bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of the Ankle-GO Score for Discriminating and Predicting Return-to-Sport Outcomes After Lateral Ankle Sprain
Authors: Picot Brice , Lopes Ronny , Rauline Gauthier , Fourchet François , Hardy Alexandre
Published: July 2023

Background:

Lateral ankle sprain (LAS) is the most common sports-related injury. However, there are currently no published evidence-based criteria to guide the patient’s return to sport (RTS) and this decision is generally time-based. The aim of this study was to assess the psychometric properties of a new score (Ankle-GO) and its predictive ability for RTS at the same level of play after LAS.

Hypothesis:

The Ankle-GO is robust for discriminating and predicting RTS outcomes.

Study Design:

Prospective diagnostic study

Level of Evidence:

Level 2.

Methods:

The Ankle-GO was administered to 30 healthy participants and 64 patients at 2 and 4 months after LAS. The score was calculated as the sum of 6 tests for a maximum of 25 points. Construct validity, internal consistency, discriminant validity, and test-retest reliability were used to validate the score. The predictive value for the RTS was also validated based on the receiver operating characteristic (ROC) curve.

Results:

The internal consistency of the score was good (Cronbach’s alpha coefficient of 0.79) with no ceiling or floor effect. Test-retest reliability was excellent (intraclass coefficient correlation = 0.99) with a minimum detectable change of 1.2 points. The 2-month scores were significantly lower than 4-month and control group scores (7.7 ± 4, 13.9 ± 4.6, and 19.6 ± 3.4 points, respectively, P < 0.01). Ankle-GO values were also significantly higher in patients who returned to their preinjury level at 4 months compared with those who did not ( P < 0.01). The predictive value of the 2-month Ankle-GO score was fair for a RTS at the same or higher than preinjury level at 4 months (area under ROC curve, 0.77; 95% CI, 0.65-0.89; P < 0.01).

Conclusion:

The Ankle-GO appears to be a valid and robust score for clinicians to predict and discriminate RTS in patients after LAS.

Clinical Relevance:

Ankle-GO is the first objective score to help in the decision-making of the RTS after LAS. At 2 months, patients with an Ankle-GO score <8 points are unlikely to RTS at the same preinjury level.
Sheba.xyz: Codifying household service solutions using a digital platform
Authors: Ahmed Jashim U , Talukder Md. Shamim , Talukdar Amreen , Ahmed Asma , Rifat Afrin
Published: July 2023

The service industry is polarizing e-commerce in Bangladesh across multiple sectors. Sheba.xyz is a marketplace for household services linking customers with verified on-demand professional service providers. By integrating technology and service experts, the platform has transformed the service industry, paving the way for other service provider markets to also adopt virtual strategies. This is probably because online platforms, like Sheba.xyz, have a sustainable future—commercially speaking—in this domain. Furthermore, the notion of an industry’s lifecycle has become outdated as innovations can be frequently made in a virtual form. This case provides an overview of Sheba.xyz, along with its current challenges and its future opportunities.
Changing times and subjective well-being in urban China 2003–2013: An age-period-cohort approach
Authors: Shu Xiaoling , Chen Jingjing , Zhu Yifei
Published: July 2023

This paper analyzes the intersection of individual lives and historical context by examining how cohort membership, historical conditions, and individual maturation influence subjective well-being in urban China. We use cross-classified multilevel models and repeated measures of happiness from seven waves of the Chinese General Social Survey (CGSS 2003–2013, N  =  43,308). The results indicate that individuals born between 1956 and 1961 experienced setbacks at various pivotal moments throughout their life, including education, employment, economic stability, and social connections, and this cohort reports a lower overall sense of happiness when compared to other cohorts. The effect of aging on happiness comprises a U-shaped pattern; the middle-aged are the least happy. We observe an upward trend in happiness from 2003 to 2013. These results are confirmed by using subjective socioeconomic status (SES) as an alternative measure of well-being from CGSS 2003 and CGSS 2005 (N  =  11,992). This paper contributes to studies of market transition by identifying the birth cohort as an important mechanism of inequality. It also augments the life-course paradigm by highlighting the significance of timing when individual lives intersect with historical context.
“We are snowflakes”: Minor transnationalism and the cultural resilience of slash fanfiction community in China
Authors: Xiao Fan
Published: July 2023

This article examines the cultural resilience of the Chinese slash fanfiction subculture. Popular among Chinese youth, the writing and reading of slash are subjected to increasingly stringent regulations due to changes in the political environment. Drawing from the theoretical framework of minor transnationalism, the current study situates the development of the Chinese slash community in the context of post-socialist reform and globalization, arguing that slash fanfiction is a form of non-institutional, border-crossing cultural practice that challenges orthodox heteronormativity in nationalistic discourses. Foregrounding the double-edge-sword role of digital platforms, this article dissects the cultural resilience of the Chinese slash community—manifested as various strategies in keeping the viability of their cultural practices, including cultural enclosure, border-crossing platform-switching, and social media activism. This article contributes to the study of subcultures by bringing a transnational perspective that focuses on continuous, resilient cultural practices in negotiations of alternative cultural and political agendas. Methodologically, it also contributes to social media ethnographic research by testing out a comprehensive toolkit that combines close reading with computational text-mining and visual network analysis in the analysis of multimodal social media discourses.
A Mixed-Methods Study of Race-Based Stress and Trauma Affecting Asian Americans During COVID
Authors: Yang Joyce P. , Do Quyen A. , Nhan Emily R. , Chen Jessica A.
Published: July 2023

COVID-19 propelled anti-Asian racism around the world; although empirical research has yet to examine the phenomenology of racial trauma affecting Asian communities. In our mixed-methods study of 215 Asian participants of 15 ethnicities, we examined experiences of racism during COVID and resulting psychological sequelae. Through qualitative content analysis, themes emerged of emotional, cognitive, and behavioral changes resulting from these racialized perpetrations, including internalizing emotions of fear, sadness, and shame; negative alterations in cognitions, such as reduced trust and self-worth; and behavioral isolation, avoidance, and hypervigilance, in addition to positive coping actions of commitment to racial equity initiatives. We engaged in data triangulation with quantitative Mann-Whitney U tests and found that individuals who experienced COVID discrimination had significantly higher racial trauma and posttraumatic stress disorder scores compared with individuals who did not. Our convergent findings provide clinicians with novel ways to assess the ongoing impact of racial trauma and implement appropriate interventions for clients.
A Prospective Clinical Trial Evaluating the Efficacy and Safety of Non-Animal Stabilized Hyaluronic Acid Injections for Non-Surgical Rhinoplasty
Authors: Nikolis Andreas , Enright Kaitlyn M , Nguyen Quynh , Sinno Hani H. , Cotofana Sebastian
Published: July 2023

Background: Non-surgical rhinoplasty with hyaluronic acid (HA) filler is a three-dimensional reshaping technique that achieves tissue enhancement by placing HA deep to nasal skin. Due to its unique rheology, Restylane® Lyft (HA-L, Galderma, Uppsala, Sweden) may be particularly well-suited for injection rhinoplasty, as it has high gel firmness (G’) for strong structural support with minimal integration propensity. Methods: A prospective clinical trial was conducted to evaluate HA-L use for non-surgical rhinoplasty. Thirty-three females were observed over eight months, using the following schedule: Visit 1 = Baseline/Treatment 1; Visit 2 = Optional touch up (Week 2); Visits 3–6 = Follow-ups (Months 1,3,6,8). The primary endpoint was subject improvement at Month 1 assessed by a blinded evaluator using the Global Aesthetic Improvement Scale (GAIS). Subject satisfaction and adverse events (AEs) were also evaluated. Results: A deep, periosteal injection using a bolus technique and 0.34 cc of HA-L was most often used. Seven cases of positive aspiration occurred in 167 injection points (4.19%), among 6/33 (18.18%) subjects. Based on the GAIS, 100% of subjects met the primary endpoint. Subject satisfaction was maximal at Month 1 (100%) and largely maintained at Month 8 (78.57%). Besides expected injection-related AEs (eg, ecchymosis, erythema), immediate AEs during/following treatment were limited to presyncopal symptoms [5/33 subjects (15.15%)]. Importantly, no cases of ischemia were observed. Subject-reported AEs (eg, swelling, erythema, pain) dissipated within 2 to 7 days. Conclusion: Given the technical nature of this technique, HA-L may be well-suited for injection rhinoplasty, due to its strong safety and efficacy profile. Level of Evidence: Level III: Evidence obtained from well-designed cohort study.
Characteristics of Team Physicians in the National Football League: The Road to Success and a Call for Diversity
Authors: Gillikin Tyler B. , Lanzetta Nicholas J. , Swiatek Peter R. , Gerlach Erik B. , Terry Michael A. , Tjong Vehniah K.
Published: July 2023

Background:

The role of team physician (TP) in professional sports is a highly coveted position within sports medicine. There is currently limited research on the demographic characteristics of TPs within the National Football League (NFL).

Purpose:

To identify demographic characteristics and educational backgrounds of NFL head TPs (HTPs) and assistant TPs (ATPs).

Study Design:

Cross-sectional study.

Methods:

A list of TPs was identified through the National Football League Physicians Society (NFLPS). Variables investigated include age, gender, race, medical specialty, location and year of residency and fellowship training, leadership among medical societies and editorial boards, academic rank, and personal Scopus Hirsch index (h-index). Linear regression was performed to determine correlation, and t tests were used to assess differences in the h-index.

Results:

Of the 170 TPs, 21.2% were HTPs and 78.8% were ATPs. TPs were 97.6% male, 91.2% were non-Hispanic White, and 60% had attained an academic rank. The mean ages of the HTPs and ATPs were a 56.2 ± 9.6 and 52.6 ± 9.6 years, respectively ( P = .047). Among orthopaedic surgeons, the most common subspecialties were sports medicine (70.5%), foot and ankle (7.6%), and spine (5.7%). Of the TPs, 48.2% and 32.9% worked for a team in the same state in which they graduated residency and fellowship, respectively. HTPs and ATPs had been in the NFLPS for a mean of 16.9 ± 10.8 and 8.8 ± 8.3 years, respectively ( P < .001). Further, TPs holding an academic rank had a mean h-index of 14.0 ± 19.3, while those without an academic rank had a mean h-index of 6.2 ± 8.8 ( P < .01). HTPs and ATPs had mean h-indices of 15.7 ± 15.9 and 9.6 ± 16.3 ( P = .0503), respectively.

Conclusion:

TPs in the NFL are typically White men in their mid-50s who have trained at specific high-ranking institutions and obtained a fellowship in sports medicine. HTPs were likely to be older with longer tenures within the NFLPS and with more impactful research than their ATP counterparts.
Vaccine Hesitancy and Factors Related to Vaccine Hesitancy in COVID-19 Vaccination among a Tribal Community of Meghalaya: A Mixed Methods Study
Authors: Sundaram Shanthosh P , Devi Ningombam J , Lyngdoh Markordor , Medhi Gajendra K , Lynrah Wallambok
Published: July 2023

Vaccine hesitancy should be dealt as an important issue as it carries both individual- and community-level risks; however, it lacks proper assessment in particular among the indigenous tribal population. A community-based sequential explanatory mixed methods study was conducted among 238 eligible individuals in Ri-Bhoi district, Meghalaya. The quantitative part involved a cross-sectional study to determine the proportion of vaccine hesitancy and the qualitative part comprised in-depth interviews among the eligible residents and key informant interviews among the health workers providing the vaccination services, to explore the facilitators and barriers of vaccine uptake. A total of 113 [47.5% (95% confidence interval [CI]: 41.0%-54.0%)] participants were found to be hesitant to vaccination, among which 16.8% (95% CI: 12.4%-22.3%) were initially hesitant and 30.7% (95% CI: 24.9%-37.0%) had vaccine refusal. The themes generated through qualitative interviews were individual-related, disease-related, vaccine-related, healthcare system and provider related and socio-cultural and religious. The main barriers for the likelihood of action were perceived susceptibility and perceived severity under the individual perception along with ambiguity aversion, scepticism about the efficacy, mistrust, concerns on side effects, rumors, and socio-cultural and religious misbeliefs. Vaccine hesitancy is found to be considerably higher and it depends on complacency toward the vaccine, confidence in its safety, perceived susceptibility to the disease and perceived severity to the disease coupled with modifying factors for cues for action. Healthcare workers should better communicate to improve the uptake of vaccines by reducing the barriers to the vaccine acceptance.
Mediating Effects of Copying Style on the Relationship between Parenting Style and Adversity Quotient of Nursing Students
Authors: Liu Ming , Wang Xin
Published: July 2023

Background

Nursing is known as a stressful job; nursing students as the future workforce particularly require the adversity quotient (AQ) in order to successfully overcome difficulties and setbacks encountered amid their studies and in their future workplaces.

Aim

To explore the relationship among parenting style, coping styles, and AQ, and investigate the mediating effects of coping style on the relationship between parenting style and AQ among nursing students.

Methods

The study employed a cross-sectional and correlational design. A convenience sampling method was used to recruit nursing students (n = 158 valid) from a higher education institute in Macao SAR. Four measuring instruments were used, including (1) The Demographic Information Form, (2) The Adversity Quotient Scale, (3) The Simplified Coping Style Questionnaire, and (4) The Chinese Version of the Parental Styles Scale.

Results

The associations only existed between negative mother-parenting styles, negative coping styles and AQ, passive mother-parenting styles and passive copying ( r = -0.166, 0.276, 0.266, 0.232, 0.229, 0.186, 0.207, P < 0.05); there is no statistically significant correlation between father parenting style and the score of AQ, negative coping style, and positive coping style at all. The obtained model fitting index: χ2/df = 1.191, RMSEA = 0.035, SRMR = 0.0305, TLI = 0.991, CFI = 0.997, indicating that the fitting indices of the model are all within the acceptable range, and there is a significant mediating effect of coping styles on the relationship between mother parenting styles and AQ of Macao nursing students.

Conclusions

Coping styles play an important role in mediating the relationship between parenting styles, particularly, mothering styles and AQ of Macao nursing students. Special attention should be paid to cultivating students’ positive coping strategies in order to mediate the negative mothering styles and to enhance their AQ for better adapting to the challenges faced by them in school and in future working places and social environments.
Timing of Hepatitis B Vaccine Birth Dose in Exposed Newborns, Southwest Ethiopia: A Cross-Sectional Study
Authors: Demissie Mebratu , Weldekidan Haregwa Asnake , Yosef Yirgalem , Sori Seboka Abebe , Tsega Daniel , Jiru Hirut Dinku , Derribow Aberash Beyene , Tetema Mesfin Difer , Jima Gudeta Beriso , Zeleke Fentahun Temene , Endeshew Fikremariam , Abeje Seblework
Published: July 2023

Introduction

Hepatitis B virus disease is a global acute and chronic communicable disease. Mother-to-child transmission is the reason for high carrier rates. Unvaccinated newborns infected through mother-to-child transmission are at >95% risk of developing chronic hepatitis B virus disease. Vaccination is the most effective measure to reduce the global incidence of hepatitis B virus disease. Despite the World Health Organization's target to achieve 90% of the hepatitis B vaccine birth dose by 2030, little is known about the vaccination status of exposed newborns.

Objective

The present study aimed to determine the timing of the hepatitis B vaccine birth dose in exposed newborns in Southwest Ethiopia.

Methods

An institution-based cross-sectional study was employed on 422 systematically selected exposed newborns from April 2, 2022, to August 28, 2022. A pretested, interviewer-administered questionnaire was used for data collection. Data were entered into Epi data 3.1 and exported into SPSS version 23 software for analysis. Both bivariable and multivariable binary logistic regressions were performed. Variables with a p-value <.05 at a 95% confidence interval (CI) were considered statistically significant.

Results

The proportion of neonates who received their first dose of the hepatitis B vaccine on time was 57 (42.5%) (95% CI: 38.3–46.1%). A higher likelihood of vaccinating their exposed newborns on time was associated with formal education (adjusted odds ratio [AOR] = 3.01, 95% CI: 2.21–7.09), four or more ANC visits (AOR = 2.33, 95% CI: 2.05–6.21), and husband engagement (AOR = 4.31, 95% CI: 2.03–6.34).

Conclusion

The proportion of timely initiation of the hepatitis B vaccine birth dose in Southwest Ethiopia was low. Thus, strengthening health education on the hepatitis B vaccine, encouraging women to have at least four ANC visits, and encouraging male involvement help improve the timely administration of the hepatitis B vaccine.
The changing dynamics of population exposure to extreme heat in the contiguous United States from 2001 to 2020
Authors: Chen Guiyu , Li Chaosu
Published: July 2023

The increasing population exposure to heat extremes in recent decades represents a formidable challenge to urban sustainability. Yet, less is known about the spatial and temporal dynamics of extreme heat events accompanied by the changing climate and the associated human exposure. In this study, we create a series of cartograms to reveal the spatial and temporal changes of population exposure to extreme heat in the contiguous United States from 2001 to 2020. Findings demonstrate a notable spatial shift in exposure from northern to southern regions over the two-decade period, with the worrying trend of prolonged extreme heat in some counties with large populations. While the majority of the population experienced fewer than 18 days of extreme heat annually, the spatial shift was accompanied by increasing population exposure to prolonged extreme heat. Results underscore the urgent need for spatially targeted climate adaptation policies to effectively mitigate the adverse impacts of heat extremes.
Queer Affirmative Approach in Mental Health: A Need of the Hour in Indian Mental Health Care
Authors: Joseph Jithin T.
Published: July 2023

The mental health needs of LGBTQIA+ individuals and the roles of mental health professionals (MHPs) in queer mental health are gaining importance in health care. Queer individuals have specific mental health needs, and the current mental health training and practice are often inadequate to handle these needs. This often leads to conflict between the queer community and MHPs, causing queer people to avoid the necessary mental health care that they need; this will lead to long-lasting consequences. The social stigma related to queer people, the mental health professional’s own cis and heteronormative assumptions, and privilege often lead to these conflicts and non-inclusive care. The queer affirmative approach is a mental health approach, which had shown effectiveness in dealing with the mental health needs of queer individuals. In this viewpoint, we will discuss about the basic concept of the queer affirmative approach, its differences with the usual mental health care, and the process involved in becoming a queer affirmative mental health professional. This will help more MHPs expand their knowledge of LGBTQIA+ mental health and provide inclusive care for queer people.
Teachers’ approaches to handling student errors in mathematics classes
Authors: Benecke Kirsten , Kaiser Gabriele
Published: July 2023

Empirical research has demonstrated that mathematical errors originate from various causes that may have different implications for the learning process. Mathematical errors are an international phenomenon as all teachers from different cultural background must handle them every day during teaching-and-learning processes. When errors arise, teachers must determine whether and how to deal with them and whether the error should be corrected. Although errors and how they are addressed by teachers are of high pedagogical importance, teachers’ approaches to handling student errors remain underexplored. The study reported herein examines the ways in which mathematics teachers handle student errors in various situations, and whether any connection between the error type and the manner in which it is corrected may be reconstructed. The study participants comprised 13 secondary mathematics teachers in a large city in northern Germany. Each teacher was video-recorded over two 90-min-lessons, and the data were subsequently evaluated using qualitative content analysis. The results indicate that teachers’ approaches to correcting mathematical student errors diverged considerably depending on the phase of the lesson during which the error occurred. In particular, during the class discussion phase, a high proportion of the corrections were performed by the students’ classmates, whereas corrections executed during the group work, partner work, or individual work phases were primarily performed by students who had made the errors and the teachers. Given that the teacher's approach to handling errors exerts a significant influence on teaching-and-learning processes, further research is required to identify the most prolific approaches to handling errors in order to foster students’ mathematical understanding.
Natural killer cells in the lung: potential role in asthma and virus-induced exacerbation?
Authors: Lepretre Florian , Gras Delphine , Chanez Pascal , Duez Catherine
Published: July 2023

Asthma is a chronic inflammatory airway disorder whose pathophysiological and immunological mechanisms are not completely understood. Asthma exacerbations are mostly driven by respiratory viral infections and characterised by worsening of symptoms. Despite current therapies, asthma exacerbations can still be life-threatening. Natural killer (NK) cells are innate lymphoid cells well known for their antiviral activity and are present in the lung as circulating and resident cells. However, their functions in asthma and its exacerbations are still unclear. In this review, we will address NK cell activation and functions, which are particularly relevant for asthma and virus-induced asthma exacerbations. Then, the role of NK cells in the lungs at homeostasis in healthy individuals will be described, as well as their functions during pulmonary viral infections, with an emphasis on those associated with asthma exacerbations. Finally, we will discuss the involvement of NK cells in asthma and virus-induced exacerbations and examine the effect of asthma treatments on NK cells.
Microbiome-metabolomics analysis reveals abatement effects of itaconic acid on odorous compound production in Arbor Acre broilers
Authors: Zhu Xin , Zhang Yinhang , Liu Haiying , Yang Guiqin , Li Lin
Published: July 2023

Background

Public complaints concerning odor emissions from intensive livestock and poultry farms continue to grow, as nauseous odorous compounds have adverse impacts on the environment and human health. Itaconic acid is a metabolite from the citric acid cycle of the host and shows volatile odor-reducing effects during animal production operations. However, the specific role of itaconic acid in decreasing intestinal odorous compound production remains unclear. A total of 360 one-day-old chicks were randomly divided into 6 treatment groups: control group (basal diet) and itaconic acid groups (basal diet + 2, 4, 6, 8 and 10 g/kg itaconic acid). The feeding experiment lasted for 42 d.

Results

Dietary itaconic acid supplementation linearly and quadratically decreased (P < 0.05) the cecal concentrations of indole and skatole but did not affect (P > 0.05) those of lactic, acetic, propionic and butyric acids. The cecal microbial shift was significant in response to 6 g/kg itaconic acid supplementation, in that the abundances of Firmicutes, Ruminococcus and Clostridium were increased (P < 0.05), while those of Bacteroidetes, Escherichia-Shigella and Bacteroides were decreased (P < 0.05), indicative of increased microbial richness and diversity. Furthermore, a total of 35 significantly (P < 0.05) modified metabolites were obtained by metabolomic analysis. Itaconic acid decreased (P < 0.05) the levels of nicotinic acid, nicotinamide, glucose-6-phosphate, fumatic acid and malic acid and increased (P < 0.05) 5-methoxytroptomine, dodecanoic acid and stearic acid, which are connected with the glycolytic pathway, citrate acid cycle and tryptophan metabolism. Correlation analysis indicated significant correlations between the altered cecal microbiota and metabolites; Firmicutes, Ruminococcus and Clostridium were shown to be negatively correlated with indole and skatole production, while Bacteroidetes, Escherichia-Shigella and Bacteroides were positively correlated with indole and skatole production.

Conclusions

Itaconic acid decreased cecal indole and skatole levels and altered the microbiome and metabolome in favor of odorous compound reduction. These findings provide new insight into the role of itaconic acid and expand its application potential in broilers.
Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula
Authors: Bime Christian , Carr Gordon E. , PU Jie , Kou Sherri , Wang Ying , Simons Michael
Published: July 2023

Background

Advanced respiratory support modalities such as non-invasive positive pressure ventilation (NiPPV) and heated and humidified high flow nasal canula (HFNC) served as useful alternatives to invasive mechanical ventilatory support for acute respiratory failure (ARF) during the peak of the SARS-CoV-2/COVID-19 pandemic. Unlike NiPPV, HFNC is a newer modality and its role in the treatment of patients with severe ARF is not yet clearly defined. Furthermore, the characteristics of responders versus non-responders to HFNC have not been determined. Although recent evidence indicates that many patients with ARF treated with HFNC survive without needing intubation, those who fail and are subsequently intubated have worse outcomes. Given that prolonged use of HFNC in patients with ARF might exacerbate patient self-inflicted lung injury, we hypothesized that among those patients with ARF due to COVID-19 pneumonia, prolonged HFNC beyond 24 h before intubation would be associated with increased in-hospital mortality.

Methods

This was a retrospective, multicenter, observational cohort study of 2720 patients treated for ARF secondary to SARS-CoV-2/COVID-19 pneumonia and initially managed with HFNC within the Banner Health system during the period from March 1st, 2020, to July 31st, 2021. In the subgroup of patients for went from HFNC to IMV, we assessed the effect of the duration of HFNC prior to intubation on mortality.

Results

1392 (51%) were successfully treated with HFNC alone and 1328 (49%) failed HFNC and were intubated (HFNC to IMV). When adjusted for the covariates, HFNC duration less than 24 h prior to intubation was significantly associated with reduced mortality.

Conclusions

Among patients with ARF due to COVID-19 pneumonia who fail HFNC, delay of intubation beyond 24 h is associated with increased mortality
Estimating medication adherence from Electronic Health Records: comparing methods for mining and processing asthma treatment prescriptions
Authors: Tibble Holly , Sheikh Aziz , Tsanas Athanasios
Published: July 2023

Background

Medication adherence is usually defined as the extent of the agreement between the medication regimen agreed to by patients with their healthcare provider and the real-world implementation. Proactive identification of those with poor adherence may be useful to identify those with poor disease control and offers the opportunity for ameliorative action. Adherence can be estimated from Electronic Health Records (EHRs) by comparing medication dispensing records to the prescribed regimen. Several methods have been developed in the literature to infer adherence from EHRs, however there is no clear consensus on what should be considered the gold standard in each use case.

Our objectives were to critically evaluate different measures of medication adherence in a large longitudinal Scottish EHR dataset. We used asthma, a chronic condition with high prevalence and high rates of non-adherence, as a case study.

Methods

Over 1.6 million asthma controllers were prescribed for our cohort of 91,334 individuals, between January 2009 and March 2017. Eight adherence measures were calculated, and different approaches to estimating the amount of medication supply available at any time were compared.

Results

Estimates from different measures of adherence varied substantially. Three of the main drivers of the differences between adherence measures were the expected duration (if taken as in accordance with the dose directions), whether there was overlapping supply between prescriptions, and whether treatment had been discontinued. However, there are also wider, study-related, factors which are crucial to consider when comparing the adherence measures.

Conclusions

We evaluated the limitations of various medication adherence measures, and highlight key considerations about the underlying data, condition, and population to guide researchers choose appropriate adherence measures. This guidance will enable researchers to make more informed decisions about the methodology they employ, ensuring that adherence is captured in the most meaningful way for their particular application needs.
Comparison of metal versus plastic stent for preoperative biliary drainage in patients with pancreatic cancer undergoing neoadjuvant therapy: a meta-analysis and systematic review
Authors: Lyu Yunxiao , Ye Shenjian , Wang Bin
Published: July 2023

Background

This study was performed to compare a metal stent (MS) and plastic stent (PS) in terms of efficacy and complications during neoadjuvant therapy (NAT) and the perioperative period.

Methods

We performed an electronic search of the following databases until 1 June 2022: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Studies comparing an MS versus PS for PBD in patients with pancreatic cancer undergoing NAT were included.

Results

The meta-analysis showed that use of an MS was associated with lower rates of reintervention (p < 0.00001), delay of NAT (p = 0.007), recurrent biliary obstruction (RBO) (p = 0.003), and cholangitis (p = 0.03). There were no significant differences between the two groups in terms of stent migration (p = 0.31), postoperative complications (p = 0.20), leakage (p = 0.90), and R0 resection (p = 0.50).

Conclusions

Use of an MS for PBD in patients with pancreatic cancer undergoing NAT followed by surgery was associated with lower rates of reintervention, delay of NAT, RBO, and cholangitis compared with use of a PS. However, the postoperative outcomes were comparable between the MS and PS. Further studies on this topic are recommended.
Herpes simplex virus dissemination with necrotizing hepatitis following Descemet membrane endothelial keratoplasty
Authors: Azeem Ahad , Baartman Brandon , Conrady Christopher D. , Meier Jeffery L. , El-Herte Rima
Published: July 2023

Background

Corneal transplants are the most common type of transplant and increasing in frequency. Donor cornea tissues are a rare source of herpes simplex virus (HSV) transmission and not routinely tested for presence of HSV. Donor graft-to-recipient transmission typically causes graft failure and anterior uveitis, and extra-ocular HSV disease has not been previously reported. We present a case of HSV transmission from donor cornea tissue that nearly cost the corneal transplant recipient his life.

Case report

An elderly immunocompetent man developed an acute illness 10 days after having donor corneal tissue implanted in a Descemet membrane endothelial keratoplasty (DMEK). He was found to have HSV necrotizing hepatitis per liver biopsy, trilineage cytopenia, rhabdomyolysis, acute kidney failure, altered mental status, early-stage hemophagocytic lymphohistiocytosis (HLH), and donor corneal tissue implant infection resulting in graft failure and anterior uveitis. HSV DNA was detected in cerebral spinal fluid, peripheral blood, explanted donor corneal tissue, and anterior chamber fluid (220 million HSV DNA copies per mL). HSV-1 seroconversion denoted a primary HSV infection, and the patient had no other risk factor for HSV acquisition. Early recognition of HSV dissemination prompting treatment with intravenous acyclovir, as well as a short course of HLH-directed therapy, resolved the systemic illness. Vision was restored to near normal by replacement of the infected corneal graft with new donor DMEK tissue in conjunction with intravitreal foscarnet treatment.

Conclusion

Awareness of the potential risk of donor cornea tissue transmitting HSV and leading to life-threatening HSV disease is paramount to early diagnosis and treatment. The role of donor cornea tissue in HSV transmission and disease merits additional attention and investigation.
Multiple intracranial enlarging dissecting aneurysms: a case report
Authors: Li Yingbin , Bai Xiaoxin , Tu Huai , Zou Zhimin , Huang Yan , Cai Jun
Published: July 2023

Background

Cases of multiple cerebral aneurysms are rare. In this case report, we describe a male patient with multiple, enlarging, and ruptured aneurysms. The two aneurysms were believed to be dissecting aneurysms.

Case description

A 47-year-old man presented with left limb paralysis. Magnetic resonance imaging revealed a cerebral infarction. Digital subtraction angiography (DSA) identified an aneurysm and occlusion in the right middle cerebral artery (MCA). The MCA aneurysm was remarkably enlarged on the eighth day after cerebral ischemia and was treated using endovascular techniques. Two weeks after the endovascular treatment, the patient experienced a severe headache and became comatose, and a subarachnoid re-hemorrhage was confirmed. The fourth DSA revealed an enlarging dissecting aneurysm in the posterior cerebral artery. The patient died without further treatment.

Conclusion

Some dissecting aneurysms rapidly enlarge and rupture.
Comparison of adverse maternal and perinatal outcomes between induction and expectant management among women with gestational diabetes mellitus at term pregnancy: a systematic review and meta-analysis
Authors: Luo Rong , Wen Wendy , Corsi Daniel J. , Fell Deshayne B. , Taljaard Monica , Wen Shi Wu , Walker Mark C.
Published: July 2023

Background

Induction at 38–40 weeks of gestation has been broadly suggested for women with gestational diabetes mellitus (GDM), yet its benefits and risks remain unclear. This study aimed to systematically review and meta-analyze existing evidence on the effect of induction at term gestation among women with GDM.

Methods

We searched MEDLINE, EMBASE, Cochrane Libraries, and Web of Science from inception to June 2021. We included randomized controlled trials (RCTs) and observational studies comparing induction with expectant management among GDM term pregnancies. Primary outcomes included caesarean section (CS) and macrosomia. All screening and extraction were conducted independently and in duplicates. Meta-analyses with random-effects models were conducted to generate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the Mantel-Haenszel method. Methodological quality was assessed independently by two reviewers using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies.

Results

Of the 4,791 citations, 11 studies were included (3 RCTs and 8 observational studies). Compared to expectant management, GDM women with induction had a significantly lower odds for macrosomia (RCTs 0.49 [0.30–0.81]); observational studies 0.64 [0.54–0.77]), but not for CS (RCTs 0.95 [0.64–1.43]); observational studies 1.03 [0.79–1.34]). Induction was associated with a lower odds of severe perineal lacerations in observational studies (0.59 [0.39–0.88]). No significant difference was observed for other maternal or neonatal morbidities, or perinatal mortality between groups.

Conclusions

For GDM women, induction may reduce the risk of macrosomia and severe perineal lacerations compared to expectant management. Further rigorous studies with large sample sizes are warranted to better inform clinical implications.
Next-generation sequencing reveals mitogenome diversity in plasma extracellular vesicles from colorectal cancer patients
Authors: Bjørnetrø Tonje , Bousquet Paula A. , Redalen Kathrine Røe , Trøseid Anne-Marie Siebke , Lüders Torben , Stang Espen , Sanabria Adriana M. , Johansen Christin , Fuglestad Anniken Jørlo , Kersten Christian , Meltzer Sebastian , Ree Anne Hansen
Published: July 2023

Background

Recent reports have demonstrated that the entire mitochondrial genome can be secreted in extracellular vesicles (EVs), but the biological attributes of this cell-free mitochondrial DNA (mtDNA) remain insufficiently understood. We used next-generation sequencing to compare plasma EV-derived mtDNA to that of whole blood (WB), peripheral blood mononuclear cells (PBMCs), and formalin-fixed paraffin-embedded (FFPE) tumor tissue from eight rectal cancer patients and WB and fresh-frozen (FF) tumor tissue from eight colon cancer patients.

Methods

Total DNA was isolated before the mtDNA was enriched by PCR with either two primer sets generating two long products or multiple primer sets (for the FFPE tumors), prior to the sequencing. mtDNA diversity was assessed as the total variant number, level of heteroplasmy (mutant mtDNA copies mixed with wild-type copies), variant distribution within the protein-coding genes, and the predicted functional effect of the variants in the different sample types. Differences between groups were compared by paired Student’s t-test or ANOVA with Dunnett’s multiple comparison tests when comparing matched samples from patients. Mann–Whitney U test was used when comparing differences between the cancer types and patient groups. Pearson correlation analysis was performed.

Results

In both cancer types, EV mtDNA presented twice as many variants and had significantly more low-level heteroplasmy than WB mtDNA. The EV mtDNA variants were clustered in the coding regions, and the proportion of EV mtDNA variants that were missense mutations (i.e., estimated to moderately affect the mitochondrial protein function) was significantly higher than in WB and tumor tissues. Nonsense mutations (i.e., estimated to highly affect the mitochondrial protein function) were only observed in the tumor tissues and EVs.

Conclusion

Taken together, plasma EV mtDNA in CRC patients exhibits a high degree of diversity.

Trial registration

ClinicalTrials.gov: NCT01816607. Registered 22 March 2013.
Characteristics and influencing factors of corneal higher-order aberrations in patients with cataract
Authors: Zhou Suowang , Chen Xu , Ortega-Usobiaga Julio , Zheng Hansong , Luo Wenjing , Tu Biyue , Wang Yong
Published: July 2023

Purpose

To observe the distribution characteristics of corneal higher-order aberrations (HOAs) in cataract patients, and analyze the relationship of HOAs with patients’ age and ocular biometric parameters.

Methods

This retrospective study reviews the patients with cataract in Wuhan Aier Eye Department from January to August 2022. Root mean square (RMS) of the total HOA (tHOA), spherical aberration (SA), coma and trefoil aberration of the anterior cornea at central 4 and 6 mm optic zone were measured by the Wavefront Aberrometer (OPD-Scan III; Nidek Inc, Tokyo, Japan). The biometric parameters including axial length (AL), keratometry (K), central corneal thickness (CCT) and lens thickness (LT) were measured by swept-source coherence laser interferometry (OA-2000; TOMEY Corp, Aichi, Japan). Subgroup analyses and multiple linear regression analyses were used to determine whether HOAs were associated with age and ocular biometric parameters.

Results

A total of 976 patients (976 eyes) were included, averagely aged 65 years. At central 4 and 6 mm optic zone, the mean RMS of tHOA were respectively 0.20 and 0.65 μm, the SA were 0.06 and 0.30 μm, the coma aberration were 0.11 and 0.35 μm, and the trefoil aberration were 0.12 and 0.30 μm. The tHOA decreased with age until 60 years and then started to increase afterwards. The tHOA, coma and trefoil aberration increased with corneal astigmatism. The tHOA, SA, and coma aberration differ among different AL groups, and emmetropes had the smallest tHOA, SA, and coma aberration.

Conclusions

With increasing age, the value of tHOA decrease first and started increasing at 60 years. The trends of corneal HOAs are consistent with corneal low-order aberrations. The values of tHOA, SA and coma aberration were the smallest in emmetropic eyes.
Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial
Authors: Caudle M. M. , Klaming R. , Fong C. , Harlé K. , Taylor C. , Spadoni A. , Bomyea J.
Published: July 2023

Background

Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care.

Methods

One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment.

Discussion

This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD.

Registry name

AAT for Alcohol Use Disorder in Veterans.

Trial registration

ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes
Authors: Frowijn Iris , Masthoff Erik , Bogaerts Stefan
Published: July 2023

Background

Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class.

Method

A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure.

Results

Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge.

Discussion

Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.