bluuebunny/crossref_metadata_2025 huggingface dataset:
Life in a time of COVID: retrospective examination of the association between physical activity and mental well-being in western Australians during and after lockdown
Authors: Piggott Ben , Chivers Paola , Sarasjärvi Kiira Karoliina , Bhoyroo Ranila , Lambert Michelle , Millar Lynne , Bulsara Caroline , Codde Jim
Published: April 2023

Background

The aim of this study was to examine physical activity and sedentary behaviours during Western Australia’s COVID-19 lockdown and their association with mental well-being.

Methods

Participants completed activity related questions approximately two months after a three-month lockdown (which formed part of a larger cross-sectional study from August to October 2020) as part of a 25-minute questionnaire adapted from the Western Australia Health and Well-being Surveillance system. Open-ended questions explored key issues relating to physical activity behaviours.

Results

During the lockdown period, 463 participants (female, n = 347; 75.3%) reported lower number of active days (W = 4.47 p < .001), higher non-work-related screen hours per week (W = 11.8 p < .001), and higher levels of sitting time (χ2=28.4 p < .001). Post lockdown body mass index was higher (U = 3.0 p = .003), with obese individuals reporting the highest non-work-related screen hours per week (Wald χ2= 8.9 p = .012). Inverse associations were found for mental well-being where higher lockdown scores of Kessler-10 (p = .011), Dass-21 anxiety (p = .027) and Dass-21 depression (p = .011) were associated with lower physical activity levels. A key qualitative message from participants was wanting to know how to stay healthy during lockdown.

Conclusions

Lockdown was associated with lower physical activity, higher non-work-related screen time and more sitting time compared to post lockdown which also reported higher body mass index. Lower levels of mental well-being were associated with lower physical activity levels during lockdown. Given the known positive affect of physical activity on mental well-being and obesity, and the detrimental associations shown in this study, a key public health message should be considered in an attempt to maintain healthy activity behaviours in future lockdowns and similar emergency situations to promote and maintain positive well-being. Furthermore, consideration should be given to the isolation of a community due to infectious disease outbreaks and to recognise the important role physical activity plays in maintaining weight and supporting good mental health.
“We bleed for our community:” A qualitative exploration of the implementation of a pragmatic weight gain prevention trial from the perspectives of community health center professionals
Authors: Berger Miriam B. , Chisholm Miriam , Miller Hailey N. , Askew Sandy , Kay Melissa C. , Bennett Gary G.
Published: April 2023

Background

Clinical trial implementation continues to shift toward pragmatic design, with the goal of increasing future adoption in clinical practice. Yet, few pragmatic trials within clinical settings have qualitatively assessed stakeholder input, especially from those most impacted by research implementation and outcomes, i.e., providers and staff. Within this context, we conducted a qualitative study of the implementation of a pragmatic digital health obesity trial with employees at a Federally qualified health center (FQHC) network in central North Carolina.

Methods

Participant recruitment was conducted through purposive sampling of FQHC employees from a variety of backgrounds. Two researchers conducted semi-structured qualitative interviews and collected demographic data. Interviews were digitally recorded, professionally transcribed and double-coded by two independent researchers using NVivo 12. Coding discrepancies were reviewed by a third researcher until intercoder consensus was reached. Responses were compared within and across participants to elucidate emergent themes.

Results

Eighteen qualitative interviews were conducted, of whom 39% provided direct medical care to patients and 44% worked at the FQHC for at least seven years. Results illuminated the challenges and successes of a pragmatically designed obesity treatment intervention within the community that serves medically vulnerable patients. Although limited time and staffing shortages may have challenged recruitment processes, respondents described early buy-in from leadership; an alignment of organizational and research goals; and consideration of patient needs as facilitators to implementation. Respondents also described the need for personnel power to sustain novel research interventions and considerations of health center resource constraints.

Conclusions

Results from this study contribute to the limited literature on pragmatic trials utilizing qualitative methods, particularly in community-based obesity treatment. To continue to merge the gaps between research implementation and clinical care, qualitative assessments that solicit stakeholder input are needed within pragmatic trial design. For maximum impact, researchers may wish to solicit input from a variety of professionals at trial onset and ensure that shared common goals and open collaboration between all partners is maintained throughout the trial.

Trial Registration

This trial was registered with ClinicalTrials.gov (NCT03003403) on December 28, 2016.
Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan
Authors: Bolo Alex , Ochira Patrick , Hakim Avi J. , Katoro Joel , Bunga Sudhir , Lako Richard , Anib Victoria , Arkangelo Golda Caesar , Lobojo Brenda Nyokani , Okiria Alfred G.
Published: April 2023

Background

Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan.

Methods

Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13–18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13.

Results

A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%.

Conclusion

Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
A case of subclinical immune checkpoint inhibitor-associated myocarditis in non-small cell lung cancer
Authors: Hu Yue , Liu Cuixia , Jin Shaojun , Yi Zihan , Wang Chao , Pan Xiaohong , Huang Huaqiong
Published: April 2023

Background

Immune checkpoint inhibitors (ICIs) have been widely used in the treatment of cancer. Moreover, immune-related adverse events (irAEs) have become a new clinical challenge. ICI-associated myocarditis is a rare but fatal condition among diverse organ injuries, and early recognition and effective interventions are critical for patients.

Case presentation

In this report, we present the case of a healthy 60-year-old male who was diagnosed with lung squamous cell carcinomas following chemotherapy and received ICIs. The patient presented with asymptomatic cardiac biomarker elevation followed by immune-related myocarditis. Fortunately, the patient achieved a good clinical result after receiving high-dose steroids. The treatment with ICIs was discontinued because of recurrent increases in troponin T.

Conclusion

ICI-mediated associated myocarditis is an uncommon but potentially life-threatening adverse event. The current data suggest that clinicians need to be cautious about reinitiation in low-grade patients; however, further study of the diagnosis and treatment is necessary.
Effect of the ethnic, profession, gender, and social background on the perception of upper dental midline deviations in smile esthetics by Chinese and Black raters
Authors: Musa Mazen , Awad Riham , Mohammed Abdalla , Abdallah Hibatalrahman , Elhoumed Mohamed , Al-waraf Leena , Qu Wanting , Alhashimi Najah , Chen Xi , Wang Shuang
Published: April 2023

Abstracts

Background

The purpose of this study was to compare the perception of upper dental midline deviation on the attractiveness of a smile among raters from different ethnicities, professions, genders, and ages and measure to what extent the presence or absence of the associated smiling structures influence the raters' evaluations.

Methods

A male subject (26 years of age) with adequate smile characteristics was selected by 3 experienced orthodontists, and 561 raters from 2 different ethnic groups (281 Chinese raters and 280 Black raters) rated the subject's smile after the subject's upper dental midline was digitally altered from 0 to 5 mm using a 5-point Likert scale on 12 smile photographs divided into two groups: group 1, in the presence of smile related structures, two-thirds of the nose, lips, and chin (NLC), and group 2, in the absence of smile related structures, the lips only (L).

Results

There were statistically significant differences (p < 0.05) between the two ethnicities, in 2 mm and 4 mm in-group NLC and 5 mm in-group L, as well as the raters' profession to each midline shift of both groups (NLC) and (L) for both ethnicities except for 0 mm. Regarding the role of associated smile structures, the smile photos were observed in the presence of smile-associated structures, and in its absence (NLC × L), statistically significant differences (p < 0.05) were found when the deviation was 5 mm among the Chinese raters; in 1 mm, and 4 mm among the Black raters. Among different genders, statistical differences were only reported (p < 0.05) for Chinese raters for 5 mm in NLC, while statistical differences were observed for 2 mm and 3 mm in NLC for Black raters. For age categories, differences were observed (p < 0.05) for 4 mm, 5 mm in NLC and 4 mm, and 5 mm in L for Chinese raters, while 5 mm in NLC and 1 mm in L for Black raters.

Conclusion

Perception of the upper dental midline deviations was influenced by the factors of ethnicity, profession, presence or absence of smile-associated structures, as well as the gender and age of the raters.
Conflict resolution styles and skills and variation among medical students
Authors: Gunasingha Rathnayaka M. Kalpanee D. , Lee Hui-Jie , Zhao Congwen , Clay Alison
Published: April 2023

Background

Conflict is inevitable on healthcare teams, yet few professional school curricula teach or assess conflict resolution skills. Little is known about the variation in conflict resolution styles across medical students and how these styles might impact conflict resolution skills.

Methods

This is a prospective, single blinded, group randomized quasi experimental trial to assess the impact of knowing one’s own conflict resolution style on conflict resolution skills in a simulated encounter. Graduating medical students completed a mandatory conflict resolution session with standardized patients acting as nurses during a transition to residency course. Coaches reviewed videotapes of the simulation, focusing on students’ skills with negotiation and emotional intelligence. Retrospectively, we assessed the impact of the students knowing their conflict resolution style prior to simulation, student gender, race, and intended field of practice on conflict resolution skills as judged by coaches.

Results

One hundred and eight students completed the simulated conflict session. Sixty-seven students completed the TKI before the simulated patient (SP) encounter and 41 after. The most common conflict resolution style was accommodating (n = 40). Knowing one’s conflict resolution style in advance of the simulation and one’s identified race/ethnicity did not impact skill as assessed by faculty coaches. Students pursuing diagnosis-based specialties had higher negotiation (p = 0.04) and emotional quotient (p = 0.006) scores than those pursuing procedural specialties. Females had higher emotional quotient scores (p = 0.02).

Conclusions

Conflict resolution styles vary among medical students. Male gender and future practice in a procedural specialty impacted conflict resolution skills but knowing conflict resolution style did not.
Creation of an asynchronous faculty development curriculum on well-written narrative assessments that avoid bias
Authors: Clay Alison S. , Andolsek Kathryn M. , Niederhoffer Kira , Kandakatla Apoorva , Zhang Gloria , Price Meghan , Alagesan Priya , Jeffs Sydney , DeLaura Isabel , Nicholson C. Phifer , Chudgar Saumil M. , Narayan Aditee P. , Knudsen Nancy W. , Blazar Melinda , Edwards Pamela , Buckley Edward G.
Published: April 2023

Background

The COVID-19 pandemic in parallel with concerns about bias in grading resulted in many medical schools adopting pass/fail clinical grading and relying solely on narrative assessments. However, narratives often contain bias and lack specificity. The purpose of this project was to develop asynchronous faculty development to rapidly educate/re-educate > 2000 clinical faculty spread across geographic sites and clinical disciplines on components of a well-written narrative and methods to minimize bias in the assessment of students.

Methods

We describe creation, implementation, and pilot data outcomes for an asynchronous faculty development curriculum created by a committee of volunteer learners and faculty. After reviewing the literature on the presence and impact of bias in clinical rotations and ways to mitigate bias in written narrative assessments, the committee developed a web-based curriculum using multimedia learning theory and principles of adult learning. Just-in-time supplemental materials accompanied the curriculum. The Dean added completion of the module by 90% of clinical faculty to the department chairperson’s annual education metric.

Module completion was tracked in a learning management system, including time spent in the module and the answer to a single text entry question about intended changes in behavior. Thematic analysis of the text entry question with grounded theory and inductive processing was used to define themes of how faculty anticipate future teaching and assessment as a result of this curricula.

Outcomes

Between January 1, 2021, and December 1, 2021, 2166 individuals completed the online module; 1820 spent between 5 and 90 min on the module, with a median time of 17 min and an average time of 20.2 min. 15/16 clinical departments achieved completion by 90% or more faculty. Major themes included: changing the wording of future narratives, changing content in future narratives, and focusing on efforts to change how faculty teach and lead teams, including efforts to minimize bias.

Conclusions

We developed a faculty development curriculum on mitigating bias in written narratives with high rates of faculty participation. Inclusion of this module as part of the chair’s education performance metric likely impacted participation. Nevertheless, time spent in the module suggests that faculty engaged with the material. Other institutions could easily adapt this curriculum with provided materials.
Ten-year distant-recurrence risk prediction in breast cancer by CanAssist Breast (CAB) in Dutch sub-cohort of the randomized TEAM trial
Authors: Zhang Xi , Gunda Aparna , Kranenbarg Elma Meershoek-Klein , Liefers Gerrit-Jan , Savitha Badada Ananthamurthy , Shrivastava Payal , Serkad Chandra Prakash Vijay Kumar , Kaur Taranjot , Eshwaraiah Mallikarjuna Siraganahalli , Tollenaar Rob A. E. M. , van de Velde Cornelis J. H. , Seynaeve Caroline M. J. , Bakre Manjiri , Kuppen Peter J. K.
Published: April 2023

Background

Hormone receptor (HR)-positive, HER2/neu-negative breast cancers have a sustained risk of recurrence up to 20 years from diagnosis. TEAM (Tamoxifen, Exemestane Adjuvant Multinational) is a large, multi-country, phase III trial that randomized 9776 women for the use of hormonal therapy. Of these 2754 were Dutch patients. The current study aims for the first time to correlate the ten-year clinical outcomes with predictions by CanAssist Breast (CAB)—a prognostic test developed in South East Asia, on a Dutch sub-cohort that participated in the TEAM. The total Dutch TEAM cohort and the current Dutch sub-cohort were almost similar with respect to patient age and tumor anatomical features.

Methods

Of the 2754 patients from the Netherlands, which are part of the original TEAM trial, 592 patients’ samples were available with Leiden University Medical Center (LUMC). The risk stratification of CAB was correlated with outcomes of patients using logistic regression approaches entailing Kaplan–Meier survival curves, univariate and multivariate cox-regression hazards model. We used hazard ratios (HRs), the cumulative incidence of distant metastasis/death due to breast cancer (DM), and distant recurrence-free interval (DRFi) for assessment.

Results

Out of 433 patients finally included, the majority, 68.4% had lymph node-positive disease, while only a minority received chemotherapy (20.8%) in addition to endocrine therapy. CAB stratified 67.5% of the total cohort as low-risk [DM = 11.5% (95% CI, 7.6–15.2)] and 32.5% as high-risk [DM = 30.2% (95% CI, 21.9–37.6)] with an HR of 2.90 (95% CI, 1.75–4.80; P < 0.001) at ten years. CAB risk score was an independent prognostic factor in the consideration of clinical parameters in multivariate analysis. At ten years, CAB high-risk had the worst DRFi of 69.8%, CAB low-risk in the exemestane monotherapy arm had the best DRFi of 92.7% [vs CAB high-risk, HR, 0.21 (95% CI, 0.11–0.43), P < 0.001], and CAB low-risk in the sequential arm had a DRFi of 84.2% [vs CAB high-risk, HR, 0.48 (95% CI, 0.28–0.82), P = 0.009].

Conclusions

Cost-effective CAB is a statistically robust prognostic and predictive tool for ten-year DM for postmenopausal women with HR+/HER2−, early breast cancer. CAB low-risk patients who received exemestane monotherapy had an excellent ten-year DRFi.
Claudin-4-adhesion signaling drives breast cancer metabolism and progression via liver X receptor β
Authors: Murakami-Nishimagi Yuko , Sugimoto Kotaro , Kobayashi Makoto , Tachibana Kazunoshin , Kojima Manabu , Okano Maiko , Hashimoto Yuko , Saji Shigehira , Ohtake Tohru , Chiba Hideki
Published: April 2023

Background

Cell adhesion is indispensable for appropriate tissue architecture and function in multicellular organisms. Besides maintaining tissue integrity, cell adhesion molecules, including tight-junction proteins claudins (CLDNs), exhibit the signaling abilities to control a variety of physiological and pathological processes. However, it is still fragmentary how cell adhesion signaling accesses the nucleus and regulates gene expression.

Methods

By generating a number of knockout and rescued human breast cell lines and comparing their phenotypes, we determined whether and how CLDN4 affected breast cancer progression in vitro and in vivo. We also identified by RNA sequencing downstream genes whose expression was altered by CLDN4-adhesion signaling. Additionally, we analyzed by RT-qPCR the CLDN4-regulating genes by using a series of knockout and add-back cell lines. Moreover, by immunohistochemistry and semi-quantification, we verified the clinicopathological significance of CLDN4 and the nuclear receptor LXRβ (liver X receptor β) expression in breast cancer tissues from 187 patients.

Results

We uncovered that the CLDN4-adhesion signaling accelerated breast cancer metabolism and progression via LXRβ. The second extracellular domain and the carboxy-terminal Y197 of CLDN4 were required to activate Src-family kinases (SFKs) and the downstream AKT in breast cancer cells to promote their proliferation. Knockout and rescue experiments revealed that the CLDN4 signaling targets the AKT phosphorylation site S432 in LXRβ, leading to enhanced cell proliferation, migration, and tumor growth, as well as cholesterol homeostasis and fatty acid metabolism, in breast cancer cells. In addition, RT-qPCR analysis showed the CLDN4-regulated genes are classified into at least six groups according to distinct LXRβ- and LXRβS432-dependence. Furthermore, among triple-negative breast cancer subjects, the "CLDN4-high/LXRβ-high" and "CLDN4-low and/or LXRβ-low" groups appeared to exhibit poor outcomes and relatively favorable prognoses, respectively.

Conclusions

The identification of this machinery highlights a link between cell adhesion and transcription factor signalings to promote metabolic and progressive processes of malignant tumors and possibly to coordinate diverse physiological and pathological events.
Some inequalities related to Csiszár divergence via diamond integral on time scales
Authors: Bilal Muhammad , Khan Khuram Ali , Nosheen Ammara , Pečarić Josip
Published: April 2023

In this paper, Csiszár f-divergence via diamond integral is introduced and some inequalities related to Csiszár f-divergence involving diamond integrals are presented. Some examples are presented for different divergence measures by fixing time scales. Some divergence measures are estimated in terms of logarithmic, identric, geometric, and arithmetic means. The obtained results generalize some known results in the literature and provide new bounds for some divergence measures in q-calculus.
A Tseng-type algorithm for approximating zeros of monotone inclusion and J-fixed-point problems with applications
Authors: Adamu Abubakar , Kumam Poom , Kitkuan Duangkamon , Padcharoen Anantachai
Published: April 2023

In this paper, a Halpern–Tseng-type algorithm for approximating zeros of the sum of two monotone operators whose zeros areJ-fixed points of relativelyJ-nonexpansive mappings is introduced and studied. A strong convergence theorem is established in Banach spaces that are uniformly smooth and 2-uniformly convex. Furthermore, applications of the theorem to convex minimization and image-restoration problems are presented. In addition, the proposed algorithm is used in solving some classical image-recovery problems and a numerical example in a Banach space is presented to support the main theorem. Finally, the performance of the proposed algorithm is compared with that of some existing algorithms in the literature.
Depression and opinion of dental students regarding the hybrid learning model during the COVID-19 pandemic
Authors: Orozco Marco Felipe Salas , de González Wendy Yesenia Escobar , Marín Nuria Patiño , Hernández Jesús Ramón Castillo , Hernandez-Cabanillas Juan Carlos , Acosta Ivan Olivares , Rider Ricardo Martinez , Casillas Santana Miguel Angel
Published: April 2023

Background

The global spread of COVID-19 forced schools at all educational levels to close, which was repeated in more than 60 countries. In addition, the COVID-19 pandemic has affected the mental health of dental students world wide. This study hypothesizes that the prevalence of depression in dental students from El Salvador is higher than that reported in studies from Europe, Asia, and North America.

Methods

This study was an online cross-sectional survey performed at the Faculty of Dentistry of the University of Salvador. The PHQ-9 questionnaire was applied to know the level of depression of the students, and a questionnaire focused on learning the opinion of the students on the hybrid teaching model adopted. Approximately 450 students participated in both questionnaires.

Results

Regarding the levels of depression present in the students, 14% had minimal depression, 29% had medium depression, 23% had moderate depression and, 34% had severe depression. The students had an excellent opinion regarding the hybrid learning model.

Conclusions

The prevalence of depression in dental students in El Salvador seems to be higher than that reported in studies in non-Latin American countries. Therefore, universities must generate care plans for mental health to avoid these harmful effects on students during future contingencies.
Electrical conduction investigation of pre-stressed carbon/epoxy fabric laminates heated by ampere-level currents
Authors: Zhou Gang , Mikinka Ewa , Bao Xujin , Sun Weiwei
Published: April 2023

A study on electrical conduction of carbon/epoxy laminates has so far been conducted in an ad hoc nature without a standardised method, involving many extrinsic factors. How these factors affect electrical conduction of carbon/epoxy laminates has not been well established. The objectives of this work are to ascertain the effects of electrical currents, temperatures, and clamping torques on the anisotropic electrical conduction of carbon/epoxy laminates. Two-probe method with solid electrodes was developed with machined carbon/epoxy laminate specimens of various dimensions. The contributions of elevated temperatures and clamping pressures to electrical conduction were investigated. Various contact conditions with or without conductive paint were examined. The relationship of electrical resistance correlating with temperature and clamping pressure was developed to aid an analysis of data trends. From the average test results of 18 groups, aided with qualitative predictions, the milliampere-to-ampere increases of current led to significant reductions in electrical conductivities in both in-plane and through-the-thickness directions. The rises of temperatures resulted in the similar reductions in electrical conductivity due to the increased resistance. The increase in clamping torque increased the electrical conductivity values in both directions. Applying conductive paint to the contact faces did not appear to affect the contact resistance. Thus, the enhanced values of electrical conductivity from the painted specimens were attributed to their lower body temperatures, as the conductive paint at the contact faces soaked up the substantial amount of the electrical energies.
Study on incidence of lamb morbidity and mortality and associated risk factors in the mixed crop-livestock production system of Gewata District, Kaffa zone, southwestern Ethiopia
Authors: Fesseha Haben , Gebremichael Gizaw , Asefa Isayas , Edaso Teshita
Published: April 2023

Lamb morbidity and mortality cause significant loss in a smallholder production system. A longitudinal prospective survey was conducted on 408 randomly selected farmers located in six purposefully selected kebeles in Gewata woreda from June 2020 to July 2021 to determine the incidence of morbidity and mortality in lambs and to identify risk factors. For this purpose, 408 lambs from the Gewata district’s mixed crop-livestock production system were examined every day from birth to three months of age. The data was analyzed using the Kaplan-Meier (K-M) method, the log-rank test, and Cox proportional hazards regression. Results showed that the cumulative incidence of all-cause of morbidity and mortality at the end of three month was 12.86% (95% CI: 10.26–16.13%), and 6.86% (95% CI: 5.03–9.35%), respectively. Diarrhea was the leading cause of morbidity and mortality, accounting for 49.33 and 50% morbidity and mortality, respectively. Pneumonia was the second most frequent cause of morbidity and death. In the K-M hazard analysis, the greatest risk of lamb morbidity and mortality was observed during the first month of life, and then the risk decreased significantly as the lamb grew. Of the 17 potential risk factors studied, the multivariable Cox proportional hazards regression model showed that lamb sex, birth weight, umbilical care, time and method of colostrum feeding were the five predictors that were significantly associated with a higher risk of morbidity, whereas birth weight, lambing difficulty, dams’ parity, method and time of colostrum feeding were the five predictors that were significantly associated with a higher risk of mortality. Moreover, a higher risk of morbidity was observed in lambs with methods of colostrum feeding after birth (HR = 3.158; p = 0.000) and with variations in birth weight (HR = 1.418; p = 0.003). Similarly, the mortality risk was 4.926 (p = 0.047), 4.023 (p = 0.012), and 3.206 (p = 0.000) times higher in lambs with lambing difficulties, at the time of colostrum feeding, and by the method of colostrum feeding, respectively. According to this research, lamb morbidity and mortality rates in the study area are significantly high which has a great impact on the replacement stock and production. Hence, awareness should be created among farmers concerning improved lamb management practices.
Fertility Preservation Decisional Turning Points for Adolescents and Young Adults With Cancer: Exploring Alignment and Divergence by Race and Ethnicity
Authors: Canzona Mollie R. , Murphy Karly , Victorson David , Harry Onengiya , Clayman Marla L. , McLean Thomas W. , Golden Shannon L. , Patel Bonnie , Strom Carla , Little-Greene Denisha , Saker Siba , Salsman John M.
Published: April 2023

PURPOSE

For adolescents and young adults (AYAs) with cancer, fertility preservation (FP) decision making is complex and distressing. Racial/ethnic minority (REM) AYAs experience disparities in FP awareness, uptake, and outcomes. A turning point (TP) is a point of reflection, change, or decisive moment(s) resulting in changes in perspectives or trajectories. To enhance understanding of AYAs' diverse experiences, this study examined alignment and/or divergence of FP decisional TPs among non-Hispanic White (NHW) AYAs and REM AYAs.

METHODS

Qualitative semistructured interviews were conducted in person, by video, or phone with 36 AYAs (20 NHW and 16 REM [nine Hispanic and seven Black/multiracial Black). The constant comparative method was used to identify and analyze themes illustrating participants' conceptualization and/or experience of FP decisional TPs.

RESULTS

Seven thematic TPs emerged: (1) emotional reaction to discovering FP procedures exist; (2) encountering unclear or dismissive communication during initial fertility conversations with health care providers; (3) encountering direct and supportive communication during initial fertility conversations with health care providers; (4) participating in critical family conversations about pursuing FP; (5) weighing personal desire for a child against other priorities/circumstances; (6) realizing FP is not feasible, and (7) experiencing unanticipated changes in cancer diagnosis or treatment plans/procedures. TP variations include REM participants reported dismissive communication and suggested cost was prohibitive. NHW participants emphasized more forcefully that biological children may become a future priority.

CONCLUSION

Understanding how clinical communication and priorities/resources may vary for NHW and REM AYAs can inform future interventions aimed at reducing health disparities and enhancing patient-centered care.
Five Decades of Trauma Anesthesiology
Authors: Dutton Richard P. , Varon Albert J.
Published: April 2023

We present a brief history of the scientific and educational development of trauma anesthesiology. Key milestones from the past 50 years are noted, as well as the current standing of the subspecialty and prospects for the future.
Peri-Intubation Hypoxia After Delayed Versus Rapid Sequence Intubation in Critically Injured Patients on Arrival to Trauma Triage: A Randomized Controlled Trial
Authors: Bandyopadhyay Anjishnujit , Kumar Pankaj , Jafra Anudeep , Thakur Haneesh , Yaddanapudi Laxmi Narayana , Jain Kajal
Published: April 2023

BACKGROUND:

Critically injured patients who are agitated and delirious on arrival do not allow optimal preoxygenation in the emergency area. We investigated whether the administration of intravenous (IV) ketamine 3 minutes before administration of a muscle relaxant is associated with better oxygen saturation levels while intubating these patients.

METHODS:

Two hundred critically injured patients who required definitive airway management on arrival were recruited. The subjects were randomized as delayed sequence intubation (group DSI) or rapid sequence intubation (group RSI). In group DSI, patients received a dissociative dose of ketamine followed by 3 minutes of preoxygenation and paralysis using IV succinylcholine for intubation. In group RSI, a 3-minute preoxygenation was performed before induction and paralysis using the same drugs, as described conventionally. The primary outcome was incidence of peri-intubation hypoxia. Secondary outcomes were first-attempt success rate, use of adjuncts, airway injuries, and hemodynamic parameters.

RESULTS:

Peri-intubation hypoxia was significantly lower in group DSI (8 [8%]) compared to group RSI (35 [35%]; P = .001). First-attempt success rate was higher in group DSI (83% vs 69%; P = .02). A significant improvement in mean oxygen saturation levels from baseline values was seen in group DSI only. There was no incidence of hemodynamic instability. There was no statistically significant difference in airway-related adverse events.

CONCLUSIONS:

DSI appears promising in critically injured trauma patients who do not allow adequate preoxygenation due to agitation and delirium and require definitive airway on arrival.
In Vitro Analysis of Platelet Adhesion, Aggregation, and Surface GP1bα Expression in Stored Refrigerated Whole Blood: A Pilot Study
Authors: Keneally Ryan J. , Gonzalez-Almada Alberto , Wargowsky Richard , Fernandez Xiomara , Kochar Olga , Cresswell Gregory , Sarani Babak , Tanaka Kenichi , Mazzeffi Michael A.
Published: April 2023

BACKGROUND:

Warm, fresh whole blood (WB) has been used by the US military to treat casualties in Iraq and Afghanistan. Based on data in that setting, cold-stored WB has been used to treat hemorrhagic shock and severe bleeding in civilian trauma patients in the United States. In an exploratory study, we performed serial measurements of WB’s composition and platelet function during cold storage. Our hypothesis was that in vitro platelet adhesion and aggregation would decrease over time.

METHODS:

WB samples were analyzed on storage days 5, 12, and 19. Hemoglobin, platelet count, blood gas parameters (pH, Po
2, Pco
2, and Spo
2), and lactate were measured at each timepoint. Platelet adhesion and aggregation under high shear were assessed with a platelet function analyzer. Platelet aggregation under low shear was assessed using a lumi-aggregometer. Platelet activation was assessed by measuring dense granule release in response to high-dose thrombin. Platelet GP1bα levels were measured with flow cytometry, as a surrogate for adhesive capacity. Results at the 3 study timepoints were compared using repeat measures analysis of variance and post hoc Tukey tests.

RESULTS:

Measurable platelet count decreased from a mean of (163 + 53) × 109 platelets per liter at timepoint 1 to (107 + 32) × 109 at timepoint 3 (P = .02). Mean closure time on the platelet function analyzer (PFA)-100 adenosine diphosphate (ADP)/collagen test increased from 208.7 + 91.5 seconds at timepoint 1 to 390.0 + 148.3 at timepoint 3 (P = .04). Mean peak granule release in response to thrombin decreased significantly from 0.7 + 0.3 nmol at timepoint 1 to 0.4 + 0.3 at timepoint 3 (P = .05). Mean GP1bα surface expression decreased from 232,552.8 + 32,887.0 relative fluorescence units at timepoint 1 to 95,133.3 + 20,759.2 at timepoint 3 (P < .001).

CONCLUSIONS:

Our study demonstrated significant decreases in measurable platelet count, platelet adhesion, and aggregation under high shear, platelet activation, and surface GP1bα expression between cold-storage days 5 and 19. Further studies are needed to understand the significance of our findings and to what degree in vivo platelet function recovers after WB transfusion.
Association Between Profound Shock Signs and Peripheral Intravenous Access Success Rates in Trauma Patients in the Prehospital Scenario: A Retrospective Study
Authors: Barsky Daniel , Radomislensky Irina , Talmy Tomer , Gendler Sami , Almog Ofer , Avital Guy
Published: April 2023

BACKGROUND:

Hemorrhage is the leading cause of preventable death in trauma patients, and establishment of intravenous (IV) access is essential for volume resuscitation, a key component in the treatment of hemorrhagic shock. IV access among patients in shock is generally considered more challenging, although data to support this notion are lacking.

METHODS:

In this retrospective registry-based study, data were collected from the Israeli Defense Forces Trauma Registry (IDF-TR) regarding all prehospital trauma patients treated by IDF medical forces between January 2020 and April 2022, for whom IV access was attempted. Patients younger than 16 years, nonurgent patients, and patients with no detectable heart rate or blood pressure were excluded. Profound shock was defined as a heart rate >130 or a systolic blood pressure <90 mm Hg, and comparisons were made between patients with profound shock and those not exhibiting such signs. The primary outcome was the number of attempts required for first IV access success, which was regarded as an ordinal categorical variable: 1, 2, 3 and higher and ultimate failure. A multivariable ordinal logistic regression was performed to adjust for potential confounders. Patients’ sex, age, mechanism of injury and best consciousness level, as well as type of event (military/nonmilitary), and the presence of multiple patients were included in the ordinal logistic regression multivariable analysis model based on previous publications.

RESULTS:

Five hundred thirty-seven patients were included, 15.7% of whom were recorded as having signs of profound shock. Peripheral IV access establishment first attempt success rates were higher in the nonshock group, and there was a lower rate of unsuccessful attempts in this group (80.8% vs 67.8% for the first attempt, 9.4% vs 16.7% for the second attempt, 3.8% vs 5.6% for the third and further attempts, and 6% vs 10% unsuccessful attempts, P = .04). In the univariable analysis, profound shock was associated with requirement for an increased number of IV attempts (odds ratio [OR], 1.94; confidence interval [CI], 1.17–3.15). The ordinal logistic regression multivariable analysis demonstrated that profound shock was associated with worse results regarding primary outcome (adjusted odds ratio [AOR], 1.84; CI, 1.07–3.10).

CONCLUSIONS:

The presence of profound shock in trauma patients in the prehospital scenario is associated with an increased number of attempts required for IV access establishment.
Factor VIII: A Dynamic Modulator of Hemostasis and Thrombosis in Trauma
Authors: Tanaka Kenichi A. , Terada Rui , Butt Amir L. , Mazzeffi Michael A. , McNeil John S.
Published: April 2023

A trace amount of thrombin cleaves factor VIII (FVIII) into an active form (FVIIIa), which catalyzes FIXa-mediated activation of FX on the activated platelet surface. FVIII rapidly binds to von Willebrand factor (VWF) after secretion and becomes highly concentrated via VWF-platelet interaction at a site of endothelial inflammation or injury. Circulating levels of FVIII and VWF are influenced by age, blood type (nontype O > type O), and metabolic syndromes. In the latter, hypercoagulability is associated with chronic inflammation (known as thrombo-inflammation).

In acute stress including trauma, releasable pools of FVIII/VWF are secreted from the Weibel-Palade bodies in the endothelium and then augment local platelet accumulation, thrombin generation, and leukocyte recruitment. Early systemic increases of FVIII/VWF (>200% of normal) levels in trauma result in a lower sensitivity of contact-activated clotting time (activated partial thromboplastin time [aPTT] or viscoelastic coagulation test [VCT]). However, in severely injured patients, multiple serine proteases (FXa plasmin and activated protein C [APC]) are locally activated and may be systemically released. Severity of traumatic injury correlates with prolonged aPTT and elevated activation markers of FXa, plasmin, and APC, culminating in a poor prognosis. In a subset of acute trauma patients, cryoprecipitate that contains fibrinogen, FVIII/VWF, and FXIII is theoretically advantageous over purified fibrinogen concentrate to promote stable clot formation, but comparative efficacy data are lacking. In chronic inflammation or subacute phase of trauma, elevated FVIII/VWF contributes to the pathogenesis of venous thrombosis by enhancing not only thrombin generation but also augmenting inflammatory functions.

Future developments in coagulation monitoring specific to trauma patients, and targeted to enhancement or inhibition of FVIII/VWF, are likely to help clinicians gain better control of hemostasis and thromboprophylaxis. The main goal of this narrative is to review the physiological functions and regulations of FVIII and implications of FVIII in coagulation monitoring and thromboembolic complications in major trauma patients.
Training Anesthesiology Residents to Care for the Traumatically Injured in the United States
Authors: Blaine Kevin P. , Dudaryk Roman , Milne Andrew D. , Moon Tiffany S. , Nagy David , Sappenfield Joshua W. , Teng Justin J.
Published: April 2023

Training and education for trauma anesthesiology have been predicated on 2 primary pathways: learning through peripheral “complex, massive transfusion cases”—an assumption that is flawed due to the unique demands, skills, and knowledge of trauma anesthesiology—or learning through experiential education, which is also incomplete due to its unpredictable and variable exposure. Residents may receive training from senior physicians who may not maintain a trauma-focused continuing medical education. Further compounding the issue is the lack of fellowship-trained clinicians and standardized curricula. The American Board of Anesthesiology (ABA) provides a section for trauma education in its Initial Certification in Anesthesiology Content Outline. However, many trauma-related topics also fall under other subspecialties, and the outline excludes “nontechnical” skills. This article focuses on the training of anesthesiology residents and proposes a tier-based approach to teaching the ABA outline by including lectures, simulation, problem-based learning discussions, and case-based discussions that are proctored in conducive environments by knowledgeable facilitators.
Is Fetal-Type Posterior Cerebral Artery a Risk Factor for Recurrence in Coiled Internal Carotid Artery–Incorporating Posterior Communicating Artery Aneurysms? Analysis of Conventional Statistics, Computational Fluid Dynamics, and Random Forest With Hyper-Ensemble Approach
Authors: Chung Jaewoo , Cheong Jin Hwan , Kim Jae Min , Lee Deok Hee , Yi Hyeong-Joong , Choi Kyu-Sun , Ahn Jae Sung , Park Jung Cheol , Park Wonhyoung
Published: April 2023

BACKGROUND:

The fetal-type posterior cerebral artery (FPCA) has been regarded as the risk factor for recurrence in coiled internal carotid artery–incorporating posterior communicating artery (ICA-PCoA) aneurysm. However, it has not been proven in previous literature studies.

OBJECTIVE:

To reveal the impact of FPCA on the recurrence of ICA-PCoA aneurysms using conventional statistical analysis, computational fluid dynamics (CFD) simulation, and random forest with hyper-ensemble approach (RF with HEA).

METHODS:

Vascular parameters and clinical information from patients who underwent coil embolization ICA-PCoA aneurysms from January 2011 to December 2016 were obtained. Conventional statistical analysis was applied to a total of 95 cases obtained from patients with a follow-up of more than 6 months. For CFD simulation, 3 sets of three-dimensional models were used to understand the hemodynamical characteristics of various FPCAs. The RF with HEA was applied to reinforce the clinical data analysis.

RESULTS:

The conventional statistical analysis fails to reveal that FPCA is a risk factor. CFD analysis shows that the diameter of FPCA alone is less likely to be a risk factor. The RF with HEA shows that the impact of FPCA is also minor compared with that of the packing density in the recurrence of coiled ICA-PCoA aneurysms.

CONCLUSION:

The gathered results of all 3 analyses show more clear evidence that FPCA is not a risk factor for coiled ICA-PCoA aneurysms. Hence, we may conclude that FPCA itself is doubtful to be the major risk factor in the recurrence of coiled ICA-PCoA aneurysms.
Recent Advances in Nanocarbon-Based Nonprecious Metal Catalysts for Oxygen/Hydrogen Reduction/Evolution Reactions and Zn-Air Battery
Authors: Ganesan Pandian , Ishihara Akimitsu , Staykov Aleksandar , Nakashima Naotoshi
Published: April 2023

In this review article, we focus on the design and creation of earth-abundant non-precious metal-coordinated eco-friendly catalysts with high oxygen reduction reaction (ORR), oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) performances. The development of a cost-effective, efficient and durable bifunctional ORR and OER electrochemical catalyst is a key for future batteries. So far, precious metals, such as Pt and Ir, have been used as efficient catalysts for the ORR and OER, respectively. However, they are expensive and their deposits on earth are limited, which are the major drawbacks of these metals. One more drawback for the practical application is the sluggish reactions of ORR and OER. Since electroconductivity of promising metal-free catalyst candidates are poor, good electronic supporting materials are needed. Owing to the high conductivity, stability and easy handling, carbon nanotubes are a most promising material. After Introduction, we summarize recent advances in i) carbon nanotube/nanocarbon-based ORR and OER catalysts, ii) metal oxide and others/nanocarbon catalysts for ORR, OER, HER and Zn-air electrodes, as well as iii) computational study for such catalyst reactions. Such studies are highly beneficial for future energy materials design and synthesis in batteries and molecular catalysts with high performances.
Epidemiology of Dog Walking–Related Injuries among Adults Presenting to US Emergency Departments, 2001–2020
Authors: MAXSON RIDGE , LELAND CHRISTOPHER R. , MCFARLAND EDWARD G. , LU JIM , MESHRAM PRASHANT , JONES VANYA C.
Published: April 2023

Purpose

Dog walking is a popular daily activity, yet information regarding its injury burden is limited. This study describes the epidemiology of injuries related to leash-dependent dog walking among adults presenting to US emergency departments from 2001 to 2020.

Methods

A retrospective analysis was performed using the National Electronic Injury Surveillance System database to identify adults (≥18 yr) presenting to US emergency departments with leash-dependent dog walking–related injuries between 2001 and 2020. Outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for sustaining a fracture or traumatic brain injury (TBI). Weighted estimates and 95% confidence intervals (CI) were generated using National Electronic Injury Surveillance System sample weights.

Results

Between 2001 and 2020, an estimated 422,659 adults presented to US emergency departments with injuries related to leash-dependent dog walking. The annual incidence increased more than fourfold during this period (n = 7282 vs n = 32,306, P < 0.001). Most patients were women (75%) and adults age 40 to 64 yr (47%), with a mean age of 53 ± 0.5 yr. Patients commonly injured their upper extremity (51%) and were injured while falling when pulled or tripped by the leash (55%). The three most common injuries were finger fracture (6.9%), TBI (5.6%), and shoulder sprain/strain (5.1%). On multivariate analysis, fracture risk among dog walkers was higher in adults age ≥65 yr (odds ratio [OR], 2.1; 95% CI, 1.8–2.5) and women (OR, 1.5; 95% CI, 1.3–1.7). Risk of TBI was also elevated among older dog walkers (OR, 1.6; 95% CI, 1.3–2.0).

Conclusions

Dog walking is associated with a considerable and rising injury burden. Dog owners should be informed of this injury potential and advised on risk-reduction strategies.