: Ding Xuming , Huang Lulu , Peng Cheng , Xu Li , Liu Yixin , Yang Yijie , Wang Ning , Gu Mengyang , Sun Chengyang , Wu Yue , Guo Wenyi
Published: June 2023

Purpose

To perform an in vivo evaluation of the changes in Schlemm’s canal (SC) among patients with primary angle-closure disease (PACD) using swept-source optical coherence tomography (SS-OCT).

Methods

Patients diagnosed with PACD who had not undergone surgery were recruited. The SS-OCT quadrants scanned herein included the nasal and temporal sections at 3 and 9 o’clock, respectively. The diameter and cross-sectional area of the SC were measured. A linear mixed-effects model was performed to analyze the effects of parameters on the SC changes. The hypothesis of interest was related to the angle status (iridotrabecular contact, ITC/open angle, OPN), which was further explored with pairwise comparisons of the estimated marginal means (EMMs) of the SC diameter and SC area. In the ITC regions, the relationship between the trabecular-iris contact length (TICL) percentage and SC parameters was also studied by a mixed model.

Results

A total of 49 eyes of 35 patients were included for measurements and analysis. The percentage of observable SCs in the ITC regions was only 58.5% (24/41), whereas it was 86.0% (49/57) in the OPN regions (χ2 = 9.44, p = 0.002). ITC was significantly associated with a decreasing SC size. The EMMs for the diameter and cross-sectional area of SC at the ITC and OPN regions were 203.34 μm versus 261.41 μm (p = 0.006) and 3174.43 μm2 versus 5347.63 μm2 (p = 0.022), respectively. Sex, age, spherical equivalent refraction, intraocular pressure, axial length, extent of angle closure, history of acute attack and treatment with LPI were not significantly associated with SC parameters. In the ITC regions, a larger TICL percentage was significantly associated with a decrease in SC diameter and area (p = 0.003 and 0.019, respectively).

Conclusions

The morphologies of SC could be affected by the angle status (ITC/OPN) in patients with PACD, and ITC was significantly associated with a decreasing SC size. These changes in SC as described by OCT scans might help to elucidate the progression mechanisms of PACD.
Mothers’ lived experience of caring for children with inborn errors of amino acid metabolism
Authors: Shirdelzade Sara , Ramezani Monir , Eshraghi Peyman , Heydari Abbas
Published: June 2023

Background

Inborn errors of amino acid metabolism are chronic conditions that have many sequels. Mothers of these children are facing different challenges which are underdetermined. This study was done to explore lived experience of mothers caring for these children.

Methods

This is an interpretive phenomenology with van Manen’s approach which has 6 steps. Data were gathered by convenience and purposeful sampling. Nine mothers with different experiences were interviewed and the interviews were audiotaped.

Results

Six final themes were revealed from the exploring mothers’ experiences including the future tied to the past, psychosis in the shadow of a lost ideal child, rebellion and blaming, the ways of escaping difficulties, self-forgetting in the shadow of full-time care, passing difficulties in the duality of hope-hopelessness, caring in a continuum of isolation-socialization.

Conclusion

Mothers have multiple challenges in taking care of their children, especially psychologically and financially. So, nurses must plan programs for helping mothers of children with inborn errors of amino acid metabolism to reduce the effects of disease on mothers and consequently the children and the whole family.
Exploring the relationship between postnatal depressive symptoms and parental burnout from the perspective of the population and individual level
Authors: Huang Yongqi , Mao Fangxiang , Zhang Xuan , wang Juan , Xu Zhaojuan , Cao Fenglin
Published: June 2023

Background

Parental burnout has become increasingly common, which can lead to a range of adverse outcomes. Postnatal mothers are vulnerable and mothers with high postpartum depression scores may be more prone to parental burnout. This study aims to investigate the association between postnatal depressive symptoms and parental burnout at both the population and individual levels.

Methods

This study comprised a cross-sectional study design and participants were recruited using convenience sampling. A total of 560 postnatal mothers answered a questionnaire on their general information, postnatal depressive symptoms and parental burnout. Multiple linear regression and binary logistic regression analysis were used to examine the association between postnatal depressive symptoms and parental burnout. Furthermore, latent class analysis was used to identify subtypes of parental burnout. Finally, binary logistic regression was used to examine the differences in postnatal depressive symptoms between latent classes comprising parental burnout.

Results

The prevalence of burnout was approximately 10%. At the population level, postnatal depressive symptoms were positively associated with parental burnout (all P < 0.05). At the individual level, two latent classes were identified (i.e., “low parental burnout class” and “high parental burnout class”). Moreover, mothers with postnatal depressive symptoms were more likely to be associated with high parental burnout (PB) class than the low parental burnout class (OR = 1.12, 95% CI:1.03 to 1.23).

Conclusion

This study found a positive relationship between postnatal depressive symptoms and parental burnout. It provided evidence for developing depression-targeted programs for parental burnout, which could bring great benefits for both mothers and infants.
Pneumococcal vaccination coverage and adherence to recommended dosing schedules in adults: a repeated cross-sectional study of the INTEGO morbidity registry
Authors: Janssens Arne , Vaes Bert , Abels Chloé , Crèvecoeur Jonas , Mamouris Pavlos , Merckx Barbara , Libin Pieter , Van Pottelbergh Gijs , Neyens Thomas
Published: June 2023

Background

Since 2014, Belgium’s Superior Health Council has recommended pneumococcal vaccination for adults aged 19–85 years at increased risk for pneumococcal diseases with a specific vaccine administration sequence and timing. Currently, Belgium has no publicly funded adult pneumococcal vaccination program. This study investigated the seasonal pneumococcal vaccination trends, evolution of vaccination coverage and adherence to the 2014 recommendations.

Methods

INTEGO is a general practice morbidity registry in Flanders (Belgium) that represents 102 general practice centres and comprised over 300.000 patients in 2021. A repeated cross-sectional study was performed for the period between 2017 and 2021. Using adjusted odds ratios computed via multiple logistic regression, the association between an individual’s characteristics (gender, age, comorbidities, influenza vaccination status and socioeconomic status) and schedule-adherent pneumococcal vaccination status was assessed.

Results

Pneumococcal vaccination coincided with seasonal flu vaccination. The vaccination coverage in the population at risk decreased from 21% in 2017 to 18.2% in 2018 and then started to increase to 23.6% in 2021. Coverage in 2021 was highest for high-risk adults (33.8%) followed by 50- to 85-year-olds with comorbidities (25.5%) and healthy 65- to 85-year-olds (18.7%). In 2021, 56.3% of the high-risk adults, 74.6% of the 50+ with comorbidities persons, and 74% of the 65+ healthy persons had an adherent vaccination schedule. Persons with a lower socioeconomic status had an adjusted odds ratio of 0.92 (95% Confidence Interval (CI) 0.87–0.97) for primary vaccination, 0.67 (95% CI 0.60–0.75) for adherence to the recommended second vaccination if the 13-valent pneumococcal conjugate vaccine was administered first and 0.86 (95% CI 0.76–0.97) if the 23-valent pneumococcal polysaccharide vaccine was administered first.

Conclusion

Pneumococcal vaccine coverage is slowly increasing in Flanders, displaying seasonal peaks in sync with influenza vaccination campaigns. However, with less than one-fourth of the target population vaccinated, less than 60% high-risk and approximately 74% of 50 + with comorbidities and 65+ healthy persons with an adherent schedule, there is still much room for improvement. Furthermore, adults with poor socioeconomic status had lower odds of primary vaccination and schedule adherence, demonstrating the need for a publicly funded program in Belgium to ensure equitable access.
Risk assessment and bioburden evaluation of Agrobacterium tumefaciens-mediated transient protein expression in plants using the CaMV35S promoter
Authors: Knödler Matthias , Reunious Paul Winman , Buyel Johannes Felix
Published: June 2023

Large-scale transient expression of recombinant proteins in plants is increasingly used and requires the multi-liter cultivation ofAgrobacterium tumefacienstransformed with an expression vector, which is often cloned inEscherichia colifirst. Depending on the promoter, unintentional activity can occur in both bacteria, which could pose a safety risk to the environment and operators if the protein is toxic. To assess the risk associated with transient expression, we first tested expression vectors containing the CaMV35S promoter known to be active in plants and bacteria, along with controls to measure the accumulation of the corresponding recombinant proteins. We found that, in both bacteria, even the stable model protein DsRed accumulated at levels near the detection limit of the sandwich ELISA (3.8 µg L−1). Higher levels were detected in short cultivations (< 12 h) but never exceeded 10 µg L−1. We determined the abundance ofA. tumefaciensthroughout the process, including infiltration. We detected few bacteria in the clarified extract and found none after blanching. Finally, we combined protein accumulation and bacterial abundance data with the known effects of toxic proteins to estimate critical exposures for operators. We found that unintended toxin production in bacteria is negligible. Furthermore, the intravenous uptake of multiple milliliters of fermentation broth or infiltration suspension would be required to reach acute toxicity even when handling the most toxic products (LD50 ~ 1 ng kg−1). The unintentional uptake of such quantities is unlikely and we therefore regard transient expression as safe in terms of the bacterial handling procedure.
The somatic care of patients with comorbid mental disorders: protocol of a mixed-methods study aiming to identify barriers to and enablers of utilization of somatic healthcare (SoKo)
Authors: Groß Sophie E. , Schellartz Isabell , Zielasek Jürgen , Schlomann Lara , Klee Inna , Ritschel Careen , Engemann Sandra , Steffens Barbara , Jänner Michaela , Funken Oliver , Juckel Georg , Gouzoulis-Mayfrank Euphrosyne
Published: June 2023

Background

Healthcare for people with somatic and comorbid mental diseases can pose a challenge to the healthcare system. The aim of the SoKo study (the Somatic care of patients with mental Comorbidity) is to assess the current state of care and the facilitators and barriers of somatic care of people with somatic disorders and comorbidity of a mental disorder.

Methods

The study is conducted as a mixed-methods approach and will include (a) descriptive and inferential analysis of secondary claims data of persons insured by a German statutory health insurance company in North Rhine-Westphalia (Techniker Krankenkasse, TK-NRW), (b) qualitative individual interviews and group discussions, and (c) based on (a) and (b), quantitative surveys of both patients and physicians. We intend to analyse a sample of claims data of about 2.6 million persons insured by TK-NRW (group comparisons between TK-NRW insured persons with a diagnosis of a prevalent somatic disease [ICD-10-GM E01–E07, E11, E66, I10–I15, I20–I25, I60–I64] with and without comorbidity of a mental disorder [F00–F99]), in order to assess the uptake of somatic care by people with mental and somatic comorbidity. In addition, primary data from patients with the aforementioned somatic illnesses and a mental comorbidity as well as primary data from physicians (general practitioners and medical specialists) will be collected. The focus here will be on support factors and barriers in the somatic care of people with mental comorbidity.

Discussion

Up to now, there have been no published results of a systematic collection of both secondary and primary data on the utilisation of different care services of somatically ill patients with mental comorbidity for Germany. The present mixed-methods study aims to address this gap.

Trial registration

The trial is registered with the German Clinical Trials Register DRKS: DRKS00030513. The trial was registered on 3rd February 2023.
Lipid production and cellular changes in Fremyella diplosiphon exposed to nanoscale zerovalent iron nanoparticles and ampicillin
Authors: Yalcin Yavuz S. , Aydin Busra , Chen Huan , Gichuki Samson , Sitther Viji
Published: June 2023

With the dramatic decrease in fossil fuel stocks and their detrimental effects on the environment, renewable energy sources have gained imminent importance in the mitigation of emissions. As lipid-enriched energy stocks, cyanobacteria are the leading group of microorganisms contributing to the advent of a new energy era. In the present study, the impact of Nanofer 25 s nanoscale zero-valent iron nanoparticles (nZVIs) and ampicillin on lipid production and cellular structural changes in Fremyella diplosiphon strain B481-SD were investigated. Total lipid abundance, fatty acid methyl ester (FAME) compositions, and alkene production as detected by high-resolution two-dimensional gas chromatography with time-of-flight mass spectrometry (GC × GC/TOF–MS) was significantly higher (p < 0.05) in the individual application of 0.8 mg/L ampicillin, 3.2 mg/L nZVIs, and a combined regimen of 0.8 mg/L ampicillin and 3.2 mg/L nZVIs compared to the untreated control. In addition, we identified significant increases (p < 0.05) in monounsaturated fatty acids (MUFAs) in F. diplosiphon treated with the combination regimen compared to the untreated control, 0.8 mg/L of ampicillin, and 3.2 mg/L of nZVIs. Furthermore, individual treatment with 0.8 mg/L ampicillin and the combination regimen (0.8 mg/L ampicillin + 3.2 mg/L nZVIs) significantly increased (p < 0.05) Nile red fluorescence compared to the untreated control, indicating neutral membrane lipids to be the main target of ampicillin added treatments. Transmission electron microscopy studies revealed the presence of single-layered thylakoid membranes in the untreated control, while complex stacked membranes of 5–8 layers were visualized in ampicillin and nZVI-treated F. diplosiphon. Our results indicate that nZVIs in combination with ampicillin significantly enhanced total lipids, essential FAMEs, and alkenes in F. diplosiphon. These findings offer a promising approach to augment the potential of using the strain as a large-scale biofuel agent.
The quality of migrant patients’ primary healthcare experiences and patient-centered medical home achievement by community health centers: results from the China greater bay area study
Authors: Huo Yongjun , Kang Xun , Zhong Chenyang , Shi Leiyu , Liu Ruqing , Hu Ruwei
Published: June 2023

Background

In China, Community Health Centers (CHCs) provide primary healthcare (PHC); however, few studies have examined the quality of PHC services experienced by migrant patients. We examined the potential association between the quality of migrant patients’ PHC experiences and the achievement of Patient-Centered Medical Home by CHCs in China.

Methods

Between August 2019 and September 2021, 482 migrant patients were recruited from ten CHCs in China’s Greater Bay Area. We evaluated CHC service quality using the National Committee for Quality Assurance Patient-Centered Medical Home (NCQA-PCMH) questionnaire. We additionally assessed the quality of migrant patients’ PHC experiences using the Primary Care Assessment Tools (PCAT). General linear models (GLM) were used to examine the association between the quality of migrant patients’ PHC experiences and the achievement of PCMH by CHCs, adjusting for covariates.

Results

The recruited CHCs performed poorly on PCMH1, Patient-Centered Access (7.2 ± 2.0), and PCMH2, Team-Based Care (7.4 ± 2.5). Similarly, migrant patients assigned low scores to PCAT dimension C—First-contact care—which assesses access (2.98 ± 0.03), and D—Ongoing care (2.89 ± 0.03). On the other hand, higher-quality CHCs were significantly associated with higher total and dimensional PCAT scores, except for dimensions B and J. For example, the total PCAT score increased by 0.11 (95% CI: 0.07–0.16) with each increase of CHC PCMH level. We additionally identified associations between older migrant patients (> 60 years) and total PCAT and dimension scores, except for dimension E. For instance, the average PCAT score for dimension C among older migrant patients increased by 0.42 (95% CI: 0.27–0.57) with each increase of CHC PCMH level. Among younger migrant patients, this dimension only increased by 0.09 (95% CI: 0.03–0.16).

Conclusion

Migrant patients treated at higher-quality CHCs reported better PHC experiences. All observed associations were stronger for older migrants. Our results may inform future healthcare quality improvement studies that focus on the PHC service needs of migrant patients.
Exercising ethnobiological resilience in turbulent times and places: in memoriam Sayed Hussain (1998–2023)
Authors: Hussain Wahid , Abbas Wasim , Pieroni Andrea
Published: June 2023

On May 4, 2023, four schoolteachers and four drivers, including the young ethnobotanist Sayed Hussain, lost their lives at their school, massacred by religious extremists in the village of Teri Mangal, Kurram District, NW Pakistan, near the Pakistani-Afghan border. Ethnobiologists working in this area believe in the power of education and community-centered rural development as prominent tools for bringing about decent sustainable livelihoods in the near future and ultimately fostering social cohesion, tolerance, and peace. Ethnobiology was expressly conceived and designed to play a pivotal role in celebrating the richness of diversity of both indigenous and minority groups and especially to stop their oppression and discrimination, building the conditions for providing them true agency in their inalienable right to shape a decent future for their children. Field ethnobiologists in Kurram feel the palpable social tension, the fears local people confront daily and even sometimes the reluctance of a few community members to discuss and share their folk knowledge, while at other times, the burden of accessing militarily controlled areas and territories affected by landmines made their field research unfeasible. Nevertheless, ethnobiologists conducting field studies and navigating through these major difficulties exercise their daily resilience daily and believe in the power of the continuous dialogue between local knowledge holders and scholars.
Resolution of a periapical lesion in an autoimmune pancreatitis patient treated with long-term low-dose glucocorticoids: a case report
Authors: Flisfisch Sohar , Schäfer Edgar
Published: June 2023

Background

Patients diagnosed with an autoimmune disease are often systemically medicated with glucocorticoids. Autoimmune pancreatitis (AIP) Type 1 is considered a rare autoimmune disease, which is very well responsive to glucocorticoids and hence can be treated optionally on a long-term basis using low dose of the drug. Apical lesions of root canal-treated teeth can be solved by retreatment of the preexisting root canal obturation or via surgical approaches.

Case presentation

This case report relates to a 76-year-old male patient, whose symptomatic acute apical periodontitis was treated nonsurgically by root canal treatment. However, overtime both roots of tooth 46 were associated with asymptomatic apical lesions. Despite progression of the lesions, due to a painless situation, the patient refrained from proceeding with any further treatment options after explaining the pathological pathway with all its consequences. A few years later the patient was prescribed 2.5 mg glucocorticoid prednisone daily for long-term therapy due to an AIP Type 1. Six years later under strict glucocorticoid therapy the apical lesions healed nearly completely and the patient remained free of symptoms without any further interventions.

Conclusions

These observations suggest that prospective clinical studies are required to further elucidate the potential healing effect of systemic long-term low-dose glucocorticoid medication on lesions of endodontic origin.
Barriers and facilitators to the implementation of guidelines in rare diseases: a systematic review
Authors: Gittus Matthew , Chong Jiehan , Sutton Anthea , Ong Albert C. M. , Fotheringham James
Published: June 2023

Background

Rare diseases present a challenge to guideline implementation due to a low prevalence in the general population and the unfamiliarity of healthcare professionals. Existing literature in more common diseases references barriers and facilitators to guideline implementation. This systematic review aims to identify these barriers and facilitators in rare diseases from existing literature.

Methods

A multi-stage strategy included searching MEDLINE PubMed, EMBASE Ovid, Web of Science and Cochrane library from the earliest date available to April 2021, Orphanet journal hand-search, a pearl-growing strategy from a primary source and reference/citation search was performed. The Integrated Checklist of Determinants of Practice which comprises of twelve checklists and taxonomies, informed by 57 potential determinants was selected as a screening tool to identify determinants that warrant further in-depth investigation to inform design of future implementation strategies.

Results

Forty-four studies were included, most of which were conducted in the United States (54.5%). There were 168 barriers across 36 determinants (37 studies) and 52 facilitators across 22 determinants (22 studies). Fifteen diseases were included across eight WHO ICD-11 disease categories. Together individual health professional factors and guideline factors formed the majority of the reported determinants (59.5% of barriers and 53.8% of facilitators). Overall, the three most reported individual barriers were the awareness/familiarity with the recommendation, domain knowledge and feasibility. The three most reported individual facilitators were awareness/familiarity with the recommendation, agreement with the recommendation and ability to readily access the guidelines. Resource barriers to implementation included technology costs, ancillary staff costs and more cost-effective alternatives. There was a paucity of studies reporting influential people, patient advocacy groups or opinion leaders, or organisational factors influencing implementation.

Conclusions

Key barriers and facilitators to the implementation of clinical practice guidelines in the setting of rare diseases were at the individual health professional and guideline level. Influential people and organisational factors were relatively under-reported and warrant exploration, as does increasing the ability to access the guidelines as a potential intervention.
Pediatric basic course goes virtual: transition from face to face to hybrid learning in pediatric critical care
Authors: Zanin Anna , Caragol Angela Aramburo , Tortorolo Luca , Patui Michele , Pedrini Beatrice , Brierley Joe , Lister Bruce , Cogo Paola
Published: June 2023

Background

To explore the impact of the transition from a traditional face-to-face course delivering essential contents in pediatric critical care to a hybrid format consisting of an online pre-course self-directed learning, an online facilitated discussion, and a face-to-face edition.

Methods

Attendees and faculty were surveyed after the face-to-face course and the hybrid version to evaluate the effectiveness and satisfaction of participants with the course.

Results

Fifty-seven students attended multiple formats of the Pediatric Basic Course between January 2020 and October 2021 in Udine, Italy. We compared course evaluation data from the 29 attendees of the face-to-face course with the 28 of the hybrid edition. Data collected included participant demographics, participant self-assessed pre and post-course ‘‘confidence’’ with a range of pediatric intensive care-related activities, and their satisfaction with elements of the course. There were no statistical differences in participant demographics or pre and post-course confidence scores. Overall satisfaction with the face-to-face course was marginally higher, 4.59 vs. 4.25/5, but did not reach significance. Pre-recorded lectures which could be viewed several times, were highlighted as a positive for the hybrid course. Residents found no significant differences comparing the two courses in rating the lectures and the technical skills stations. Hybrid course facilities (online platform and uploaded material) were reported to be clear, accessible, and valuable by 87% of attendees. After six months, they still find the course relevant to their clinical practice (75%). Candidates considered the respiratory failure and mechanical ventilation modules the most relevant modules.

Conclusions

The Pediatric Basic Course helps residents strengthen their learning and identify areas to improve their knowledge. Both face-to-face and hybrid model versions of the course improved attendees’ knowledge and perceived confidence in managing the critically ill child.