bluuebunny/crossref_metadata_2025 huggingface dataset:
Internet-delivered cognitive behavioural therapy for insomnia disorder in depressed patients treated at an outpatient clinic for mood disorders: protocol of a randomised controlled trial
Authors: Schotanus A. Y. , Dozeman E. , Ikelaar S. L. C. , van Straten A. , Beekman A. T. F. , van Nassau F. , Bosmans J. E. , van Schaik A.
Published: January 2023

Background

Major depression is a highly prevalent disorder causing severe personal distress, and high societal costs. Patients with depression often have comorbid insomnia disorder (ID) leading to even worse personal distress and worse treatment outcomes. Recent results from a non-randomised pilot study with internet-delivered Cognitive Behavioural Therapy (CBTi) for Insomnia (I-Sleep) added to regular depression care were promising regarding feasibility and initial effects on insomnia complaints and depression. However, no randomised controlled trial (RCT) has been performed yet to access the (cost-) effectiveness of I-Sleep for depression. Therefore, this protocol article presents the design of an RCT aimed to assess the (cost-) effectiveness of I-Sleep in addition to usual care for depression compared to usual care alone in depressed patients with a comorbid Insomnia Disorder (ID) treated at outpatient clinics for mood disorders. 

Methods /design

This is a multi-centre RCT with measurements at baseline and at 3, 6, 9, and 12 months of follow-up. Patients with depression and an ID are randomised to either I-Sleep treatment followed by regular depression care or to regular depression care alone. Our aim is to recruit one hundred and seventy-five patients from multiple outpatient clinics for mood disorders. The primary outcome is the change in depressive symptoms over 12 months of follow-up measured with the Patient Health Questionnaire (PHQ-9). Secondary outcomes are recovery from depression (PHQ-9), insomnia severity (Insomnia Severity Index, ISI), daily functioning (Work and Social Adjustment Scale, WSAS), general quality of life (EuroQol 5-level version, EQ-5D-5L), and societal costs (Adapted versions of the iMTA Productivity Cost Questionnaire, iPCQ and iMTA Medical Cost Questionnaire, iMCQ).

Discussion

We hypothesize that the addition of I-Sleep to usual care will result in a significant improvement in depression treatment outcomes and quality of life as well as a decrease in healthcare and societal costs compared to usual care alone. This study is the first pragmatic RCT evaluating the effectiveness and cost-effectiveness of adding CBTi to usual care for depression.

Trial registration

Netherlands Trial Register (NL8955). Registered on October 6th2020. https://trialsearch.who.int/Trial2.aspx?TrialID=NL8955
Disability digital divide: survey of accessibility of eHealth services as perceived by people with and without impairment
Authors: Pettersson Linda , Johansson Stefan , Demmelmaier Ingrid , Gustavsson Catharina
Published: January 2023

Background

Sustainable and effective eHealth requires accessibility for everyone. Little is known about how accessibility of eHealth is perceived among people with various impairments. The aim of this study was to compare use and perceived difficulty in the use of eHealth among people with and without impairment, and how different types of impairment were associated with perceived difficulty in the use of eHealth.

Methods

This study used data collected in a nationwide survey in Sweden. Snowball sampling was used to recruit participants with self-reported impairment, from June to October 2019. In February 2020, the survey was posted to people in the general population who were matched to the participants with impairment by age, gender and county of residence. Multiple logistic regression was used to analyse the use of four eHealth services, and perceived difficulty in the use of six eHealth services.

Results

In total, 1631 participants with, and 1084 participants without impairment responded to the survey. Participants with impairment reported less use and more difficulty in the use of all eHealth services as compared to participants without impairment. When comparing types of impairment, booking healthcare appointments online was least used and most avoided by participants with communication, language and calculation impairments (adjusted odds ratio (aOR) use 0.64, 95% confidence interval (95%CI) 0.49–0.83; aOR avoid 1.64, 95%CI 1.19–2.27), and intellectual impairments (aOR use 0.28, 95%CI 0.20–0.39; aOR avoid 2.88, 95%CI 1.86–4.45). The Swedish national web-portal for health information and services, 1177.se, was reported difficult to use the most among participants with communication, language and calculation impairments (aOR 2.24, 95%CI 1.50–3.36), deaf-blindness (aOR 11.24, 95%CI 3.49–36.23) and hearing impairment (aOR 2.50, 95%CI 1.17–5.35).

Conclusions

The results confirm the existence of an eHealth disability digital divide. People with impairment were not one homogeneous group, but differed in perceived difficulties in regard to eHealth. Based on a purposeful subgrouping of impairments, we showed that people with communication, language and calculation impairments, and intellectual impairments, reported least use and most difficulty in using eHealth. The findings can guide further research in creating eHealth that is accessible for all, including those with the most significant difficulties.
Clinical values of diaphragmatic movement in patients with chronic obstructive pulmonary disease
Authors: Kim Taehwa , Huh Sungchul , Chung Jae Heun , Kim Yun Seong , Yun Ra Yu , Park Onyu , Lee Seung Eun
Published: January 2023

Background

The limitation of activity due to dyspnea in chronic obstructive pulmonary disease (COPD) patients is affected by diaphragmatic dysfunction and reduced lung function. This study aimed to analyze the association between diaphragm function variables and forced expiratory volume in the first second (FEV1) and to estimate the clinical significance of diaphragm function in the correlation between COPD severity and lung function.

Methods

This prospective, single-center, cross-sectional observational study enrolled 60 COPD patients in a respiratory outpatient clinic. Data for baseline characteristics and the dyspnea scale were collected. Participants underwent a pulmonary function test (PFT), a 6-minute walk test (6MWT), and diaphragm function by ultrasonography.

Results

The right excursion at forced breathing showed the most significant correlation with FEV1 (r = 0.370, p = 0.004). The cutoff value was 6.7 cm of the right diaphragmatic excursion at forced breathing to identify the FEV1 above 50% group. In the group with a right diaphragmatic excursion at forced breathing < 6.7 cm, modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire and the total distance of 6MWT showed no difference between groups with FEV1 under and above 50% (p > 0.05). In the group with ≥ 6.7 cm, mMRC and the total distance of 6MWT showed a significant difference between FEV1 under and above 50% (p = 0.014, 456.7 ± 69.7 m vs. 513.9 ± 60.3 m, p = 0.018, respectively).

Conclusion

The right diaphragmatic forced excursion was closely related to FEV1, and analysis according to the right diaphragmatic forced excursion-based cut-off value showed a significant difference between both groups. When the diaphragm function was maintained, there was a lot of difference in the 6MWT’s factors according to the FEV1 value. Our data suggest that diaphragmatic function should be performed when interpreting PFT.
Using patient storytelling to improve medical students’ empathy in Japan: a pre-post study
Authors: Kagawa Yumi , Ishikawa Hirono , Son Daisuke , Okuhara Tsuyoshi , Okada Hiroko , Ueno Haruka , Goto Eiko , Tsunezumi Aiko , Kiuchi Takahiro
Published: January 2023

Background

Empathy for patients is now internationally accepted as one of the competencies of physicians for patient-centered medical practice and an essential component of medical education. Recently, “patient storytelling” has attracted attention in empathy education for medical students to understand patients’ experiences, feelings, and perspectives. This study aimed to quantitatively evaluate how patient storytelling enhanced undergraduate medical students’ empathy in Japan to the extent that they sustained it for six months.

Methods

Participants were 159 fourth-year undergraduate medical students in Tokyo in academic years 2018 and 2019. The questionnaire surveys were conducted three times: at the beginning of the class, immediately after the class, and six months after the class. The Japanese version of the Jefferson Scale of Empathy-Student Version was used in this study. Gender, age, and clinical orientation were also obtained through the self-reported questionnaire. We invited a male patient storyteller who was diagnosed with chronic kidney disease to the classes on “Professionalism.” The title of his storytelling was “The Power of Medical Professionals’ Words.”

Results

JSE-S scores improved significantly immediately after listening to patient storytelling. The scores remained improved six months after the class. Interest of specialty was significantly positively associated with an immediate change in JSE-S scores. However, gender had no significant association with changes in JSE-S scores either immediately or six months after education.

Conclusions

Our findings may suggest that patient storytelling would be useful to cultivate empathy among undergraduate medical students. It is to be expected that more medical schools will use patient storytelling to educate medical students in humanistic and communication education.
A landscape assessment of the use of patient reported outcome measures in research, quality improvement and clinical care across a healthcare organisation
Authors: Snowdon David A. , Srikanth Velandai , Beare Richard , Marsh Lucy , Parker Emily , Naude Kim , Andrew Nadine E.
Published: January 2023

Background

Patient reported outcome measures (PROMs) can be used by healthcare organisations to inform improvements in service delivery. However, routine collection of PROMs is difficult to achieve across an entire healthcare organisation. An understanding of the use of PROMs within an organisation can provide valuable insights on the purpose, scope and practical considerations of PROMs collection, which can inform implementation of PROMs.

Methods

We used multiple research methods to assess the use of PROMs in research projects, data registries and clinical care across a healthcare organisation from January 2014 to April 2021. The methods included an audit of ethics applications approved by the organisation’s human research ethics committee and registries which the health organisation had contributed data to; a literature review of peer-reviewed journal articles reporting on research projects conducted at the organisation; and a survey of health professionals use of PROMs in research projects, data registries and clinical care. The scope of PROMs was determined by classifying PROMs as either ‘specific’ to a particular disease and/or condition, or as a ‘generic’ measure with further classification based on the health domains they measured, using the World Health Organization International Classification Framework. Practical considerations included mode and timing of PROMs administration. Data were described using frequency and proportion.

Results

PROMs were used by 22% of research projects (n = 144/666), 68% of data registries (n = 13/19), and 76% of clinical specialties in their clinical care (n = 16/21). Disease specific PROMs were most commonly used: 83% of research projects (n = 130/144), 69% of clinical registries (n = 9/13), and 75% of clinical specialties (n = 12/16). Greater than 80% of research projects, clinical registries and clinical specialties measured health domains relating to both body impairments and participation in daily life activities. The most commonly used generic PROM was the EQ-5D (research projects n = 56/144, 39%; data registries n = 5/13, 38%; clinical specialties n = 4/16, 25%). PROMs used in clinical care were mostly paper-based (n = 47/55, 85%).

Conclusions

We have elicited information on the use of PROMs to inform a health organisation wide implementation strategy. Future work will determine clinician and patient acceptability of the EQ-5D, and co-design a system for the collection of PROMs.
Exaggerated levels of some specific TLRs, cytokines and chemokines in Japanese encephalitis infected BV2 and neuro 2A cell lines associated with worst outcome
Authors: Shukla Mukti , Garg Atul , Dhole T. N. , Chaturvedi Rachna
Published: January 2023

Japanese encephalitis (JE) disease, a viral brain fever is caused by Japanese encephalitis virus (JEV). Despite the availability of effective vaccines against this deadly infection, JE is the leading cause of epidemic viral encephalitis in children in South-east Asia. There is no treatment available for the JE disease which might be due to incomplete understanding of the pathogenesis of JE virus. The JEV infections lead to permanent neurological deficits even in those who survive from the infection. Activated microglia may play a potentially detrimental role by eliciting the expression of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) influencing the surrounding brain tissue. Microglial activation, proinflammatory cytokine release and leukocytes trafficking are associated following JEV infection in central nervous system (CNS). How the pattern recognition receptors sense the viral nucleic acid and how the microglial and neuronal cells behaves following JEV infection is still unelucidated. There is scarcity of data on the expression levels of toll like receptors (TLRs), cytokines and chemokines in JEV infection in invitro model. To explore the molecular mechanisms of JEV infection of microglial cells and neuronal cells, we studied the expression profile of TLRs, cytokines and chemokines in JEV infected microglial cell line BV2 and Neuronal cell line Neuro 2A. For the present study, we developed the mouse model of encephalitis by intracerebral (IC) injection of JE virus for virus propagation, disease progression and damage study. Our results demonstrate the exaggerated release of some specific TLRs, cytokines and chemokines in invitro cell culture of microglial and Neuro 2A cell line, which are associated with bad outcome in invivo study.
Is it possible to predict the severity of acute appendicitis? Reliability of predictive models based on easily available blood variables
Authors: Afzal Barza , Cirocchi Roberto , Dawani Aruna , Desiderio Jacopo , Di Cintio Antonio , Di Nardo Domenico , Farinacci Federico , Fung James , Gemini Alessandro , Guerci Lorenzo , Kam Sen Yin Melina , Lakunina Svetlana , Madi Lee , Mazzetti Stefano , Nadyrshine Bakhtiar , Shams Ola , Ranucci Maria Chiara , Ricci Francesco , Sharmin Afroza , Trastulli Stefano , Yasin Tanzela , Bond-Smith Giles , Tebala Giovanni D.
Published: January 2023

Introduction

Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process.

Methods

Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created.

Results

18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed.

Conclusion

Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.
Structural organization of the neuronal pathways of the superior ovarian nerve in the rat
Authors: Pastelin Cesar F. , Rivera-Castro María E. , Mirto-Aguilar Nancy , Moran Carolina
Published: January 2023

Background

In the rat, studies have shown that ovary innervation arrives via the superior ovarian nerve (SON) and the ovarian plexus nerve, which originates from the celiac plexus (CP). In the present study, we performed a neuroanatomical technique to investigate the anatomy of the SON between the ovary and the CP.

Results

We found that the SON fibers were concentrated on the lateral border of the suprarenal ganglion and projected towards, then inserted into the suspensory ligament. Then, it ran parallel to the long axis of the ligament to reach and innervate the ovaries. At this level, the SON was composed of two coiled nerve fibers, each between 10 and 15 µm in diameter. The SON was linked to three different ganglia: the suprarenal ganglia, the celiac ganglia, and the superior mesenteric ganglion.

Conclusions

The postganglionic fibers that project to the ovary via the SON emerge from the suprarenal ganglia. The trajectories on the right and left sides to each ovary are similar. The somas of ipsilateral and contralateral SON neurons are located in the prevertebral ganglia, mostly in the celiac ganglia.
Species richness of bat flies and their associations with host bats in a subtropical East Asian region
Authors: Poon Emily Shui Kei , Chen Guoling , Tsang Hiu Yu , Shek Chung Tong , Tsui Wing Chi , Zhao Huabin , Guénard Benoit , Sin Simon Yung Wa
Published: January 2023

Background

Understanding the interactions between bat flies and host bats offer us fundamental insights into the coevolutionary and ecological processes in host-parasite relationships. Here, we investigated the identities, host specificity, and patterns of host association of bat flies in a subtropical region in East Asia, which is an understudied region for bat fly research.

Methods

We used both morphological characteristics and DNA barcoding to identify the bat fly species found on 11 cavernicolous bat species from five bat families inhabiting Hong Kong. We first determined the phylogenetic relationships among bat fly species. Then, we elucidated the patterns of bat-bat fly associations and calculated the host specificity of each bat fly species. Furthermore, we assembled the mitogenomes of three bat fly species from two families (Nycteribiidae and Streblidae) to contribute to the limited bat fly genetic resources available.

Results

We examined 641 individuals of bat flies and found 20 species, of which many appeared to be new to science. Species of Nycteribiidae included fiveNycteribiaspp., threePenicillidiaspp., twoPhthiridiumspp., oneBasiliasp., and one species from a hitherto unknown genus, whereas Streblidae includedBrachytarsina amboinensis, threeRaymondiaspp., and four additionalBrachytarsinaspp. Our bat-bat fly association network shows that certain closely related bat flies within Nycteribiidae and Streblidae only parasitized host bat species that are phylogenetically more closely related. For example, congenerics ofRaymondiaonly parasitized hosts inRhinolophusandHipposideros, which are in two closely related families in Rhinolophoidea, but not other distantly related co-roosting species. A wide spectrum of host specificity of these bat fly species was also revealed, with some bat fly species being strictly monoxenous, e.g. nycteribiidNycteribiasp. A,Phthiridiumsp. A, and streblidRaymondiasp. A, while streblidB. amboinensisis polyxenous.

Conclusions

The bat fly diversity and specificity uncovered in this study have shed light on the complex bat-bat fly ecology in the region, but more bat-parasite association studies are still needed in East Asian regions like China as a huge number of unknown species likely exists. We highly recommend the use of DNA barcoding to support morphological identification to reveal accurate host-ectoparasite relationships for future studies.

Graphical Abstract
Early marriage and marital satisfaction among young married men in rural Uttar Pradesh, India
Authors: Chauhan Shekhar , Sekher T. V.
Published: January 2023

Objective

Lack of reliable and valid scales of Indian origin prompt researchers to borrow the marital satisfaction scale developed in different settings. The lack of a reliable scale to understand marital satisfaction in India prompted us to examine the marital satisfaction among young married men using ENRICH Marital Satisfaction (EMS) Scale developed in the Western context. Assessing the reliability of the EMS scale on the rural population of Lalitpur and Shrawasti, Uttar Pradesh, India; this study examines the determinants of marital satisfaction among young married men.

Results

Cronbach’s alpha coefficient of 0.936 confirms the high reliability of the EMS scale for the surveyed population in two districts of India. Men belonging to households with higher monthly income (OR- 3.33; 95% C.I. − 1.71–6.50) were more likely to be satisfied in their marriage than their counterparts. Similarly, fathers’, mothers’, and married men’s educational status were other important determinants of marital satisfaction. The study emphasizes the importance of family education as a strong predictor of marital satisfaction, and therefore policymakers may look into this aspect.
The inhomogeneous p-Laplacian equation with Neumann boundary conditions in the limit $p\to \infty $
Authors: Bungert Leon
Published: January 2023

We investigate the limiting behavior of solutions to the inhomogeneousp-Laplacian equation$-\Delta _{p} u = \mu _{p}$−Δpu=μpsubject to Neumann boundary conditions. For right-hand sides, which are arbitrary signed measures, we show that solutions converge to a Kantorovich potential associated with the geodesic Wasserstein-1 distance. In the regular case with continuous right-hand sides, we characterize the limit as viscosity solution to an infinity Laplacian / eikonal type equation.
Primary headache types in adult epilepsy patients
Authors: Schiller Katharina , Rauchenzauner Markus , Avidgor Tamir , Hannan Sana , Lorenzen Carlo , Kaml Manuela , Walser Gerald , Unterberger Iris , Filippi Vera , Broessner Gregor , Luef Gerhard
Published: January 2023

Background

Headache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs).

Methods

In this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected.

Results

Of 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028).

Conclusion

MIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.
Total auxin level in the soil–plant system as a modulating factor for the effectiveness of PGPR inocula: a review
Authors: Pantoja-Guerra Manuel , Valero-Valero Nelson , Ramírez Camilo A.
Published: January 2023

Biofertilizers are an alternative to face the sustainability problem that chemical fertilizers represent in agriculture. Among them, plant growth-promoting rhizobacteria (PGPR) is a microbial group with high potential, but lack of reproducible results from their application is a bottleneck for its use in agricultural production. Here we highlight a factor that could partially explain this inconsistency: the total auxin level in the soil–plant system. Auxin production is recognized as a main mechanism for plant growth promotion by PGPR; however, the final effect of auxins depends on a fine balance of its content, and this will be a result of all the sources of auxin compounds in the system. In addition to the auxins produced by inoculated bacteria, the plant itself produces its own hormones as part of complex physiological processes, varying in amount and sensitivity. Also, soil organic matter displays like auxin activity, causing plant responses just like those produced by added auxins. Therefore, the inoculation of an auxin-producing PGPR on plants might cause a wide variety of responses, ranging from effective growth promotion to growth restriction, depending on the total auxin content in root tissue. We think this must be considered for the practical use of bacterial biofertilizers, in order to have better and more consistent results of inoculation.

Graphical Abstract
Lightweight underwater robot developed for archaeological surveys and excavations
Authors: Hotta Shohei , Mitsui Yusuke , Suka Mizuki , Sakagami Norimitsu , Kawamura Sadao
Published: January 2023

This paper reports the development of a lightweight remotely operated vehicle that performs underwater excavation work for archaeological surveys. Discovering underwater artifacts is generally difficult because they are in high risk areas and are often covered with sediment. To discover them, divers and large remotely operated vehicles must conduct excavation work with a manipulator(s). Nevertheless, accomplishing such tasks is difficult for small and portable underwater robots without a manipulator(s). As described herein, we developed a lightweight underwater robot of 35 kg that can remove sediment from the seabed or lake bottom using its thrusters instead of a manipulator. Numerous redundant thrusters are equipped with the robot to compensate the reaction force of the thrusters for sediment removal. Eight thrusters are arranged not only for sediment removal but also for fine maneuvering. First, through preliminary experiments, we investigated the potential use of a water flow generated using a pair of small marine thrusters to remove surface sediment. Next, we described the design and development of a lightweight underwater robot with eight thrusters and high-definition cameras for archaeological surveys. Finally, we conducted field experiments to demonstrate the sediment removal performance and usefulness of the developed robot.
Utilization of waste materials as a substitute for the sand drain in clayey soil
Authors: Aparna R. P. , Bindu J.
Published: January 2023

The practice of pre-compression with sand drains is a widely accepted soil stabilization method for improving soft soil deposits. The scarcity of quality sand contributed to the substitution of a more cost-effective material. An effort was made in the present investigation to utilize waste products like quarry dust (QD), coir pith (CP), fly ash (FA), and rice husk ash (RHA) as the vertical drain in clayey soils. A sand drain (SD) has been used for comparison purposes. Kuttand Clay (KC) and Cochin marine clay (CMC) was selected for the study. Tests were conducted on conventional oedometer cells with a diameter of 6 cm and a height of 2 cm using vertical and radial consolidation models. In addition, this paper demonstrated the effect of the density of drain on radial consolidation characteristics. From the analysis, it was observed that the rate of consolidation increases with the inclusion of any drain material. The radial coefficient of consolidation using sand, quarry dust, and coir pith drain shows a higher value when comparing with the other drain material, which can be owing to their high permeability. The present study can recommend that the quarry dust and coir pith drain, or maybe the combination can be a better alternative for the sand drain.
The relationship between the orientation of the lateral decubitus position for spinal anesthesia and positioning pain in patients with a femoral neck fracture: randomized non-inferiority trial
Authors: Yoshida Keisuke , Hareyama Itaru , Noji Yoshie , Tanaka Shiori , Watanabe Kazuhiro , Inoue Satoki
Published: January 2023

Background

To date, no clinical studies have investigated the relationship between positioning pain and orientation of the lateral decubitus position for hip fracture surgery. The aim of the present study was to test the hypothesis that performing spinal anesthesia in the lateral decubitus position with the fracture side up or down does not affect positioning pain in patients with a femoral neck fracture.

Methods

This single-center, prospective, randomized non-inferiority trial examined 78 patients who received surgery for a femoral neck fracture under spinal anesthesia. By performing spinal anesthesia in the left lateral decubitus position in all patients, the positioning of the fracture up or down was randomized. Pain score during spinal anesthesia was evaluated objectively (0, calm; 1, facial grimacing; 2, moaning; 3, screaming; or 4, unable to proceed because of restlessness or agitation).

Results

The data from 66 patients (fracture side down [n = 35] and up [n = 31]) were analyzed. There were no significant differences between the fracture side down and fracture side up groups regarding the percentage of patients who were assessed to have intense pain (score ≥ 3) when changing position from the supine to lateral position (13/35 [37%] vs 12/31 [39%]; 95% confidence interval [95% CI] for the difference of the percentage of patients of intense pain between the groups − 25.0 to 2.2; p = 1.000).

Conclusions

There were no significant differences in the percentage of patients experiencing severe pain between the two groups. The 95% CI exceeded the preliminarily set a margin of inferiority of 20%; thus, the present study could not demonstrate the non-inferiority of the fractured side down group in terms of pain score.
Leading co-production in five UK collaborative research partnerships (2008–2018): responses to four tensions from senior leaders using auto-ethnography
Authors: van der Graaf Peter , Kislov Roman , Smith Helen , Langley Joe , Hamer Natalie , Cheetham Mandy , Wolstenholme Daniel , Cooke Jo , Mawson Sue
Published: January 2023

Background

Despite growing enthusiasm for co-production in healthcare services and research, research on co-production practices is lacking. Multiple frameworks, guidelines and principles are available but little empirical research is conducted on ‘how to do’ co-production of research to improve healthcare services. This paper brings together insights from UK-based collaborative research partnerships on leading co-production. Its aim is to inform practical guidance for new partnerships planning to facilitate the co-production of applied health research in the future.

Methods

Using an auto-ethnographic approach, experiential evidence was elicited through collective sense making from recorded conversations between the research team and senior leaders of five UK-based collaborative research partnerships. This approach applies a cultural analysis and interpretation of the leaders’ behaviours, thoughts and experiences of co-production taking place in 2008–2018 and involving academics, health practitioners, policy makers and representatives of third sector organisations.

Results

The findings highlight a variety of practices across CLAHRCs, whereby the intersection between the senior leaders’ vision and local organisational context in which co-production occurs largely determines the nature of co-production process and outcomes. We identified four tensions in doing co-production: (1) idealistic, tokenistic vs realistic narratives, (2) power differences and (lack of) reciprocity, (3) excluding vs including language and communication, (4) individual motivation vs structural issues.

Conclusions

The tensions were productive in helping collaborative research partnerships to tailor co-production practices to their local needs and opportunities. Resulting variation in co-production practices across partnerships can therefore be seen as highly advantageous creative adaptation, which makes us question the utility of seeking a unified ‘gold standard’ of co-production. Strategic leadership is an important starting point for finding context-tailored solutions; however, development of more distributed forms of leadership over time is needed to facilitate co-production practices between partners. Facilitating structures for co-production can enable power sharing and boost capacity and capability building, resulting in more inclusive language and communication and, ultimately, more credible practices of co-production in research. We provide recommendations for creating more realistic narratives around co-production and facilitating power sharing between partners.
Extraction and concentration of nanoplastic particles from aqueous suspensions using functionalized magnetic nanoparticles and a magnetic flow cell
Authors: Surette Mark C. , Mitrano Denise M. , Rogers Kim R.
Published: January 2023

Although a considerable knowledge base exists for environmental contamination from nanoscale and colloidal particles, significant knowledge gaps exist regarding the sources, transport, distribution, and effects of microplastic pollution (plastic particles < 5 mm) in the environment. Even less is known regarding nanoplastic pollution (generally considered to be plastic particles < 1 μm). Due to their small size, nanoplastics pose unique challenges and potential risks. We herein report a technique focused on the concentration and measurement of nanoplastics in aqueous systems. Hydrophobically functionalized magnetic nanoparticles (HDTMS-FeNPs) were used as part of a method to separate and concentrate nanoplastics from environmentally relevant matrices, here using metal-doped polystyrene nanoplastics (PAN-Pd@NPs) to enable low-level detection and validation of the separation technique. Using a magnetic separation flow cell, PAN-Pd@NPs were removed from suspensions and captured on regenerated cellulose membranes. Depending on the complexity of solution chemistry, variable extraction rates were possible. PAN-Pd@NPs were recovered from ultrapure water, synthetic freshwater, synthetic freshwater with a model natural organic matter isolate (NOM; Suwannee River Humic Acid), and from synthetic marine water, with recoveries for PAN-Pd@NPs of 84.9%, 78.9%, 70.4%, and 56.1%, respectively. During the initial method testing, it was found that the addition of NaCl was needed in the ultrapure water, synthetic freshwater and synthetic fresh water with NOM to induce particle aggregation and attachment. These results indicate that magnetic nanoparticles in combination with a flow-through system is a promising technique to extract nanoplastics from aqueous suspensions with various compositions.
Anesthetic Implications of Previously Undiagnosed Temporomandibular Joint Ankylosis: A Case Report
Authors: Thepmankorn Parisorn , Sufian Mahir A. , Singer Omar , Gupta Somdatta , Grech Dennis , Ballesteros Tomas , Shah Shridevi Pandya
Published: January 2023

Temporomandibular joint (TMJ) ankylosis is characterized by bony fusion that limits TMJ mobility. We present the case of an elderly woman who was brought to the operating room for dental rehabilitation under general anesthesia. The patient had an undiagnosed TMJ ankylosis, which was discovered only after induction of anesthesia due to her nonverbal status and advanced dementia. The surgical team canceled the case due to limited access to the surgical field. We discuss the factors that suggest TMJ ankylosis and propose the perioperative management when TMJ ankylosis is suspected but unconfirmed.
Management of Hemorrhage During Cesarean Delivery in a Patient With Vascular Ehlers-Danlos Syndrome: A Case Report
Authors: Grant Orna , Mulligan Karen , Donnelly Jennifer , Ní Áinle Fionnuala , Mhuircheartaigh Róisín Ní
Published: January 2023

Parturients with vascular Ehlers-Danlos syndrome are at particular risk of hemorrhage, and there is little evidence to guide prevention or management of hemorrhage in these patients. We present the case of a patient with vascular Ehlers-Danlos syndrome who had a cesarean delivery complicated by an intraoperative hemorrhage. Administration of desmopressin and tranexamic acid appeared to be of marked benefit in achieving hemostasis. To the best of our knowledge, this is the first report of the use of desmopressin during major obstetric hemorrhage in vascular Ehlers-Danlos syndrome.
Parallel repair mechanisms in plants and animals
Authors: Byatt Timothy C. , Martin Paul
Published: January 2023

All organisms have acquired mechanisms for repairing themselves after accidents or lucky escape from predators, but how analogous are these mechanisms across phyla? Plants and animals are distant relatives in the tree of life, but both need to be able to efficiently repair themselves, or they will perish. Both have an outer epidermal barrier layer and a circulatory system that they must protect from infection. However, plant cells are immotile with rigid cell walls, so they cannot raise an animal-like immune response or move away from the insult, as animals can. Here, we discuss the parallel strategies and signalling pathways used by plants and animals to heal their tissues, as well as key differences. A more comprehensive understanding of these parallels and differences could highlight potential avenues to enhance healing of patients’ wounds in the clinic and, in a reciprocal way, for developing novel alternatives to agricultural pesticides.
Enabling or Limiting Cognitive Flexibility? Evidence of Demand for Moral Commitment
Authors: Saccardo Silvia , Serra-Garcia Marta
Published: January 2023

Moral behavior is more prevalent when individuals cannot easily distort their beliefs self-servingly. Do individuals seek to limit or enable their ability to distort beliefs? How do these choices affect behavior? Experiments with over 9,000 participants show preferences are heterogeneous—30 percent of participants prefer to limit belief distortion, while over 40 percent prefer to enable it, even if costly. A random assignment mechanism reveals that being assigned to the preferred environment is necessary for curbing or enabling self-serving behavior. Third parties can anticipate these effects, suggesting some sophistication about the cognitive constraints to belief distortion. (JEL C91, D82, D83, D91)
Droughts, Deluges, and (River) Diversions: Valuing Market-Based Water Reallocation
Authors: Rafey Will
Published: January 2023

This paper develops and applies a method to value water trading on a river network. The framework relies on regulatory variation in diversion caps to identify production functions for irrigated farms, then uses the estimated shadow values to assess the market’s reallocation. I apply this framework to the largest water market in human history, located in southeastern Australia. Observed water trading increased output by 4–6 percent from 2007 to 2015, equivalent to avoiding an 8–12 percent uniform decline in water resources. Reallocation and average surplus both increase substantially during drought, implying that water markets can be most valuable when climatic variability is most severe. (JEL D23, D24, Q12, Q15, Q25, Q54)
Technology Gaps, Trade, and Income
Authors: Sampson Thomas
Published: January 2023

This paper quantifies the contribution of technology gaps to international income inequality. I develop an endogenous growth model where cross-country differences in R&D efficiency and cross-industry differences in innovation and adoption opportunities together determine equilibrium technology gaps, trade patterns, and income inequality. Countries with higher R&D efficiency are richer and have comparative advantage in more innovation-dependent industries. I calibrate R&D efficiency by country and innovation dependence by industry using R&D, patent, and bilateral trade data. Counterfactual analysis implies technology gaps account for one-quarter to one-third of nominal wage variation within the OECD. (JEL D21, D24, D31, F14, O31, O33, O47)
Transhepatic or transperitoneal technique for cholecystostomy: results of the multicentre retrospective audit of cholecystostomy and further interventions (MACAFI)
Authors: Jenkins Paul Edward , MacCormick Andrew , Zhong Jim , Makris Gregory C , Gafoor Nelofer , Chan David ,   on behalf of the MACAFI Collaborators
Published: January 2023

Objective:

This analysis of the MACAFI (multicentre audit of cholecystostomy and further interventions) data aims to assess the procedural technique and technical specifications related to percutaneous cholecystostomy (PC) insertion in patients with acute calculous cholecystitis (ACC). PC can be performed either with transperitoneal (TP) or a transhepatic (TH) approach. There is no clear evidence for the superiority of either technique.

Methods:

The data set included patients who underwent PC for ACC between first January 2019 and first January 2021. Data included patient demographics, imaging diagnosis, insertion technique, tube size, and outcomes including 6 month follow-up.

Results:

1186 patients from 36 sites were identified through the MACAFI study with 913 patients having access route recorded. A transhepatic route was used in 572 [62.6%] compared to 308 TP [33.7%]. There was an increased rate of bleeding when using the TH route (2.6% vs 0.3%, p = 0.01) although other post-procedural complications (such as bile leak) were similar between the two groups. No significant difference was demonstrated in 30- or 90-day mortality (TH vs TP, 8.7vs 9.3%, p = 0.86 and 13.8vs 15.4%, p = 0.58, respectively). The readmission rate with recurrent cholecystitis was significantly greater in those with TH compared to TP approach (22.0% vs  14.9%, p = 0.01, respectively).

Conclusion:

The TP PC approach may be safer than TH, with lower bleeding complication rate and fewer readmissions.

Advances in knowledge:

A transperitoneal approach for cholecystostomy was associated with lower bleeding complication rate and lower rate of readmissions with recurrent cholecystitis compared to the transhepatic approach.
Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy
Authors: Altaf Abeer , Abbas Zaigham , Qadeer Muhammad Ali , Siyal Mehreen
Published: January 2023

Objectives: COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the asymptomatic patients undergoing the endoscopic procedure, already triaged based on history and examination.

Methods: Total 207 patients were enrolled during a time period of five months during October 2020 to April 2021 at Dr. Ziauddin Hospital Clifton campus, Karachi. In this prospective observational study patients undergoing endoscopic procedures were included after taking informed consent. The patients who already tested positive for COVID-19 by PCR were excluded. Patients were tested for Covid serology by immunochromatographic rapid serology test (ICT). Standard Operating Procedures for dealing with endoscopy patients during the COVID era were followed in all patients irrespective of antibody status.

Results: Total number of patients included was 207; males were 121 (58.5%). The mean age was 48.5 ± 17.55 (range 13 to 92). Forty eight patients (23.2%) were positive for either antibody suggesting exposure to the COVID-19 virus. Out of these combined IgM and IgG positivity was seen in 24 (11.5%), IgM mono antibody positivity was seen in 7 (3.38%) and 17 (8.21%) of the study population tested positive for IgG only. 15 out of 46 (32.6%) patients with chronic liver disease in the cohort were seropositive for COVID antibodies.

Conclusion: About one-fourth of the patients undergoing the endoscopic procedure were tested positive for COVID antibodies of which a significant percentage had chronic liver disease. It stresses the need of observing standard precautions to prevent the spread of infection during these procedures, especially in the vulnerable population.

doi: https://doi.org/10.12669/pjms.39.2.5659

How to cite this: Altaf A, Abbas Z, Qadeer MA, Siyal M. Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.5659

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Neurofibromatosis Type-2 presenting with vision impairment
Authors: Alshoabi Sultan Abdulwadoud
Published: January 2023

Neurofibromatosis Type-2 (NF2) is an autosomal dominant genetic tumour-predisposing condition caused by mutations in the NF2 gene located on chromosome 22q12. It is characterized by multiple benign tumours of the central and peripheral nervous systems and meninges, causing high morbidity. Herein, presentation of a rare case of NF2 in a 36-year-old female who presented with right eye visual disturbances, followed by tinnitus with hearing impairment. The visual disturbance developed into blindness. Magnetic resonance imaging (MRI) was performed, which showed a right-side cerebellopontine angle vestibular schwannoma and multiple meningiomas around the brain. According to the MRI findings, the patient was diagnosed with NF2. This case report aims to elucidate the importance of early brain imaging in any visual disturbances in young adults and to highlight the key role of medical imaging in the diagnosis of rare cases. Moreover, this describe the MRI features and the diagnostic accuracy for the tumours occurring in NF2 in detail.

doi: https://doi.org/10.12669/pjms.39.2.6813

How to cite this: Alshoabi SA. Neurofibromatosis Type-2 presenting with vision impairment. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6813

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.