bluuebunny/crossref_metadata_2025 huggingface dataset:
Herbal medicines use and associated factors among pregnant women in Debre Tabor town, north West Ethiopia: a mixed method approach
Authors: Addis Getu Tesfaw , Workneh Birhanu Demeke , Kahissay Mesfin Haile
Published: October 2021

Background

Use of herbal medicines during pregnancy has been increase in many developing and developed countries. In spite of the studies done on herbal medicine, no study has addressed use of herbal medicine among pregnant women in Debre Tabor Town. Hence, the major aim of this study was to assess the prevalence of herbal medicine use and associated factors.

Methods

A community based explanatory sequential mixed methods was employed. The quantitative method used cross-sectional study design with a sample size of 267 women, also 12 participants in a group for focus group discussion and 6 in-depth interviews from focus group were included for a qualitative part using a purposive sampling technique. The data were coded and entered into Epidata 4.2.0.0 and analysis was done using SPSS version 25, while thematic analysis was used for qualitative data. Bivariate and multivariate logistic analyses were used to assess associations between dependent and independent variables.

Results

Ninety-five (36.3%) of pregnant women used herbal medicine during pregnancy. Prior use of herbal medicine (AOR: 3.138; 95% CI: 1.375, 7.162), unable to read & write (AOR: 9.316; 95% CI: 2.339, 37.101), presence of health problems (AOR: 3.263; 95% CI: 1.502, 7.090), drug availability (AOR: 9.872; 95% CI: 4.322, 22.551) and distance to the health facilities (AOR 6.153; 95% CI 2.487, 15.226) were significantly associated with use of herbal medicine. Only 5(5.3%) of herbal medicine users disclosed their herbal medicine use to their healthcare providers. Zingiber officinale, Eucalyptus globulus, Rutachalepensis, Linumusitatissimum, and Moringa stenopetala were the most commonly used herbal medicines by pregnant women.

Conclusions

The use of herbal medicine during pregnancy is a common practice and significantly associated with educational status, prior use of herbal medicine, presence of health problems, drug availability and distance to the health facilities. Since there was high prevalence and low disclosure rate of herbal medicine use, it should be ensured that physicians/midwives establish a good level of communication with pregnant women.
Immunomodulatory and anti-inflammatory effects of Phellinus linteus mycelium
Authors: Shin Mi-Rae , Lee Ji Hye , Lee Jin A , Kim Min Ju , Park Hae-Jin , Park Byeong Wook , Seo Seung Bo , Roh Seong-Soo
Published: October 2021

Background

The present study extensively aimed to evaluate the underlying mechanism of the immunomodulatory and anti-inflammatory effects of Phellinus linteus mycelium (PLM).

Methods

To assess whether PLM influences the production of markers related to inflammation, Lipopolysaccharide (LPS)-stimulated RAW264.7 cells were treated with PLM (50, 100, 200, and 500 μg/mL). Splenocyte, thymus, peritoneal exudate cells (PEC), and peripheral blood mononuclear cells (PBMC) were isolated from the Balb/c mice treated with Korean red ginseng or PLM once a day for 5 weeks. Moreover, all mice except normal mice were stimulated with 10% proteose peptone (PP) treated 3 days before the sacrifice and 2% starch treated 2 days before the sacrifice. Subsequently, the cytotropic substance was evaluated by using flow cytometry analysis and ELISA assay.

Results

PLM200 treatment significantly suppressed the production of nitric oxide (NO) and prostaglandin E2 (PGE2) and inhibited the release of proinflammatory cytokines such as interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α dose-dependently in the LPS-stimulated RAW264.7 cells. PLM200 supplementation showed a significant increase in IL-2, IL-12, and interferon (IFN)-γ production and upregulated the ratio of IFN-γ (T-helper type 1, Th1) to IL-4 (T-helper type 2, Th2) in splenocytes. After PLM200 treatment, the significant elevation of CD4+CD25+, CD4+&CD8+, and CD4+CD69+ treatment were detected in thymus. Moreover, CD4+ and CD4+CD69+ in PBMC and CD69+ in PEC were also shown in a significant increase.

Conclusions

Taken together, these results showed an immunomodulatory effect of PLM about an elevated INF-γ/IL4 ratio, as an index of Th1/Th2, as well as the anti-inflammatory effect in the LPS-stimulated RAW264.7 cells. Therefore, our findings demonstrate that PLM possesses immunostimulatory and anti-inflammatory effects.
Machine learning with asymmetric abstention for biomedical decision-making
Authors: Gandouz Mariem , Holzmann Hajo , Heider Dominik
Published: October 2021

Machine learning and artificial intelligence have entered biomedical decision-making for diagnostics, prognostics, or therapy recommendations. However, these methods need to be interpreted with care because of the severe consequences for patients. In contrast to human decision-making, computational models typically make a decision also with low confidence. Machine learning with abstention better reflects human decision-making by introducing a reject option for samples with low confidence. The abstention intervals are typically symmetric intervals around the decision boundary. In the current study, we use asymmetric abstention intervals, which we demonstrate to be better suited for biomedical data that is typically highly imbalanced. We evaluate symmetric and asymmetric abstention on three real-world biomedical datasets and show that both approaches can significantly improve classification performance. However, asymmetric abstention rejects as many or fewer samples compared to symmetric abstention and thus, should be used in imbalanced data.
Telehealth and digital developments in society that persons 75 years and older in European countries have been part of: a scoping review
Authors: Raja Moonika , Bjerkan Jorunn , Kymre Ingjerd G. , Galvin Kathleen T. , Uhrenfeldt Lisbeth
Published: October 2021

Background

Demographic changes are leading to an ageing population in Europe. People are becoming more dependent on digital technologies and health ministries invest increasingly in digitalisation. Societal digital demands impact older people and learning to use new telehealth systems and digital devices are seen as a means of securing their needs.

Methods

The present study undertakes a scoping review in order to map relevant evidence about telehealth and digital developments in society involving citizens aged 75 and over in European countries. It focuses on their experiences and the main barriers to, and facilitators of, societal digital demands. A framework proposed by Arksey and O`Malley was used to guide the scoping review process. The studies included in the review covered telehealth, digital technology and digital devices, and the context covered participants` own home or surroundings. A comprehensive search on PubMed/MEDLINE, CINAHL, Scopus, Embase and Open Grey was undertaken.

Results

Out of 727 identified citations, 13 sources which met the inclusion criteria (9 original study articles, 2 theses, 1 letter about a product and 1 project report). Few of the studies identified have investigated European citizens 75 years and older separately. The studies included varied in their design, location and focus. Older people have experienced both telehealth and digital devices making life easier and the opposite. The outstanding facilitator found was that technology should be easy to use, and difficulty in remembering the instructions was seen as an important barrier. Interestingly, both social support and lack of social support were found as facilitators of using new devices.

Conclusions

Telehealth may give a sense of security but learning to use a new device often takes extra effort. Older people were more open to new devices if the possible advantages of the new technology outweighed the effort that would be involved in adopting a new strategy. As technology develops rapidly, and life expectancy in Europe is anticipated to rise continually, there is a need for new and additional research among older European citizens. Future research should cover the technical solutions most relevant to older people today, social support and participants` access to the devices.
Implementation of a pediatric early warning score tool in a pediatric oncology Ward in Palestine
Authors: Mills David , Schmid Alexis , Najajreh Mohammad , Al Nasser Ahmad , Awwad Yara , Qattush Kholoud , Monuteaux Michael C. , Hudgins Joel , Salman Zeena , Niescierenko Michelle
Published: October 2021

Background

Pediatric Early Warning Scores (PEWS) are nurse-administered clinical assessment tools utilizing vital signs and patient signs and symptoms to screen for patients at risk for clinical deterioration.1–3 When utilizing a PEWS system, which consists of an escalation algorithm to alert physicians of high risk patients requiring a bedside evaluation and assessment, studies have demonstrated that PEWS systems can decrease pediatric intensive care (PICU) utilization, in-hospital cardiac arrests, and overall decreased mortality in high income settings. Yet, many hospital based settings in low and lower middle income countries (LMIC) lack systems in place for early identification of patients at risk for clinical deterioration.

Methods

A contextually adapted 16-h pediatric resuscitation program included training of a PEWS tool followed by implementation and integration of a PEWS system in a pediatric hematology/oncology ward in Beit Jala, Palestine. Four PDSA cycles were implemented post-implementation to improve uptake and scoring of PEWS which included PEWS tool integration into an existing electronic medical record (EMR), escalation algorithm and job aid implementation, data audits and ward feedback.

Results

Frequency of complete PEWS vital sign documentation reached a mean of 89.9%. The frequency and accuracy of PEWS scores steadily increased during the post-implementation period, consistently above 89% in both categories starting from data audit four and continuing thereafter. Accuracy of PEWS scoring was unable to be assessed during week 1 and 2 of data audits due to challenges with PEWS integration into the existing EMR (PDSA cycle 1) which were resolved by the 3rd week of data auditing (PDSA cycle 2).

Conclusions

Implementation of a PEWS scoring tool in an LMIC pediatric oncology inpatient unit is feasible and can improve frequency of vital sign collection and generate accurate PEWS scores.

Contribution to the literature

This study demonstrates how to effectively implement a PEWS scoring tool into an LMIC clinical setting.

This study demonstrates how to utilize a robust feedback mechanism to ensure a quality program uptake.

This study demonstrates an effective international partnership model that other institutions may utilize for implementation science.
Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016
Authors: Sserwanja Quraish , Mukunya David , Musaba Milton W. , Kawuki Joseph , Kitutu Freddy Eric
Published: October 2021

Background

Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda.

Methods

We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49 years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25).

Results

The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8–77.5). The odds of women aged 15–19 years giving birth at health facilities were twice as those of women aged 40 to 49 years (adjusted odds ratio, AOR = 2.29; 95% CI: 1.71–3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR = 3.13; 95% CI: 2.15–4.56). Women with tertiary education (AOR = 4.96; 95% CI: 2.71–9.11) and those in the richest wealth quintile (AOR = 4.55; 95% CI: 3.27–6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare.

Conclusion

Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.
CT appearance and measurements of the normal thyroid gland in goats
Authors: Pankowski Filip , Bartyzel Bartłomiej Jan , Paśko Sławomir , Moroz Agata , Mickiewicz Marcin , Szaluś-Jordanow Olga , Bonecka Joanna
Published: October 2021

Background

Goats are increasingly being kept as companion animals, thus their owners expect advanced medical care, including modern diagnostic imaging. Computed tomography (CT) is now widely used in veterinary medicine, in both clinical practice and for scientific purposes. So far, the CT appearance of various body parts has been described in goats, but reports on thyroid gland CT are still lacking. The thyroid gland in goats may become enlarged due to dietary, genetic or neoplastic disorders. CT examination, as in other animals and humans, could aid in the diagnosis of thyroid diseases in goats and could be used for research purposes. The aim of the study was to present the CT characteristics of the normal caprine thyroid gland, in particular its dimensions, volume and density.

Results

Fifty-seven goats were included in the study. None of the animals had clinical, CT, post-mortem or histopathologic abnormalities in the thyroid gland. CT features of the thyroid gland were determined, such as dimensions, volume, density, location and shape. The presence of the thyroid isthmus and ectopic thyroid tissue was also assessed. The gland was visible in every animal as two homogenous, highly attenuating, well-circumscribed lobes located in the most cranial part of the trachea. The mean dimensions of the thyroid lobe were 30.3 × 12.7 × 6.7 mm, the mean density was 80.9 Hounsfield Units (HU) and the mean volume was 1.32 cm3 or 1.39 cm3, depending on the method used. Also, the internal parathyroid glands were visible in some animals.

Conclusions

For the first time, the normal CT appearance of the thyroid gland has been presented. CT clearly shows the thyroid gland in goats and therefore can be used in clinical practice and for research. The results of the current study may serve as a radiological guideline for practitioners and may be the basis for further CT studies on normal and diseased caprine thyroid glands.
Evaluation of totally implantable catheters in healthy horses
Authors: de Souza Garcia Adriana Fernandes , Ribeiro Gesiane , de Assis Arantes Julia , Reginato Gustavo Morandini , Xavier Nathalia Villaca , Carregaro Adriano Bonfim , Silva Thiago Jhonatha Fernandes , Grigoletto Renan , de Freitas Silvio Henrique , Dória Renata Gebara Sampaio
Published: October 2021

Background

For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device’s placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7–60 days).

Results

Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis.

Conclusions

The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.
Role of PRKDC in cancer initiation, progression, and treatment
Authors: Chen Yu , Li Yi , Xiong Jiani , Lan Bin , Wang Xuefeng , Liu Jun , Lin Jing , Fei Zhaodong , Zheng Xiaobin , Chen Chuanben
Published: October 2021

The PRKDC gene encodes the DNA-dependent protein kinase catalytic subunit (DNA-PKcs) protein. DNA-PKcs plays an important role in nonhomologous end joining (NHEJ) of DNA double-strand breaks (DSBs) and is also closely related to the establishment of central immune tolerance and the maintenance of chromosome stability. The occurrence and development of different types of tumors and the results of their treatment are also influenced by DNA-PKcs, and it may also predict the results of radiotherapy, chemotherapy, and therapy with immune checkpoint inhibitors (ICIs). Here, we discuss and review the structure and mechanism of action of PRKDC and DNA-PKcs and their relationship with cancer.
Hypomethylation and downregulation of miR-23b-3p are associated with upregulated PLAU: a diagnostic and prognostic biomarker in head and neck squamous cell carcinoma
Authors: Huo Zirong , Li Xiaoguang , Zhou Jieyu , Fan Yuqin , Wang Zhentao , Zhang Zhihua
Published: October 2021

Background

DNA methylation and miRNA-target genes play an important part in the early development of various tumors and have been studied as tumor biomarkers. Although previous studies have reported a cluster of molecular events (such as aberrant alterations of genomics and epigenetics), little is known of the potential biomarkers for early diagnosis and prognostic evaluation in head and neck squamous cell carcinoma (HNSCC).

Methods

Multiple bioinformatics tools based on The Cancer Genome Atlas (TCGA) database and clinical samples were applied to evaluate the beneficial biomarkers in HNSCC. We focused on the role of plasminogen activator urokinase (PLAU), including diagnostic and prognostic significance, gene expression analysis, aberrant DNA methylation characteristics, interaction of miRNAs and associated signaling pathways.

Results

We found that PLAU was aberrantly upregulated in HNSCC, regardless of the mRNA or protein level. The results of receiver operating characteristic (ROC) curve and Cox regression analysis revealed that PLAU was a diagnostic and independent prognostic factor for patients with HNSCC. Hypomethylation of PLAU was closely related to poor survival in HNSCC. Additionally, miR-23b-3p was predicted to target PLAU and was significantly downregulated in HNSCC tissues. Therefore, our findings suggested that PLAU functioned as a promoter in the pathological process of HNSCC. DNA hypomethylation and downregulation of miR-23b-3p were associated with PLAU overexpression. Finally, our findings provided evidence of a significant interaction between PLAU-target and miRNAs-target pathways, indicating that miR-23b-3p suppresses malignant properties of HNSCC by targeting PLAU via Ras/MAPK and Akt/mTOR signaling pathways.

Conclusions

PLAU is overexpressed and may serve as an independent diagnostic and prognostic biomarker in HNSCC. Hypomethylation and downregulation of miR-23b-3p might account for the oncogenic role of PLAU in HNSCC.
Pan-cancer analysis combined with experiments predicts CTHRC1 as a therapeutic target for human cancers
Authors: Peng Dazhao , Wei Cheng , Zhang Xiaoyang , Li Shenghui , Liang Hao , Zheng Xingyu , Jiang Shulong , Han Lei
Published: October 2021

Background

The function of collagen triple helix repeat containing 1 (CTHRC1) as an oncogene has been reported in a growing number of publications. Bioinformatics methods represent a beneficial approach to examine the mechanism and function of the CTHRC1 gene in the disease process of cancers from a pan-cancer perspective.

Methods

In this study, using the online databases UCSC, NCBI, HPA, TIMER2, Oncomine, GEPIA, UALCAN, cBioPortal, COSMIC, MEXPRESS, STRING, CCLE, LinkedOmics, GTEx, TCGA, CGGA, and SangerBox, we focused on the relationship between CTHRC1 and tumorigenesis, progression, methylation, immunity, and prognosis. qPCR was used to detect CTHRC1 expression in glioma tissues and cell lines.

Results

The pan-cancer analysis showed that CTHRC1 was overexpressed in most tumors, and a significant correlation was observed between CTHRC1 expression and the prognosis of patients with cancer. CTHRC1 genetic alterations occur in diverse tumors and are associated with tumor progression. Levels of CTHRC1 promoter methylation were decreased in most cancer tissues compared with normal tissues. In addition, CTHRC1 coordinated the activity of ICP genes through diverse signal transduction pathways, was also associated with immune cell infiltration and the tumor microenvironment, and potentially represented a promising immunotherapy target. We identified CTHRC1-related genes across cancers using the GEPIA2 tool. The single-gene GO analysis of CTHRC1 across cancers showed that it was involved in some signaling pathways and biological processes, such as the Wnt signaling pathway, cell migration, and positive regulation of protein binding. The expression and function of CTHRC1 were also further verified in glioma tissues and cell lines.

Conclusions

CTHRC1 is overexpressed in various cancer types and functions as an important oncogene that may promote tumorigenesis and development through different mechanisms. CTHRC1 may represent an important therapeutic target for human cancers.
Network-driven analysis of human–Plasmodium falciparum interactome: processes for malaria drug discovery and extracting in silico targets
Authors: Agamah Francis E. , Damena Delesa , Skelton Michelle , Ghansah Anita , Mazandu Gaston K. , Chimusa Emile R.
Published: October 2021

Background

The emergence and spread of malaria drug resistance have resulted in the need to understand disease mechanisms and importantly identify essential targets and potential drug candidates. Malaria infection involves the complex interaction between the host and pathogen, thus, functional interactions between human and Plasmodium falciparum is essential to obtain a holistic view of the genetic architecture of malaria. Several functional interaction studies have extended the understanding of malaria disease and integrating such datasets would provide further insights towards understanding drug resistance and/or genetic resistance/susceptibility, disease pathogenesis, and drug discovery.

Methods

This study curated and analysed data including pathogen and host selective genes, host and pathogen protein sequence data, protein–protein interaction datasets, and drug data from literature and databases to perform human-host and P. falciparum network-based analysis. An integrative computational framework is presented that was developed and found to be reasonably accurate based on various evaluations, applications, and experimental evidence of outputs produced, from data-driven analysis.

Results

This approach revealed 8 hub protein targets essential for parasite and human host-directed malaria drug therapy. In a semantic similarity approach, 26 potential repurposable drugs involved in regulating host immune response to inflammatory-driven disorders and/or inhibiting residual malaria infection that can be appropriated for malaria treatment. Further analysis of host–pathogen network shortest paths enabled the prediction of immune-related biological processes and pathways subverted by P. falciparum to increase its within-host survival.

Conclusions

Host–pathogen network analysis reveals potential drug targets and biological processes and pathways subverted by P. falciparum to enhance its within malaria host survival. The results presented have implications for drug discovery and will inform experimental studies.
Study protocol for an evaluability assessment of an anti-human trafficking program
Authors: Wretman Christopher J. , Macy Rebecca J. , Stylianou Amanda M. , Teekah Anita S. , Ebright Elizabeth N. , Kim Jeongsuk , Luo Jia , Rizo Cynthia Fraga
Published: October 2021

Background

Human trafficking is a serious global challenge associated with a complex array of health inequities for individuals, families, and communities. Consequently, in addition to a conventional criminal justice approach, anti-trafficking scholars have increasingly called for a public health approach to address this global challenge. Such calls have emphasized that a comprehensive, robust, and social justice-informed public health strategy for anti-trafficking must include services to facilitate survivors’ HT exit and recovery, and to prevent their re-victimization. Fortunately, many community-based organizations and non-governmental organizations worldwide have heeded these calls and developed anti-trafficking programs for survivors. Unfortunately, despite the growing numbers of organizations providing anti-trafficking services, research concerning these programs’ effectiveness remains nascent overall, and even more scant when filtered through an equity focus.

Methods

To advance the field by developing guidance concerning how best to evaluate anti-human trafficking programs, an ongoing research project aims to conduct a mixed methods evaluability assessment of a prominent anti-trafficking program using a social justice framework. Guided by well-established evaluability assessment frameworks, the study activities include four sequential steps: (a) focusing the assessment, (b) developing the program theory and logic, (c) gathering feedback, and (d) applying the assessment findings. Activities will include qualitative interviews and focus groups, observations, and quantitative analysis of program data among others. Human subjects and ethical review for the evaluability assessment has been granted by the Office of Human Subjects Research at The University of North Carolina at Chapel Hill.

Discussion

Once completed, evaluability assessment results will provide evidence and products that have the potential to guide both evaluation research and service provision not only for the specific organization under study, but also for other anti-human trafficking programs worldwide. Findings will be developed into a variety of dissemination products tailored for both practice professionals and researchers. In the interim, this protocol manuscript offers research strategies and recommendations that can help inform the development of other studies in the developing field of anti-trafficking program evaluation research.
Community-based health financing: empirical evaluation of the socio-demographic factors determining its uptake in Awka, Anambra state, Nigeria
Authors: Iyalomhe Felix O. , Adekola Paul O. , Cirella Giuseppe T.
Published: October 2021

Background

There is an increasing global concern of financing poor people who live in low- and middle-income countries. The burden of non-communicable diseases of these people is, by in large, connected to a lack of access to effective and affordable medical care, weak financing, and delivery of health services. Policymakers have assumed, until recently, that poor people in developing countries would not pay health insurance premiums for the cost of future hospitalization. The emergence of community-based health financing (CBHF) has brought forth a renewed and empowered alternative. CBHF schemes are designed to be sustainable, varying in size, and well organized. Developing countries, such as Nigeria, have been testing and finetuning such schemes in the hope that they may 1 day reciprocate high-income countries.

Methods

A sample size of 372 respondents was used to assess the slums of Awka, the capital city of Anambra State, Nigeria, and empirically evaluate the socio-demographic characteristics of those who uptake CBHF using the provider Jamii Bora Trust (JBT). Cross-sectional research used a quantitative research approach with the instrumentality of structured questionnaires. Descriptive analysis was adopted to determine the socio-demographic characteristics of those who have CBHF uptake in Awka and evaluate the presence and benefits of CBHF in the city’s slums.

Results

The results show that more youth and middle-aged persons from 18 to 50 years are more insured (i.e., 73.8% combined) than those who are over 50 years of age. Gender distribution confirm more females (i.e., 61.9%) to be health-insured than their male counterpart (i.e., 38.1%). This perhaps reflected the reproductive roles by women and the fact that women have better health-seeking behavioral attitude. Moreover, the results correlate with previous studies that confirm women are more involved in local sustainable associations in low-income settings, of this nature, in sub-Saharan Africa. Corroborating this further, married people are more insured (i.e., 73.8%) than those who are not married (i.e., 26.2%) and insured members report higher use of hospitalization care than the non-insured.

Conclusion

CBHF uptake favored members in the lower income quintiles who are more likely to use healthcare services covered by the JBT scheme. This confirmed that prepayment schemes and the pooling of risk could reduce financial barriers to healthcare among the urban poor. Recommendations are suggested to improve enrollment levels in the CBHF programs.
Prevalence of β-lactamase-encoding genes and molecular typing of Acinetobacter baumannii isolates carrying carbapenemase OXA-24 in children
Authors: Yousefi Nojookambari Neda , Sadredinamin Mehrzad , Dehbanipour Razieh , Ghalavand Zohreh , Eslami Gita , Vaezjalali Maryam , Nikmanesh Bahram , Yazdansetad Sajjad
Published: October 2021

Background

β-Lactam antibiotics have been broadly used for the treatment of Acinetobacter baumannii infections, resulting in development of β-lactam inactivating β-lactamases. Here, we described antibiotic resistance rate, prevalence of β-lactamase-encoding genes, and clonal relationships of A. baumannii strains isolated from children referred to Children’s Medical Center in Tehran, Iran, during 2019–2020.

Methods

A total of 60 non-replicate A. baumannii isolates were recovered from clinical specimens of pediatric patients. Antibiotic susceptibility testing was done by the disc diffusion method. Colistin susceptibility of isolates was performed by the broth microdilution method. β-lactamase-encoding genes were characterized by PCR. The presence of ISAba1 element upstream of the several oxacillinase genes was also checked. Genetic relatedness of isolates was determined by using random amplification of polymorphic DNA (RAPD) typing.

Results

The antimicrobial susceptibility tests showed that 83.3% of A. baumannii isolates were MDR, and 40% XDR. Both MDR and XDR A. baumannii isolates were susceptible to colistin. The frequency of blaOXA-51-like, blaOXA-23-like, blaTEM, blaOXA-24-like, blaPER, blaSHV, blaCTX-M, blaOXA-58-like, and blaIMP was 100, 93.33, 60, 36.67, 28.33, 8.33, 5, 3.33, and 1.67%, respectively. Coexistence of ISAba1/blaOXA-23-like and ISAba1/blaOXA-51-like was observed in 65% and 85% of isolates, respectively. RAPD analysis revealed 4 common types and 2 single types of A. baumannii isolates.

Conclusions

The multiple clones harboring blaOXA-23-like, ISAba1-blaOXA-51-like, and ISAba1-blaOXA-23-like were responsible for the spread of A. baumannii isolates in our clinical wards. Dissemination of the well-established clones is worrisome and would become therapeutic challenges due to the possible transferring genetic elements associated with resistance.
Understanding of catalytic ROS generation from defect-rich graphene quantum-dots for therapeutic effects in tumor microenvironment
Authors: Wang Xichu , Hu Chuangang , Gu Zi , Dai Liming
Published: October 2021

Owing to their low cost, high catalytic efficiency and biocompatibility, carbon-based metal-free catalysts (C-MFCs) have attracted intense interest for various applications, ranging from energy through environmental to biomedical technologies. While considerable effort and progress have been made in mechanistic understanding of C-MFCs for non-biomedical applications, their catalytic mechanism for therapeutic effects has rarely been investigated. In this study, defect-rich graphene quantum dots (GQDs) were developed as C-MFCs for efficient ROS generation, specifically in the H2O2-rich tumor microenvironment to cause multi-level damages of subcellular components (even in nuclei). While a desirable anti-cancer performance was achieved, the catalytic performance was found to strongly depend on the defect density. It is for the first time that the defect-induced catalytic generation of ROS by C-MFCs in the tumor microenvironment was demonstrated and the associated catalytic mechanism was elucidated. This work opens a new avenue for the development of safe and efficient catalytic nanomedicine.
Chitosan oligosaccharides packaged into rat adipose mesenchymal stem cells-derived extracellular vesicles facilitating cartilage injury repair and alleviating osteoarthritis
Authors: Li Shenglong , Liu Jie , Liu Siyu , Jiao Weijie , Wang Xiaohong
Published: October 2021

Objectives

This study aimed to investigate the roles of adipose mesenchymal stem cell (AMSC)-derived extracellular vesicles (EVs) binding with chitosan oligosaccharides (COS) in cartilage injury, as well as the related mechanisms.

Results

IL-1β treatment significantly inhibited the viability and migration of chondrocytes and enhanced cell apoptosis (P < 0.05), while chitosan oligosaccharides and extracellular vesicles-chitosan oligosaccharide conjugates (EVs-COS/EVs-COS conjugates) reversed the changes induced by IL-1β (P < 0.05), and the effects of extracellular vesicles-chitosan oligosaccharide conjugates were better than those of chitosan oligosaccharides (P < 0.05). After cartilage damage, IL-1β, OPN, and p53 were significantly upregulated, COL1A1, COL2A1, OCN, RUNX2, p-Akt/Akt, PI3K, c-Myc, and Bcl2 were markedly downregulated, and extracellular vesicles-chitosan oligosaccharide conjugates reversed the expression induced by cartilage injury. Through sequencing, 760 differentially expressed genes (DEGs) clustered into four expression patterns were associated with negative regulation of the canonical Wnt, PI3K-Akt, AMPK, and MAPK signaling pathways.

Conclusion

Extracellular vesicles-chitosan oligosaccharide conjugates may serve as a new cell-free biomaterial to facilitate cartilage injury repair and improve osteoarthritis.

Graphical Abstract
Texture feature extraction from microscope images enables a robust estimation of ER body phenotype in Arabidopsis
Authors: Basak Arpan Kumar , Mirzaei Mohamadreza , Strzałka Kazimierz , Yamada Kenji
Published: October 2021

Background

Cellular components are controlled by genetic and physiological factors that define their shape and size. However, quantitively capturing the morphological characteristics and movement of cellular organelles from micrograph images is challenging, because the analysis deals with complexities of images that frequently lead to inaccuracy in the estimation of the features. Here we show a unique quantitative method to overcome biases and inaccuracy of biological samples from confocal micrographs.

Results

We generated 2D images of cell walls and spindle-shaped cellular organelles, namely ER bodies, with a maximum contrast projection of 3D confocal fluorescent microscope images. The projected images were further processed and segmented by adaptive thresholding of the fluorescent levels in the cell walls. Micrographs are composed of pixels, which have information on position and intensity. From the pixel information we calculated three types of features (spatial, intensity and Haralick) in ER bodies corresponding to segmented cells. The spatial features include basic information on shape, e.g., surface area and perimeter. The intensity features include information on mean, standard deviation and quantile of fluorescence intensities within an ER body. Haralick features describe the texture features, which can be calculated mathematically from the interrelationship between the pixel information. Together these parameters were subjected to multivariate analysis to estimate the morphological diversity. Additionally, we calculated the displacement of the ER bodies using the positional information in time-lapse images. We captured similar morphological diversity and movement within ER body phenotypes in several microscopy experiments performed in different settings and scanned under different objectives. We then described differences in morphology and movement of ER bodies between A. thaliana wild type and mutants deficient in ER body-related genes.

Conclusions

The findings unexpectedly revealed multiple genetic factors that are involved in the shape and size of ER bodies in A. thaliana. This is the first report showing morphological characteristics in addition to the movement of cellular components and it quantitatively summarises plant phenotypic differences even in plants that show similar cellular components. The estimation of morphological diversity was independent of the cell staining method and the objective lens used in the microscopy. Hence, our study enables a robust estimation of plant phenotypes by recognizing small differences in complex cell organelle shapes and their movement, which is beneficial in a comprehensive analysis of the molecular mechanism for cell organelle formation that is independent of technical variations.
Mapping out epistemic justice in the clinical space: using narrative techniques to affirm patients as knowers
Authors: Rosen Leah Teresa
Published: October 2021

Epistemic injustice sits at the intersection of ethics, epistemology, and social justice. Generally, this philosophical term describes when a person is wrongfully discredited as a knower; and within the clinical space, epistemic injustice is the underlying reason that some patient testimonies are valued above others. The following essay seeks to connect patterns of social prejudice to the clinical realm in the United States: illustrating how factors such as race, gender identity, and socioeconomic status influence epistemic credence and associatively, the quality of healthcare a person receives.

After describing how epistemic injustice disproportionately harms already vulnerable patients, I propose a narrative therapy intervention. This intervention can help providers re-frame their relationships with patients, in such that they come to view patients as valuable sources of unique knowledge. Though I identify this intervention as a valuable step in addressing clinical epistemic injustice, I call upon medical educators and practitioners to further uplift the voices, perspectives, and stories of marginalized patients.
Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study
Authors: Garpenhag Lars , Dahlman Disa
Published: October 2021

Background

People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them.

Methods

Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach.

Results

Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history.

Conclusion

This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff.
Cone beam CT-based dose accumulation and analysis of delivered dose to the dominant intraprostatic lesion in primary radiotherapy of prostate cancer
Authors: Tamihardja Jörg , Cirsi Sinan , Kessler Patrick , Razinskas Gary , Exner Florian , Richter Anne , Polat Bülent , Flentje Michael
Published: October 2021

Background

Evaluation of delivered dose to the dominant intraprostatic lesion (DIL) for moderately hypofractionated radiotherapy of prostate cancer by cone beam computed tomography (CBCT)-based dose accumulation and target coverage analysis.

Methods

Twenty-three patients with localized prostate cancer treated with moderately hypofractionated prostate radiotherapy with simultaneous integrated boost (SIB) between December 2016 and February 2020 were retrospectively analyzed. Included patients were required to have an identifiable DIL on bi-parametric planning magnetic resonance imaging (MRI). After import into the RayStation treatment planning system and application of a step-wise density override, the fractional doses were computed on each CBCT and were consecutively mapped onto the planning CT via a deformation vector field derived from deformable image registration. Fractional doses were accumulated for all CBCTs and interpolated for missing CBCTs, resulting in the delivered dose for PTVDIL, PTVBoost, PTV, and the organs at risk. The location of the index lesions was recorded according to the sector map of the Prostate Imaging Reporting and Data System (PIRADS) Version 2.1. Target coverage of the index lesions was evaluated and stratified for location.

Results

In total, 338 CBCTs were available for analysis. Dose accumulation target coverage of PTVDIL, PTVBoost, and PTV was excellent and no cases of underdosage in DMean, D95%, D02%, and D98% could be detected. Delivered rectum DMean did not significantly differ from the planned dose. Bladder mean DMean was higher than planned with 19.4 ± 7.4 Gy versus 18.8 ± 7.5 Gy, p < 0.001. The penile bulb showed a decreased delivered mean DMean with 29.1 ± 14.0 Gy versus 29.8 ± 14.4 Gy, p < 0.001. Dorsal DILs, defined as DILs in the posterior medial peripheral zone of the prostate, showed a significantly lower delivered dose with a mean DMean difference of 2.2 Gy (95% CI 1.3–3.1 Gy, p < 0.001) compared to ventral lesions.

Conclusions

CBCT-based dose accumulation showed an adequate delivered dose to the dominant intraprostatic lesion and organs at risk within planning limits. Cautious evaluation of the target coverage for index lesions adjacent to the rectum is warranted to avoid underdosage.
Which sagittal evaluation system can effectively predict mechanical complications in the treatment of elderly patients with adult degenerative scoliosis? Roussouly classification or Global Alignment and Proportion (GAP) Score
Authors: Sun Xiangyao , Sun Wenzhi , Sun Siyuan , Hu Hailiang , Zhang Sitao , Kong Chao , Lu Shibao
Published: October 2021

Background

To achieve the proper sagittal alignment, previous studies have developed different assessment systems for adult degenerative scoliosis (ADS) which could help the spine surgeon in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or global alignment and proportion (GAP) score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS.

Methods

ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. Basic information and radiologic measurements were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. Mechanical complications included proximal junctional kyphosis (PJK), proximal junctional failure (PJF). GAP categories divided GAP score into proportioned spinopelvic position, moderately disproportioned position, and severely disproportioned position according to the cut-off values. The correlation between evaluation systems and mechanical complications was analyzed through a logistic regression model via stepwise backward elimination based on the Wald statistics. Receiver operator characteristic (ROC) curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. Area under the curve (AUC) was used to evaluate the validity of the thresholds.

Results

A total of 80 patients were included in this study. There were 41 patients in mechanical complication group and 39 patients in no mechanical complication group. GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P = 0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was more effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724) than Roussouly score; GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.

Conclusions

Roussouly classification could only be a rough estimate of optimal spinopelvic alignment. Quantitative parameters in GAP score made it more effective in predicting mechanical complications, PJK and PJF than Roussouly classification.