bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience to hazards overlapping a pandemic: A shelter resource stabilization model
Authors: Hutton Nicole S , Whytlaw Jennifer L , Behr Joshua , Yusuf Juita-Elena (Wie) , Olanrewaju Lasisi Taiwo C , Marshall Jennifer , Seiler Rimer Vicky
Published: September 2023

COVID-19 and the resulting financial impacts had budget and workforce implications for organizations involved in emergency shelter provision. To address distancing and sanitation protocols as well as virus transmission and vaccination rates, shelter supplies, facility modifications, and staffing adjustments were needed. As funding and authorizations to implement public health guidance and stabilize the workforce expired, emergency managers had to determine whether to continue pandemic protocols. In order to understand these relationships, we conducted a workshop in September 2021 with 137 emergency managers, public health leaders, and other government and nonprofit practitioners from 20 states, the U.S. Virgin Islands, and Canada to identify resource reallocation strategies utilized for sheltering from post-lockdown to post-vaccine periods of the COVID-19 pandemic. We applied a fiscal recovery framework to explore how these operational changes were influenced by and have implications for fiscal and policy support as well as operational adaptability. Results show that as fiscal and policy support waned, some pandemic protocols were suspended, thereby shifting and reducing human and facility resource needs. Distancing protocols benefited from improvements in masking, vaccine, and testing availability without consistent mandates, but non-congregate shelter provision was reduced as authorizations and funding expired. Modified service contracts and increased utilization of special needs registries can realign resources with health and safety needs. Based on participant responses, we developed a Retractable Stabilization Model to indicate how shelter resources can be reallocated and supported by future policy interventions to provide a range of emergency sheltering options during pandemics and overlapping hazards.
Study on failure characteristics of fiber reinforced composite structural connections
Authors: Shao Jiaru , Yang Zhiqiang , Liu Niu , Yang Yu , Zheng Zijun , Zhang Ziying
Published: September 2023

In this paper, the three-dimensional progressive damage finite element models of composite bolted connection and adhesive-bolt hybrid connection were constructed, and the accuracy of the model is verified by comparing with the experimental results. The energy-based B-K criterion was used to simulate the damage and evolution of the adhesive layer, and the effects of bolt hole diameter, pre-tightening force and layup sequence on the failure characteristics of composite mechanical connections were analyzed. The results show that, in the bolted connection model, the final failure mode is typically extrusion damage near the bolt hole, with matrix failure being the primary form of failure. Appropriately increasing the diameter of the bolt hole or applying an appropriate pre-tightening force can both enhance the connection strength. Maximal strength of the connection structure is achieved when the first layer in the connection area is oriented at 0°, whereas if the first layer is oriented at 90°, the connection's bearing capacity is minimally reduced. In the adhesive-bolt hybrid connection model, the fiber and matrix damage of the four plies closest to the adhesive layer mainly spread along the 45°direction, and the damage is mainly matrix tensile damage.
Fermented Cordyceps Powder Attenuates Inflammation and Pulmonary Arterioles Remodeling by Inhibiting p38 MAPK/NF-κB Signaling Pathway in Hypoxic Pulmonary Hypertension Rats
Authors: Li Jia , Chen Tingting , Yang Zhanting , Su Shanshan , Wang Yuhua , Li Zhanqiang , Lu Dianxiang
Published: September 2023

Background

Pulmonary hypertension (PH) is a pulmonary vascular disease caused by a variety of causes and has a poor prognosis. Hypoxic pulmonary hypertension (HPH) is one of the types of PH. Cordyceps sinensis could treat a variety of lung diseases; its pharmacological active ingredients mainly include cordycepin, nucleosides, cordyceps polysaccharides, sterols, and amino acids. Fermented cordyceps powder (FCP) is an alternative to C. sinensis. In order to investigate the effect of FCP on HPH in rats, we established the HPH rat model.

Materials and Methods

Forty-two male Sprague–Dawley (SD) rats were randomly divided into a control group, hypoxia group, hypoxia + FCP (0.1 g.kg−1.d−1), hypoxia + FCP (0.2 g.kg−1.d−1), hypoxia + FCP (0.4 g.kg−1.d−1), and hypoxia + sildenafil (30 mg.kg−1.d−1) group. Except for the control group, the other five groups of rats were fed in the hypobaric chamber. The corresponding dose was given by intragastric administration, once a day, for 28 days. The mean pulmonary arterial pressure (mPAP) and right ventricle hypertrophy index (RVHI) were measured; hematological parameters white blood cells (WBC), neutrophils (Neu), Lymphocytes (Lym), monocytes (Mon), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), and platelets (PLT) levels were detected; serum levels of interleukin-1β (IL-1β) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA); the morphological changes of pulmonary arterioles were observed by hematoxylin and eosin (H&E) staining, and the vascular remodeling indexes, vessel wall thickness as a percentage of vascular outer diameter (WT%), vascular wall area as a percentage of total vessel area (WA%), and lumen area as a percentage of the total vascular area (LA%) were calculated; the protein expression levels of IL-1β, IL-6, p-p38, p38, p-IκBα, IκBα, p-p65, and p65 were determined by western blotting.

Results

FCP could significantly downregulate mPAP, improve pulmonary arteriole remodeling, and reduce the serum levels of IL-1β and IL-6 in HPH rats. In addition, FCP downregulated the protein levels of IL-1β, IL-6, p-p38, p-IκBα, and p-p65.

Conclusion

FCP could alleviate mPAP and vascular remodeling in HPH rats. Its mechanism could be through inhibiting the p38 mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B (NF-κB) signaling pathway and by downregulating the expression of inflammatory factors. Our study might provide a research basis for the therapeutic potential of FCP in HPH.
Trans women’s status in contemporary Iran: Misrecognition and the cultural politics of aberu
Authors: Saeidzadeh Zara
Published: September 2023

In this paper, I explore the socio-legal status of trans women in contemporary Iran especially as it relates to Gender Affirmation Surgery. More specifically, I try to understand how trans women embody gender by investigating gender practices and relations in family, law, and medicine. Based on my fieldwork in Iran, the findings suggest that aberu – a phenomenon specific to Iranian culture – plays a big role in shaping trans women’s lives. By bringing together feminist philosopher Nancy Fraser’s work on the politics of recognition and sociologist Raewyn Connell’s understanding of social embodiment, I discuss how the status of trans women is pervasively misrecognised and how they are denied economic participation and democratic representation in Iranian society. Adopting the method of thematic analysis, I argue that the social pressure associated with aberu, and the lack of legal protection have made trans women simultaneously invisible and yet also subject to violence. Finally, I discuss how trans women go through the process of gender embodiment by problematising misrecognition, redefining femininity, and reclaiming womanhood through everyday life challenges.
The media operations of postcolonial mobility regimes: The cases of Filmstichting West Indië and Vereniging Ons Suriname in 1940s and 1950s Netherlands
Authors: Leurs Koen , Seuferling Philipp
Published: September 2023

This article analyses the communication activities of Filmstichting West Indië, which in the late 1940s and early 1950s produced 12 documentary propaganda films about Dutch colonial Suriname, and the resistance against these reductive representations in zines of the Surinamese migrant organization Vereniging Ons Suriname. We draw on hence unstudied archival material to dissect the role of media operations, as persuasive, strategic media productions, in constructing and challenging differential relations between colonizers and colonial subjects, and symbolically negotiating how different territories and bodies relate to each other. A visual and textual analysis of the cases unpacks historical struggles over the regimes of (post)colonial (im)mobilities, as they are produced and articulated within regimes of representation. We ultimately argue that, in order to understand the historical constitution of mobility regimes (and, in order to be able to critique them), we need to study the co-production of mobility regimes within regimes of mediated representation.
Exploring why “memory loss” is a misleading descriptor of people living with dementia and can lead to dysfunctional care
Authors: Sabat Steven R , Warren Alison
Published: September 2023

Amidst goals for prevention and improved treatment for people living with dementia, much remains needed to enhance the quality of life of those currently diagnosed, especially the transfer of accurate information from professionals to the public. Although many healthcare professionals understand the various types of memory and which are likely to be more affected than others during the progression of dementia, lay persons are more frequently unaware of that important information. The terms used to describe the symptoms of dementia can have a great impact on perceptions of faculties that are absent, compromised, or preserved. Understanding the nuances of preserved memory faculties and other cognitive abilities retained by persons with dementia is important in this regard. The term “memory loss” as a descriptor of the syndrome of dementia and ascribing it to persons with dementia connotes an inability to form new memories and participate in meaningful social interactions, which is detrimental to their personhood. From a multidisciplinary approach drawn from neurology, neurobiology, psychology, and case vignettes, we aim herein to highlight the ways in which the term “memory loss” can be inaccurate, counterproductive and potentially promote dementia-related misperceptions, malignant positioning and malignant social psychology. Persons with dementia unequivocally struggle with explicit memory, or recalling on demand, but retain implicit memory, as evidenced by research and everyday actions. Therefore, we propose the use of alternative medical language to reflect accurately memory impairment and preservation of some important memory capabilities.
Pile defect assessment using distributed temperature sensing: fundamental questions examined
Authors: Sun Qianchen , Elshafie Mohammed ZEB , Xu Xiaomin , Schooling Jennifer
Published: September 2023

Thermal integrity testing has been successfully used to assess the quality of cast-in-place piles for the past decade. It employs temperature data measured during concrete curing to identify defects along the piles’ length. However, the uptake of this technology has been rather limited in the piling industry. The main concerns are that the method is not standardised and its reliability is not well understood. In order to address these, there are a number of fundamental questions that need to be explored in more detail, including (a) the optimum time to conduct the assessment, (b) the defect thermal impact, (c) the zone of influence on temperature sensors, (d) the minimum detectable size of a defect and (e) the associated optimum sensor location required. In this paper, experimental and numerical studies were conducted to examine these questions. Fibre optic sensors were employed on model concrete piles in laboratory tests to provide fully distributed temperature data throughout the curing process. The test results showed that the optimum time to assess the defects is approximately at 60% of the time to reach peak temperature and the minimal detectable defect size, using the currently available optical fibre sensor technology, is 4% of the cross-sectional area. In addition, the thermal influence of different defect sizes is presented. Following this, it is shown in the paper that the minimum numbers of sensor cables required to identify defects with cross-sectional areas of 4%, 5% and 8% are eight, six and four cables, respectively. The optimum layout of these sensor cables within a pile cross-section has also been discussed. When specifying pile instrumentation for integrity assessment, the findings of this paper enable practising engineers to make informed judgements in relation to the size of defects they would like to detect (and hence the associated risk this entails) together with the corresponding instrumentation layout required.
Facilitators and Barriers for Adopting a Plant-Based Diet: Results From a Pilot Study Among Vegans in the United States
Authors: Lopez Nanette V. , Sirvinskas Eric , Sutliffe Jay T.
Published: September 2023

Research has demonstrated the health benefits of shifting from an animal product diet to a plant-based diet. However, social beliefs may be barriers to eating plant-based. Thus, we determined facilitators and barriers to transitioning to plant-based consumption. U.S. adults consuming an exclusively plant-based (i.e., vegan) diet (n = 1,141, 86% female, 81% non-Hispanic White) were recruited from 38 vegan Facebook groups and surveyed from December 2020 through January 2021. Results from chi square analyses indicated significant relationships between length of veganism and main motivator for becoming vegan (χ2 = 37.07, P < .001), most effective facilitator in helping flexitarians to fully become vegan (χ2 = 17.35, P = .001), most effective strategy in helping others become vegan (χ2 = 12.07, P = .017), and main barrier to becoming vegan (χ2 = 23.80, P < .001). There were significant relationships between time to become vegan and perceived main facilitator for the recent increase in transitioning to veganism (χ2 = 16.81, P = .019), and main barrier to becoming vegan (χ2 = 24.34, P < .001). Future interventions can use these results to address facilitators and barriers and create a toolkit for transitioning to plant-based consumption and improving dietary behaviors in the United States.
“Underpaid, undervalued, undermined”: Examining the cultural identities, challenges, and coping strategies of U.S. Latinas in public relations
Authors: Vasquez Rosalynn A , Neill Marlene S
Published: September 2023

Despite being one of the fastest growing and highly influential segments of the U.S. population, Latino/a/xs have been largely underrepresented in the public relations field. In response to the scarcity of research examining the role and influence of Latinas in public relations, this study contributes a unique perspective by providing new insights into the challenges U.S. Latinas face in the public relations industry, their coping strategies, and how those may vary based on cultural identities (immigrant, first-generation, and non-immigrant Latinas). Through 24 in-depth interviews with Latinas working in mid-management and senior-executive level roles, this study reveals inclusion, intersectionality, isolation, language, pay equity, and pigeonholing as key challenges to career advancement; and identifies action, rational thinking, avoidance, emotional support, instrumental support, and personal advocacy as main coping strategies used to address these challenges. Findings also provide recommendations and a timely call for greater cultural sensitivities, accountability, and DEIB in public relations.
Retrospective analysis of the management of pelvic decubitus ulcers and their outcomes
Authors: Damioli Laura , Shepard Zachary , Wilson Melissa P. , Erlandson Kristine M.
Published: September 2023

Background:

Many patients with decubitus-related osteomyelitis are ineligible for myocutaneous flapping, and optimal management in this population is unknown. We describe treatments and outcomes of hospitalized patients with decubitus ulcer-related osteomyelitis who did not undergo surgical reconstruction or coverage.

Methods:

We systematically identified hospitalized patients with diagnoses of pelvic, sacral, or femoral osteomyelitis due to decubitus ulceration between 1 January 2018 and 31 December 2018. Demographics, comorbidities, laboratory data, and outcomes were collected by manual chart review. T-tests or Chi-square tests were used for descriptive statistical comparisons; logistic regressions were used to explore the odds of readmission, osteomyelitis-related readmission, and death.

Results:

Of 89 patients meeting inclusion criteria, 34 (38%) received surgical debridement and ⩾6 weeks of antibiotics; 55 (62%) received either antibiotics alone or debridement and <6 weeks of antibiotics. Mean age was 55 (standard deviation 18) years, 55% of patients were male, and 69% had spinal cord injury or other form of paralysis. Within 1 year, 56 (63%) patients were readmitted, 38 (44%) patients were readmitted due to complications from osteomyelitis, and 15 (17%) died. We found no significant differences in readmission (OR = 1.33, 95% CI: 0.54–3.21, p = 0.53), readmission related to osteomyelitis (OR = 1.64, 95% CI: 0.69–4.04, p = 0.27), subsequent sepsis (OR = 2.27, 95% CI: 0.83–6.93, p = 0.13), or death (OR = 2.88, 95% CI: 0.83–13.4, p = 0.12) by treatment group.

Conclusions:

Among patients with decubitus-related osteomyelitis who did not undergo myocutaneous flapping, outcomes were generally poor regardless of treatment, and not significantly improved with prolonged antibiotics. Prospective studies are needed to assess best practice strategies for this challenging patient population.
A New Media Frontier, or More of the Same? A Descriptive Analysis of the “Missing White Woman Syndrome” in Top True Crime Podcasts
Authors: Slakoff Danielle C. , Duran Destiny
Published: September 2023

True crime podcasts are a newer addition to the media and true crime landscape, and listenership is steadily growing. While other forms of true crime have been shown to overrepresent harm against White women and children, no study to date has examined whether White missing women/girls are overrepresented in true crime podcasts compared to women/girls of color. In this study, the researchers examined data from four of the top listened-to podcasts in the United States with two goals in mind: (1) to determine whether White women and girls are overrepresented in true crime podcasts about missing women/girls and (2) to report on the overarching themes, if any, found in podcast episode titles and descriptions for episodes that feature missing women/girls. Based on data gleaned from podcast titles and descriptions, descriptive results show that White women and girls were overrepresented in episodes about missing women/girls compared to missing women and girls of color. Further, an inductive qualitative content analysis of episode descriptions revealed that some were written in casual/friendly tones, which signified an affable relationship between the hosts and the listeners. Areas of further inquiry are discussed, as is the need to uplift podcasts that feature stories about people of color.
Sport Celebrities’ COVID-19 Prevention on Social Media: The Effect of Credibility, Social Distance, Identification, and Message’s Power Style on Health Behavioral Intentions
Authors: Chung Kyu-soo , Goebert Chad
Published: September 2023

During the COVID-19 outbreak, there emerged on social media an active cohort of sport celebrities, promoting through their messages virus-prevention behaviors. The study tested how people’s intentions to adopt COVID-19 prevention practices were affected by their perceived credibility of sport celebrities, perceived social distance of sport celebrities, and identification with sport celebrities. The study also tested how the message’s power style moderated those relations. The researchers selected four sport celebrities who were active on social media and applied powerful and powerless linguistic styles in developing their social media messages. College students ( N = 284) were randomly exposed to one of eight stimuli and asked the questions in the self-administered online survey. The perceived credibility positively affected COVID-19 prevention intentions regardless of the message’s power style. The perceived social distance was effective for intentions only in the powerless message. Identification with sport celebrities was effective regardless of the message’s power style, with the powerless message being more effective than the powerful one. The study provides a theoretical perspective on how people utilize sport celebrities’ characteristics as peripheral cues during health information processing. Also, the study offers practical implications for leveraging social media and sports celebrities to promote virus prevention.
Evaluating Dysphagia Duration and Severity After ACDF in Patients With Underlying Dysphagia - A Prospective, Multicenter Study
Authors: Mazmudar Aditya , Paziuk Taylor , Tran Khoa S. , Henry Tyler , Oh Samuel , Purtill Caroline , Habbal Daniel , Yalla Goutham , Harrill Quinlin , Sherrod Brandon , Bisson Erica , Brodke Darrel , Kepler Christopher , Schroeder Gregory , Vaccaro Alexander , Hilibrand Alan , Rihn Jeffrey A.
Published: September 2023

Study Design

Prospective Cohort Study

Objectives

The purpose of this study was to prospectively evaluate the impact of preoperative dysphagia on the postoperative incidence and severity of dysphagia in patients undergoing ACDF at multiple institutions.

Methods

After IRB approval, patients over 18 years of age who underwent an elective ACDF for degenerative conditions were prospectively enrolled at two academic centers from 2018 to 2021. Preoperative dysphagia was self-reported by patients through a pre-operative questionnaire on a binary basis. Patients completed dysphagia surveys (Bazaz, Dysphagia Short Questionnaire, 10-item Eating Assessment Tool) to assess dysphagia severity during their preoperative visit, and these dysphagia surveys were repeated immediately postoperatively, at two weeks and again at six, 12, and 24 weeks postoperatively. Patients were stratified into three subgroups based on dysphagia status preoperatively and immediately postoperatively and compared using ANOVA tests or Kruskal–Wallis tests for continuous variables and Pearson chi-square analysis or Fisher’s Exact test for categorical variables.

Results

A total of 168 patients (23 with preoperative dysphagia, 145 without preoperative dysphagia) met study criteria and were enrolled in the study. Patients with preoperative dysphagia had less frequent alcohol consumption (23.8% vs 53.7%, P = .0210), and higher rates of dysphagia at 2-weeks (77.8% vs 38.7%, P = .004) and 24-weeks (43.8% vs 14.8%, P = .010) postoperatively. These patients also had higher severity scores for dysphagia on the Bazaz ( P = .001), DSQ ( P = .012), EAT10 ( P = .022) questionnaires at the 2-week follow-up period, higher DSQ scores ( P = .036) at the 6-week follow-up period, higher EAT-10 scores ( P = .009) at the 12-week follow-up period, and higher Bazaz ( P = .001), DSQ ( P = .002), and EAT-10 ( P = .005) scores at the 24-week follow-up period. There were no differences in demographic, medical history, surgical variables, rates of ENT consultation, length of stay, or other in-hospital events between groups.

Conclusions

Patients undergoing ACDF who had preoperative dysphagia have prolonged postoperative dysphagia and greater dysphagia severity. Surgeons should be aware of the risk of prolonged dysphagia severity that may persist past 24 weeks after surgery when discussing clinical decisions with patients.
Comparison of Knee Articular Cartilage Defect Size Between Measurements Obtained on Preoperative MRI Versus During Arthrotomy
Authors: Perry Jade , Kuiper Jan Herman , McCarthy Helen S. , Jermin Paul , Gallacher Peter D. , Tins Bernhard , Roberts Sally
Published: September 2023

Background:

Treatment decisions for cartilage defects are often based on lesion size. Magnetic resonance imaging (MRI) is widely used to diagnose cartilage defects noninvasively; however, their size estimated from MRI may differ from defect sizes measured during arthrotomy, especially after debridement to healthy cartilage if undergoing autologous chondrocyte implantation.

Purpose/Hypothesis:

The purpose of this study was to evaluate the reliability of 2 methods to assess knee cartilage defect size on preoperative MRI and determine their accuracy in predicting postdebridement defect sizes recorded during arthrotomy. It was hypothesized that defect size would be predicted more accurately by the total area of abnormal articular cartilage rather than the area of full-thickness cartilage loss as identified on MRI.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

This study included 64 patients (mean age, 41.8 ± 9.6 years) who underwent autologous cell therapy. Each patient received a 3-T MRI at 6.1 ± 3.0 weeks before cell implantation. Three raters, a radiologist, a surgeon, and a scientist, measured (1) the full-thickness cartilage defect area and (2) the total predicted abnormal cartilage area, identified by an abnormal signal on MRI. Interrater reliability was assessed using the intraclass correlation coefficient (ICC). Actual pre- and postdebridement defect sizes were obtained from intraoperative surgical notes. Postdebridement surgical measurements were considered the clinical reference standard and were compared with the radiologist’s MRI measurements.

Results:

Eighty-seven defects were assessed, located on the lateral (n = 8) and medial (n = 26) femoral condyle, trochlea (n = 17), and patella (n = 36). The interrater reliability of the cartilage defect measurements on MRI was good to excellent for the full-thickness cartilage defect area (ICC = 0.74) and the total predicted abnormal cartilage area (ICC = 0.78). The median full-thickness cartilage defect area on MRI underestimated the median postdebridement defect area by 78.3%, whereas the total predicted abnormal cartilage area measurement underestimated the postdebridement defect area by 14.3%.

Conclusion:

Measuring the full-thickness cartilage defect area on MRI underestimated the area to treat, whereas measuring the total abnormal area provided a better estimate of the actual defect size for treatment.
Training in Radiation and Clinical Oncology in Europe
Authors: Lara Pedro C , Benstead Kim , Erikssen Jesper Grau
Published: September 2023

The European population is strongly affected by cancer. Radiotherapy is roughly used in 50% of cancer patients in European countries. The increased cancer burden demands a new generation of radiation/clinical oncologist (RO/CO) that, besides a strong evidence-based oncological knowledge, will be ready for leadership in cancer care. The mutual recognition of professional qualifications of Radiation/Clinical Oncology in the EU needs training harmonization. The European Society of Radiotherapy and Oncology (ESTRO) and the European Union for Medical Specialties (UEMS) made important efforts toward a European Common Curriculum for RO/CO leadership in cancer care. If qualifications are mutually recognized, the training supporting these qualifications should be also harmonized. Since 1991, ESTRO produced several editions of the Core Curriculum in Radiation Oncology (1991, 2004, 2012, 2019). These Core Curricula were endorsed as European Training Requirements by the UEMS in 2004, 2013, and 2019. A core curriculum for clinical oncology was also produced to provide this harmonization tool to countries where radiation oncology is practiced inside the broader specialty of clinical oncology. New initiatives are in place to continuously adapt the training programs to the rapidly evolving cancer care organization.
Are there more acute cardiac hospitalizations in winter in patients with systemic sclerosis? An analysis from the National Inpatient Sample
Authors: Luo Yiming , Ross Laura , Zheng Jiayi , Bernstein Elana J
Published: September 2023

Objective:

Cold-induced transient myocardial ischemia has been described in patients with systemic sclerosis. The clinical impact of cold exposure in systemic sclerosis patients with acute cardiac conditions is unknown. We compared the seasonal variation of acute cardiac hospitalizations in patients with and without systemic sclerosis.

Methods:

We performed a retrospective cross-sectional study using the National Inpatient Sample from 2016 to 2019. The primary outcome was acute cardiac hospitalization primarily due to heart failure, acute myocardial infarction, or cardiac arrhythmias. We compared the proportion of acute cardiac hospitalizations in each season in patients with and without systemic sclerosis. We also performed a subgroup analysis by US geographic region (Northeast, Midwest, South, West).

Results:

There were a total of 10,118,002 acute cardiac hospitalizations over the 4-year study period. Compared to those without systemic sclerosis, patients with systemic sclerosis who were hospitalized for acute cardiac care were younger (mean age 67 ± 13 vs 70 ± 14 years, p < 0.01), a greater proportion were female (82% vs 45%, p < 0.01), and a smaller proportion were Caucasian (68% vs 71%, p < 0.01). There was a lesser proportion of traditional cardiovascular risk factors in systemic sclerosis compared to non-systemic sclerosis patients. There was no significant difference in the proportion of winter admissions between systemic sclerosis and non-systemic sclerosis patients for total acute cardiac hospitalizations (26.4% vs 25.9%, p = 0.51), heart failure (27.0% vs 26.5%, p = 0.64), acute myocardial infarction (26.9% vs 25.5%, p = 0.50), or arrhythmias (24.3% vs 25.0%, p = 0.68). The results were consistent across all four US geographic regions.

Conclusion:

Our study did not support that patients with systemic sclerosis had a disproportionally higher risk of acute cardiac hospitalization in winter compared to the general population. We found that systemic sclerosis patients hospitalized for acute cardiac care had a lower burden of traditional cardiovascular risk factors than their non-systemic sclerosis counterparts.
Using stakeholder intervention refinement teams to develop approaches for real-time integration of patient-reported safety information during older adults’ hospital-to-home-health care transitions
Authors: Arbaje Alicia I , Greyson Sylvan , Keita Fakeye Maningbe , Hohl Dawn , Carl Kimberly , Hsu Yea-Jen , Leff Bruce
Published: September 2023

Background

The hospital-to-home transition remains a high-risk care interval for older adults. Skilled home health (HH) agencies are uniquely positioned to address care-transitions-associated patient safety threats. We previously developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index to identify safety issues after hospital discharge. Our objective is to evaluate a participatory ergonomics process engaging stakeholders to develop strategies to implement the H3TQ into HH agency workflow to improve transition-associated safety issues in real-time.

Methods

Stakeholders participated in three, two-hour Intervention Refinement Team (IRT) meetings with a focus on: (1) identifying facilitators and barriers to collect H3TQ data in real-time, (2) integration of H3TQ into workflows, and (3) sharing H3TQ safety threat information to improve care transition safety outcomes. We used the human factors engineering-informed Systems Ambiguity Framework to guide the structure of IRT meetings and qualitative data analysis to evaluate the IRT process itself.

Results

Stakeholders (N = 9) represented patients, family caregivers, and HH staff. Stakeholders identified three key strategies for H3TQ implementation: (1) mechanism and timing of H3TQ data collection using multiple platforms; (2) data sharing conditions for safety reporting across the health system; and (3) identification of targeted care transitions outcomes for improvement. Participants highly rated IRT meetings regarding meeting usefulness, comfort, and degree of input into the discussion.

Conclusions

The IRT participatory ergonomics process was successful. Stakeholders identified strategies to facilitate implementation of the H3TQ implementation to improve the hospital-to-HH. IRTs have potential application to other health system issues related to the care of people with complex needs.
Vitamin C and D supplementation in acute myeloid leukemia
Authors: Mouchel Pierre Luc , Bérard Emilie , Tavitian Suzanne , Gadaud Noémie , Vergez François , Rieu Jean Baptiste , Luquet Isabelle , Sarry Audrey , Huguet Françoise , Largeaud Laetitia , Delabesse Eric , Huynh Anne , Bertoli Sarah , Récher Christian
Published: September 2023

Recent studies have highlighted the role of vitamin C and D in acute myeloid leukemia (AML). In 2018, we changed our practices to add both vitamins to the supportive care for all consecutive patients with AML undergoing intensive chemotherapy. In this study, we compared the outcomes of patients treated before and after this change in practice. From 2015 to 2020, 431 patients were included, 262 of whom received no supplementation and 169 of whom received vitamin supplementation. Vitamin C and vitamin D was administered from day 10 of chemotherapy until hematologic recovery from induction and consolidation. Most patients presented at diagnosis with low levels of vitamin C and D. Upon recovery from induction, vitamin D levels among the vitamin C/D group significantly increased compared with those at diagnosis, and pretransplant levels were significantly higher in the vitamin C/D group compared with the control group (median of 33 vs 19 ng/mL; P < .0001). During induction, the rates of bacterial or fungal infection, hemorrhage, or macrophage activation syndrome were lower in the vitamin C/D group, whereas there was no difference in response rate, relapse incidence, and overall survival (OS). However, the multivariate analysis for OS showed a significant interaction between vitamin C/D and NPM1 mutation, meaning that vitamin C/D supplementation was significantly and independently associated with better OS in patients with NPM1 mutations (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.30-0.90; P = .019) compared with patients with wild-type NPM1 (HR, 1.01; 95% CI, 0.68-1.51; P = .95). In conclusion, vitamin C/D supplementation is safe and could influence the outcomes of patients with AML undergoing intensive chemotherapy.
Representations of urban cycling in sustainability transitions research: a review
Authors: Valentini Daniel , Wangel Josefin , Holmgren Sara
Published: September 2023

Background

Increased cycling is generally recognized as a highly important project in decarbonizing urban transport. Despite well-researched and broadly accepted benefits of cycling, bicycle mobility plays only a marginal role in the modal share for most cities.

Purpose

To make sense of this paradox, this review article investigates how cycling research engages with the governance of cycling. The review focuses on how cycling mobility is envisioned, approached and described within the change-oriented field of sustainability transitions research.

Findings

Through a systematic reading of 25 peer reviewed scientific journal articles, we find that the articles mainly focus on technological objects of change (e-bikes and bikesharing systems); incumbent actors; and established planning and policy measures applied to new contexts. Most studies are evaluative, lacking the forward-looking and change oriented ambition transitions research set out to address. To contribute to increased cycling mobility in urban contexts, we conclude that future cycling research might benefit from adopting more diverse and clear notions of governance objects, actors and measures.
IHCP: interpretable hepatitis C prediction system based on black-box machine learning models
Authors: Fan Yongxian , Lu Xiqian , Sun Guicong
Published: September 2023

Background

Hepatitis C is a prevalent disease that poses a high risk to the human liver. Early diagnosis of hepatitis C is crucial for treatment and prognosis. Therefore, developing an effective medical decision system is essential. In recent years, many computational methods have been proposed to identify hepatitis C patients. Although existing hepatitis prediction models have achieved good results in terms of accuracy, most of them are black-box models and cannot gain the trust of doctors and patients in clinical practice. As a result, this study aims to use various Machine Learning (ML) models to predict whether a patient has hepatitis C, while also using explainable models to elucidate the prediction process of the ML models, thus making the prediction process more transparent.

Result

We conducted a study on the prediction of hepatitis C based on serological testing and provided comprehensive explanations for the prediction process. Throughout the experiment, we modeled the benchmark dataset, and evaluated model performance using fivefold cross-validation and independent testing experiments. After evaluating three types of black-box machine learning models, Random Forest (RF), Support Vector Machine (SVM), and AdaBoost, we adopted Bayesian-optimized RF as the classification algorithm. In terms of model interpretation, in addition to using common SHapley Additive exPlanations (SHAP) to provide global explanations for the model, we also utilized the Local Interpretable Model-Agnostic Explanations with stability (LIME_stabilitly) to provide local explanations for the model.

Conclusion

Both the fivefold cross-validation and independent testing show that our proposed method significantly outperforms the state-of-the-art method. IHCP maintains excellent model interpretability while obtaining excellent predictive performance. This helps uncover potential predictive patterns of the model and enables clinicians to better understand the model's decision-making process.
Genomic analysis of Colletotrichum camelliae responsible for tea brown blight disease
Authors: Kong Linghong , Chen Jiao , Dong Kaili , Shafik Karim , Xu Wenxing
Published: September 2023

Background

Colletotrichum camelliae, one of the most important phytopathogenic fungi infecting tea plants (Camellia sinensis), causes brown blight disease resulting in significant economic losses in yield of some sensitive cultivated tea varieties. To better understand its phytopathogenic mechanism, the genetic information is worth being resolved.

Results

Here, a high-quality genomic sequence of C. camelliae (strain LT-3-1) was sequenced using PacBio RSII sequencing platform, one of the most advanced Three-generation sequencing platforms and assembled. The result showed that the fungal genomic sequence is 67.74 Mb in size (with the N50 contig 5.6 Mb in size) containing 14,849 putative genes, of which about 95.27% were annotated. The data revealed a large class of genomic clusters potentially related to fungal pathogenicity. Based on the Pathogen Host Interactions database, a total of 1698 genes (11.44% of the total ones) were annotated, containing 541 genes related to plant cell wall hydrolases which is remarkably higher than those of most species of Colletotrichum and others considered to be hemibiotrophic and necrotrophic fungi. It’s likely that the increase in cell wall-degrading enzymes reflects a crucial adaptive characteristic for infecting tea plants.

Conclusion

Considering that C. camelliae has a specific host range and unique morphological and biological traits that distinguish it from other species of the genus Colletotrichum, characterization of the fungal genome will improve our understanding of the fungus and its phytopathogenic mechanism as well.
Determinants of access to general practice in a shared care model for people living with HIV: a qualitive study of patients’ perspectives in an Australian rural community
Authors: Cunningham Juliet , Bailie Jodie , Warner Sherridan , Condon Ashleigh , Cheung Daniel , Minc Ariane , Herbert Simone , Edmiston Natalie
Published: September 2023

Background

Improved management of human immunodeficiency virus (HIV) has resulted in improved life expectancy for people living with HIV and an ageing population with a significant comorbidity burden. Shared care models, involving the co-ordinated liaison between general practitioners and specialist physicians, have been advocated for in Australia to provide comprehensive care. People living with HIV in rural areas have reduced access to general practice and therefore shared care. This study explores the perspectives of people living with HIV on the barriers and enablers to accessing shared care in an Australian rural setting.

Methods

In this qualitative study, semi-structured interviews were conducted with adults living with HIV who either resided in or accessed care in a rural area of Australia. Interviews were conducted via video conferencing, phone or face-to-face. Transcripts were imported into NVivo, coded and analysed in alignment with a conceptual framework of healthcare access defined by Levesque and colleagues.

Results

Thirteen interviews were conducted in total. Participants’ narratives demonstrated the substantial influence of accessibility to general practice on their ability to engage in effective shared care. Challenges included the perception that general practitioners would not provide additive value to participants’ care, which restricted the ability to both seek and engage in the shared care model. Healthcare beliefs, expectations and experiences with stigma led participants to prioritise the perceived interpersonal qualities of specialist care above a shared care system. Access to shared care was facilitated by continuity of care in general practice but logistical factors such as affordability, transport and availability impacted the ability to access regular high-quality healthcare.

Conclusions

Navigating patient priorities and anticipated stigma in general practice within the resource limitations of rural healthcare were barriers to effective shared care. General practitioners’ ability to build rapport and long-term relationships with participants was instrumental in the perception of valuable care. Strategies are required to secure continuity of care with interpersonally skilled general practitioners to ensure provision of quality primary care for people living with HIV, which can be supported by specialist physicians in a shared care model.
Multicentre prospective study to evaluate effectiveness and safety of gel-forming and hyaluronic-acid containing chewable tablets as add-on treatment in patients with gastroesophageal reflux disease (GERD) symptoms and unsatisfying proton pump inhibitor therapy
Authors: Gross Manfred , Neuschwander Dennis , Steffens Lisa , Thomsen Jörn , Röschmann-Doose Kristina
Published: September 2023

Background

Gastroesophageal reflux disease (GERD) is a common disease which in the majority of patients is treated with proton pump inhibitors (PPI). However, up to 45% of the patients remain symptomatic on a standard dose of PPI. This study investigated the effectiveness and safety of an add-on therapy with the gel-forming chewable tablet Sobrade® in patients unsatisfied with PPI treatment. The bioadhesive gel covers the oesophagus and thereby protects the mucosa from reflux events.

Methods

47 patients with symptomatic GERD despite PPI treatment participated in this study. The gel-forming tablets were taken up to four times daily after meals and prior to bedtime. Severity and frequency of GERD symptoms were evaluated during two onsite visits prior and following 14 days of treatment and used to calculate the GERD score of the Reflux Disease Questionnaire. Furthermore, patients recorded symptoms as well as onset and duration of symptoms relief daily in their electronic dairies. Effectiveness of treatment was analysed using non-parametric paired Wilcoxon test. In addition, anchor-based minimal important differences (MID) were assessed.

Results

Treatment resulted in significant reduction of GERD symptoms. Severity and frequency of 8 of the 9 assessed symptoms improved significantly during the treatment phase whereby most pronounced improvement was observed for heartburn. In agreement, all three subscales of the GERD score improved significantly. MID results suggest that patients considered a mean improvement of symptoms > 30% of initial severity as beneficial. Self-assessments by patients revealed first significant improvements of symptoms like heartburn and regurgitation from day 5 of treatment onwards. 49% of patients reported relief of symptoms within 15 min which lasted on average for 3.5 h. During the study no treatment emergent adverse events were reported and in 98% of all cases tolerability of the product was rated as very good or good.

Conclusions

This study revealed a pronounced improvement of the symptoms after add-on treatment with the gel-forming medical device. The very good safety and tolerability profile indicate an advantageous risk-benefit ratio.

Trial registration

This non-interventional study was prospectively positively evaluated by the responsible ethic-committees.
Nationwide clinico-epidemiological treatment analysis of adult patients with tumors of cerebellopontine angle and internal acoustic meatus in Poland during 2011–2020
Authors: Żurek Michał , Wojciechowski Tomasz , Niemczyk Kazimierz
Published: September 2023

Objective

The aim of this study is to report the epidemiologic characteristics of tumors of the cerebellopontine angle (CPAT) and internal acoustic meatus in adult Polish population throughout the second decade of XXI century and to analyze their treatment.

Material and methods

A retrospective analysis of patients with cerebellopontine angle (CPA) and internal acoustic meatus tumors diagnosed in Poland in 2011–2020 was performed. Data recorded in the National Health Fund (NHF) database were analyzed. International Classification of Diseases codes (ICD-9 and ICD-10) were used to identify study group patients and treatment procedures.

Results

From 2011 to 2020 6,173 Polish adult patients were diagnosed with cerebellopontine angle and internal acoustic meatus tumors. The average incidence in Poland is 1.99 per 100,000 residents/year. It mostly affects women (61.64%), and the average age of patients is 53.78 years. The incidence has steadily increased over the past decade. Treatment has changed significantly over the years, with a definite increase in the number of patients treated with radiotherapy (from 0.54 to 19.34%), and a decrease in surgical therapies (from 41.67 to 6.8%). The most common symptoms were vertigo and/or dizziness (43.48%) and sensorineural hearing loss (39.58%). 4.65% of patients suffered from sudden deafness, in this group of patients the risk of CPAT detection was the highest (6.25 / 1000 patients).

Conclusions

The total incidence of CPAT and demographic characteristics of patients were comparable to other studies. Our study demonstrated the increased number of patients are being treated with radiotherapy and fewer with microsurgery. Sudden sensorineural hearing loss (SSNHL) is an uncommon manifestation of CPAT but proper diagnosis should be undertaken because the risk of diagnosis such tumors is greater in this group.