bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning Predict Survivals of Spinal and Pelvic Ewing’s Sarcoma with the SEER Database
Authors: Fan Guoxin , Yang Sheng , Qin Jiaqi , Huang Longfei , Li Yufeng , Liu Huaqing , Liao Xiang
Published: October 2022

Study Design

Retrospective Cohort Study.

Objectives

This study aimed to develop survival prediction models for spinal Ewing’s sarcoma (EWS) based on machine learning (ML).

Methods

We extracted the SEER registry’s clinical data of EWS diagnosed between 1975 and 2016. Three feature selection methods extracted clinical features. Four ML algorithms (Cox, random survival forest (RSF), CoxBoost, DeepCox) were trained to predict the overall survival (OS) and cancer-specific survival (CSS) of spinal EWS. The concordance index (C-index), integrated Brier score (IBS) and mean area under the curves (AUC) were used to assess the prediction performance of different ML models. The top initial ML models with best performance from each evaluation index (C-index, IBS and mean AUC) were finally stacked to ensemble models which were compared with the traditional TNM stage model by 3-/5-/10-year Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis (DCA).

Results

A total of 741 patients with spinal EWS were identified. C-index, IBS and mean AUC for the final ensemble ML model in predicting OS were .693/0.158/0.829 during independent testing, while .719/0.171/0.819 in predicting CSS. The ensemble ML model also achieved an AUC of .705/0.747/0.851 for predicting 3-/5-/10-year OS during independent testing, while .734/0.779/0.830 for predicting 3-/5-/10-year CSS, both of which outperformed the traditional TNM stage. DCA curves also showed the advantages of the ensemble models over the traditional TNM stage.

Conclusion

ML was an effective and promising technique in predicting survival of spinal EWS, and the ensemble models were superior to the traditional TNM stage model.
Communication barriers to education to referrals from the perspective of referrals to health centers and health care providers
Authors: Iranpour Abedin , Mirafzali Sedigheh , Borhaninejad Vahidreza , Alizadeh Somayeh
Published: October 2022

Introduction:

One of the most important factors affecting the increase of clients’ satisfaction is how health care providers (HCP) communicate with clients. On the other hand, different factors can hinder proper communication and thus education, which is one of the main tasks of HCP. Therefore, the purpose of this study was to investigate communication barriers to education to referrals from the perspective of referrals to health centers (RHC) and HCP.

Method:

This descriptive-analytical study was conducted on RHC and HCP in Kerman in 2021. Using a multi-stage sampling method, 162 HCP and 414 RHC were included in the study. The data collection tool was two researcher-made questionnaires. Data were analyzed using SPSS 16.

Findings:

From the perspective of RHC and HCP, most communication barriers were related to environmental and then socio-cultural factors. Among the demographic variables of HCP, level of education showed a significant relationship with the physical-psychological, verbal-non-verbal, and informational domains. And in relation to RHC, a significant relationship was found between education and job in the socio-cultural field and environmental barriers ( p < 0.05).

Conclusion:

HCP face a variety of barriers in educating people, most of which are related to environmental factors. Given the cost-effectiveness of education to the public, it is essential that planners and policymakers use strategies to eliminate environmental factors as well as the placement of indigenous HCP in health facilities to reduce communication barriers.
Liver Metastasis From Intracranial Hemangiopericytoma 8 Years After Initial Resection: Case Report
Authors: Hendrickson Rahmlow Tara , Kolagatla Sandhya , Mattingly Kathleen , Grube Jonathan , Ganti Subramanya Shyam , Moka Nagabhishek
Published: October 2022

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare intracranial tumor that arises from pericytes surrounding the blood vessels. Solitary fibrous tumor/hemangiopericytoma accounts for less than 1% of primary brain tumors and is classified as grades I, II, or III based on mitotic count. These tumors often masquerade as meningiomas. Histologically, SFT/HPC is vascular with high cellularity and often surrounded by connective tissue. Immunohistochemistry is positive for stat 6, vimentin, and CD34. Although aggressive surgical resection is the mainstay of treatment, close long-term follow-up is necessary as recurrence or extra cranial metastasis can present several years after resection.
Cadaveric Biomechanical Evaluation of Capsular Constraint and Microinstability After Hip Capsulotomy and Repair
Authors: Donnelly Emma , Vakili Samira , Getgood Alan , Willing Ryan , Degen Ryan M.
Published: October 2022

Background:

It remains unclear if capsular management contributes to iatrogenic instability (microinstability) after hip arthroscopy.

Purpose:

To evaluate changes in torque, stiffness, and femoral head displacement after capsulotomy and repair in a cadaveric model.

Study Design:

Controlled laboratory study.

Methods:

A biomechanical analysis was performed using 10 cadaveric hip specimens. Each specimen was tested under the following conditions: (1) intact, (2) portals, (3) interportal capsulotomy (IPC), (4) IPC repair, (5) T-capsulotomy (T-cap), (6) partial T-cap repair, and (7) T-cap repair. Each capsular state was tested in neutral (0°) and then 30°, 60°, and 90° of flexion, with forces applied to achieve the displacement-controlled baseline limit of external rotation (ER), internal rotation (IR), abduction, and adduction. The resultant end-range torques and displacement were recorded.

Results:

For ER, capsulotomies significantly reduced torque and stiffness at 0°, 30°, and 60° and reduced stiffness at 90°; capsular repairs failed to restore torque and stiffness at 0°; and IPC repair failed to restore stiffness at 30° ( P < .05 for all). For IR, capsulotomies significantly reduced torque and stiffness at 0°, 30°, and 60° and reduced stiffness at 90°; and capsular repairs failed to restore torque or stiffness at 0°, 30°, and 60° and failed to restore stiffness at 90° ( P < .05 for all). For abduction, IPC significantly decreased torque at 60° and 90° and decreased stiffness at all positions; T-cap reduced torque and stiffness at all positions; IPC repair failed to restore stiffness at 0° and 90°; and T-cap repair failed at 0°, 60°, and 90° ( P < .05 for all). For adduction, IPC significantly reduced torque at 0° and reduced stiffness at 0° and 30°; T-cap reduced torque at 0° and 90° and reduced stiffness at all positions; IPC repair failed to restore stiffness at 0° and 90°; and T-cap repair failed at 0°, 60°, and 90° ( P < .05 for all). There were no statistically significant femoral head translations observed in any testing configurations.

Conclusion:

Complete capsular repair did not always restore intact kinematics, most notably at 0° and 30°. Despite this, there were no significant joint translations to corroborate concerns of microinstability.

Clinical Relevance:

Caution should be employed when applying rotational torques in lower levels of flexion (0° and 30°).
Exploring large-scale spatial distribution of fear of crime by integrating small sample surveys and massive street view images
Authors: Jing Fengrui , Liu Lin , Zhou Suhong , Li Zhenlong , Song Jiangyu , Wang Linsen , Ma Ruofei , Li Xiaoming
Published: October 2022

A tremendous amount of research use questionnaires to obtain individuals’ fear of crime and aggregate it to the neighborhood level to measure the spatial distribution of fear of crime. However, the cost of using questionnaires to measure the large-scale spatial distribution of fear of crime is high. The built environment is known to influence people’s perceptions, including fear of crime. This study develops a machine learning model to link built environment extracted from street view images to fear of crime obtained from questionnaires, and then applies this model to extrapolate fear of crime for neighborhoods without the questionnaires. Using massive street view images and a survey among 1,741 residents in 80 neighborhoods in Guangzhou, China, this study developed a novel systematic approach to measuring large-scale spatial fear of crime at the neighborhood level for 1,753 neighborhoods. This is the first study to measure fear of crime at the neighborhood level for a metropolitan area of nearly 20 million people. The integration of survey data and street view images provides an opportunity to develop a more effective way to measure the spatial distribution of fear of crime. This approach could be applied to map other types of perceptions at a spatial resolution of the neighborhood level.
Improving Timeliness in Surgical Discharge Summary Distribution: A Quality Improvement Initiative
Authors: You Peng , Liu Jimmy , Moist Louise , Fung Kevin , Strychowsky Julie E.
Published: October 2022

Objective

To implement a quality improvement initiative to achieve an institutional targeted discharge summary distribution metric of 50% within 48 hours of patient discharge from hospital within an academic tertiary care otolaryngology–head and neck surgery department.

Methods

A pre‐ and postintervention study was conducted. Process mapping was performed. Interventions included education and engagement, implementation of auto‐authentication (distribution immediately following transcription without review by the most responsible physician), and audit and feedback. The percentage of discharge summaries dictated with the auto‐authentication code was evaluated. Process measures were collected for 12 months pre‐ and postimplementation. Balancing measures included workload and revisions to auto‐authenticated notes. Analysis included summary statistics, statistical process control charting, and unpaired t tests.

Results

The mean ± SD percentage of discharge summaries distributed within 48 hours increased from 19% ± 6.4% preintervention to 54% ± 20% postintervention (P <. 0001). Seventy‐four percent of discharge summaries were dictated via the auto‐authentication code. The target metric was met in 71% of discharges with the auto‐authentication codes as compared with 26% with non–auto‐authentication. The interventions did not result in any change to perceived workload, and the incidence of auto‐authentication revisions was <1%. The results were sustained with an increase of 72% the following quarter. For fiscal year 2021‐2022, performance remained sustained with an 85% completion rate.

Discussion

Our surgical department exceeded and sustained the targeted metric for timely discharge summary distribution using a quality improvement approach.

Implications for Practice

Timely distribution of discharge summaries optimizes patients’ transitions of care and can be achieved through stakeholder education and engagement, auto‐authentication, and audit with feedback.
Circulating small extracellular vesicle-encapsulated SEMA5A-IT1 attenuates myocardial ischemia–reperfusion injury after cardiac surgery with cardiopulmonary bypass
Authors: Wu Ting , Shi Guoning , Ji Zhenhua , Wang Shu , Geng Lizhu , Guo Zhigang
Published: October 2022

Cardiomyocyte injury is a common complication during cardiac surgery with cardiopulmonary bypass (CPB). Studies have shown that circulating small extracellular vesicles (sEVs) are involved in the pathological process of cardiovascular diseases via delivering signaling molecules. This study aims to investigate the relationship between circulating sEV-encapsulated long noncoding RNAs (lncRNAs) and cardiac injury after CPB. Here, we found that the expression of sEV SEMA5A-IT1 in serum samples of patients after CPB was higher than that of pre-CPB serum samples. Moreover, serum-derived sEV SEMA5A-IT1 levels were negatively correlated with creatine kinase-MB (CK-MB) levels in patients who underwent CPB operation. Notably, circulating sEVs packaged with SEMA5A-IT1 could be uptaken by cardiomyocyte-like cells AC16 and increased SEMA5A-IT1 expression in AC16 cells. Upregulated SEMA5A-IT1 protected cardiomyocytes against hypoxia/reoxygenation injury, confirmed by increased cell viability, reduced cell apoptosis, and inhibited ferroptosis in AC16 cells. Mechanistically, SEMA5A-IT1 regulated the expression of B-cell CLL/lymphoma 2 (BCL2) and solute carrier family 7 member 11 (SLC7A11) through sponging miR-143-3p. Transfection of miR-143-3p mimics,BCL2, orSLC7A11knockdown could attenuate the protective effect of SEMA5A-IT1 on cardiomyocytes. In conclusion, we propose that SEMA5A-IT1, which is transported to cardiomyocytes through circulating sEVs, is an important regulatory molecule that protects cardiomyocytes from ischemia–reperfusion injury, providing a target for the prevention and treatment of myocardial ischemia–reperfusion injury.
SumStatsRehab: an efficient algorithm for GWAS summary statistics assessment and restoration
Authors: Matushyn Mykyta , Bose Madhuchanda , Mahmoud Abdallah Amr , Cuthbertson Lewis , Tello Carlos , Bircan Karatuğ Ozan , Terpolovsky Andrew , Bamunusinghe Varuna , Khan Umar , Novković Biljana , Grabherr Manfred G. , Yazdi Puya G.
Published: October 2022

Background

Generating polygenic risk scores for diseases and complex traits requires high quality GWAS summary statistic files. Often, these files can be difficult to acquire either as a result of unshared or incomplete data. To date, bioinformatics tools which focus on restoring missing columns containing identification and association data are limited, which has the potential to increase the number of usable GWAS summary statistics files.

Results

SumStatsRehab was able to restore rsID, effect/other alleles, chromosome, base pair position, effect allele frequencies, beta, standard error, and p-values to a better extent than any other currently available tool, with minimal loss.

Conclusions

SumStatsRehab offers a unique tool utilizing both functional programming and pipeline-like architecture, allowing users to generate accurate data restorations for incomplete summary statistics files. This in turn, increases the number of usable GWAS summary statistics files, which may be invaluable for less researched health traits.
Combining denoising of RNA-seq data and flux balance analysis for cluster analysis of single cells
Authors: Galuzzi Bruno G. , Vanoni Marco , Damiani Chiara
Published: October 2022

Background

Sophisticated methods to properly pre-process and analyze the increasing collection of single-cell RNA sequencing (scRNA-seq) data are increasingly being developed. On the contrary, the best practices to integrate these data into metabolic networks, aiming at describing metabolic phenotypes within a heterogeneous cell population, have been poorly investigated. In this regard, a critical factor is the presence of false zero values in reactions essential for a fundamental metabolic function, such as biomass or energy production. Here, we investigate the role of denoising strategies in mitigating this problem.

Methods

We applied state-of-the-art denoising strategies - namely MAGIC, ENHANCE, and SAVER - on three public scRNA-seq datasets. We then associated a metabolic flux distribution with every single cell by embedding its noise-free transcriptomics profile in the constraints of the optimization of a core metabolic model. Finally, we used the obtained single-cell optimal metabolic fluxes as features for cluster analysis. We compared the results obtained with different techniques, and with or without the use of denoising. We also investigated the possibility of applying denoising directly on the Reaction Activity Scores, which are metabolic features extracted from the read counts, rather than on the read counts.

Results

We show that denoising of transcriptomics data improves the clustering of single cells. We also illustrate that denoising restores important metabolic properties, such as the correlation between cell cycle phase and biomass accumulation, and between the RAS scores of reactions belonging to the same metabolic pathway. We show that MAGIC performs better than ENHANCE and SAVER, and that, denoising applied directly on the RAS matrix could be an effective alternative in removing false zero values from essential metabolic reactions.

Conclusions

Our results indicate that including denoising as a pre-processing operation represents a milestone to integrate scRNA-seq data into Flux Balance Analysis simulations and to perform single-cell cluster analysis with a focus on metabolic phenotypes.
Effects of different depth of anesthesia on perioperative inflammatory reaction and hospital outcomes in elderly patients undergoing laparoscopic radical gastrectomy
Authors: Lv An-qing , Huang Li-cai , Lao Wei-long , Song Qi-liang , Zhou Qi-fu , Jiang Zong-ming , Chen Zhong-hua
Published: October 2022

Background

To investigate the effect of different depth of anesthesia on inflammatory factors and hospital outcomes in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer, in order to select an appropriate depth of anesthesia to improve the prognosis of patients undergoing surgery and improve the quality of life of patients.

Methods

A total of 80 elderly patients aged 65 and above who underwent laparoscopic radical gastrectomy in our hospital were by convenience sampling and randomly divided into two groups : 55 groups ( group H ) and 45 groups ( group L ), 40 cases in each group. The depth of anesthesia was maintained using a closed-loop target-controlled infusion system: the EEG bispectral index was set to 55 in the H group and 45 in the L group. Venous blood samples were collected 2 h (T2), 24 h (T3) and 72 h (T4) after the start of surgery. The intraoperative dosage of propofol and remifentanil, operation duration, postoperative PACU stay time, intraoperative consciousness occurrence, postoperative hospital stay and postoperative pulmonary inflammatory events were recorded.

Results

The patient characteristic of the two groups had no statistical difference and were comparable (P > 0.05). The intraoperative dosage of propofol in group H was lower than that in group L (P < 0.05). Compared with the L group, the plasma IL-6 and IL-10 concentrations in the H group were significantly increased at T2 (P < 0.05), and the plasma IL-10 concentration was significantly increased at T4 (P < 0.05). The plasma concentrations of IL-6 and IL-10 were higher in both groups at T2, T3 and T4 than at T1, while at T4, the concentration of TNF-α in group H was higher than at T1 (P < 0.05).

Conclusion

When the BIS value of the depth of anesthesia is 45, the perioperative release of inflammatory factors in elderly patients with laparoscopic radical gastrectomy for gastric cancer is less than BIS 55, and does not affect the prognosis.
Effect of glycopyrrolate on vasopressor requirements for non-elective cesarean section under spinal anesthesia: a randomized, double-blind, placebo-controlled trial
Authors: Deshar Rajesh , Subedi Asish , Pokharel Krishna , Sah Birendra Prasad , Prasad Jagat Narayan
Published: October 2022

Background

The study aimed to investigate whether prophylactic use of glycopyrrolate decreases the vasopressor requirements to prevent hypotension following spinal anesthesia during non-elective cesarean section.

Method

In this double-blind randomized clinical trial, 258 patients undergoing non-elective cesarean section were randomly assigned (1:1) to receive intravenous 0.2 mg glycopyrrolate or normal saline (placebo) before spinal anesthesia. The primary outcome was phenylephrine equivalent needed intraoperatively. Secondary outcomes included incidences of maternal hypotension, reactive hypertension, bradycardia, need for atropine, tachycardia, intraoperative nausea/vomiting, shivering, pruritus, dry mouth, dizziness; neonatal APGAR score at 1 min and 5 min, neonatal resuscitation needed, NICU admission and neonatal death.

Results

Three patients withdrew from the study due to failed spinal anesthesia. 128 patients in the glycopyrrolate group and 127 patients in the placebo group were analyzed. The mean phenylephrine equivalent needed was 1108.96 μg in the glycopyrrolate group and 1103.64 μg in the placebo group (mean difference, 5.32 μg [95% CI − 67.97 to 78.62]; P = 0.88). Hypotension occurred in 38 patients (30%) in the glycopyrrolate group as compared with 49 patients (39%) in the placebo group (P = 0.13). Tachycardia was reported in 70% of the participants in the glycopyrrolate group and 57% of those in the placebo group (P = 0.04). No statistically significant difference was noted in hypotensive episodes > 1, reactive hypertension, bradycardia, need for atropine, nausea, vomiting, shivering, and dry mouth between the two groups. Neonatal outcomes were similar in the two groups.

Conclusion

Prophylactic use of glycopyrrolate does not decrease the requirements of vasopressor to prevent hypotension in non-elective cesarean section under spinal anesthesia.

Trial registration

Registration number: NCT04401345. Date of registration: 26/05/2020. Website: https://clinicaltrials.gov
A comparison between the clinical frailty scale and the hospital frailty risk score to risk stratify older people with emergency care needs
Authors: Alshibani Abdullah , Coats Tim , Maynou Laia , Lecky Fiona , Banerjee Jay , Conroy Simon
Published: October 2022

Background

Older adults living with frailty who require treatment in hospitals are increasingly seen in the Emergency Departments (EDs). One quick and simple frailty assessment tool—the Clinical Frailty Scale (CFS)—has been embedded in many EDs in the United Kingdom (UK). However, it carries time/training and cost burden and has significant missing data. The Hospital Frailty Risk Score (HFRS) can be automated and has the potential to reduce costs and increase data availability, but has not been tested for predictive accuracy in the ED. The aim of this study is to assess the correlation between and the ability of the CFS at the ED and HFRS to predict hospital-related outcomes.

Methods

This is a retrospective cohort study using data from Leicester Royal Infirmary hospital during the period from 01/10/2017 to 30/09/2019. We included individuals aged + 75 years as the HFRS has been only validated for this population. We assessed the correlation between the CFS and HFRS using Pearson’s correlation coefficient for the continuous scores and weighted kappa scores for the categorised scores. We developed logistic regression models (unadjusted and adjusted) to estimate Odds Ratios (ORs) and Confidence Intervals (CIs), so we can assess the ability of the CFS and HFRS to predict 30-day mortality, Length of Stay (LOS) > 10 days, and 30-day readmission.

Results

Twelve thousand two hundred thirty seven individuals met the inclusion criteria. The mean age was 84.6 years (SD 5.9) and 7,074 (57.8%) were females. Between the CFS and HFRS, the Pearson correlation coefficient was 0.36 and weighted kappa score was 0.15. When comparing the highest frailty categories to the lowest frailty category within each frailty score, the ORs for 30-day mortality, LOS > 10 days, and 30-day readmission using the CFS were 2.26, 1.36, and 1.64 and for the HFRS 2.16, 7.68, and 1.19.

Conclusion

The CFS collected at the ED and the HFRS had low/slight agreement. Both frailty scores were shown to be predictors of adverse outcomes. More research is needed to assess the use of historic HFRS in the ED.
“Sometimes choices are not made, because we have ‘a’ choice, they’re made because they are ‘the’ choice”: Barriers to weight management for clients in rural general practice
Authors: Norman Kimberley , Burrows Lisette , Chepulis Lynne , Lawrenson Ross
Published: October 2022

Background

Obesity is an international health issue which currently affects over 34% of New Zealand adults and leads to further physical and psychosocial health complications. People living in rural communities experience health inequities and have a high-risk of becoming obese. The aim of this study was to explore and identify barriers to effective weight management in rural Waikato general practice.

Methods

Using semi-structured interviews, 16 rural Waikato participants shared their experiences with barriers to weight management. Interviews were transcribed and analysed using thematic analysis.

Results

Four themes were identified: resource constraints, rural locality barriers, rural sociocultural norms barriers, and participants’ understanding the solutions needed to overcome their specific barriers to effective weight management. For these participants, finding a feasible weight management strategy was a challenging first step in their weight management journey. A programme that would ‘work’ meant one that was economically viable for low-income persons, accessible, even if living rurally with less resources, and did not cause harm or jeopardise their social connections within family or community.

Conclusion

Overall, participants noted a lack of weight management strategy ‘choice’ because of income, isolation or accessibility of their rural location and/or the sociocultural norms of the community they lived in restricted options available to them. Future weight management initiatives may be better devised from within communities themselves and will need to be cognisant of the barriers specific to rural communities. Rural perspectives have much to offer in any such reconsideration of weight management initiatives.
Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey
Authors: Deilkås Ellen Tveter , Rosta Judith , Baathe Fredrik , Søfteland Eirik , Lexberg Åse Stavland , Røise Olav , Rø Karin Isaksson
Published: October 2022

Background

Lack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice.

Methods

A cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019.

Results

The response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians’ interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated.

Conclusions

This study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.
Serological evidence of chronic pulmonary Aspergillosis in tuberculosis patients in Kenya
Authors: Mohamed Abdi , Obanda Benear A. , Njeri Hannah K. , Loroyokie Sally N. , Mashedi Olga M. , Ouko Tom T. , Gatumwa Evangeline M. , Korir Richard K. , Yaguchi Takashi , Bii Christine C.
Published: October 2022

Background

Pulmonary tuberculosis (PTB) is a significant risk factor for fungal infection. The cavitary lesions post PTB serves as a good reservoir for fungal colonization and subsequent infection. Furthermore, the severe immunosuppression associated with HIV and TB co-infection is another predisposition. The inadequate capacity to investigate and manage fungal infection in PTB patients increases their morbidity and mortality. The study aimed to provide serological evidence of chronic pulmonary aspergillosis (CPA) among PTB patients in Kenya. Towards this, we analysed 234 serum samples from patients presenting with persistent clinical features of PTB infections despite TB treatment in four referral hospitals.

Methods

This was a cross sectional laboratory based study and patients were recruited following an informed consent. Serological detection of Aspergillus fumigatus IgG was done using enzyme-linked immunosorbent assay (Bordier Affinity Products SA). Sputum samples were subjected to microscopy and standard fungal culture. The isolated fungi were subjected to macro and micro morphological identifications and confirmed by sequence analysis of calmadulin, betatubilin and ITS genes.

Results

Serological evidence of CPA or fungal sensitization was 46(19.7%) and equivocal or borderline was 14(6.0%). Mycological investigations of sputum resulted in 88(38%) positive for fungal culture. Aspergillus spp. accounted for 25(28%) of which A. fumigatus was 13(14.8%), A. niger 8(9.1%), A. terreus, A. flavus, A. candidus and A. clavatus 1 (1.1%) each. This was followed by Penicillium spp. 10 (11.4%), Scedosporium spp. 5 (5.7%) and Rhizopus spp. 3 (3.4%). Among the yeasts; Candida albicans accounted for 18(20.5%) followed by C. glabrata 5(5.7%). Cryptococcus spp. was isolated from 3(3.4%) of the samples while 13(14.8%) were other yeasts.

Conclusion

Chronic pulmonary aspergillosis is a significant co-morbidity in PTB patients in Kenya that could be misdiagnosed as relapse or treatment failures in the absence of reliable diagnostic and clinical management algorithm. It could be the cause of persistent clinical symptoms despite TB treatment often misdiagnosed as TB smear/GeneXpert MTB/RIF® negative or relapse. We recommend that all patients with persistent clinical symptoms despite TB treatment should be subjected to fungal investigations before retreatment.
Smoking-mediated nicotinic acetylcholine receptors (nAChRs) for predicting outcomes for head and neck squamous cell carcinomas
Authors: Shen Yujie , Huang Qiang , Ji Mengyou , Hsueh Chi-Yao , Zhou Liang
Published: October 2022

Background

As a human tumor disease, head and neck squamous cell carcinoma (HNSCC) is associated with a high mortality rate worldwide. Nicotinic acetylcholine receptors (nAChRs) are transmembrane receptor proteins and exert their biological effects following activation by nicotine. We aimed to construct a prognostic signature based on the expression of nAChRs among smokers with HNSCC.

Methods

The transcriptome profile of nAChRs was obtained from The Cancer Genome Atlas (TCGA). Following the integration of survival information, univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analyses were performed to screen the prognosis-related nAChRs and construct a prognostic signature. Kaplan–Meier (KM), receiver operating characteristic (ROC), principal component analysis (PCA), and independent prognostic analysis were utilized to verify the predictive power of the nAChR-associated prognostic signature. The expression of α5 nAChR in clinical samples was verified by quantitative reverse transcriptase PCR.

Results

Subunits α2, α5, α9, and β4 were related to the prognosis. The prognostic signature comprised the expression of subunits α5, α9, and β4. The nAChR-associated signature showed high sensitivity and specificity for prognostic prediction and was an independent factor for overall survival. Based on the clinical variables and expression of nAChRs, a nomogram was constructed for predicting the outcomes of HNSCC patients who were smokers in the clinical settings. In clinical specimens, α5 nAChR showed high expression in HNSCC tissues, especially among smokers.

Conclusions

The nAChR-associated signature constructed in this study may provide a better system for the classification of HNSCC patients and facilitate personalized treatment according to their smoking habits.
The dose–effect relationships of cigarette and alcohol consumption with depressive symptoms: a multiple-center, cross-sectional study in 5965 Chinese middle-aged and elderly men
Authors: Liu Qian , Leng Pei , Gu Yiqun , Shang Xuejun , Zhou Yuanzhong , Zhang Huiping , Zuo Liandong , Mei Guangan , Xiong Chengliang , Wu Tianpeng , Li Honggang
Published: October 2022

Background

Although association of depressive symptoms with cigarette or alcohol is well documented, the dose–response relationship between them is rarely studied. This study aims to evaluate dose–response relationships of cigarette and alcohol consumption with depressive symptoms in Chinese middle-aged and elderly men, providing evidence to guide cigarette and alcohol control.

Methods

This multiple-center, cross-sectional study including 5965 Chinese men aged 40–79 years was conducted in 2013–2016 in China. Depressive symptoms were evaluated by Beck Depression Inventory-Short Form. History of cigarette smoking and alcohol drinking were collected with a structured questionnaire. Prevalence of depressive symptoms was compared depending on cigarette and alcohol consumption. Adjusted odds ratios (OR) and 95% confidence interval (CI) were estimated by binary logistic regression. Interpolation analysis was applied to test dose–effect relationships.

Results

A parabolic-shaped relationship was observed between cigarette consumption and depressive symptoms. Compared to never smokers, 59.0% (OR = 1.59, 95% CI 1.30–1.94) and 29.0% (OR = 1.29, 95% CI 1.08–1.54) higher odds of depressive symptoms were observed in men smoking < 10 cigarettes/day and 10–20 cigarettes/day, whereas, similar odds of depressive symptoms among men smoking > 20 cigarettes/day (P = 0.092). An inverted J-shaped relationship was observed between alcohol consumption and depressive symptoms. Compared to never drinkers, a tendency of higher prevalence of depressive symptoms (OR = 1.16, 95% CI 0.99–1.36) was observed in men drinking < 140 g/week, and similar prevalence was observed in those drinking 140–280 g/week (P = 0.920), whereas, 29.4% (OR = 0.71, 95% CI 0.57–0.88) lower odds in men drinking > 280 g/week.

Conclusions

Associations of cigarette smoking and alcohol drinking with depressive symptoms differ with consumption in middle-aged and elderly men. Health-care providers should exercise great caution on depressive symptoms in conducting cigarette and alcohol control.
“I can’t do it”: A qualitative study exploring case and contact experiences with COVID-19 contact tracing
Authors: Shelby Tyler , Arechiga Cailin , Gupta Amanda J. , Hennein Rachel , Schenck Christopher , Weeks Brian , Bond Maritza , Niccolai Linda , Davis J. Lucian , Grau Lauretta E.
Published: October 2022

Background

Low engagement in contact tracing for COVID-19 dramatically reduces its impact, but little is known about how experiences, environments and characteristics of cases and contacts influence engagement.

Methods

We recruited a convenience sample of COVID-19 cases and contacts from the New Haven Health Department’s contact tracing program for interviews about their contact tracing experiences. We analyzed transcripts thematically, organized themes using the Capability, Opportunity, Motivation, Behavior (COM-B) model, and identified candidate interventions using the linked Behavior Change Wheel Framework.

Results

We interviewed 21 cases and 12 contacts. Many felt physically or psychologically incapable of contact tracing participation due to symptoms or uncertainty about protocols. Environmental factors and social contacts also influenced engagement. Finally, physical symptoms, emotions and low trust in and expectations of public health authorities influenced motivation to participate.

Conclusion

To improve contact tracing uptake, programs should respond to clients’ physical and emotional needs; increase clarity of public communications; address structural and social factors that shape behaviors and opportunities; and establish and maintain trust. We identify multiple potential interventions that may help achieve these goals.
Pre-vaccination RT-PCR negative contacts in workplace settings show high, SARS COV-2 neutralizing antibody levels
Authors: Karunathilake Ridma P , Hewage Sameera , Vidanapathirana Gihani , Kumara Athula , Ranasinghe Prabhath , Noordeen Faseeha , Gawarammana Indika , Ratnatunga Champa N
Published: October 2022

Background

Asymptomatic SARS-CoV-2 infection occurring in RT-PCR negative individuals represent a poorly characterized cohort with important infection control connotations. While household and community-based studies have evaluated seroprevalence of antibody and transmission dynamics in this group, workplace-based data is currently unavailable.

Methods

A cohort study was carried out in July 2021, during and immediately following the peak of the 3rd wave of COVID-19 in Sri Lanka, prior to mass vaccination. A total of 92 unvaccinated individuals between the ages of 17–65 years were purposively sampled from an office and two factory settings. The selected cohort that had been exposed to RT-PCR positive cases in the workplace was tested RT-PCR negative. Serological samples collected six weeks post exposure were tested for anti-SARS-CoV-2 neutralizing antibody.

Results

The seroprevalence for SARS-CoV-2 specific neutralizing antibodies in the overall cohort was 63.04% (58/92). Seroprevalences in the office setting, factory setting 1 and factory setting 2 were 69.2% (9/13), 55.7% (34/61) and 83.33% (15/18), respectively. Primary risk factor associated with seropositivity was face to face contact with no mask for > 15 min (p < 0.024, Odds Ratio (OR); 5.58, 95%CI;1.292– 25.65). Individuals with workspace exposure had significantly higher levels of neutralizing antibodies than those who did not (percentage neutralization in assay 63.3% (SD:21)vs 45.7% (SD:20), p = 0.0042), as did individuals who engaged socially without protective measures (62.4 (SD:21.6)% vs 49.7 (SD:21)%, p = 0.026).

Conclusion

There was a high seroprevalence for SARS-CoV-2 specific neutralizing antibodies among RT-PCR negative contacts in workplace settings in Sri Lanka. Higher levels of transmission of SARS-CoV-2 infection than estimated based on RT-PCR positive contact data indicate need for targeted infection control measures in these settings during future outbreaks.
Parathyroid carcinoma during pregnancy: a novel pathogenic CDC73 mutation – a case report
Authors: Dematapitiya Chinthana , Perera Chiara , Pathmanathan Sivatharshiya , Subasinghe Vindya , Anandagoda Gayani , Dissanayaka Vajira , Wijenayake Umesha , Dissanayake Preethi , Gamage Kavinga , Wijewickrama Piyumi , Sumanatilleke Manilka
Published: October 2022

Background

Parathyroid carcinoma is an uncommon cause of PTH-dependent hypercalcemia. Only a handful of cases have been reported of parathyroid carcinoma during pregnancy.

Case presentation

Twenty-four – Year – old female presented with proximal myopathy was found to have hypercalcemia. Her serum corrected total calcium was – 15 mg/dl (8.5 – 10.3), serum phosphate – 2.3 mg/dl (2.5 – 4.5), intact PTH – 118 pg/ml (20 – 80), Vitamin D – 15 ng/ml and Urine Ca/Cr ratio – 2.1 (0.1 – 0.2). Her CECT–neck revealed a well-defined mass lesion posterior to the right lobe of the thyroid – 2.6 cm × 2.5 cm × 2.9 cm in size. She was started on vitamin D supplementation, and she underwent right lower focal parathyroidectomy. Her PTH levels normalized following surgery. Her histology revealed an atypical parathyroid adenoma. She was treated with calcium and vitamin D. Her follow up was uneventful.

One year following initial surgery the patient became pregnant and at 16 weeks of POA, the patient presented with a rapidly enhancing neck mass for one week duration. Her biochemical investigations were suggestive of a recurrence of primary hyperparathyroidism. Her ultrasound scan of the neck revealed a well-defined discreate hypoechoic nodule, superior to the thyroid isthmus which was confirmed by a non-contrast MRI scan of the neck. She underwent an uncomplicated second trimester parathyroid tumour excision with normalization of post op PTH. Her histology revealed a parathyroid carcinoma with vascular and capsular invasion. Her genetic studies revealed a novel frameshift mutation of the CDC73 gene. She was treated with calcium and vitamin D supplementation and closely followed up with ionized calcium and PTH levels which were normal throughout the pregnancy. She had an uncomplicated caesarean section at a POA of 37 weeks. Currently she is twelve weeks post-partum, in remission of disease.

Conclusion

This case shows the importance of stringent follow up of atypical parathyroid adenoma patients, the benefit of second trimester surgery in management of hypercalcemia due to parathyroid carcinoma during pregnancy and the importance of identifying the novel CDC73 gene mutation.
Influence of demographic and socio-economic factors in choosing hospitalist careers among US medical students
Authors: Rachoin Jean-Sebastien , Vilceanu M. Olguta , Franzblau Natali , Gordon Sabrina , Hunter Krystal , Cerceo Elizabeth
Published: October 2022

Background

The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students.

Methods

We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020.

Results

We analyzed 46,614 questionnaires. 19.3% of respondents (N = 8,977) intended to work as a Hospital Medicine [HM] (unchanged from 2018 to 2020), mostly combined with specialties in Internal medicine (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, sexual orientation minorities (Lesbian/Gay or Bisexual), Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher median total debt ($170,000 vs. $155,000). Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM.

Conclusion

About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of debt, planning to enter a loan forgiveness program, or are interested in doing a fellowship.
The extraordinary makes the ordinary visible - nursing students’ experiences of their learning in clinical practice during COVID-19: a qualitative study
Authors: Boman Lena Engqvist , Stark Åsa Johansson , Georg Carina , Silén Charlotte
Published: October 2022

Background

The COVID-19 crisis had a significant impact on health care and nursing education as a large part of it is carried out in clinical practice. However, it is not known how the learning situations during the pandemic affected students’ learning. To deepen the understanding of students’ learning, learning theories within a constructive paradigm is used as a framework for this study. The purpose of the study was to explore nursing students´ perceptions of their learning in clinical practice during COVID-19.

Methods

In this interpretative qualitative study, seven focus group discussions were conducted with 21 nursing students at different stages of the nursing programme, all of whom performed clinical practice during the outbreak of COVID-19. The analysis of the discussions was performed with interpretative content analysis related to theoretical assumptions about learning.

Results

The learning situation was characterised by chaos and confusion affecting both the students’ opportunities to learn and what they learned. Despite the uncertainty the students appreciated having experienced this unique situation, which contributed to valuable learning. Things otherwise taken for granted or not encountered before became visible. The learning processes were characterised by complexity and challenges that hindered or stimulated learning. It depended on the student’s approach and the management of the clinical education. Concerns about one´s own and relatives’ health, and not being able to finish studies, also affected learning. The students learned about important measures during a pandemic regarding hygiene, care organisation, communication, and the multifaceted role of the nurse.

Conclusion

Unpredictable situations such as a pandemic can lead to unique learning since “the extraordinary makes the ordinary visible”. The students learned things additional to the formal learning outcomes, and the experiences strengthened their will to become nurses. Challenges due to a crisis can become important driving forces for learning, if not experienced as overwhelming. Some students felt they received space for own initiatives and responsibility while others felt lost and abandoned. Preparing for a crisis means preparing for an unknown future. Students therefore need to experience dilemmas and uncertain situations and reflect in a safe environment.
Patient satisfaction with surgical informed consent at Jimma Medical Center, Ethiopia
Authors: Biyazin Tsegaw , Taye Ayanos , Belay Yeshitila
Published: October 2022

Background

Informed consent is a process in which a healthcare provider obtains permission from an individual prior to surgery. Patient satisfaction with the informed consent process is one of the main indicators of healthcare service quality. This study aimed to assess patient satisfaction with surgical informed consent at Jimma Medical Center, Ethiopia, in 2020.

Methods

A facility-based cross-sectional study was conducted from April 1 to June 30, 2020, at Jimma Medical Center. Face-to-face interviews were conducted using structured questionnaires. A systematic sampling technique was used to select the study participants. The collected data were coded, entered into Epi data version 3.1, and analyzed using SPSS version 25. Bivariate and multivariate regression analyses were performed to determine the association between patient satisfaction and socio-demographic and facility-related factors. In multivariate regression, predictors with a P-value of < 0.05 were considered statistically significant.

Results

Totally 372 study participants were interviewed with a response rate of 97.8%. Nearly two-fifths (43%) of patients were satisfied with surgical informed consent. Living in an urban area (AOR: 2.279, 95% CI 1.257–4.131), having current referred history (AOR: 1.856, 95% CI 1.033–3.337), consent form version (AOR: 2.076, 95% CI 1.143–3.773), time spent on the provision of informed consent (AOR: 5.227, 95% CI 2.499–10.936) and having better patient-health providers relationship (AOR: 5.419, 95% CI 3.103–9.464) predictors were positively associated with patient satisfaction.

Conclusion

Patient satisfaction with the surgical informed consent process was relatively low. Therefore, Health care professionals need to emphasize a way of delivering informed consent, patients' needs and obey a standard informed consent to improve patient satisfaction.