bluuebunny/crossref_metadata_2025 huggingface dataset:
Passenger‐perception dynamic ridesharing service based on parallel technology
Authors: Xue Shouqiang , Song Rui , He Shiwei , Li Guangye , Chi Jushang
Published: May 2023

With the emergence of new information and communication technology, mobile‐based ridesharing services have received more attention and have improved. They offer timely and convenient service and exert an enormous influence on pollution and congestion by allowing passengers to share overlapping routes. However, ridesharing services have also been discussed and called into question by people with respect to their attractiveness, their comfort, and passenger safety. This paper proposes a ridesharing algorithm with a perceived mechanism by introducing multiple dimensions of perceived value to overall assess passengers’ perceptions. The approach involved can continuously track the psychological changes in passengers during travel, capture the dynamic and comprehensive perceptions of passengers, and make real‐time adjustments on this basis. Furthermore, the proposed partition‐based parallel strategy can ensure high‐quality services and further enhance computational efficiency. Finally, numerical experiments are conducted based on the urban transportation network and the actual trip data from Manhattan to evaluate the performance of the proposed algorithm. The results show that it is important to effectively capture the passengers’ perception of ridesharing services and apply them to optimization mechanisms, which will contribute to improving the perception of ride experiences and attracting potential passengers.
Pregnant Patients with a Documented History of Penicillin Allergy and Associated Maternal and Neonatal Outcomes at a Tertiary Care Center
Authors: Azmy Veronica , Lundsberg Lisbet S. , Culhane Jennifer , Kwah Jason , Partridge Caitlin , Son Moeun
Published: May 2023

Objective Pregnant individuals are likely to need antibiotics during the peripartum period. For pregnant individuals who report a history of penicillin allergy, non-β-lactam antibiotics are often administered. Compared with first-line β-lactam antibiotics, alternative antibiotics can be less effective, more toxic, and more costly. It remains unclear if being labeled with a penicillin allergy is associated with adverse maternal and neonatal outcomes.

Study Design We conducted a retrospective cohort study of all pregnant patients who delivered a viable singleton between 24 and 42 weeks of gestation at a large academic hospital from 2013 to 2021. We compared patients who had a documented penicillin allergy history in their electronic medical record versus those who did not and examined whether there were significant differences in maternal outcomes and neonatal outcomes. Bivariable and multivariable analyses were performed.

Results Of 41,943 eligible deliveries included in the analysis, 4,705 (11.2%) patients had a penicillin allergy history documented in their electronic medical record and 37,238 (88.8%) did not. Even after adjusting for potential confounders, patients with a documented penicillin allergy had a higher risk of postpartum endometritis (adjusted odds ratio [aOR]: 1.46; 95% confidence interval [CI]: 1.01–2.11) and a higher risk of their neonates having a postnatal hospital stay lasting more than 72 hours (aOR: 1.10; 95% CI: 1.02–1.18). There were no significant differences seen in the other maternal and neonatal outcomes in both bivariable and multivariable analyses.

Conclusion Pregnant patients who are labeled as having a penicillin allergy are more likely to have postpartum endometritis, and neonates born to mothers who are labeled as having a penicillin allergy are more likely to have a postnatal hospital stay lasting more than 72 hours. There were no other significant differences seen in pregnant patients and their newborns whether they were labeled as having a penicillin allergy history or not. However, pregnant individuals with a penicillin allergy documented in their medical record were significantly more likely to receive alternative non-β lactam antibiotics, and may have benefitted from having more details of their allergy history available as well as proper allergy verification with testing.

Key Points
Risk Factors for Early- and Late-Onset Superimposed Preeclampsia
Authors: Onishi Kazuma , Seagraves Elizabeth , Baraki Dana , Donaldson Thomas , Barake Carole , Abuhamad Alfred , Huang Jim C. , Kawakita Tetsuya
Published: May 2023

Objective Risk factors of early- and late-onset preeclampsia among pregnant individuals with chronic hypertension are not well described in the literature. We hypothesized that early- and late-onset superimposed preeclampsia (SIPE) have different risk factors. Therefore, we aimed to examine the risk factors of early- and late-onset SIPE among individuals with chronic hypertension.

Study Design This was a retrospective case-control study of pregnant individuals with chronic hypertension who delivered at 22 weeks' gestation or greater at an academic institution. Early-onset SIPE was defined as SIPE diagnosed before 34 weeks' gestation. To identify risk factors, we compared individuals' characteristics between individuals who developed early- and late-onset SIPE and those who did not. We then compared characteristics between individuals who developed early-onset SIPE and late-onset SIPE. Characteristics with p-values of less than 0.05 by bivariable variables were analyzed by simple and multivariable logistic regression models to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Missing values were imputed with multiple imputation.

Results Of 839 individuals, 156 (18.6%) had early-onset, 154 (18.4%) had late-onset SIPE and 529 (63.1%) did not have SIPE. The multivariate logistic regression model showed that serum creatinine ≥ 0.7 mg/dL compared to less than 0.7 mg/dL (aOR: 2.89 [95% CI: 1.63–5.13]), increase of creatinine (1.33 [1.16–1.53]), nulliparity compared to multiparity (1.77 [1.21–2.60]), and pregestational diabetes (1.70 [1.11–2.62]) were risk factors for early-onset SIPE. The multivariate logistic regression model showed that nulliparity compared to multiparity (1.53 [1.05–2.22]) and pregestational diabetes (1.74 [1.14–2.64]) was a risk factor for late-onset SIPE. Serum creatinine ≥ 0.7 mg/dL (2.90 [1.36–6.15]) and increase of creatinine (1.33 [1.10–1.60]) were significantly associated with early-onset SIPE compared to late-onset SIPE.

Conclusion Kidney dysfunction seemed to be associated with the pathophysiology of early-onset SIPE. Nulliparity and pregestational diabetes were common risk factors for both early- and late-onset SIPE.

Key Points
Questioning global health in the times of COVID-19: Re-imagining primary health care through the lens of politics of knowledge
Authors: Priya Ritu , Sarkar Amitabha , Das Sayan , Gaitonde Rakhal , Ghodajkar Prachinkumar , Gandhi Mohit P.
Published: May 2023

The advent of the COVID-19 pandemic and the inequitable response to it has created a space for rethinking the knowledge translation that informs current health policy formulation and planning. Wide recognition of the failure of global health governance and national health systems has led to calls for reviving the Primary Health Care (PHC) agenda for post-COVID health systems development. Despite the joint international declaration on PHC made four decades ago, it has had limited application. This paper argues that the recent attempts to rethink PHC will prove inadequate without analysing and learning from the politics of knowledge (PoK) underlying global health policy and planning. Even with the growing relevance of the spirit of the Alma-Ata Declaration (1978) and its operationalisation as detailed in the report of conference proceedings, reassessment of reasons for its limited implementation continues to be located largely in the political economy of the medical establishment, the international economic order or in national governance flaws. Failure to address the dominant knowledge paradigm in the Alma Ata articulation of PHC has contributed to its limited application. This calls for expansion in the analysis from knowledge translation to generation and hierarchisation of knowledge. The paper discusses how the application of PoK as an analytical lens helps understand the power equations underlying the process of knowledge generation and its translation into policy and practice. Beneath the techno-centric and commodified health system is the dominant ‘knowledge’ system whose foundations and assumptions ought to be interrogated. By following a PoK approach, a reorientation of thinking about the relationship between various forms of knowledge and knowledge holders is anticipated. A new health service system design is outlined—translating the spirit of PHC of 1978 into a ‘PHC Version 2.0’—that addresses the PoK gap in operational terms, with an approach to guide all levels of healthcare. It suggests how the world can be empowered to respond better by engaging with diverse ontologies and epistemologies to conceptualise knowledge and frame policies. Further, in the contexts of Asia, Africa and Latin America, it can contribute to the development of self-reliance to democratise general health policy and planning in the post-pandemic period.
In Australian hospitals and residential aged care facilities, how do we train nursing and direct care staff to assist patients and residents to move? A national survey
Authors: Brusco Natasha , Haines Terry , Taylor Nicholas F. , Rawson Helen , Boyd Leanne , Ekegren Christina , Kugler Helen , Dawes Helen , Radia-George Camilla , Graven Christine , Hill Keith
Published: May 2023

Objective Nursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements. Method Using a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services. Results Respondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health. Conclusion Most Australian health and aged care services provide clinical staff with regular manual handling training for staff‐assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in‐the‐moment risk assessment during staff‐assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.
廈門閩南語的文、白形式在構詞層面上的分工與競爭
Authors: Kwok Bit-Chee
Published: May 2023

抽象的

閩南語的「文白異讀」很大程度上是透過構詞層面體現出來的。根據筆者對廈門閩南語的調查，至少有兩個因素能決定構詞時到底採用的是白讀形式，還是文讀形式，即「語體因素」和「語義因素」。只要這兩個因素不衝突，白讀形式和文讀形式便會形成分工，各司其職；但當兩個因素發生衝突時，文、白形式便會發生競爭，牽涉的複合詞也會因而出現變體。本文的分析也適用於其他閩南語。
格西霍爾語的示證範疇
Authors: Tian Qianzi , Sun Jackson T.-S.
Published: May 2023

抽象

霍爾語群分佈於川西阿壩、甘孜兩州六個縣，屬於漢藏語系羌語支嘉戎語組。本文沿用並進一步闡釋Tournadre & LaPolla對示證式的修正定義，系統介紹中部霍爾語格西話謂語的示證範疇。格西話採用零標記及三種後綴構成的「四元對立」示證體系。說話者報導敘實、自知、過去親歷、現場親察等情況時，對訊息有高度的掌握，無需添加任何示證標記；而三種示證後綴分別代表說話者掌握度較低的三類訊息，即現場察知的「新知」訊息、事後方知的「後知」訊息、以及二手轉知的「旁知」訊息。此外尚有兩種動詞成分可表達近似示證的語意，然而尚未充分語法化成為示證體系的一部分。格西話示證體系的形式與用法都有鮮明的特點，在霍爾語群中具有代表性。雖不能排除藏語示證模式的影響，但主要為自身發展形成的語法範疇。
Park Aesthetics Between Wilderness Representations and Everyday Affordances
Authors: Lobo Tea
Published: May 2023

Scholars criticize privileging aesthetics over social and ecological considerations in park design. I argue that the real culprit is not aesthetics, but aestheticism. Aestheticism treats aesthetic objects as if they were ontologically distinct from everyday objects. Aestheticism in park design—treating parks like artworks to be admired like paintings—dovetails into treating parks like representations of a romanticized wilderness: of pristine, untouched landscapes. I argue that aestheticism is a means of constructing an ontological distinction between the beholder and the beheld, for landscapes are not truly pristine if they are sullied by human presence. As an alternative, and while drawing on the works of John Dewey and Yuriko Saito, I argue for a continuity between everyday objects and aesthetic objects. I also draw attention to the question of whose every day is privileged and propose to introduce Wittgenstein’s concept of multi-aspectivity in the analysis of everyday affordances.
Utilization of a technology-assisted workflow to prepare controlled substance oral syringes
Authors: Nester Tina , Proffitt Katrina , Anderson Jamie , Hays Amanda , Eidem Leslie , Greszler Craig
Published: May 2023

Purpose

Utilization of technology-assisted workflow (TAWF) systems has gained popularity in the sterile compounding setting. This study was designed to evaluate whether safety and efficiency could be seen when preparing oral controlled substance doses gravimetrically vs volumetrically.

Methods

This 2-phase observational study combined manual data collection with automated logs generated by a single TAWF. During phase I, oral controlled substance solutions were prepared volumetrically. In phase II, the same subset of medications was to be prepared gravimetrically via the same TAWF. Findings from phases I and II were compared against each another to determine safety, efficiency, and documentation differences between the volumetric and gravimetric workflows.

Results

Thirteen different medications were evaluated during phase I (1,495 preparations) and phase II (1,781 preparations) of this study. Mean compounding time (min:sec) increased in phase II when compared to phase I (1:49 vs 1:28; P < 0.01), with the deviation detection rate also increasing (7.9% vs 4.7%; P < 0.01). Despite a target in phase II of utilizing gravimetric analysis for more than 80% of preparations, only 45.5% (811 preparations) were prepared with this workflow, as adoption challenges and dose size limitations prevented compliance. Doses that were prepared gravimetrically had a mean accuracy rate of 100.6% (the mean achieved dose was 0.6% higher than the mean prescribed dose) and a rejection rate of 0.99% (compared to the phase I rejection rate of 1.07%; P = 0.67).

Conclusion

The gravimetric workflow provided accuracy and additional safety checks when compared to the volumetric alternative, all while providing users with greater access to data. Health systems should consider staffing, product sourcing, patient populations, and medication safety when determining the balance between volumetric and gravimetric workflows.
A novel pharmacy liaison program to address health-related social needs at an urban safety-net hospital
Authors: Borden Caroline G , Ashe Erin M , Buitron de la Vega Pablo , Gast Vi , Saint-Phard Tracey , Brody-Fialkin Julianna , Power Julia , Wang Na , Lasser Karen E
Published: May 2023

Purpose

Patients with unmet health-related social needs (HRSNs) often experience poor health outcomes and have high levels of healthcare utilization. We describe a program where dually trained pharmacy liaison–patient navigators (PL-PNs) screen for and address HRSNs while providing medication management services to patients with high levels of acute care utilization in a Medicaid Accountable Care Organization. We are unaware of prior studies that have described this PL-PN role.

Methods

We analyzed case management spreadsheets for the 2 PL-PNs who staffed the program to identify the HRSNs that patients faced and the ways PL-PNs addressed them. We administered surveys, including an 8-item client satisfaction questionnaire (CSQ-8), to characterize patient perceptions of the program.

Results

Initially, 182 patients (86.6% English speaking, 80.2% from a marginalized racial or ethnic group, and 63.2% with a significant medical comorbidity) were enrolled in the program. Non–English-speaking patients were more likely to receive the minimum intervention dose (completion of an HRSN screener). Case management spreadsheet data (available for 160 patients who engaged with the program) indicated that 71% of participants faced at least one HRSN, most often food insecurity (30%), lack of transportation (21%), difficulty paying for utilities (19%), and housing insecurity (19%). Forty-three participants (27%) completed the survey with an average CSQ-8 score of 27.9, indicating high levels of satisfaction with the program. Survey participants reported receiving medication management services, social needs referrals, health-system navigation assistance, and social support.

Conclusion

Integration of pharmacy medication adherence and patient navigation services is a promising approach to streamline the HRSN screening and referral process at an urban safety-net hospital.
Neuropsychological Profile of Hospitalized Patients Due to COVID-19: Clinical and Inflammatory Correlates
Authors: Tsiaras Yiannis , Kitsakis Nikolaos , Papadopoulou Eleftheria , Karanikas Evangelos , Kourbetis Dimitrios , Aretouli Eleni
Published: May 2023

Objectives

In the present study, we investigated the pattern of cognitive difficulties in hospitalized patients due to COVID-19 and its relation with the clinical features of the disease.

Method

Forty hospitalized patients with COVID-19 [mean age: 46.98 years (SD = 9.30); mean years of education: 13.65 (SD = 2.07) and 40 sex-, age- and education-matched healthy controls completed a set of neuropsychological measures administered by telephone. Participants’ premorbid intellectual skills and patients’ anxiety and depressive symptoms were also evaluated. The association of COVID-19-related biomarkers [oxygen saturation (SpO2), C-reactive protein (CRP), D-dimer and ferritin levels] with neuropsychological performances was examined with a series of hierarchical multiple linear regression analyses, after controlling for demographic and clinical characteristics, psychological distress and premorbid intellectual skills.

Results

Patients performed worse than healthy participants on measures of verbal memory, attention and working memory. SpO2 levels were associated with patients’ performance on verbal and working memory, whereas CRP levels were associated with performance on verbal memory, abstract reasoning and verbal fluency, after controlling for demographic and clinical characteristics. Ferritin levels predicted performance on the verbal fluency test, whereas D-dimer levels did not predict any of the neuropsychological measures.

Conclusions

Cognitive difficulties in verbal memory, attention and working memory were noted in patients with COVID-19. Markers of hyperinflammation predicted patients’ performance above and beyond demographic characteristics, duration of symptoms, length of hospitalization and psychological distress.
Streamlining the Fat: A Systematic Review of Active Closed Wash and Filtration in Autologous Fat Grafting After Breast Reconstruction
Authors: Vernice Nicholas A , Jung Wooram F , Black Grant G , Demetres Michele , Otterburn David M
Published: May 2023

Although fat grafting in breast reconstruction continues to grow in popularity, the optimal technique remains elusive and outcomes are varied. This systematic review of available controlled studies utilizing active closed wash and filtration (ACWF) systems sought to examine differences in fat processing efficiency, aesthetic outcomes, and revision rates. A literature search was performed from inception to February 2022 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in Ovid MEDLINE (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), Ovid Embase (Wolters Kluwer), and Cochrane Library (Wiley, Hoboken, NJ). Two independent reviewers screened the studies for eligibility with Covidence software. Bibliographies and citing references from selected articles were screened from Scopus (Elsevier, Amsterdam, the Netherlands). The search identified 3476 citations, with 6 studies included. Three studies demonstrated a significantly higher volume of graftable fat harvested in a significantly lower mean grafting time with ACWF than with their respective controls. With respect to adverse events, 3 studies reported significantly lower incidences of nodule or cyst formation with ACWF with respect to control. Two studies reported a significantly lower incidence of fat necrosis with ACWF vs control, with this trend upheld in 2 additional studies. Three studies reported significantly lower revision rates with ACWF with respect to control. No study reported inferiority with ACWF for any outcome of interest. These data suggest that ACWF systems yield higher fat volumes in less time than other common techniques, with decreased rates of suboptimal outcomes and revisions, thereby supporting active filtration as a safe and efficacious means of fat processing that may reduce operative times. Further large-scale, randomized trials are needed to definitively demonstrate the above trends.

Level of Evidence: 4
Differences and similarities in teledermatological primary care case histories between people with different skin tones
Authors: Vroom Iris R , Hulshof Maaike A , Schelhaas Willeke , Koning Steven N , Sanavro Sanne M , van der Worp Henk , Jansen Daniëlle E M C , Blanker Marco H
Published: May 2023

Evaluation of teleconsultations on the Prisma platform revealed differences in the type of questions posted by Dutch general practitioners and advice received from dermatologists regarding people with skin of colour (SOC) and those with white skin. A survey of users of this interdisciplinary platform confirmed low competence in recognizing and treating problems in people with SOC, and a need for additional education to provide care for people with SOC identified.
Prevalence of psoriasis and other autoimmune skin diseases in a recently contacted indigenous community in the Auaris region, Yanomami Indigenous Territory, Brazil
Authors: Romiti Ricardo , Martins Luciana P F , Santana Yago R T , Timbó Renata V , Kurizky Patrícia S , Barroso Daniel H , de Andrade Rafael R , Gomes Ciro M , Griffiths Christopher E M
Published: May 2023

Previous studies have discussed the low prevalence of psoriasis among indigenous peoples of South America. The state of Roraima, Brazil, where the present study was performed, is crossed by the equator line. It is likely that key factors for the absence of psoriasis in this indigenous population include genetic factors, a lack of environmental triggers and high sun exposure.
Patient-reported influences on COVID-19 vaccine acceptance and hesitancy in people with hidradenitis suppurativa
Authors: Williams Jazzmin C , Alhusayen Raed , Guilbault Sandra , Ingram John R , Lowes Michelle A , Yannuzzi Christine A , Naik Haley B
Published: May 2023

COVID-19 continues to pose a risk to patients with hidradenitis suppurativa (HS) due to the high prevalence of comorbidities associated with severe COVID-19 disease. We aimed to characterize perspectives on COVID-19 vaccination among patients with HS. International respondents from 20 online HS support groups were recruited to complete a voluntary, anonymous, online cross-sectional survey from 25 October to 21 November 2021 to obtain perspectives from people with HS who may and may not access healthcare. We report higher rates of COVID-19 vaccine hesitancy among patients with HS who expressed dissatisfaction with their dermatological care.
Defective cathepsin Z affects EGFR expression and causes autosomal dominant palmoplantar keratoderma
Authors: Malovitski Kiril , Sarig Ofer , Feller Yarden , Bergson Shir , Assaf Sari , Mohamad Janan , Pavlovsky Mor , Giladi Moshe , Sprecher Eli
Published: May 2023

Background

The abnormal function of epidermal growth factor receptor (EGFR) has recently been shown to underlie various disorders of cornification.

Objectives

To delineate the genetic basis of a novel dominant form of palmoplantar keratoderma (PPK).

Methods

Whole-exome (WES) and direct sequencing, quantitative real-time polymerase chain reaction, protein modelling, confocal immunofluorescence microscopy, immunoblotting, three-dimensional skin equivalents and an enzyme activity assay were used to delineate the genetic basis of a novel dominant form of PPK.

Results

WES revealed heterozygous variants (c.274T > C and c.305C > T) in CTSZ (encoding cathepsin Z) in four individuals (belonging to three unrelated families) with focal PPK. Bioinformatics and protein modelling predicted the variants to be pathogenic. Previous studies have suggested that EGFR expression may be subject to cathepsin regulation. Immunofluorescence revealed reduced cathepsin Z expression in the upper epidermal layers and concomitant increased epidermal EGFR expression in patients harbouring CTSZ variants. Accordingly, human keratinocytes transfected with constructs expressing PPK-causing variants in CTSZ displayed reduced cathepsin Z enzymatic activity, as well as increased EGFR expression. In line with the role played by EGFR in the regulation of keratinocyte proliferation, human keratinocytes transfected with the PPK-causing variants showed significantly increased proliferation that was abolished upon exposure to erlotinib, an EGFR inhibitor. Similarly, downregulation of CTSZ resulted in increased EGFR expression and increased proliferation in human keratinocytes, suggestive of a loss-of-function effect of the pathogenic variants. Finally, three-dimensional organotypic skin equivalents grown from CTSZ-downregulated cells showed increased epidermal thickness and EGFR expression as seen in patient skin; here, too, erlotinib was found to rescue the abnormal phenotype.

Conclusions

Taken collectively, these observations attribute to cathepsin Z a hitherto unrecognized function in epidermal differentiation.
RNA therapeutics for neurological diseases
Authors: Brentari Ilaria , Zadorozhna Mariia , Denti Michela Alessandra , Giorgio Elisa
Published: May 2023

Introduction

Ribonucleic acid (RNA) therapeutics are a new class of drugs whose importance is highlighted by the growing number of molecules in the clinic.

Sources of data

We focus on RNA therapeutics for neurogenetic disorders, which are broadly defined as diseases with a genetic background and with at least one clinical sign affecting the nervous system. A systematic search identified 14 RNA drugs approved by FDA and many others in development.

Areas of agreement

The field of RNA therapeutics is changing the therapeutic scenario across many disorders.

Areas of controversy

Despite its recent successes, RNA therapeutics encountered several hurdles and some clinical failures. Delivery to the brain represents the biggest challenge.

Growing points

The many advantages of RNA drugs make the development of these technologies a worthwhile investment.

Areas timely for developing research

Clinical failures stress the importance of implementing clinical trial design and optimizing RNA molecules to hold the promise of revolutionizing the treatment of human diseases.
The unspoken barriers to treatment for chronic plaque psoriasis
Authors: Wolinska Anna , Doyle Claire , McFeely Orla , Costa Blasco Marta , Murphy Lisa , Andrawis Madonna  , Beatty Paula , Tobin Anne-Marie
Published: May 2023

Research in dermatology that includes groups that have been historically marginalized is limited. Dermatologists should be vigilant to ensure that we are well-informed and respectful of the social and cultural traditions of our patients. In doing so, we can foster a strong patient–doctor relationship with all our patients and limit the potential for healthcare disparity across groups that have been historically marginalized.
China’s Family Education Promotion Law: Family Governance, the Responsible Parent and the Moral Child
Authors: Cheng Kwan Yiu
Published: May 2023

This article discusses China’s newly enacted Family Education Promotion Law (FEPL). The FEPL symbolizes that family education through parenting has elevated from a private matter to a State affair in the country. The Law seeks to promote family governance through the concept of ‘parenting in accordance with the law’ so as to attain national ideals and improve the protection of minors. The prominent ends at the national level are the moral development of children and the construction of a harmonious State. Concepts of ‘population quality’ and ‘double alleviation’ are discussed with reference to their significance in relation to the enactment of the Law. The promulgation of the FEPL targets substandard parenting practices in China, including hyper-parenting on the one end and abandonment on the other. Typical practices such as inter-generational child-rearing are examined to illustrate why the Law is considered necessary from the State’s point of view. The article provides an analysis of the legislative intentions, background, and key provisions of the Law. It concludes that family governance through the notion of responsible parenting is an instrument of social policy in modern China.
Poorer survival after out-of-hospital cardiac arrest among cancer patients: a population-based register study
Authors: Hägglund Hanna L , Jonsson Martin , Hedayati Elham , Hedman Christel , Djärv Therese
Published: May 2023

Aims

The association between cancer and survival after out-of-hospital cardiac arrest (OHCA) has not been thoroughly investigated. We aimed to address this knowledge gap using national, population-based registries.

Methods and results

For this study, 30 163 patients with OHCA (≥18 years) were included from the Swedish Register of Cardiopulmonary Resuscitation. Through linkage to the National Patient Registry, 2894 patients (10%) with cancer diagnosed within 5 years prior to OHCA were identified. Differences in 30-day survival between patients with cancer and controls (defined as patients with OHCA without previous cancer diagnosis) were assessed related to cancer stage (locoregional vs. metastasized cancer) and cancer site (e.g. lung cancer, breast cancer, etc.) using logistic regression adjusted for prognostic factors. Long-term survival was presented as a Kaplan–Meier curve. For locoregional cancer, no statistically significant difference in return of spontaneous circulation (ROSC) was seen compared with controls, and metastasized disease was associated with a poorer chance of ROSC. Cancer was associated with a lower 30-day survival for all cancers [adjusted odds ratio (OR) 0.57, confidence interval (CI) 0.49–0.66], locoregional cancer (adjusted OR 0.68, CI 0.57–0.82), and metastasized cancer (adjusted OR 0.24, CI 0.14–0.40) compared with controls. A lower 30-day survival compared with controls was seen for lung, gynaecological and haematological cancers.

Conclusion

Cancer is associated with poorer 30-day survival after OHCA. This study suggests that cancer site and disease stage are more relevant factors than cancer in general with regard to its effect on survival after OHCA.
Sudden cardiac arrest due to recurrent coronary spasm in a young woman: a case report
Authors: Favorini Serena , Perrin Tilman , Hellige Gerrit , Arenja Nisha
Published: May 2023

Background

Coronary artery spasm (CAS) is a pathological condition resulting from transient functional narrowing of the coronary arteries leading to myocardial ischaemia and in some rare cases even to sudden cardiac arrest (SCA). The most important preventable risk factor is use of tobacco, whereas possible precipitating factors include some medications and psychological stress.

Case summary

A 32-year-old woman was hospitalized with burning chest pain. The immediate investigations revealed the diagnosis of non-ST-segment elevation myocardial infarction, because of ST elevations in one single lead and increased high-sensitivity troponin. Due to ongoing chest pain and a severe impaired left ventricular ejection fraction (LVEF) of 30% with apical akinesia, a prompt coronary angiography (CAG) was scheduled. After aspirin administration, she developed anaphylaxis with pulseless electrical activity (PEA). She could be resuscitated successfully. CAG revealed multi-vessel CAS for which she received calcium channel blockers. Five days after, she suffered from a second SCA due to ventricular fibrillation and was resuscitated again. Repeated CAG showed no critical coronary artery occlusion. LVEF improved progressively during hospitalization. Drug therapy was increased, and a subcutaneous implantable cardioverter defibrillator (ICD) was implanted for secondary prevention.

Discussion

CAS may in some instances lead to SCA, especially in case of multi-vessel involvement. Allergic and anaphylactic events can trigger CAS, which are frequently underestimated. Regardless of the cause, cornerstone of CAS prophylaxes remains optimal medical therapy as in the avoidance of predisposing risk factors. In case of life-threatening arrhythmia, the implantation of an ICD should be considered.
Working-Class Women and the Buying and Selling of Stolen Goods in Urban Communities in the North West of England and Belfast, 1918–1960
Authors: Wildman Charlotte
Published: May 2023

The buying and selling of stolen goods by working-class women was a relatively widespread and accepted practice in some inner urban communities in the North West of England and in Belfast between 1918 and 1960. It relied on the training and engagement of children and the co-operation and compliance of neighbours, and was facilitated by the spatial dynamics within inner urban terraced homes. This article analyses local court records, memoirs and contemporary social surveys to demonstrate that, after 1918, the buying and selling of stolen goods by working-class women did not just play a part in people’s economic lives. It argues that, even outside times of poverty, in certain neighbourhoods the practice reinforced strong community bonds and allowed some women to contest the inequalities they experienced by consolidating their position within strong supportive networks against a society that afforded them little formal power. Together, these sources present a quotidian culture of minor criminality that challenges received views of working-class cultures of domesticity, family life and ‘respectability’, suggesting that trading in stolen goods could afford women offenders status and respect within their neighbourhoods. The article highlights the enduring practice of home-based buying and selling of stolen goods across the period, particularly in areas untouched by housing clearance and redevelopment. Despite significant developments in the state provision of welfare and greater scrutiny of working-class families, the offence endured as a way to bolster close-knit community bonds in protest against the harsh living conditions and persistent inequities many still experienced.
Novel mechanisms and therapeutic targets in atherosclerosis: inflammation and beyond
Authors: Weber Christian , Habenicht Andreas J R , von Hundelshausen Philipp
Published: May 2023

This review based on the ESC William Harvey Lecture in Basic Science 2022 highlights recent experimental and translational progress on the therapeutic targeting of the inflammatory components in atherosclerosis, introducing novel strategies to limit side effects and to increase efficacy. Since the validation of the inflammatory paradigm in CANTOS and COLCOT, efforts to control the residual risk conferred by inflammation have centred on the NLRP3 inflammasome-driven IL-1β-IL6 axis. Interference with the co-stimulatory dyad CD40L–CD40 and selective targeting of tumour necrosis factor-receptor associated factors (TRAFs), namely the TRAF6–CD40 interaction in macrophages by small molecule inhibitors, harbour intriguing options to reduce established atherosclerosis and plaque instability without immune side effects. The chemokine system crucial for shaping immune cell recruitment and homoeostasis can be fine-tuned and modulated by its heterodimer interactome. Structure–function analysis enabled the design of cyclic, helical, or linked peptides specifically targeting or mimicking these interactions to limit atherosclerosis or thrombosis by blunting myeloid recruitment, boosting regulatory T cells, inhibiting platelet activity, or specifically blocking the atypical chemokine MIF without notable side effects. Finally, adventitial neuroimmune cardiovascular interfaces in advanced atherosclerosis show robust restructuring of innervation from perivascular ganglia and employ sensory neurons of dorsal root ganglia to enter the central nervous system and to establish an atherosclerosis-brain circuit sensor, while sympathetic and vagal efferents project to the celiac ganglion to create an atherosclerosis-brain circuit effector. Disrupting this circuitry by surgical or chemical sympathectomy limited disease progression and enhanced plaque stability, opening exciting perspectives for selective and tailored intervention beyond anti-inflammatory strategies.
Dapagliflozin vs. metolazone in heart failure resistant to loop diuretics
Authors: Yeoh Su Ern , Osmanska Joanna , Petrie Mark C , Brooksbank Katriona J M , Clark Andrew L , Docherty Kieran F , Foley Paul W X , Guha Kaushik , Halliday Crawford A , Jhund Pardeep S , Kalra Paul R , McKinley Gemma , Lang Ninian N , Lee Matthew M Y , McConnachie Alex , McDermott James J , Platz Elke , Sartipy Peter , Seed Alison , Stanley Bethany , Weir Robin A P , Welsh Paul , McMurray John J V , Campbell Ross T
Published: May 2023

Background and Aims

To examine the decongestive effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin compared to the thiazide-like diuretic metolazone in patients hospitalized for heart failure and resistant to treatment with intravenous furosemide.

Methods and results

A multi-centre, open-label, randomized, and active-comparator trial. Patients were randomized to dapagliflozin 10 mg once daily or metolazone 5–10 mg once daily for a 3-day treatment period, with follow-up for primary and secondary endpoints until day 5 (96 h). The primary endpoint was a diuretic effect, assessed by change in weight (kg). Secondary endpoints included a change in pulmonary congestion (lung ultrasound), loop diuretic efficiency (weight change per 40 mg of furosemide), and a volume assessment score. 61 patients were randomized. The mean (±standard deviation) cumulative dose of furosemide at 96 h was 977 (±492) mg in the dapagliflozin group and 704 (±428) mg in patients assigned to metolazone. The mean (±standard deviation) decrease in weight at 96 h was 3.0 (2.5) kg with dapagliflozin compared to 3.6 (2.0) kg with metolazone [mean difference 0.65, 95% confidence interval (CI) −0.12,1.41 kg; P = 0.11]. Loop diuretic efficiency was less with dapagliflozin than with metolazone [mean 0.15 (0.12) vs. 0.25 (0.19); difference −0.08, 95% CI −0.17,0.01 kg; P = 0.10]. Changes in pulmonary congestion and volume assessment score were similar between treatments. Decreases in plasma sodium and potassium and increases in urea and creatinine were smaller with dapagliflozin than with metolazone. Serious adverse events were similar between treatments.

Conclusion

In patients with heart failure and loop diuretic resistance, dapagliflozin was not more effective at relieving congestion than metolazone. Patients assigned to dapagliflozin received a larger cumulative dose of furosemide but experienced less biochemical upset than those assigned to metolazone.

Trial registration

ClinicalTrials.gov Identifier: NCT04860011
Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure: a meta-analysis of three randomized controlled trials
Authors: Clephas Pascal R D , Radhoe Sumant P , Boersma Eric , Gregson John , Jhund Pardeep S , Abraham William T , McMurray John J V , de Boer Rudolf A , Brugts Jasper J
Published: May 2023

Aims

Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question.

Methods and results

A systematic literature search was performed for randomized clinical trials with PA pressure monitoring devices in patients with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Three eligible randomized clinical trials were identified that included 1898 outpatients in New York Heart Association functional classes II–IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. The mean follow-up was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58–0.86) (P = .0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61–0.91; P = .0037) and for all-cause mortality 0.92 (0.73–1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect.

Conclusion

The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations.
Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach
Authors: Cai Yurun , Leveille Suzanne G , Andreeva Olga , Shi Ling , Chen Ping , You Tongjian
Published: May 2023

Background

Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach.

Methods

The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions.

Results

During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as “lost my balance and fell.”

Conclusions

Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.
Does the Economic Status of Adult Children Influence Self-Rated Health Among Older Adults in China?
Authors: Zhang Wencheng , Silverstein Merril
Published: May 2023

Objectives

We aim to investigate the association between children’s economic status and parents’ self-rated health and examine the potential mediating mechanisms for this relationship.

Methods

Utilizing nationally representative data in China in 2014, this study predicted parent’s self-rated health from children’s economic status using inverse probability of treatment weighting to account for selection and endogeneity bias. We further examined depressive symptoms, kin and nonkin social support networks, emotional closeness to children, and economic support from children, as potential mediators of this relationship.

Results

The study reveals that parents whose children had greater economic success tended to have better self-rated health. For both rural and urban older adults, depressive symptoms served as the most influential mediator. However, only among rural older adults did the size of their support networks mediate the relationship between children’s economic status and perceived health.

Discussion

The results from this study suggest that children’s economic success contributes to better self-rated health among older adults. In part, this relationship was explained by better emotional well-being and greater availability of support resources among parents in rural areas with successful children. This quasi-causal analysis demonstrates that adult children remain important for the well-being of their older parents in China, but also suggests that health inequalities in later life are exacerbated by the chance of having economically successful offspring.
Social Participation and Persistent Smoking Among Older Chinese With Smoking-Related Morbidity
Authors: Gao Manjing , Park Soojin , Lee Chioun
Published: May 2023

Objectives

Chronic diseases are common in midlife and old age and smoking can pose more health and longevity challenges for older people with chronic illnesses. In China where smoking is highly prevalent, older adults are likely to continue smoking even after developing severe chronic diseases. We examined the national prevalence of persistent smoking among older adults. We also investigated the sociodemographic characteristics of persistent smoking among ever-smokers with chronic diseases and its association with social participation (of various types).

Methods

We used data from a nationally representative sample of older adults aged 45–80 in the China Health and Retirement Longitudinal Study (2011–2018). Multinomial logistic and multilevel logistic models were fitted.

Results

The national prevalence of persistent smoking was around 24% of older men and 3% of older women. Among those with a history of smoking and chronic illness, younger, nonmarried/partnered, nonretired, or less educated individuals are more likely to continue smoking. Social participation is significantly associated with persistent smoking among those with chronic diseases, but the association differs across different forms of activities. Although the most popular but sedentary activities in China (playing Mahjong, chess, or cards) are associated with an elevated risk of persistent smoking, physical social activities (community-organized dancing, fitness, and qigong) are associated with a reduced risk of persistent smoking.

Discussion

Given the enormous burden of persistent smoking on individuals and society, public smoking cessation inventions should address sociocultural factors of persistent smoking and target older adults who participate in specific social activities.