bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness analysis of serplulimab in combination with cisplatin plus 5-fluorouracil chemotherapy compared to cisplatin plus 5-fluorouracil chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China
Authors: Lin Ying-Tao , Zhou Chong-Chong , Xu Kai , Zhang Meng-Die , Li Xin
Published: November 2023

Background:

This study evaluated the cost-effectiveness of serplulimab plus chemotherapy versus chemotherapy alone in treating advanced/metastatic esophageal squamous cell carcinoma (ESCC) within the Chinese health care system.

Methods:

A partitioned survival model based on ASTRUM-007 trial patient characteristics was developed. Efficacy, safety, and medical/economic data were obtained from the trial and real-world clinical practice. Costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs) were calculated for both treatment strategies. Sensitivity, subgroup, and scenario analyses were performed to assess the uncertainty impact.

Results:

Serplulimab combined with chemotherapy yielded an ICER of US$ 53,538.27/QALY. Deterministic sensitivity analysis identified patient survival and serplulimab price as influential parameters. Probabilistic sensitivity analysis showed a 47.33% probability of cost-effectiveness at a willingness-to-pay (WTP) threshold of US$ 53,541/QALY and 0.05% at three times China’s GDP per capita. Subgroup analysis revealed that patients with a programmed death-ligand 1 (PD-L1) expression combined positive score (CPS) ⩾10 had a lower hazard ratio (0.59) and ICER (US$ 29,935.23/QALY), with a 95.36% probability of cost-effectiveness. Scenario analysis demonstrated that the drug donation discount policy significantly increased the likelihood of cost-effective serplulimab-chemotherapy combinations in Jiangsu, Fujian, and Guangdong at 99.99%, 99.90%, and 94.16%, respectively.

Conclusion:

Compared to chemotherapy alone, serplulimab combined with chemotherapy is currently not a cost-effective first-line treatment for advanced/metastatic ESCC in China. However, as serplulimab plus chemotherapy regimens evolve and price competition among programmed death 1 (PD-1) inhibitors intensifies, this combination may become a cost-effective treatment option.
Anti-NMDA Receptor Encephalitis Related to Renal Cell Carcinoma: A Case Report
Authors: Vervloet Sollero Carlos Eduardo , Piquet Amanda L , Robinson Christopher , Gyang Tirisham V. , Carlson Aaron
Published: November 2023

Anti-NMDA receptor (NMDAR) encephalitis is characterized by a well-defined neuropsychiatric syndrome and CSF antibodies against the GluN1 subunit of the NMDAR. 40% of cases are related to underlying tumors, the vast majority ovarian teratomas (94%). We report a case of anti-NMDAR encephalitis associated with renal cell carcinoma (RCC). A 20-year-old female presented to the ED with behavioral changes, involuntary movements, tachycardia, and alternating obtundation with agitation which progressed over 3 weeks. Involuntary movements were severe, requiring intubation and sedation for control, and were accompanied by rhabdomyolysis. Brain MRI showed bilateral mesiotemporal T2/FLAIR hyperintensities. Anti-NMDAR antibodies were present in the serum (1:640) and CSF (1:320). Malignancy screening revealed a renal mass concerning for RCC, which was confirmed upon resection. She was started on high dose IV methylprednisolone and plasmapheresis, followed by rituximab. Lack of response led to escalating immunotherapy with cyclophosphamide. Clinical course was complicated by prolonged ICU admission, prolonged sedation, severe dysautonomia and bacteremia. Improvement began 2 months after immunotherapy, and she was discharged to rehabilitation 100 days after admission with mild neuropsychiatric symptoms. Repeat malignancy screenings, including whole-body imaging and transvaginal ultrasound were consistently negative. Herein, we describe a case of definite anti-NMDAR encephalitis in the setting of newly diagnosed RCC. This case illustrates how tumors other than ovarian teratomas may act as immunological triggers, as well as the complex and prolonged symptomatic and immunosuppressive therapies required in severe presentations of anti-NMDAR encephalitis.
A 6-week, phase IIb, randomized, double-blind, placebo-controlled trial of Anyu Peibo capsules for the treatment of major depressive disorder in adults
Authors: He Shen , Yu Yimin , Huang Jingjing , Yin Jiahui , Niu Yajuan , Lu Yazhou , Wu Bin , Fang Maosheng , Wang Xue , Tao Zhiping , Li Lehua , Li Kan , Li Yan , Ding Xiujuan , Shen Yifeng , Li Huafang
Published: November 2023

Background:

Almost one-third of patients with major depressive disorder (MDD) do not respond to conventional antidepressants, and new treatments for MDD are urgently needed.

Objectives:

This phase IIb clinical trial was designed to evaluate the efficacy and safety of Anyu Peibo capsules in the treatment of adults with MDD.

Design:

A multicenter, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study.

Methods:

A total of 172 patients with MDD from nine study centers were randomized (1:1) to receive placebo ( n = 86) or oral Anyu Peibo capsules (0.8 g) twice per day ( n = 86) for 6 weeks. The primary endpoint was the change in the Montgomery Åsberg Depression Rating Scale (MADRS) total score from baseline to week 6, analyzed using an analysis of covariance (ANCOVA) approach with the baseline MADRS score, center effect and center by group interaction as the covariates. Other efficacy endpoints and variables included clinical response and remission rates according to the MADRS and the 17-item Hamilton Depression Rating Scale (HAMD-17) scores, the change in the HAMD-17, Clinical Global Impression – Severity scale and Clinical Global Impression – Improvement scale scores and the reduction in the Hamilton Anxiety Scale from baseline to week 6.

Results:

The mean baseline MADRS total scores were 29.20 and 29.72 in the Anyu Peibo ( n = 82) and placebo groups ( n = 81), respectively. The least squares mean change in the MADRS score from baseline to week 6 was 16.59 points in the Anyu Peibo group and 14.51 points in the placebo group. Although there were greater reductions in the MADRS score from baseline to week 6 in the Anyu Peibo capsule group compared to the placebo group, the difference did not reach statistical significance (least-squares mean difference, 2.07 points; 95% confidence interval, −0.27 to 4.41; p = 0.0819). The results of sensitivity analyses by ANCOVA with the last observation carried forward method for missing data indicated that the administration of Anyu Peibo capsules may lead to a significant reduction in depressive symptoms compared to the placebo (least-squares mean difference: 3.29 points; 95% confidence interval: 0.64–5.93; p = 0.0152). Furthermore, Anyu Peibo capsules showed significant benefits over placebo when the change in the HAMD-17 score from baseline to week 6 was evaluated as the secondary analysis ( t = 2.01; 95% confidence interval, 0.03–4.23; p = 0.0464).

Conclusion:

Anyu Peibo capsules may have an effective and safe antidepressant effect, which warrants further research.
(In)Visibility and the smartphone: Experiencing homelessness as dictated by urban figurations of social control
Authors: Tissot Anna Xymena , Sowa Frank
Published: November 2023

This contribution sheds light on how people experiencing homelessness in Germany make sense of an app designed with them in mind and whether using it would be of benefit to them. However, it must be acknowledged that the app has yet to be developed. “Urban figurations of social control,” a term we use to refer to the social conditions of homelessness in Germany, give rise to a significant loss of trust as well as a state of vulnerability, feelings of loneliness, and limited agency for people experiencing homelessness. Drawing on a group discussion with 12 people experiencing homelessness that took place in Germany in 2019, our findings demonstrate that the respondents project particular fears and desires onto the use of the potential app. Whenever they fear surveillance and institutional control, they wish to be invisible to the app. On the other hand, their desire to access resources and information (food, places to sleep, housing) and to meet with peers in order to create meaningful social relationships requires their visibility. Thus, navigating between visibility and invisibility by way of a smartphone involves situationally and strategically constructing a safe environment for their digital participation, helping them to reduce their vulnerability and loneliness and restore their agency. Moreover, in that the app is used as a means of rendering assistance to homeless people (and highlighting the grievances associated with this) that is visible to others, the respondents challenge the current framing of homelessness. The supposed system of help is revealed to be the social problem itself.
Vitamin D and preeclampsia: A systematic review and meta-analysis
Authors: AlSubai Abdulla , Baqai Muhammad Hadi , Agha Hifza , Shankarlal Neha , Javaid Syed Sarmad , Jesrani Eshika Kumari , Golani Shalni , Akram Abdullah , Qureshi Faiza , Ahmed Shaheer , Saran Simran
Published: November 2023

Objectives:

Preeclampsia is one of the most frequent pregnancy disorders, with a global incidence of 2%–8%. Serum 25-hydroxyvitamin D is an essential mineral for human health; some studies suggest link between 25-hydroxyvitamin D deficiency and preeclampsia, while others offer contradictory findings. Thus, the goal of this study is to evaluate the relationships between maternal 25- hydroxyvitamin D concentrations and the risk of preeclampsia. In addition to this, our study also evaluates the effects of 25- hydroxyvitamin D supplementation on the incidence of preeclampsia. Therefore, assessing 25- hydroxyvitamin D’s potential as a possible intervention to lower the risk of preeclampsia.

Methods:

The Medline database was queried from inception until July 2021 for randomized controlled trials and observational studies without any restrictions. The studies assessing the association between 25-hydroxyvitamin D deficiency and preeclampsia and the impact of 25-hydroxyvitamin D supplementation on the incidence of preeclampsia were incorporated. The results were reported using a random-effects meta-analysis and the Mantel-Haenszel odds ratio. A p-value of <0.05 was considered significant for the analysis.

Results:

This analysis includes 34 papers, including 10 randomized controlled trials and 24 observational studies. According to our pooled analysis, 25-hydroxyvitamin D supplementation was significantly associated with a lower risk of preeclampsia in pregnant women (OR: 0.50; 95% CI: 0.40–0.63; p = 0.00001), while 25-hydroxyvitamin D deficiency was significantly associated with an increased risk of preeclampsia (OR: 4.30; 95 % CI: 2.57–7.18; p < 0.00001, OR: 1.71; 95 % Cl: 1.27–2.32; p = 0.0005, OR 1.61; 95 % Cl: 1.21–2.16; p = 0.001).

Conclusion:

Results suggest that 25-hydroxyvitamin D has a significant relationship with preeclampsia as confirmed by the findings that low maternal 25-hydroxyvitamin D concentrations cause increased risk of preeclampsia while 25-hydroxyvitamin D supplementation reduces the incidence of preeclampsia. Our findings indicate that 25-hydroxyvitamin D supplementation can be used as a possible intervention strategy in preventing one of the most common causes of maternal mortality around the world, preeclampsia.
Paclitaxel-induced periarticular thenar eminence erythema with onycholysis: A case report
Authors: Charron-Ligez François , Désy Delphine , Auclair Marie-Hélène
Published: November 2023

Paclitaxel is a drug frequently used in the treatment of gynecological cancers. Its cutaneous side effects are fairly well documented. A subtype of hand-foot syndrome, periarticular erythema of the thenar eminences with onycholysis, is rarer. Here, we present a case of a woman treated with paclitaxel for recurrent ovarian cancer who developed periarticular thenar eminence erythema with onycholysis syndrome. Involvement presented as an erythematous rash on the top of the left hand progressing up the arm. A lesion was also present on the right lower limb and on the dorsal surface of the right foot with onycholysis. Edema was present in the fingers, hands, forearms, and feet. A punch biopsy and pathological analysis confirmed the diagnosis of periarticular thenar eminence erythema with onycholysis syndrome. Rapid identification and treatment with topical corticosteroids limited irreversible damage.
Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
Authors: Pieroni Domenic , Leon Silvia J. , Krueger Amanda L , Burton Lauren , Tremblay-Savard Olivier , Tangri Navdeep , Komenda Paul , Bohm Clara , Rigatto Claudio
Published: November 2023

Background:

During the 30-day period prior to initiating dialysis, there is a 10-fold rise in emergency department visits and hospitalizations related to kidney failure.

Objective:

The Virtual Ward Incorporating Electronic Wearables (VIEWER) trial implemented a home telemonitoring system to track changes in patients’ vitals and assess their adherence and the acceptability of telemonitoring in a chronic kidney disease (CKD) population.

Design:

A pilot prospective clinical trial using a mixed methods approach was performed.

Setting:

The research was conducted in Winnipeg, Manitoba.

Participants:

There were 2 phases: Phase 1 was a 2-week-long pilot trial consisting of 10 participants. Phase 2 was a 3-month-long trial with a total of 26 participants. Patients with an estimated glomerular filtration rate <15 and a >40% risk of beginning dialysis in the next 2 years according to the kidney failure risk equation were eligible to participate in the study.

Methods:

The primary quantitative outcome was adherence, defined as the proportion of daily self-assessments completed using VIEWER over the follow-up period. The usability and acceptability of VIEWER was assessed qualitatively at the end of the trial through structured questionnaires and focus groups.

Results:

Phase 1 participants (n = 10) had a median adherence of 77.17% for the 2-week observation period. Phase 2 participants (n = 26) showed a lower median adherence of 36% for the 3-month period. Focus group participants (n = 11) identified many positive aspects of VIEWER, including increased awareness and empowerment over health, simplicity of the data platform, and the ability to show clinical staff their health trends. Some challenges identified with VIEWER were connectivity issues with the Bluetooth, perceived inconvenience, and negative thoughts toward their health

Limitations:

Limitations of the study include a small sample size, which limited our ability to measure quantitative outcomes. In addition, patients agreeing to participate in any trial are generally more highly motivated and engaged in their care than those declining participation. Therefore, our results may not be generalizable to individuals who are not interested in self-management of their health.

Conclusion:

Our results suggest that home telemonitoring in patients with advanced CKD is feasible using a CKD-specific platform like VIEWER. We anticipate that improved functionality with incorporation of feedback from this study will result in greater long-term adherence. A future randomized clinical trial is planned.
High blood pressure mediated the effect of fasting insulin level on nonalcoholic fatty liver disease risk: A Mendelian randomization study
Authors: Wang Ziwen , Zhu Mengpei , Huang Yumei , Cao Jiali , Xiong Zhifan
Published: November 2023

Objective

The interactions between fasting insulin levels, high blood pressure and nonalcoholic fatty liver disease (NAFLD) are still unclear. We examined the causal mechanisms between these three cardiometabolic traits using Mendelian randomization (MR) approach by utilizing genetic instruments.

Methods

Three different genome-wide association studies resources of European ancestry were utilized for the present study. Two-sample MRs were used to assess causal effects between fasting insulin levels, high blood pressure and NAFLD. Multivariate MR was used to calculate the mediating effect. The inverse variance-weighted method was used as the main analysis method.

Results

Our study confirmed a causal effect of fasting insulin levels (IVW-OR = 9.54, P = 0.001) and high blood pressure (IVW-OR = 3.926, P = 0.005) on NAFLD risk. And fasting insulin level was positively casually associated with high blood pressure risk (IVW-OR = 1.170, P < 0.001). However, the impact of high blood pressure on fasting insulin levels was still uncertain because of the presence of horizontal pleiotropy. Reverse MR showed NAFLD had a positive correlation with fasting insulin levels (IVW-OR = 1.010, P < 0.001) and a negative causal effect on high blood pressure risk (IVW-OR = 0.997, P = 0.037). Combined the multivariate MR result revealed high blood pressure partially mediated the contribution of fasting insulin level to NAFLD risk (proportion mediated: 9.091%).

Conclusions

Our study suggests there is a bidirectional causal relationship between fasting insulin levels and NAFLD. High blood pressure seems to play a mediating role in the development of NAFLD caused by changes in fasting insulin levels. However, it is uncertain whether high blood pressure is a mediator between NAFLD and the risk of fasting insulin level.
Interatrial Septum Stenting for Hypoplastic Left Heart Syndrome in Ex Utero Intrapartum Therapy
Authors: Sanchez-Escobar Isabel C. , Giraldo-Pinto Manuel , Quintero-Gomez Alejandro , Arias Andrea , de la Peña Ancizar , García Raúl , Gutierrez Jorge , Uribe Andres , Lince-Varela Rafael , Ruz Montes Miguel , Espinal Juan Alberto , Correa-Velasquez Rafael
Published: November 2023

Patients with hypoplastic left heart syndrome (HLHS) with intact atrial septum have an increased mortality rate. This presentation occurs in 6% to 10% of cases. We present a patient with fetal diagnosis of HLHS with restrictive atrial septum. We performed a cesarean section at 37 weeks of gestation, and under ex utero intrapartum treatment proceeded with a median sternotomy and transatrial stenting for left atrial decompression due to findings of intact atrial septum on the fetal echocardiogram performed during the procedure. Subsequently, the patient underwent hybrid stage I palliation followed by a comprehensive stage II procedure at five months of age, but unfortunately died from postoperative complications.
Carbon Emission, Air Pollution, and Total Factor Productivity: Evidence from Prefecture-Level Cities in China
Authors: Chen Yanyun , Kong Xinzi , Wang Fang
Published: November 2023

Based on the instrumental variable method and the panel data of 283 prefecture-level cities in China from 2004 to 2016, we explore the relationship between carbon emission, air pollution, and total factor productivity (TFP). The results show that: (1) Both carbon emission-induced and air pollution-induced environmental regulations positively promote TFP. For every 1% increase in the two indicators of the intensity of environmental regulation, carbon emission, and air pollution, TFP will increase by 1.7150 percentage points and 0.6366 percentage points respectively. (2) Carbon emission-induced and air pollution-induced environmental regulation have similar coefficients on TFP, indicating that the effects of the two are synergistic. Carbon emission has a greater impact on TFP, so enhancing environmental regulation on carbon emission can better promote the improvement of TFP. (3) Financial scale and government intervention have a significant intermediary effect between environmental regulation in both aspects and TFP.
Nomenclature of Chinese Street Food Names in Malaysia: A Scalar Analysis
Authors: Zhu Hongxiang , Ang Lay Hoon , Mansor Nor Shahila , Lam Kai Chee
Published: November 2023

This study examines how the nomenclature of street food names includes trans-local, trans-regional, and trans-national scales in local language resources. The study adopts a qualitative case study on street food names in Malaysia. The study sample comprised 856 street food names collected in Kuala Lumpur. The food nomenclature framework and the concepts of trans-local, trans-regional, and trans-national scales were adopted to elicit the data. It was found that: (i) there are more complex combinations based on ingredient, cooking method, food attribute, commemorative aspect, and good name; (ii) there are scale-making ways, via the presentation and the transliteration of street food elements. In conclusion, the nomenclature of street food names labels Malaysia as a multiscalar locality in which trans-local, trans-regional, and trans-national scales can be discerned. Thus, this study reveals how nomenclature shapes and is shaped by geographical scales. Therefore, it contributes to the nomenclature of food and place marketing.
Prevalence and Characteristics of Lumbar Spondylolysis in White and Black Patients
Authors: Yoshihara Hiroyuki , Yen Winston , Horowitz Evan , Nadarajah Vidushan
Published: November 2023

Study Design

Retrospective case series.

Objective

To the best of our knowledge, the prevalence of lumbar spondylolysis in white and black populations has never been studied using computed tomography (CT). The purpose of this study was to examine and compare the prevalence and characteristics of lumbar spondylolysis in white and black patients.

Methods

This study is a cross sectional study. Patients aged 20-79 who underwent abdominal and pelvic CT for trauma screening in the New York City area and whose race was classified as “white” and “black” on the questionnaire were recruited to the study. A total of 1200 white patients (600 women, 600 men) and 1200 black patients (600 women, 600 men) were included for the analysis. The presence of lumbar spondylolysis, level, unilateral/bilateral, and the presence of spondylolisthesis at lumbar spondylolysis level were evaluated using CT.

Results

The prevalence of lumbar spondylolysis was 3.0% (n = 36) for white patients and .8% (n = 10) for black patients, with 3.3% (n = 20) and 1.0% (n = 6) for white and black females, respectively; and 2.7% (n = 16) and .7% (n = 4) for white and black males, respectively. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients ( P < .0001). Lumbar spondylolysis was at L5 in 44/46 patients (95.7%) and bilateral in 41/46 patients (89.1%). Spondylolisthesis at lumbar spondylolysis level was found in 40/46 patients (87.0%).

Conclusions

The prevalence of lumbar spondylolysis was 3.0% for white patients and .8% for black patients. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients.
Preferred Strength of Noise Reduction for Normally Hearing and Hearing-Impaired Listeners
Authors: Houben Rolph , Reinten Ilja , Dreschler Wouter A. , Mathijssen Roland , Dijkstra Tjeerd M. H.
Published: November 2023

Preference for noise reduction (NR) strength differs between individuals. The purpose of this study was (1) to investigate whether hearing loss influences this preference, (2) to find the number of distinct settings required to classify participants in similar groups based on their preference for NR strength, and (3) to estimate the number of paired comparisons needed to predict to which preference group a participant belongs. A paired comparison paradigm was used in which participants listened to pairs of speech-in-noise stimuli processed by NR with 10 different strength settings. Participants indicated their preferred sound sample. The 30 participants were divided into three groups according to hearing status (normal hearing, mild hearing loss, and moderate hearing loss). The results showed that (1) participants with moderate hearing loss preferred stronger NR than participants with normal hearing; (2) cluster analysis based solely on the preference for NR strength showed that the data could be described well by dividing the participants into three preference clusters; (3) the appropriate cluster membership could be found with 15 paired comparisons. We conclude that on average, a higher hearing loss is related to a preference for stronger NR, at least for our NR algorithm and our participants. The results show that it might be possible to use a limited set of pre-set NR strengths that can be chosen clinically. For our NR one might use three settings: no NR, intermediate NR, and strong NR. Paired comparisons might be used to find the optimal one of the three settings.
Challenges Faced by Mothers Practicing Kangaroo Mother Care (KMC) in a Resource-Limited Setting During the COVID-19 Pandemic: Insights From the Voices of Mothers of Preterm Babies and Their Suggested Solutions
Authors: Afande Mukhola Beatrice , Kivuti-Bitok Lucy W. , Chepchirchir Angeline
Published: November 2023

Objectives. We investigated the challenges faced by mothers of preterm babies practicing KMC during the Covid-19 pandemic and documented the mothers’ suggestions of possible interventions. Methods. We conducted a cross-sectional descriptive study at the New Born Unit of Kenyatta National Hospital(KNH). We interviewed 82 mothers using a researcher-administered questionnaire with closed and open-ended questions. Qualitative data generated from open-ended questions was analyzed thematically. Results. KMC was majorly affected by; fear of the baby contracting COVID-19, fear of contracting COVID-19, and social distancing restrictions. The mothers’ suggested interventions included; the need for more KMC rooms, provision of appropriate clothing, strict application of COVID-19 prevention guidelines, and greater support of practice by the family. Conclusion. The mother’s pivotal role as a partner in decision-making in regard to the improvement of KMC during pandemics and possibly other settings was demonstrated. Targeted interventions should incorporate the suggestions from the mothers.
Parental Knowledge, Attitude and Practices Toward Dental Sealants as Preventive Strategy for Dental Caries in Children: A Cross Sectional Study
Authors: Iftikhar Ayman , Lal Abhishek , Imran Aimen , Wasif Mariam , Ahmed Naseer , Heboyan Artak
Published: November 2023

Aim. This study aimed to evaluate the knowledge, attitude, and practices of parents residing in Pakistan toward pits and fissure sealants in children. Materials and Methods. This descriptive, cross-sectional study was carried out between November 2022 to March 2023. An online questionnaire was distributed through various social media platforms. Independent t-test and Multiple Linear Regression analysis were performed. Results. A total of 570 participants were recruited. For protection against tooth decay, most of the participants 456(80%) believed that fissure sealants should be placed to protect teeth from decay. Placement of fissure sealants was considered to be a cost-effective measure by majority of the 480 (84.2%) respondents. Conclusion. Fissure sealants are one of the most effective preventive measures against tooth decay. The knowledge, attitude and practice of parents were some being aware of fissure sealants and some were not. It appeared to support the placement of fissure sealants for their children.
Patient Perspectives of Chronic Disease Management and Unmet Care Needs in South Korea: A Qualitative Study
Authors: Yi Kyunghee , Kim Sujin
Published: November 2023

Understanding and incorporating patients’ perspectives are necessary to address the emerging challenge of chronic disease management. Our study examined patients’ perceptions and experiences for the current chronic disease management system in South Korea. Focus group interviews were conducted on 23 patients and 11 themes emerged by qualitative content analysis. The participants experienced in terms of provider-patient interaction: doctors only prescribe medicine, doctors who provide conventional advice, doctors who do not respect the patients’ opinion, long wait times and inadequate consultations, lack of personalized care, and freedom to select another doctor. They also experienced in their community and health system: struggling alone, commercial media and folk remedies, lack of IT technologies for care, demanding visiting services, and lack of collaboration in the community. We found that patients needed comprehensive and personalized care, respect from providers, and self-management support and collaborated care with the community using information technologies advancement. Our findings suggest that a fundamental change in the South Korean healthcare system paradigm is required for successful chronic care, including payment and healthcare delivery systems.
The Social Overload Thesis Revisited: Exploring the Mechanisms of Size-Dependent Participation Behavior in Voluntary Communities
Authors: Shi Yongren , Shi Qianyi
Published: November 2023

Sociological and urban studies have consistently reported that human behavior exhibits a discernible correlation with population size, following a power-law function. Individuals residing in larger communities exhibit significantly higher levels of activity in contrast to their counterparts in smaller communities. However, the underlying processes responsible for such behavioral patterns remain unclear. The authors propose that organizational crowding tends to generate competitive pressure that results in social overload for individuals, who in turn divide time and energy among many groups while reducing the time spent in each. The social overload thesis predicts integration, rather than mutual exclusion of groups, when experiencing competition. A large-scale event participation dataset from 11 major U.S. technology clusters over a period of 10 years is used to test these hypotheses. The results support the mediating role of competition in the relationship between population size and participation intensity. The authors demonstrate the impact of competition on network structure.
Dealing with Uncertainties During COVID-19 Pandemic: Learning from the Case Study of Bombay Mothers and Children Welfare Society (BMCWS), Mumbai, India
Authors: Singh Archana
Published: November 2023

The article presents the case study of ‘Bombay Mothers and Children Welfare Society’, a non-governmental organisation (NGO), working for the welfare of the people primarily in the area of health, education and vocational training, in both, urban and rural areas of Maharashtra (India). Following a qualitative approach, the article aims to understand the challenges encountered by the organisation due to uncertainties induced by the COVID-19 pandemic situation in India and its responses. The study shows that innovative business strategy and participatory-public-philanthropy-person (PPPP) model of sustenance helped the organisation to transform it into a ‘sustainable organisation’. Several long-term measures undertaken with its focus on innovation, stakeholders’ engagement for strategic decisions, community participation, collaboration, and business-like behaviour enabled the organisation to deal with the uncertainties in ‘normal times’. The legacy of good work done by the organisation helped it to gain the trust of all the stakeholders involved. During the COVID-19 crisis, the organisation undertook several short-term measures immediately to respond to the situation and received unconditional support from the staff and also from the community. The outcome was organisation and community resilience, which helped them to deal with the uncertainties in normal times as well as emergency/crisis situation. This article developed a framework for the NGO to deal with uncertainties for achieving their mission during a crisis situation like COVID-19. A combination of long-term and short-term measures, and its focus on innovative business strategy and PPPP model of sustenance, is the clear reflection of the entrepreneurial approach adopted for community development and decisions made by the leader of the NGO played critical role. Thus, the study suggests to follow ‘judgement-based approach towards entrepreneurship’ for understanding NGOs’ actions in crisis situation. The findings provide learnings for NGOs, interested in creating sustainable social organisation, and help them to prepare better to deal with uncertainties during a crisis situation.
Recanalization status and temporal evolution of early ischemic changes following stroke thrombectomy
Authors: Virtanen Pekka , Tomppo Liisa , Georgiopoulos Georgios , Brandstack Nina , Peltola Erno , Kokkonen Tatu , Lappalainen Kimmo , Korvenoja Antti , Strbian Daniel
Published: November 2023

Introduction:

Present-day computer tomography (CT) scanners have excellent spatial resolution and signal-to-noise ratio and are instrumental detecting early ischemic changes (EIC) in brain. We assessed the temporal changes of EIC based on the recanalization status after thrombectomy.

Patients and methods:

The cohort comprises consecutive patients with acute ischemic stroke in anterior circulation treated with thrombectomy in tertiary referral hospital. All baseline and follow-up scans were screened for any ischemic changes and further classified using Alberta Stroke Program Early CT Score (ASPECTS). Generalized linear mixed models were used to analyze the impact of recanalization status using modified Thrombolysis in Cerebral Infarction (mTICI) on temporal evolution of ischemic changes.

Results:

We included 614 patients with ICA, M1, or M2 occlusions. Median ASPECTS score was 9 (IQR 7–10) at baseline and 7 (5-8) at approximately 24 h. mTICI 3 was achieved in 207 (33.8%), 2B 241 (39.3%), 2A in 77 (12.6%), and 0–1 in 88 (14.3%) patients. Compared to patients with mTICI 3, those with mTICI 0–1 and 2A had less favorable temporal changes of ASPECTS ( p < 0.001). Effect of recanalization was noted in the cortical regions of ICA/M1 patients, but not in their deep structures or patients with M2 occlusions. All ischemic changes detected at baseline were also present at all follow-up images, regardless of the recanalization status.

Conclusions:

Temporal evolution of the ischemic changes and ASPECTS are related to the success of the recanalization therapy in cortical regions of ICA/M1 patients, but not in their deep brain structures or M2 patients. In none of the patients did EIC revert in any brain region after successful recanalization.
Diagnostic accuracy of large and medium vessel occlusions in acute stroke imaging by neurology residents and stroke fellows: A comparison of CT angiography alone and CT angiography with CT perfusion
Authors: Alotaibi Fawaz F , Alshahrani Asma , Mohamed Gamal , AlShamrani Mohamed A , Bin Amir Hussain , Alsaeed Ali , Heji Alaa , Alghanmi Suwaidi , Alqurishi Mohammed , Alanazi Azhar , Aldraye Hamad , Asiri Muhannad , Alqahtani Mohammed , Alreshaid Abdulrahman A , AlKawi Ammar , AlHazzani Adel , AlZawahmah Mohamed , Alokaili Riyadh N , Shuaib Ashfaq , Al-Ajlan Fahad S
Published: November 2023

Introduction:

Neurology senior residents and stroke fellows are first to clinically assess and interpret imaging studies of patients presenting to the emergency department with acute stroke. The aim of this study was to compare the diagnostic accuracy of brain CT angiography (CTA) with and without CT perfusion (CTP) between neurology senior residents and stroke fellows.

Methods:

In this neuroimaging study, nine practitioners (four senior neurology residents (SNRs) and five stroke fellows (SFs)) clinically assessed and interpreted the imaging data of 50 cases (15 normal images, 21 large vessel occlusions (LVOs) and 14 medium vessel occlusions (MeVOs) in two sessions, 1 week apart in comparison to final diagnosis of experienced neuroradiologist and experienced stroke neurologist consensus. Interrater agreement of CTA alone and CTA with CTP was quantified using kappa statistics, sensitivity, specificity and overall accuracy.

Results:

Overall, arterial occlusions were correctly identified in 221/315 (70.1%) with CTA alone and in 266/315 (84.4%) with CTA and CTP ( p < 0.001). The sensitivity of overall arterial occlusions detection with CTA alone was 94.2% (95% CI: 90.8%–96.6%) while with addition of CTP was 98% (95% CI: 95.6%–99.3%), The specificity of CTA alone was 74.7% (95% CI: 67.2%–81.3%) which increased with CTP to 84.4% (95% CI: 77.7%–89.8%). The likelihood of correct identification with CTA alone was 156/189 (82.54%) for LVOs and 65/126 (51.59%) for MeVOs. This increased to 169/189 (89.42%; p = 0.054) for LVOs and 97/126 (76.98%; p < 0.001) for MeVOs when the CTA images with CTP were viewed. There was good overall interrater agreement between readers when using CTA alone ( k 0.71, 95% CI, 0.62–0.80) and almost perfect ( k 0.85, 95% CI, 0.76–0.94) when CTP was added to the image for interpretation. CTA and CTP had a significantly lower median interquartile range (IQR) interpretation time than CTA alone (114 [IQR, 103–120] s vs 156 [IQR, 133–160] s, p < 0.001).

Discussion:

In cerebral arterial occlusions, the rate of LVO and MeVOs detections increases when adding CTP to CTA. The accuracy and time for diagnosing arterial occlusion can be significantly improved if CTP is added to CTA. As MeVOs are commonly missed by front-line neurology senior residents or stroke fellows, cases with significant deficits and no apparent arterial occlusions need to be reviewed with neuroradiological expertise.
Outcomes in systemic sclerosis patients hospitalized with COVID-19: Insight from the National Inpatient Sample
Authors: Cheema Huzaifa Ahmad , Akhlaq Anum , Mustafa Biah , Shahid Abia , Ayyan Muhammad , Edigin Ehizogie
Published: November 2023

Objective:

COVID-19, a respiratory infection caused by the novel coronavirus SARS-CoV-2, can cause varying degrees of illness ranging from mild respiratory illness to severe respiratory failure. Systemic sclerosis is a chronic autoimmune disease, with an increased prevalence of infections as compared to the general population. In this study, we compare the clinical outcomes and resource utilization for COVID-19 hospitalizations in patients with and without systemic sclerosis.

Methods:

We used the National Inpatient Sample database, 2020, to study the characteristics, morbidity, mortality, cost, and resource utilization among primary COVID-19 hospitalizations with and without systemic sclerosis.

Results:

There were 1,050,040 patients aged ⩾ 18 years with a diagnosis of COVID-19. Of these, 775 (0.07%) patients had a secondary diagnosis of systemic sclerosis. Although there was no statistically significant difference regarding individual outcomes; in-hospital mortality, vasopressor use, cardiac arrest, acute kidney injury, and disposition to facility were numerically higher in hospitalizations with systemic sclerosis. The composite endpoint of major adverse events was higher in the systemic sclerosis cohort (adjusted odds ratio 1.52, 95% confidence interval: 1.06–2.17, p = 0.022).

Conclusion:

COVID-19 patients with systemic sclerosis had worse outcomes (i.e. higher composite endpoint of major adverse events) than those without systemic sclerosis. Further studies are needed to establish a better understanding of the relationship between COVID-19 and systemic sclerosis.
Examining mGlu5 Receptor Availability as a Predictor of Vulnerability to PTSD: An [18F]FPEB and PET Study in Male and Female Rats
Authors: Asch Ruth H. , Fowles Krista , Pietrzak Robert H. , Taylor Jane R. , Esterlis Irina
Published: November 2023

Background

Females are twice as likely to experience post-traumatic stress disorder (PTSD) than males, yet specific factors contributing to this greater risk are not fully understood. Our clinical and recent preclinical findings suggest a role for the metabotropic glutamate receptor 5 (mGlu5) in PTSD and differential involvement between males and females.

Methods

Here, we further investigate whether mGlu5 receptor availability may contribute to individual and sex differences in PTSD susceptibility by quantifying receptor availability using the mGlu5 receptor-specific radiotracer, [18F]FPEB, and positron emission tomography in male (n = 16) and female (n = 16) rats before and after traumatic footshock exposure (FE) and assessment of stress-enhanced fear learning (SEFL) susceptibility, as compared with no-shock controls (CON; n = 7 male; n = 8 female).

Results

Overall, FE rats displayed greater fear generalization as compared with CON ( p < .001). Further, greater mGlu5 receptor availability at baseline ( p = .003) and post-test ( p = .005) was significantly associated with expression of the SEFL phenotype. Notably, FE female rats displayed a shift to more passive coping (ie, freezing), and displayed greater SEFL susceptibility ( p = .01), and had lower baseline mGlu5 availability ( p = .03) relative to their FE male rat counterparts.

Conclusion

Results are consistent with clinical findings of higher mGlu5 receptor availability in PTSD, and add to growing evidence implicating these receptors in the pathophysiology of PTSD and sex-differences in susceptibility for this disorder.
Invisibly Invisible: An LGBTQ+ Self-Advocate Perspective on the Anti-LGBTQ+ Movement
Authors: Price Richard A. , Adler Nicole , Gilmartin Elaine M.
Published: November 2023

Despite historical shifts toward inclusion for individuals with Disabilities, negative views and societal stigmas still persist, specifically regarding gender and sexuality. Concurrently, there has been an increase in anti-LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) legislation, which poses a significant risk to the well-being and civil rights of LGBTQ+ individuals with Disabilities. In this article, Nicole Adler, a self-advocate who identifies in the LGBTQ+ community, tells her coming-out story. She emphasizes the critical need to proactively support and advocate for the rights and well-being of sexual and gender minorities within the Disability community. Nicole emphasizes the significance of inclusive sex education and provides a call to action for educators to better support LGBTQ+ students with Disabilities. Nicole hopes to inspire and encourage others by sharing her thoughts on the importance of advocating for LGBTQ+ individuals with Disabilities through this article.
Precise Prediction of Transitional Occlusion Using Reverse Engineering in Surgery-first Orthognathic Surgery Case
Authors: Ko Jaemin , Lu Xuanyu , Urata Mark M. , Hammoudeh Jeffrey A. , Yen Stephen L.-K.
Published: November 2023

With surgery-first approach, the skeletal discrepancy is corrected with orthognathic surgery at the start of treatment, but the teeth remain in their original compensated positions. This change in treatment sequence means clinicians have to determine what the occlusion immediately after the surgery, which is called transitional occlusion, should look like during the planning process. This report describes the surgical and orthodontic planning for a surgery-first case that corrected a large Cl III malocclusion. Virtual planning was used to reverse engineer the transitional postsurgical occlusion from the final ideal position. A multiplatform software can be a powerful tool for analyzing problems in finishing a surgery-first case, predicting outcomes, and improving the accuracy in planning surgery-first approach.
Caring in the Context of Systems: Service Provider Perspectives on the Mental Health Needs of Newcomer Young Men
Authors: Tulli-Shah Mia , Hilario Carla , Salami Bukola , Pui-Hing Wong Josephine
Published: November 2023

In this study, we applied an intersectional framework to explore service providers’ perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men’s mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men’s senses of self in relation to macro-systems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men’s mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes.
How I treat thrombocytopenia in pregnancy
Authors: Fogerty Annemarie E. , Kuter David J.
Published: November 2023

Thrombocytopenia is a common hematologic abnormality in pregnancy, encountered in ∼10% of pregnancies. There are many possible causes, ranging from benign conditions that do not require intervention to life-threatening disorders necessitating urgent recognition and treatment. Although thrombocytopenia may be an inherited condition or predate pregnancy, most commonly it is a new diagnosis. Identifying the responsible mechanism and predicting its course is made challenging by the tremendous overlap of clinical features and laboratory data between normal pregnancy and the many potential causes of thrombocytopenia. Multidisciplinary collaboration between hematology, obstetrics, and anesthesia and shared decision-making with the involved patient is encouraged to enhance diagnostic clarity and develop an optimized treatment regimen, with careful consideration of management of labor and delivery and the potential fetal impact of maternal thrombocytopenia and any proposed therapeutic intervention. In this review, we outline a diagnostic approach to pregnant patients with thrombocytopenia, highlighting the subtle differences in presentation, physical examination, clinical course, and laboratory abnormalities that can be applied to focus the differential. Four clinical scenarios are presented to highlight the pathophysiology and treatment of the most common causes of thrombocytopenia in pregnancy: gestational thrombocytopenia, preeclampsia, and immune thrombocytopenia.
Genome-wide association study exploring the genetic architecture of eggshell speckles in laying hens
Authors: Cheng Xue , Li Xinghua , Yang Mengyuan , Zheng Chuanwei , Li Haiying , Qu Lujiang , Ning Zhonghua
Published: November 2023

Background

Eggshell speckle phenotype is an important trait in poultry production because they affect eggshell quality. However, the genetic architecture of speckled eggshells remains unclear. In this study, we determined the heritability of eggshell speckles and conducted a genome-wide association study (GWAS) on purebred Rhode Island Red (RIR) hens at 28 weeks to detect potential genomic loci and candidate genes associated with eggshell speckles.

Results

The heritability of eggshell speckles was 0.35 at 28 weeks, and the speckle level is not related to other eggshell quality traits in terms of phenotypic correlation. We detected 311 SNPs (6 significantly, and 305 suggestively associated) and 39 candidate genes associated with eggshell speckles. Based on the pathway analysis, the 39 candidate genes were mainly involved in alpha-linolenic acid metabolism, linoleic acid metabolism, ether lipid metabolism, GnRH signaling pathway, vascular smooth muscle contraction, and MAPK signaling pathway. Ultimately, ten genes, LOC423226, SPTBN5, EHD4, LOC77155, TYRO3, ITPKA, DLL4, PLA2G4B, PLA2G4EL5, and PLA2G4EL6 were considered the most promising genes associated with eggshell speckles that were implicated in immunoregulation, calcium transport, and phospholipid metabolism, while its function in laying hens requires further studies.

Conclusions

This study provides new insights into understanding the genetic basis of eggshell speckles and has practical application value for the genetic improvement of eggshell quality.